Adaptation to Chronic Dialysis

While dialysis is a medical advance that enables people to live who would otherwise die, it is often experienced as an ordeal by those who must live with it. Patients and staff experience difficulties in their adaptation to chronic dialysis. A program that excepts all patients, regardless of motivation and stability, carries with it the responsibility of offering care in a way the patient can tolerate and of providing a regimen within the context of his personality structure and social adaptation.     

Perceived Benefits of Online Support Groups for Women with Metastatic Breast Cancer

Women with metastatic breast cancer (MBC), a life-threatening illness, stand to benefit a great deal from online support groups, but none have been studied specifically within this population. The present mixed-method study was carried out to determine which therapeutic factors occurred in online MBC support groups, and to see how such factors might have acted to benefit participants. Participants were 20 women with MBC who participated in online peer support groups. Most reported benefiting in some way from their groups. Six therapeutic factors theorized to be helpful in online support groups and cancer support groups were present in the groups studied: group cohesiveness, information exchange, universality, instillation of hope, catharsis, and altruism. However, although participants reported being able to discuss many other concerns freely, they had difficulty discussing death and dying, which are critical issues for this category of women with BC.     

Nonfinancial Barriers to Prenatal Care

No abstract available for this article.     

Potato processing in the central highlands of Peru

The processing of food products is an important economic activity of rural households in the Andean Highlands of Perú. Potatoes are processed into several dehydrated products the most common of which are chuño and papa seca. Chuño is a freezedried product made principally from bitter types of potatoes (Solarium juzepczukii and S. curtilobum) while papa seca is made from common varieties. This article describes how these and other products are made and their role within the Peruvian diet.     

In This Issue

No abstract available for this article.     

Looking ahead: planning for the first human intracortical visual prosthesis by using pilot data from focus groups of potential users

In planning for our research team's first human implant of a technologically advanced intracortical visual prosthesis we have conducted three focus groups with blind persons from a pool of likely participants. Guided by the principles of the Independent Living movement and Participatory Action Research (PAR), we asked the participants to share their thoughts and concerns about the procedure. The preliminary results reveal that achievement of the desired highest ethical of informed consent will require extensive pre-operative learning opportunities, such as those provided by these focus groups. Persons who are blind may be motivated to participate in research like this based on a need to know, understand, and explore ones environment, to leave a legacy, and to experience some restored perception.     

Impact of patient age on biochemical recurrence rates following radical prostatectomy

PURPOSE: Increased age has been suggested to predict worse clinical outcomes in patients with prostate cancer. An explanation that was proposed for this observation is that it is due to inherent differences in the biological properties of prostate cancer in older men. Stage migration, prostate specific antigen and prostate biopsy pathology are variables that may confound the interpretation of age as an independent prognosticator of outcomes following radical prostatectomy. MATERIALS AND METHODS: Matched pairs analysis was performed comparing the 3 age cohorts 46 to 55, 56 to 65 and older than 65 years to a cohort of 435 patients who were 45 years or younger based on propensity scores calculated with all known preoperative variables. Postoperative clinical and pathological characteristics were compared among the 4 matched age cohorts. A Cox hazards model was used to compare time to prostate specific antigen recurrence across the different age cohorts and the actuarial risk of recurrence was calculated using Kaplan-Meier and log rank survivor analyses. RESULTS: Younger patients showed lower grade disease (p <0.001), and lower rates of positive surgical margin rates (p = 0.035) and extraprostatic extension (p <0.001) but they did not have higher rates of lymph node involvement (p = 0.85) or seminal vesicle invasion (p = 0.56). Kaplan-Meier analysis showed no significant differences in biochemical recurrence across the age cohorts (log rank 0.38). On multivariate analysis prostatectomy Gleason score, pathological stage, positive surgical margins (each p <0.001) and preoperative prostate specific antigen (p = 0.04) were independently predictive of biochemical recurrence. CONCLUSIONS: We report that increased age is not associated with worse biochemical outcomes following radical prostatectomy and it should not be considered an independent prognosticator for disease recurrence. Rather, age is a surrogate for known predictors of biochemical recurrence following surgery.     

Quality Measurements in Radiology: A Systematic Review of the Literature and Survey of Radiology Benefit Management Groups

PurposeAs the US health care system transitions toward value-based reimbursement, there is an increasing need for metrics to quantify health care quality. Within radiology, many quality metrics are in use, and still more have been proposed, but there have been limited attempts to systematically inventory these measures and classify them using a standard framework. The purpose of this study was to develop an exhaustive inventory of public and private sector imaging quality metrics classified according to the classic Donabedian framework (structure, process, and outcome).MethodsA systematic review was performed in which eligibility criteria included published articles (from 2000 onward) from multiple databases. Studies were double-read, with discrepancies resolved by consensus. For the radiology benefit management group (RBM) survey, the six known companies nationally were surveyed. Outcome measures were organized on the basis of standard categories (structure, process, and outcome) and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsThe search strategy yielded 1,816 citations; review yielded 110 reports (29 included for final analysis). Three of six RBMs (50%) responded to the survey; the websites of the other RBMs were searched for additional metrics. Seventy-five unique metrics were reported: 35 structure (46%), 20 outcome (27%), and 20 process (27%) metrics. For RBMs, 35 metrics were reported: 27 structure (77%), 4 process (11%), and 4 outcome (11%) metrics. The most commonly cited structure, process, and outcome metrics included ACR accreditation (37%), ACR Appropriateness Criteria (85%), and peer review (95%), respectively.ConclusionsImaging quality metrics are more likely to be structural (46%) than process (27%) or outcome (27%) based (P < .05). As national value-based reimbursement programs increasingly emphasize outcome-based metrics, radiologists must keep pace by developing the data infrastructure required to collect outcome-based quality metrics.     

Evaluating peer support for prostate cancer: the Prostate Cancer Peer Support Inventory

OBJECTIVE: To develop and test a measure for assessing peer support for men attending prostate cancer support groups, and to describe socio-demographic, medical and adjustment characteristics of Australian men who attend these support groups. PATIENTS AND METHODS: In all, 1224 men (51% response) from 44 prostate-cancer support groups across Australia were recruited by mail. Men completed self-report measures that included the Prostate Cancer Peer Support Inventory (PCSI), the UCLA Prostate Cancer Index bother scales, psychological distress, quality of life (QoL), bother from pain and tiredness, perception of the clinician's support for group participation. Group-level variables were also included in the analyses. RESULTS: Peer support was rated positively by most men; a high satisfaction with support groups was related to better QoL, lower pain, younger age, higher perceived clinician support for group participation, use of alternative therapies, lower education, and regular attendance; dissatisfaction with support groups was related to higher psychological distress, lower QoL, and lower perceived clinician support for group participation. Group variables did not predict positive or negative support. Overall QoL was similar to community norms and psychological distress was low, with only 8% of men reporting high distress. The most common physical symptom was sexual bother, with 74% of men reporting moderate or high bother. CONCLUSIONS: The PCSI was a useful measure of peer support. Perception of the benefits of peer support was related to individual but not group differences. The clinicians' attitudes to participation in support groups influenced the men's experience of these groups, and this finding has implications for developing support services for these men.     

腰椎压缩性骨折编码对DRGs分组的影响

目的 探讨腰椎压缩性骨折错误编码对DRGs相关指标的影响,为入组准确性提供参考.方法 利用广西桂林市某三级甲等医院2019年6月30日-2020年6月30日156份腰椎压缩性骨折病例,结合病案内容核对主要诊断和主要手术的填写情况与编码情况,并将错误编码与正确编码模拟分组,比较正确与错误编码间CMI值的差异,最后对错误编...