Factors associated with changes in satisfaction with care

OBJECTIVE: Satisfaction with care is an important outcome for evaluating the effectiveness of medical care. Many factors can influence satisfaction, including disease state, healthcare utilization, and health-status changes. However, few studies have investigated the association between these factors and changes in satisfaction. DESIGN: This study examined the influence of personal characteristics, type of health plan, disease states, and healthcare utilization on changes in satisfaction with care in a prospective cohort over a 12-month period through two surveys, baseline and follow-up. PARTICIPANTS: Enrollees in one of three different commercial health plans: point-of-service product, an unrestricted fee-for-service product, and a preferred-provider organization product. MEASUREMENTS AND MAIN RESULTS: Two multivariate logistic regression models were constructed. The first model evaluated factors that predicted increased satisfaction with care between the two surveys. Compared with respondents who reported no change in health status, both those with improved health status (odds ratio [OR], 1.29, 95% confidence interval [CI95], 1.03-1.61) and those with declines in health (OR, 1.29, CI95, 1.03-1.61) were significantly more likely to report an increase in satisfaction with care. Those with a history of hospitalization were also more likely to report an increase in satisfaction with care (OR, 1.27, CI95, 1.01-1.59). The second multivariate logit model evaluated factors that predicted decreases in satisfaction with care from the baseline survey. Those with reported declines in health status were more likely to report decreases in satisfaction with medical care (OR, 1.43, CI95, 1.13-1.79). Neither age, gender, race, type of health plan, disease state, nor doctor's office visits were related to observed changes in satisfaction with medical care. CONCLUSION: Changes in satisfaction with care appear to be related to changes in health status. However, the relation between these two attributes is not intuitively apparent.     

Soy isoflavones in conjunction with radiation therapy in patients with prostate cancer

Soy isoflavones sensitize prostate cancer cells to radiation therapy by inhibiting cell survival pathways activated by radiation. At the same time, soy isoflavones have significant antioxidant and anti-inflammatory activity, which may help prevent the side effects of radiation. Therefore, we hypothesized that soy isoflavones could be useful when given in conjunction with curative radiation therapy in patients with localized prostate cancer. In addition to enhancing the efficacy of radiation therapy, soy isoflavones could prevent the adverse effects of radiation. We conducted a pilot study to investigate the effects of soy isoflavone supplementation on acute and subacute toxicity (≤6 mo) of external beam radiation therapy in patients with localized prostate cancer. Forty-two patients with prostate cancer were randomly assigned to receive 200 mg soy isoflavone (Group 1) or placebo (Group 2) daily for 6 mo beginning with the first day of radiation therapy, which was administered in 1.8 to 2.5 Gy fractions for a total of 73.8 to 77.5 Gy. Adverse effects of radiation therapy on bladder, bowel, and sexual function were assessed by a self-administered quality of life questionnaire at 3 and 6 mo. Only 26 and 27 patients returned completed questionnaires at 3 and 6 mo, respectively. At each time point, urinary, bowel, and sexual adverse symptoms induced by radiation therapy were decreased in the soy isoflavone group compared to placebo group. At 3 mo, soy-treated patients had less urinary incontinence, less urgency, and better erectile function as compared to the placebo group. At 6 mo, the symptoms in soy-treated patients were further improved as compared to the placebo group. These patients had less dripping/leakage of urine (7.7% in Group 1 vs. 28.4% in Group 2), less rectal cramping/diarrhea (7.7% vs. 21.4%), and less pain with bowel movements (0% vs. 14.8%) than placebo-treated patients. There was also a higher overall ability to have erections (77% vs. 57.1%). The results suggest that soy isoflavones taken in conjunction with radiation therapy could reduce the urinary, intestinal, and sexual adverse effects in patients with prostate cancer.     

Experience with intra-arterial thrombolysis in patients with acute stroke

The authors report on their results with local intraarterial thrombolysis in four patients. PATIENTS: Three patients suffered from vertebrobasilar artery occlusion, and one from carotid-T occlusion. All were treated with local intraarterial thrombolysis by a joint team of neurologist, neuroanaesthesist and interventional neuroradiologist in the stroke-department of St. Stephen Municipal Hospital in collaboration with National Institute of Neurosurgery. Selection of patients suitable for successful intraarterial thrombolysis has to be done in the neurological department with help of ultrasound and neurological examination and CT scan. Patients were transferred to the therapeutic angiosuit and interventional treatment was initiated immediately upon establishing the diagnosis. At least one million units of urokinase was infused directly into the embolus in each case. RESULTS: Complete recanalisation was achieved in three of the four cases. That was associated with full recovery in two patients, in whom good collateral circulation and no signs of atherosclerotic lesions were found prior to treatment. Another patients has died despite of full recanalisation of the basilar artery. One patient survived after partial recanalisation of bilateral vertebral artery occlusion with mild residual tetraparesis. CONCLUSION: Local intraarterial thrombolysis is effective and is associated with good clinical outcome in properly selected patients. Careful and accurate ultrasound diagnostics of the site of occlusion plays a significant role in proper patient selection. Although difficult, acute intraarterial thrombolysis can be organized in a timely fashion even utilizing the required facilities in two different institutions, providing that all efforts is being made by each party for the fast diagnosis and treatment initiation.     

Factors Associated with Sarcopenia in Patients with Colorectal Cancer

Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.     

Re-irradiation with hyperthermia in patients with recurrent breast cancer

In the Daniel den Hoed Cancer Centre in Rotterdam, the Netherlands, patients with recurrent breast cancer within a previously irradiated area, are treated by application of hyperthermia in addition to reirradiation. In this development, the following issues are important: (a) the choice of an effective and tolerable reirradiation schedule; (b) the establishment of the limitations of the hyperthermia techniques available; (c) the finding that additional hyperthermia has to be applied to the total tissue volume at risk for tumour recurrence; (d) the assessment of the value of additional hyperthermia by a randomised study. With the reirradiation schedule of 8 x 4 Gy and the hyperthermia application technique at present available, local control is achieved in 76% of the patients for a median duration of 32 months. The probability of local control is related to tumour size. The treatment is tolerated well, with acceptable toxicity. In patients with recurrent breast cancer in a previously irradiated area, combined reirradiation and hyperthermia is very effective, well tolerated and little toxic.     

脑血管病患者并发低血糖症状的临床护理

低血糖是指由于各种原因引起的血糖下降低于正常水平,一般指用氧化酶法测静脉血浆葡萄糖浓度＜2.8 mmol/L.临床上表现为一系列交感神经兴奋和中枢神经系统功能紊乱综合征.笔者通过对24例脑血管病患者发生低血糖反应的观察和护理,体会到密切观察病情变化、积极采取有效措施的重要性.     

Experience with prostate-specific antigen in patients with prostatic cancer

The authors investigated 71 prostatic cancer patients and 45 BPH patients. The serum concentration of prostatic specific antigen (PSA), the prostatic acid phosphatase (PAP) by radio-immunoassay, the same enzyme (SPP) and the total acid phosphatase (SP) by enzymatic method were determined. In the untreated cancer patients the PSA concentration proved to be pathological in a higher proportion in all stage groups comparing to the results of the PAP, SPP, SP. The clearing of the PSA and PAP concentration on the following days and months after the beginning of the therapy reflects the excellent monitoring capability of the PSA determination. This was demonstrated by several cases too. The authors suggest more frequent use of this method in clinical practice.     

Double-blind studies with mefloquine alone and in combination with sulfadoxine-pyrimethamine in 120 adults and 120 children with falciparum malaria in Vietnam

In 120 adult Vietnamese patients with uncomplicated falciparum malaria the efficacy of, and tolerance to, mefloquine (M) vs the combination of mefloquine + sulfadoxine + pyrimethamine (MSP) was studied in a double-blind, randomized comparative trial with chloroquine. Also, a double-blind dose finding study of MSP was performed in 120 Vietnamese children with uncomplicated falciparum malaria. In the adults the mean parasite clearance time with M was 3.8 d and with MSP 3.6 d. Defervescence occurred in 2.9 and 3.0 d respectively for M and MSP. There was a 36.8% resistance rate in 38 patients treated with chloroquine. 96% of the children were sensitive or showed a delayed RI response. The lowest dose of MSP (10 mg/kg M + 20 mg/kg S + 1.0 mg/kg P, 1 tablet Fansimef) was as effective as 1.5-2x this dose in children weighing 23-30 kg. Side effects were mild, except for vomiting which required alternative therapy in 4 patients.     

Falling in love with romantic ideals: women in relationships with child molesters

Drawing on data from a larger research study, this paper explores intersecting and competing social relations that influenced the romantic desires of women who became intimately involved with men who molested children. Through a feminist poststructuralist lens, women’s narratives were analysed with the use of feminist interpretations of Foucauldian discourse theory. Analysis informed of a discursive power over participants that made the attainment of romantic desires an imperative for ensuring social respect, worth and credibility as women. When all was not ideal, these same romantic desires compelled women to fix and hold onto their relationships – even when with men that attract damning societal responses towards them. Even upon acknowledgement of their partners’ sexual transgressions, the fear of relationship breakdown meant that romantic desires again featured as imperatives for the women. The imagined pleasure of achieving romantic desires is discursive; so powerful that it outweighed women’s fears and dangers of precarious intimate life with men who commit abhorrent acts.