Performance of activities of daily living among hospitalized cancer patients

Background: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. Methods: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). Results: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. Results from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments. Conclusion: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.     

The impact of itch symptoms in psoriasis: results from physician interviews and patient focus groups

Background  

The objective of this qualitative study was to better understand the impact of psoriasis symptoms using a 3-part process: 1) develop a disease model for psoriasis to identify the most important concepts relevant to psoriasis patients; 2) conduct interviews with dermatologists to identify key areas of clinical concern; and 3) explore psoriasis patients' perceptions of the impact of psoriasis.     

个性化心理干预改善长期住院尘肺病患者心理状态及生活质量

目的 探讨个性化心理干预对长期住院的尘肺病患者心理状态及生活质量的影响。 方法 选择2012年5月-2015年5月间接受住院治疗的尘肺病患者92例为研究对象,根据入院时间顺序分为观察组及对照组各46例。对照组患者接受常规护理,观察组患者加入个性化心理干预,比较两组患者的心理状态及生活质量等指标。 结果 干预3个月后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分值均低于干预前,差异有统计学意义(P<0.05);观察组患者SAS、SDS评分值均低于对照组,差异有统计学意义(P<0.05)。干预后,两组患者生理机能等生活质量评分均较干预前明显提高,差异有统计学意义(P<0.05),观察组患者生理机能等生活质量评分均高于对照组,差异有统计学意义(P<0.05)。 结论 个性化护理干预有助于缓解长期住院尘肺病患者焦虑抑郁情绪,改善生活质量。     

Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews

A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18–48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.     

Knowledge and beliefs about abnormal pap test results and HPV among women with high-risk HPV: results from in-depth interviews

The purpose of this qualitative study was to explore women's knowledge and understanding of abnormal Pap tests and HPV. Forty-four in-depth interviews were conducted with low-income, high-risk human papillomavirus (HPV) positive women (ages 18-64 years). Major themes regarding abnormal Pap test results were: (a) getting cancer; (b) need for repeat Pap testing; (c) need for additional tests/treatment; (d) low concern; (e) variety of causes; (f) sexual transmission; and (g) connection to HPV/other sexually transmitted disease (STD). Major themes related to HPV were: (a) getting follow-up care and (b) association of HPV with cancer. Findings indicate a need for clear, consistent educational messages.     

Hovering between suffering and enduring: the meaning of living with serious chronic illness

Illness is part of life and hence always has a place in a life history. All that went on before the time of the illness, how life was in the past and what hopes and dreams were interrupted and changed, all influence the experiences of illness. The authors interviewed 5 women and 5 men with different kinds of serious chronic illnesses and used phenomenological hermeneutic method to interpret the transcribed interviews. They present the findings in three major themes: experiencing the body as a hindrance, being alone in illness, and struggling for normalcy. Participants seemed to hover between an escape from the emotional suffering pain of illness and the emotionless state of enduring. The comprehensive understanding illuminated that living with a serious chronic illness means living a life that is hovering between enduring and suffering but also including the process of reformulation of the self.     

Cost-of-illness in patients with moderate to severe psoriasis: a cross-sectional survey in Hungarian dermatological centres

Background

Despite the widespread availability of biological drugs in psoriasis, there is a shortage of disease burden studies.

Objectives

To assess the cost-of-illness and quality of life of patients with moderate to severe psoriasis in Hungary.

Methods

Consecutive patients with Psoriasis Area and Severity Index (PASI) > 10 and Dermatology Life Quality Index (DLQI) > 10, or treated with traditional systemic (TST) or biological systemic treatment (BST) were included. Demographic data, clinical characteristics, psoriasis related medication, health care utilizations and employment status in the previous 12 months were recorded. Costing was performed from the societal perspective applying the human capital approach. Quality of life was assessed using DLQI and EQ-5D measures.

Results

Two-hundred patients were involved (females 32 %) with a mean age of 51 (SD 13) years, 103 (52 %) patients were on BST. Mean PASI, DLQI and EQ-5D scores were 8 (SD 10), 6 (SD 7) and 0.69 (SD 0.3), respectively. The mean total cost was €9,254/patient/year (SD 8,502) with direct costs accounting for 86 %. The main cost driver was BST (mean €7,339/patient/year). Total costs differed significantly across treatment subgroups, mean (SD): no systemic therapy €2,186 (4,165), TST €2,388 (4,106) and BST €15,790 (6,016) (p < 0,001). Patients with BST had better PASI and DLQI scores (p < 0.01) than the other two subgroups.

Conclusions

Patients with biological treatment have a significantly better quality of life and higher total costs than patients with or without traditional systemic treatment. Our study is the largest in Europe and the first in the CEE region that provides cost-of-illness data in psoriasis involving patients with BST.

     

大数据时代学术期刊高质量发展问题透视——与四位主编的深度访谈

【目的】 大数据时代,学术期刊的发展问题更为复杂,为全面透视并准确把握大数据时代学术期刊的发展,选择4位学术期刊主编进行半结构化深度访谈。【方法】 理论分析和实证分析相结合,与4位主编进行半结构化访谈。【结果】 4位主编认为,大数据时代学术期刊在选题策划、组稿约稿、编辑校对、发行推送等环节都受到了一定影响,虽然可应对的手段和方法不一,但是在发展重点上,学术期刊都需要正确看待大数据、牢牢坚守内容为王,系统拓展学术期刊的品牌价值,解析与重构学术生产机制并激励编辑群体的多元化转型。【结论】 大数据时代,唯有坚守社会效益、打造学术品牌、加强各类数字化工具并提升编辑人才的培养成效,才能最终实现学术期刊的高质量发展。     

The work of hospitalized patients

Patient's participation in their own care, conceived as work, is the central theme of this paper. A second theme is the patients' work in relation to technology. A third is: the prevalence of chronic illness and how this relates to patients' work in the service of their own care. Data are from a multi-hospital field-research and interviewing study of technology and patient care, carried out in San Francisco and the Bay Area, California. Questions addressed in this paper include the following: What are the sources of patients' work? What types of work do patients do? How does that work relate to courses of illness and the phases? What is the relation of that work to staff work? Under what conditions is the work visible or invisible to staff? Under what conditions is the work appreciated or not by staff? What are some consequences of patient work for staff work, for the management of the courses of illness, and for the patients' own medical and biographical fates? How does patient work at the hospital relate to patient work done at home?     

Management of severe psoriasis: about 50 cases

BACKGROUND: With its varied clinical presentation, psoriasis is actually considered as a public health care problem. Severe psoriasis remains difficult to treat. METHODS: Our study was retrospective involving 50 patient with severe psoriasis treated in the dermatology unit of military hospital of Tunis from January 1990 to December 2003. Aim of our study was to evaluate actual different therapeutic attitudes and new treatments in case of severe psoriasis. RESULTS: During the 14 years studied the frequency of severe psoriasis was about 19.5%. Extended psoriasis was noticed on 64% of the patients. Arthropatic psoriasis was found on only 6% of the patients. Erythrodermic psoriasis, pustular psoriasis and palmoplantar psoriatic keratoderma were equally noticed in 10% of the patients. PUVA-therapy was firstly prescribed on 96.6% of the patients with extended psoriasis, bettering was noticed on 71% of all them during the 3 first cures. From the 20 patients that have received acitretin, 65% have noticed improvement. Méthotrexate and Re-PUVA was secondarily used (only for the cases of psoriasic arthritis amd méthotrexate) on respectively 18% and 10% of the patients. All our patients reported worsening on thems quality of life. CONCLUSION: Cyclosporin is more and more used initially in cases of rebellious psoriasis. Actually therapeutic hope leans on biological therapies.     

The reliability of telephone interviews compared with in-person interviews using memory aids

PURPOSE: Information obtained by telephone interviews and in-person interviews is generally considered comparable, but it is unclear if extensive memory aids can be used effectively with telephone interviews. We compared a telephone interview to an in-person interview using the same questionnaire and memory aids in both. METHODS: A convenience sample of 103 women, aged 25 to 69 years, completed a telephone interview and at least four weeks later, completed an in-person interview. Memory aids included a life events calendar, cue lists, and worksheets. RESULTS: Agreement values, measured by kappa/weighted kappa, were as follows: parity (1.00), age at menarche (0.76), menopausal status (0.95), a history of reproductive organ surgery (0.98) or tubal ligation (0.91), self-reported infertility (0.76), and a first degree family history of breast/ovarian cancer (0.90). Agreement values for duration variables, measured by the intraclass correlation, were as follows: lactation (0.96), oral contraceptive use (0.98), any hormone replacement therapy (0.98), exclusive estrogen and progesterone therapy (0.83), and exclusive estrogen therapy (0.99). CONCLUSIONS: The good to excellent level of agreement found in this study indicates that telephone administration of our questionnaire with extensive memory aids is a reliable method of obtaining detailed exposure information relative to in-person interviews.     

Combining food records with in-depth probing interviews improves quality of dietary intake reporting in a group of South Asian women

Objective: To investigate if the addition of an in‐depth interview focused on cultural dietary practices could improve the quality of dietary data from food records among South Asian women in New Zealand. Methods: Cross‐sectional data were collected from 134 South Asian women (≥20 years), living in Auckland. Dietary data were collected using four‐day food records. Nutritional analysis revealed 33.6% under‐reporting of energy intakes. All women were recalled for an in‐depth probing interview focused on culture‐specific foods and dietary practices. Results: The interview revealed extensive use of dairy products and plant oils. The nutrient content of the food record alone and the food record plus interview were compared; median energy intakes were 6,852 kJ vs 7,246 kJ (p<0.001); under‐reporting decreased by 14.2%, and total fat and protein intakes (g/day) increased (p<0.001). Estimates of poly‐ and mono‐unsaturated fatty acids increased significantly (p<0.001) due to greater use of plant oils due to greater use of plant oils replacing saturated fatty acid‐rich fats in food preparation. A significant increase (17%) (p<0.001) in calcium intake reflects the higher dairy intake identified with the interview. Conclusion: The addition of an in‐depth probing interview to a four‐day food record enhanced food intake reporting. Self‐reported dietary assessments in immigrant population groups require quality control for accuracy. Implications: Methods to ensure high‐quality dietary data are essential to assess health outcomes and to inform public health interventions, especially in immigrant populations.     

Predictors of recurrent hypoglycemia following a severe hypoglycemic event among hospitalized patients

Objectives: Severe hypoglycemia is associated with poor hospital outcomes, but variables contributing to the adequacy of treatment have not been described. The objective of this study was to determine predictors of recurrent hypoglycemia among hospitalized patients with a severe hypoglycemic event. Methods: Patients with severe hypoglycemia (glucose <40 mg/dl) with a concomitant insulin order were identified using the study institution’s Information Warehouse. The primary outcome was the prevalence of recurrent hypoglycemia (defined as <70 mg/dl within 24 hours) and to identify independent predictors of recurrent hypoglycemia. Secondary outcomes included time to blood glucose recheck, time to blood glucose ≥70 mg/dl, and rebound hyperglycemia (defined as glucose >300 mg/dl within 24 hours). Multivariable linear and logistic regression models were performed. Results: A total of 129 patients with severe hypoglycemia were identified. The median time to repeat glucose measurement was 29 (IQR 15–61) minutes, while the time to resolution of hypoglycemia was 49 (IQR 26–103) minutes. Recurrent hypoglycemia occurred in 49% of patients, while 19% of patients experienced rebound hyperglycemia. Independent predictors of recurrent hypoglycemia included lower repeat glucose (p = 0.025), low glomerular filtration rate (p = 0.033), and lack of insulin adjustment (p = 0.012). Independent predictors of maximum glucose post-event were type 1 diabetes (p = 0.0003), history of any diabetes (p = 0.013), and total bolus dose of insulin (p < 0.0001). Overnight timing of events was the only predictor of shorter time to hypoglycemia resolution (p < 0.0001). Conclusions: Recurrent hypoglycemia following severe hypoglycemia is common in the hospital, suggesting the need for enhanced monitoring in such patients. Further research is needed to identify methods to reduce the incidence of recurrent hypoglycemia.     

上海市松江区成人严重急性呼吸道感染住院病例流行病学特征分析

目的 了解上海市松江区成人严重急性呼吸道感染(severe acute respiratory infection,SARI)住院病例的流行病学特征及病原谱,探索新发传染病症状监测工作模式。方法 收集松江区某监测哨点医院2017年1月—2018年3月372例成人SARI住院病例监测资料,按照是否感染流感病毒,将病例分为流感组与非流感组,对流行病学及病原学特征等情况进行分析性描述。结果 共纳入372例SARI住院病例,SARI病例住院率4.15%,有夏季峰和冬季峰。发热、咳嗽、咳痰等是SARI住院病例最常见的临床症状,肺炎是最常见的并发症(48.66%),所有病例均未接种肺炎疫苗;流感组SARI病例数80例,流感病毒检测阳性率21.5%,其中甲型流感病毒占优势(56.25%);非流感组中其他病原体检出率为16.13%,以人肠病毒/鼻病毒的检出率最高(28.3%)。老年人在流感组中占比较高,差异有统计学意义(χ²=15.68,P<0.05);流感组的抗生素使用率较非流感组高,差异有统计学意义(χ²=27.73,P<0.05),非流感组呼吸衰竭的发生率较流感组高,差异有统计学意义(χ²=7.829,P<0.05)。结论 成人SARI病例监测的开展不仅是对新发传染病症状监测模式的探索实践,也对了解成人严重急性呼吸道感染的流行病学及病原学特征具有重要意义,建议提高老年人肺炎疫苗接种率以及流感病人临床抗病毒药物的使用。     

2010年郑州市儿童医院轻重症手足口病患儿流行病学分析

目的了解郑州及周边地区住院轻重症手足口病病例流行病学特征及其对比情况,掌握其流行规律,为防治提供依据。方法应用描述性流行病学方法及卡方检验进行分析。结果住院轻症手足口病病例以5～7月份发病率最高,郑州市各县(市)区病例数占66.4%,以4岁以下发病率最高,男女比1.57∶1;住院重症病例以3～8月份发病率最高,男女比1.73∶1,郑州市各县(市)区病例数占71.4%,以3岁以下发病率最高,PE和EV71混合阳性率最高为66.3%,占总阳性数的82.8%。住院手足口病病例1～2岁年龄组发病数最多为615例,占44.4%。结论住院重症病例发病高峰年龄较轻症患儿普遍小1岁左右,发病季节较轻症患儿较早,且持续时间长,男孩发病多于女孩,其中1～2岁年龄段是轻重症手足口病病例共同发病高峰。住院重症手足口病病例主要病原体是EV71型,且多与PE型病原体混合性感染。     

糖皮质激素治疗三氯乙烯药疹样皮炎22例分析

目的 探讨三氯乙烯所致药疹样皮炎治疗的较好方法，降低死亡率。方法 对22例三氯乙烯所致药疹样皮炎患者采用糖皮质激素控制变态反应。结果 19例治愈（占86．4％），19例中，1例于皮肤损害消退，肝功能恢复正常1月后出现糖水病；3例死亡，其中2例于昏迷30h后转发 主我院，死于多脏器功能障碍，1例死于金黄色葡萄球菌性败血症。结论 糖皮质激素是救治此病成败的关键，使用中须注意，及早使用，足量，规则用药。     

The structure of hospitalized patients in Russia

Main trends in the time course of resource provision and volume of activities of hospitals in Russia and their specific regional features are analyzed. Comparison of the main parameters with those in the USA helped disclose the reserves of improving the efficiency of hospital treatment, an expensive type of medical care.