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Alexandre Chan Deren Soh Yu Ko Yu-Chu Huang Joen Chiang 《Supportive care in cancer》2014,22(7):1875-1881
Background
Studies have examined drug-related problems (DRPs) that have led to hospital admissions in the general population. However, there is a lack of information on the characteristics of DRPs in the cancer population.Objective
The objective of this study was to investigate the type, causality, severity, and preventability of DRPs that result in unplanned hospitalizations among cancer patients.Methods
This was a prospective, cohort study conducted in two oncology wards between July and December 2012. All patients who were diagnosed with solid tumor or lymphoma and required unplanned hospitalization were included. The incidence of DRPs among hospital admissions was captured, and the nature of the DRPs (causality, severity, and preventability) was characterized.Results
There were 1,299 admissions and 1,275 were eligible for analysis. Among the 1,275 eligible admissions, 158 (12.4 %) were considered to be associated with a DRP. In the 158 admissions associated with DRPs, 164 DRPs were found. The majority of the DRP-related admissions were adverse drug reactions (ADRs) (n?=?155/164, 94.5 %), probable (n?=?98, 59.8 %), moderately severe (n?=?155, 94.5 %), and probably or definitely preventable (n?=?86, 52.4 %). Most patients with DRPs recovered and were discharged. Febrile neutropenia was the most common adverse drug reaction, and drug combinations involving antihypertensives and long-term corticosteroids raised the risks for potential drug-drug interactions among patients with cancer.Conclusion
The incidence of DRP-induced unplanned hospital admissions was 12.4 % among cancer patients. Approximately half of these were preventable events. 相似文献2.
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Gonçalves F Marques A Rocha S Leitão P Mesquita T Moutinho S 《Palliative medicine》2005,19(7):526-531
The disclosure of information to patients about diagnosis and prognosis and other aspects of care is still a matter of debate. We have conducted a study in advanced cancer patients about their experiences and preferences concerning this issue. A questionnaire was developed and completed during the first appointment in the outpatient clinic of an oncology centre's palliative care unit, before the patient had any contact with the staff of the unit. The study was conducted on a convenience sample of 47 patients. We found that 34 (72%) of those patients thought they had been informed of their diagnosis, most of them by the hospital doctor. However, not all stated the diagnosis in a manner clearly showing that they were aware of the nature of their disease. Most patients were with a family member when the diagnosis was disclosed, which is what the majority had preferred. Of the 13 uninformed patients, only one preferred to remain uninformed. Most patients (89%) participated in decisions concerning treatment, although only 68% thought they should have participated. Some 39 patients (83%) were informed that they were being referred to the palliative care unit, but surprisingly only eight had received an explanation of the unit's function. We concluded that, although most patients had been informed of their disease, there remains many problems, the most important of which, in our view, is the difference between the information provided and the patients' needs. 相似文献
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A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting 总被引:1,自引:0,他引:1
Finkers F Maring JG Boersma F Taxis K 《Journal of clinical pharmacy and therapeutics》2007,32(5):469-476
BACKGROUND: Little is known about the extent of drug-related problems of polypharmacy patients in Dutch nursing homes. OBJECTIVES: We investigated the feasibility of teams of hospital pharmacists and nursing home physicians carrying out medication reviews. We aimed to identify the number and nature of drug-related problems of nursing home patients receiving more than nine drugs (polypharmacy). METHODS: The study was carried out in five Dutch nursing homes (n = 742 beds) between October 2005 and May 2006. Ninety-one polypharmacy patients, (average age 80 years) were included. A medication review was carried out by teams consisting of one hospital pharmacist and the patient's nursing home physician with a follow-up meeting of the same team 6 weeks later. RESULTS: A total of 323 drug-related problems were identified (mean of 3.5 problems per patient). Sixty-two per cent of problems, in 87% of patients, were classified as 'unclear or not confirmed indication or need for review' of the prescribed drug. By the time of the follow-up, a mean of 1.7 (n = 159) problems per patient had been solved and the number of drugs per patient had decreased significantly from 13.5 to 12.7 (P < 0.0001). CONCLUSIONS: The majority of patients had at least one drug prescribed for which the indication was unknown. The intervention was accompanied by a significant decrease in the number of drugs per patient, but half of the drug-related problems remained unsolved. 相似文献
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Sonya S. Lowe Sharon M. Watanabe Vickie E. Baracos Kerry S. Courneya 《Supportive care in cancer》2010,18(11):1469-1475
Goals of the work
The purpose of the present study was to examine the physical activity interests and preferences of palliative cancer patients.Patients and methods
Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of less than 12 months and Palliative Performance Scale greater than 30% were recruited from an outpatient palliative care clinic and a palliative home care program. An interviewer-administered survey was used to assess physical activity behavior, interests, and preferences.Main results
The majority of palliative cancer patients in this sample indicated that they would be interested and felt able to participate in a physical activity program. There were strong preferences for home-based physical activity programs that could be completed alone. The majority of participants in this sample reported walking as the type of physical activity in which they were most interested.Conclusions
These findings suggest that this sample of palliative cancer patients is interested and feel able to participate in a physical activity program. Examining these unique physical activity preferences may aid in the development of an appropriate physical activity program for palliative cancer patients that can be tested in clinical research. 相似文献9.
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The objective of this study was to examine the factor structure of Achenbach's Child Behavior Checklist, using confirmatory factor analysis, in a group of pediatric oncology patients in Taiwan and to compare the competence and behavioral/emotional problems scores of these children with normative scores to assess competence and emotional/behavioral problems of Taiwanese children with cancer. Subjects included parents (124 mothers and 22 fathers) of 146 pediatric oncology patients who completed the measures. Factor loadings of the overall fit indices for the study subjects yielded or approached satisfactory results for all syndromes, except for aggressive behavior. The indices for both internalizing and externalizing syndromes also showed good model fit. Taiwanese children with cancer had significantly lower competence scores on the Child Behavior Checklist/4-18 than did Achenbach's sample, except Taiwanese girls with cancer, who had higher activity competence scores, but these scores were not statistically significant. Taiwanese boys with cancer had significantly higher scores on all of the emotional/behavioral problems, but had lower delinquent behavior, aggressive behavior, and externalizing syndrome scores. In contrast, girls with cancer had significantly higher scores on somatic complaints and internalizing syndrome, but significantly lower aggressive behavior and externalizing syndrome scores. Taiwanese adolescents with cancer had significantly lower competence scores compared with normative scores, with the exception being that the adolescents in the current study had significantly higher school competence scores. These adolescents also had significantly fewer attention problems but tended to have more somatic complaints. These findings clearly indicate that healthcare for children with cancer should include psychological services to prevent long-term emotional/behavioral problems. 相似文献
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Thoracic surgical services for one cancer network in London are based at one NHS Trust. Approximately 80% of the surgery performed in the period January-December 2003 was for the diagnosis, palliation or treatment of cancer. The range of different patient groups and needs is very wide, ranging from teenagers undergoing metastatectomy to adults and older adults undergoing resections or palliative surgery. An audit of lung cancer resections performed in 2001 on behalf of the Network lung tumour board indicated that the service was fragmented and there were several bottlenecks in the lung cancer pathway, causing patient delays and a feeling of dissatisfaction amongst referrers and patients. A clinician with oncology experience was appointed in 2002. Immediate action to track patients and ensure referrers knew the outcome of surgery and histology was taken. As part of the NHS Modernisation agenda, the local Cancer Services Collaborative then facilitated mapping the pathway for lung cancer, identifying problems and ways of tackling them. Changes from this, subsequent initiatives and adopting a collaborative approach have also had a positive impact on the lung cancer service. These strategies have been adapted to all thoracic surgery pathways for cancer or suspected cancer. Examples include decreased wait time, sector-wide patient information, multiprofessional working practice and educational initiatives. 相似文献
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L. Grassi T. Giraldi E. G. Messina K. Magnani E. Valle G. Cartei 《Supportive care in cancer》2000,8(1):40-45
Disclosure of a diagnosis of cancer to patients is a major problem among physicians in Italy. The aim of the study was to
assess physicians' attitudes to and opinions about disclosure. A convenience sample of 675 physicians in Udine (North Italy)
completed a ten-item questionnaire. About 45% indicated that, in principle, patients should always be informed of the diagnosis,
but only 25% reported that they always disclosed the diagnosis in practice. Physicians with a surgical specialization employed
in general hospitals endorsed disclosure of the diagnosis more frequently than GPs and older physicians. One third of the
responding physicians persist in the belief that the patients never want to know the truth. Hospital doctors considered the
hospital, rather than the patient's home, was the most appropriate place to inform the patients. The opposite result was found
among GPs. Almost all the physicians endorsed the involvement of family members when disclosing the diagnosis, but, at the
same time they also indicated that families usually prefer their ill relative not to be informed. Ninety-five per cent of
physicians believed that the GP should always be involved in the processes of diagnosis and communication, and 48% indicated
that the GP should communicate the diagnosis to the patient (as opposed to the physician who made the diagnosis). Having guidelines
for breaking bad news to patients was indicated as an important need by 86% of the responding physicians. Despite changes
in medical education, improvement of communication skills in dealing with cancer patients and their families represents an
important need in healthcare settings.
Published online: 22 July 1999 相似文献
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Race and preventive services delivery among black patients and white patients seen in primary care 总被引:7,自引:0,他引:7
BACKGROUND: Numerous studies have documented racial disparities in delivery of health care treatment services, but there is little information to determine whether similar disparities exist in the delivery of preventive services. OBJECTIVE: To determine if disparities exist in preventive service delivery to non-Hispanic white patients and black patients in primary care. RESEARCH DESIGN: Multimethod study using direct observation of patient encounters, medical record review, and patient exit questionnaire. SUBJECTS: Four thousand three hundred thirteen outpatients presenting to 138 family physicians. MEASURES: Delivery of 15 screening, 24 health-habit counseling and 11 immunization services recommended by the US Preventive Services Task Force. RESULTS: Using multilevel linear regression analysis, no significant racial differences were found in rates of delivery of screening services or immunizations. However, black patients were more likely to receive preventive health-habit counseling (mean percent of patients up-to-date on all recommended counseling services, adjusted for covariates: 11.6% for black patients, 9.5% for whites, P = 0.003). CONCLUSIONS: Black patients able to access primary care receive preventive services at rates equal to or greater than white patients. This suggests that efforts to increase delivery of preventive care in black patients need to focus on access to primary care. 相似文献
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Helena Maria Lizardo Daudt Cheri Cosby Darcy L. Dennis Nancy Payeur Rubayed Nurullah 《Supportive care in cancer》2012,20(7):1417-1423