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1.
Gerard J. Molloy Derek W. Johnston Marie Johnston Chuan Gao Miles D. Witham Allan D. Struthers Marion E. T. McMurdo 《British journal of health psychology》2008,13(3):401-417
Objectives The demand–control (D–C) model of job strain has generated a considerable body of empirical support in predicting psychological health outcomes in the context of work. This study aimed to extend previous work using the D–C model of job strain to predict caregiver burden and satisfaction in the informal caregivers of patients with heart failure. Design and method Data were gathered from 60 caregiver/patient dyads in a cross‐sectional design. Patients with chronic stable heart failure were recruited from out‐patient clinics. The dependent variables were caregiver burden and satisfaction. Demand and control were measured using both patient‐ and caregiver‐derived measures. Results The D–C model accounted for 15 and 19% of the variance in caregiver burden, after controlling for age, gender and relationship to the patient. Lower control was associated with higher burden. The D–C model did not predict caregiver satisfaction. Conclusion The D–C model was associated with caregiver burden, but not satisfaction in caregivers, with control being the dominant predictor. Research linking the theory and findings from job strain and informal caregiving studies may elucidate both fields of research. Using the demand–control model of job strain to predict caregiver burden and caregiver satisfaction in the informal caregivers of heart failure patients. 相似文献
2.
In contrast to routine flexor tendon injuries, flexor tendon ruptures following blunt injury or re-ruptures following repair can be difficult to diagnose. The authors investigated the efficacy of using ultrasound to assist in the diagnosis. From 1996 to 1997, 8 patients underwent evaluation of the flexor tendons using an ATL HDI-3000 ultrasound machine with a high-resolution, 5 to 9-MHz hockey stick linear probe. Dynamic evaluation was performed in real time, simulating clinical symptoms. Six patients underwent surgical exploration. Sonographic diagnosis and intraoperative findings were correlated. Ultrasound was used to diagnose 3 patients with ruptured flexor digitorum profundus tendons. Mechanisms of injury included forceful extension, penetrating injury, and delayed rupture 3 weeks after tendon repair. Subsequent surgical exploration confirmed the ruptures and location of the stumps. Five patients had intact flexor tendons by ultrasound after forceful extension, penetrating injury, phalangeal fracture, crush injury, and unknown etiology. In 3 patients who underwent surgery for tenolysis, scar release, or arthrodesis, the flexor tendons were found to be intact, as predicted by ultrasound. The authors found ultrasound to be accurate in diagnosing the integrity of flexor tendons and in localizing the ruptured ends. They conclude that ultrasound is helpful in evaluating equivocal flexor tendon injuries. 相似文献
3.
Kinta Beaver PhD MRes BA DPSN RGN David Jones MD FRCS † Shabbir Susnerwala MD FRCR ‡ Olive Craven MSc RGN RM Onc.Cert § Mary Tomlinson BA RGN ¶ Gary Witham BA RGN Onc.Cert PG.Cert Karen A Luker PhD BNurs FMedSci †† 《Health expectations》2005,8(2):103-113
OBJECTIVES: To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions. DESIGN: Qualitative study using semi-structured interviews with patients. SETTING AND PARTICIPANTS: Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer. RESULTS: For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care. CONCLUSION: This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment. 相似文献
4.
Niranjan A Witham T Kondziolka D Lunsford LD 《The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques》2000,27(3):229-235
OBJECTIVE: To evaluate the role of stereotactic cyst aspiration in the context of multimodality management of cystic glial and metastatic tumors, we retrospectively reviewed our experience with 38 patients during a 10-year interval. METHODS: All 38 patients had one or more computed tomography or magnetic resonance imaging guided stereotactic cyst aspirations. Twenty-seven patients had glial neoplasms and 11 had metastatic brain tumors. Twenty-two patients underwent cyst aspiration as the initial treatment modality while 15 patients had cyst aspiration following previous treatments. RESULTS: In the immediate postoperative period, 19 of the 27 (70%) patients with gliomas and nine of the 11 (82%) patients with metastatic tumors experienced symptomatic improvement. No procedure-related morbidity was encountered. Twelve patients (31.5%) eventually required a catheter-reservoir system. Thirty-seven percent of patients with cystic glial neoplasms and 18% of patients with metastatic tumors had delayed cytoreductive surgery by craniotomy subsequent to stereotactic cyst aspiration. Reduction in tumor volume following aspiration facilitated Gamma knife radiosurgery in seven patients. CONCLUSION: Single stereotactic aspiration is a low risk procedure that provides immediate relief of symptoms in patients with cystic brain tumors. It appears to be valuable together with the use of other therapeutic strategies. 相似文献
5.
IntroductionOlder patients in nursing homes are more likely to be prescribed multiple drugs than other age groups as multimorbidity is the norm. This clinical study reviewed all prescribed centrally active medications for residents in a nursing home in Dundee. Subsequent analysis was carried out to examine whether particular patient criteria are associated with an exposure to centrally acting drugs and to examine the adequacy of analgesia for care home residents.MethodsThe study was carried out in a Dundee nursing home with two different units with varying admission criteria. The research team reviewed patient records establishing background patient characteristics and medical diagnoses where psychoactive prescribing may be appropriate. In addition, information on specific prescribed medications, patient pain scores (PAINAD system), quantified cognition (6CIT score) was gathered. The non-parametric Mann Whitney U test (P < 0.05) was used to compare exposure to CNS active medications between nursing home floors.ResultsPatients with dementia in nursing homes are particularly likely to have bodily pain, insomnia and unipolar depression. Patients with more severe dementia were statistically more likely to be exposed to CNS active medications (P-value = 0.01). Importantly, despite being exposed to significant levels of psychoactive prescribing this patient group may be undertreated for chronic pain.ConclusionCentrally active prescribing in the community for geriatric patients remains high and may be associated with patient risk. Furthermore, despite this patients may be undertreated for pain syndromes. 相似文献
6.
Concurrent use of intranasal and orally inhaled fluticasone propionate does not affect hypothalamic-pituitary-adrenal-axis function. 总被引:2,自引:0,他引:2
Ketan K Sheth Cindy K Cook Edward E Philpot Barbara A Prillaman Lori A Witham Melissa A Faris Kristofer C Klein Kathleen A Rickard 《Allergy and asthma proceedings》2004,25(2):115-120
Two double-blind, randomized, placebo-controlled, parallel group safety and efficacy studies included evaluation of the hypothalamic-pituitary-adrenal (HPA)-axis effects of concurrent treatment with intranasal and orally inhaled fluticasone propionate (FP). In the first study, patients with asthma who were > or =12 years of age were assigned randomly to receive twice-daily doses (either 88 or 220 microg) of orally inhaled FP delivered from a metered-dose inhaler (MDI). In the second study, patients were assigned randomly to receive either orally inhaled FP 250 microg or orally inhaled FP 250 microg/salmeterol 50 microg delivered via the Diskus device. In both studies, patients with rhinitis were allowed to continue the use of intranasal FP at their usual dosing. Treatment periods were 26 weeks and 12 weeks for the MDI and Diskus studies, respectively. HPA-axis effects were assessed using response to short cosyntropin stimulation testing. The number and percentage of patients with an abnormal cortisol response, defined as a morning plasma cortisol of <5 microg/dL, a poststimulation peak of <18 microg/dL, or a poststimulation rise of <7 microg/dL, were summarized in two subgroups: patients who used intranasal FP and those who did not. The concurrent administration of intranasal FP and orally inhaled FP via an MDI or Diskus or via Diskus with salmeterol was not associated with HPA-axis effects compared with orally inhaled FP alone. The results of these two studies suggest that concurrent use of intranasal FP with orally inhaled FP administered via MDI or Diskus for treatment of comorbid rhinitis and asthma does not increase the risk of HPA-axis abnormalities. 相似文献
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Sex steroid hormone production and feedback mechanisms are critical components of the hypothalamic-pituitary-gonadal (HPG) axis and regulate fetal development, puberty, fertility, and menopause. In female mammals, developmental exposure to excess androgens alters the development of the HPG axis and has pathophysiological effects on adult reproductive function. This study presents an in-depth reproductive analysis of a murine model of prenatal androgenization (PNA) in which females are exposed to a low dose of dihydrotestosterone during late prenatal development on embryonic d 16.5-18.5. We determined that PNA females had advanced pubertal onset and a delay in the time to first litter, compared with vehicle-treated controls. The PNA mice also had elevated testosterone, irregular estrous cyclicity, and advanced reproductive senescence. To assess the importance of the window of androgen exposure, dihydrotestosterone was administered to a separate cohort of female mice on postnatal d 21-23 [prepubertal androgenization (PPA)]. PPA significantly advanced the timing of pubertal onset, as observed by age of the vaginal opening, yet had no effects on testosterone or estrous cycling in adulthood. The absence of kisspeptin receptor in Kiss1r-null mice did not change the acceleration of puberty by the PNA and PPA paradigms, indicating that kisspeptin signaling is not required for androgens to advance puberty. Thus, prenatal, but not prepubertal, exposure to low levels of androgens disrupts normal reproductive function throughout life from puberty to reproductive senescence. 相似文献
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