The patient from receiver of information to informed decision-maker

In this article the change of paradigm currently taking place within the field of patient education is indicated. In this change of paradigm the patient is increasingly being seen as responsible for his own health and as someone who makes independent choices in this respect. This has consequences for the role the patient is given in decisions on individuals care. The consequences of current developments within the Dutch society and in medical techniques as these relate to the need for patient education are enlightened. Some of the main topics for patient education are mentioned and the effects of patient education as established through meta-analyses are summarised. A planning model for a systematic development of patient education interventions is recommended. Relevant topics for research on patient education in the Netherlands are indicated.     

Patient education through teaching for conceptual change

It is not enough for clinicians to gather good patient information and then dictate management plans. If patient education is to be successful, attention must be paid to tailoring educational input to the patient's particular needs. If the conceptual change approach is followed, patient differences due to factors such as age and culture will be taken into account. Likewise, the different types of patient education described earlier can be accommodated, since the patient and his or her particular needs are always the focus of all medical conversations. The conceptual change approach for patient education potentially can help clinicians avoid the temptation to ignore patients' perspectives and provide instruction tailored to patient needs, thereby reducing the possibility of educational negligence.     

Functional impairment and coping style.

The study of how patient attributes interact with psychological treatments (i.e., aptitude by treatment interactions [ATI's]) is a complex and often neglected area of research. ATI research includes patient dimensions and covariates or moderators that selectively and predictably alter the effect of various models of psychotherapy. A number of patient dimensions that moderate treatment effects have been identified. This article focuses on two of these patient variables: patient level of functional impairment and patient coping style. This article describes these concepts and the methods of their measurement and then reviews empirical literature that identifies the effects of these patient contributions on treatment outcome. The practical implications for treatment are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stress of patient suicidal behavior during clinical training: Incidence, impact, and recovery.

Enhances and replicates an earlier study (P. Kleespies et al, 1990) on the incidence and impact of patient suicidal behavior on psychology interns/trainees, using a much larger sample, a broader spectrum of patient suicidal behaviors, and more adequate comparison groups. The findings indicate that more than one-fourth of the interns/trainees needed to deal with a patient suicide attempt, and that one-ninth had to cope with a patient suicide completion. Stress level followed a graduated increase in impact with increasing severity of patient suicidal behavior (i.e., from suicidal ideation to suicide attempt to suicide completion). Trainees who had a patient suicide were distinguished from those who experienced patient suicide by ideation significantly greater feelings of shock, disbelief, failure, sadness, self-blame, guilt, shame, and depression. Results are discussed in terms of the importance of developing mechanisms to assist trainees in anticipating and working through the strong psychological impact of losing a patient through a self-inflicted death. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient suicide: Occupational hazard for psychologists and psychiatrists.

Using data from our earlier national surveys, we compared the frequency and impact of patient suicide among psychologists and psychiatrists. We also report data from a new survey designed to examine the influence of patient type, practice setting, and pattern of practice on risk of experiencing patient suicide and on its impact on the therapist. Twenty-two percent of psychologists and 51% of psychiatrists reported having experienced the loss of a patient to suicide. Both groups reported experiencing significant disruptions in their professional and personal lives after the patient's suicide. Work setting, kind of patient treated, and profession were most strongly associated with the occurrence in patient suicide. We argue that patient suicide is an occupational hazard for psychologists and psychiatrists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The benefits of patient education

In this article, the role of the nurse in patient education is described, as well as the benefits of patient education, such as improved quality of care, improved patient satisfaction, increased compliance, improved staff satisfaction, and effective use of resources. Strategies for effective patient teaching also are presented.     

Clinical case report: multiple idiosyncratic adverse effects of antiepileptic drugs in trisomy 9p

We report the case of a mentally retarded 30 y.o. patient with partial trisomy of chromosome 9, affected by epilepsy. Following treatment with antiepileptic drugs (AEDs), the patient developed several rare complications: after beginning therapy with phenytoin, the patient developed pseudolymphoma; after monotherapy with carbamazepine (CBZ), the patient thereafter developed myoclonic jerks of upper and lower limbs upon awakening; after one year of treatment with valproate (VPA) the patient developed clinical and immuno-haematological signs of SLE. Gradual withdrawal of AED, obtained clinical remission. The possibility that the chromosomal abnormality of the patient was responsible for the three rare complications observed during AED therapy is considered.     

Relation of patient pretreatment characteristics to the therapeutic alliance in diverse psychotherapies.

The prediction of the therapeutic alliance from patient pretreatment characteristics was investigated with a sample of elderly depressed outpatients treated in behavioral, cognitive, and brief dynamic psychotherapy (N?=?60). For the sample as a whole, a higher degree of patient defensiveness was related to a lower patient contribution to the alliance as reflected in patient commitment and working capacity. Also, the availability of environmental support was positively associated with greater patient commitment across treatment conditions. The association of patient pretreatment characteristics with alliance was similar across behavioral and cognitive therapy and less similar across brief dynamic and behavioral or cognitive therapy. The nature of the therapeutic alliance in diverse treatment modalities is discussed, and implications for selection criteria and technical strategies for engaging the difficult patient are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Myophosphorylase deficiency and limb-girdle muscular dystrophy in the same pedigree

We report 2 familial patients with limb-girdle muscular dystrophy (LGD). The parents of patient 1 showed a consanguineous marriage and patient 2 was a paternal cousin of patient 1. Slowly progressive muscular weakness/wasting and dystrophic changes in the biopsied muscles were observed in both patients. However, a quantitative assay revealed a severely reduced myophosphorylase activity in patient 1 with normal activity in patient 2. A semi-ischemic exercise test disclosed no elevation of venous lactate in patient 1 with a normal increase in patient 2. A leukocytes DNA analysis in patient 1 did not show the gene deficits previously recognized in patients with McArdle's disease (McD). Patient 1 may only have abnormal myophosphorylase activity with dystrophic changes secondary to the myophosphorylase deficiency or coincidentally two genomic abnormalities for McD and LGD. LGD still has heterogenous etiologies and the responsible genes for these two disorders may be closely mapped.     

Patient education: a mandate for health care in the 21st century

OBJECTIVE: This first article, of a two-part series, presents the foundation for patient education in the nuclear medicine department. The need for patient education through mandates, such as the JCAHO, is discussed and the relevant literature surrounding the delivery of patient education is reviewed. The emphasis is on proper learning by patients, including the means of maximizing the facilitators to learning and minimizing barriers that limit patient learning in the clinical setting. After completing the article, the reader should be able to: (a) describe the mandates for patient education; (b) discuss the current practice of patient education in health care; (c) describe the effective implementation of learning; (d) list barriers and facilitators to patient learning; and (e) give examples of how barriers to learning can be minimized and facilitators can be maximized. Practical applications will be discussed in the second article.     

Dual application of dentin bonding agents: effect on bond strength

The objective of this paper is to provide an ethical analysis of the concept of the fetus as a patient and to identify the clinical implications of this concept for maternal-fetal medicine. The principles of beneficence and respect for autonomy are applied to the viable and previable fetus. We argue that the viable fetus is a fetal patient. The previable fetus is a fetal patient only when the pregnant woman confers such status on it. When the fetus is a patient, directive counseling for fetal benefit is ethically justified. When the fetus is not a patient, counseling should be non-directive.     

Biliary strictures after liver transplantation

Biliary strictures in the liver transplant population remain significant potential sources of patient morbidity in both early and late postoperative periods. Continuous monitoring of the patient through periodic laboratory testing, ultrasonography, and pre-emptive cholangiography permits early detection and safer management of the patient. A multimodality approach emphasizing both non-surgical and surgical treatment options contributes to continued excellent function of the graft and maximal quality of life for the patient.     

Physician practice styles and patient outcomes: differences between family practice and general internal medicine

OBJECTIVES: This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine. METHODS: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured. RESULTS: There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation. CONCLUSIONS: There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.     

Difficult patients: their construction in group therapy

Written from the perspective of intersubjective theory, this article addresses how the leader and group members co-construct the difficult patient. Too often, therapists and patients have tended to attribute difficulties in therapy groups to "the difficult patient" without appreciating how they themselves contribute to the construction, the needs this construction serves, and the potential value of such patients to the group. Mistakes in group leadership, vicissitudes of intersubjectivity, disturbing intrapsychic defenses, and whole-group dynamics interact to produce the difficult patient. Also discussed is the group member who is difficult but who no longer meets the criteria for patienthood. By exploring the factors involved in the co-construction of the difficult patient, the authors hope to guide clinicians in the deconstruction of such impediments, thus allowing the difficult patient to become "just another group patient."     

Attendance of the anaesthesiologist to the patient. National recommendations for standard of anaesthetic practice

The national recommendations for standard of anaesthetic practice in six countries of the European Community are compared with respect to the attendance of the anaesthesiologist to the patient. These standards apply to anaesthesia, major regional anaesthesia and sedation administered by anaesthesiologists. The attendance to the patient varies from strict continuous presence of the anaesthesiologist to observation of the patient by a non-medical assistant and the anaesthesiologist taking care of another anaesthetized patient. Items which all standards should mention are defined.     

Pleasure or frustration? Satisfaction of nursing students with the choice of their profession at the end of their second school year

Patient education has always been an integral part of quality patient care. Effective patient education is a necessary component of patient satisfaction and has proven instrumental in decreasing hospital days while improving clinical outcomes. Joint Commission and state public health departments regard patient education as one of many organizational performance standards. To be effective, health education must be coordinated among all disciplines involved in the continuum of care. The Patient Family Educational Advisory Committee (PFEAC) directed its efforts in identifying common patient education issues. The committee's initial work focused on areas dealing with culture, documentation and competency.     

A guide to understanding informed consent

Anesthesia providers are expected to provide information to the patient during the preanesthesia interview that enables the patient to make informed choices. Adequate disclosure during the informed consent process ensures the equalization of the practitioner/patient relationship and the decision-making rights of the patient. Both certified registered nurse anesthetists (CRNAs) and anesthesiologists are not only legally required to provide information that will allow a patient to make an informed judgment about how to proceed with various anesthetic modalities but are also obligated by their standards of practice. This article informs the CRNA about the principles of informed consent so that they can better understand their role in the informed consent process.     

Neurogenic bladder in patients with acquired immunodeficiency syndrome

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an areflexic detrusor in the first 2 patients, and a hyperreflexic detrusor in the third patient.     

Sumatriptan nasal spray (20 mg/dose) in the acute treatment of cluster headache

BACKGROUND: Family medicine predoctoral programs frequently have medical students record patient diagnoses in logbooks. Little is known about the accuracy of such logbooks. No studies have compared patient records dictated by students with cases recorded in logbooks. METHODS: Over 2 years, all patient encounters dictated by 79 medical students during their 8-week family medicine rotations were recorded and compared with information in the students' logbooks. RESULTS: Students dictated 2,520 patient encounters but only recorded 2,085 (82.7%) of them in their logbooks. Still, this rate of inclusion is higher than other studies where students did not dictate patient encounters. On the average, each student saw and dictated 32 patient encounters but omitted five to six from their logs. There were no significant differences between the 10 honors and 69 non-honors students in the proportion of patients omitted from logbooks. CONCLUSIONS: Medical students underreport patient encounters in clerkship logbooks. Keeping a record of the patients dictated by medical students was helpful in determining the accuracy of students' logbooks.