scholarly journals 635 Expectations and Concerns of Patients Attending a Spinal Outpatient Clinic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Jones ◽  
A Stanley ◽  
M J H McCarthy
Keyword(s):  
Outpatient Clinic ◽  
Treatment Options ◽  
Healthcare Systems ◽  
Loss Of Function ◽  
Previous Surgery ◽  
Permanent Disability ◽  
Work Related ◽  
Clinical Consultation ◽  
Future Work

Abstract Aim Identifying expectations and concerns of patients is vital during clinical consultation in patient-centred healthcare systems. Most spinal surgery is elective and focussed on improving quality of life. Understanding what patients want from treatment at baseline may improve experience and outcomes. Method New patient data from the caseload of a single orthopaedic spinal surgeon (from April 2012-18) was analysed with expectations and concerns reported in the outpatient clinic letter (standard practice for surgeon). Results Of 940 patients (498 NHS, 442 private), mean age was 58.3 with 46.0% male and 54.0% female. Nearly 1-in-6 patients underwent previous surgery. The most common expectation was ‘reduce pain’ (41.8%), followed by diagnosis (23.0%), treatment options (13.5%), unsure (10.5%). The most common concern was ‘continuation/worsening of pain’ (27.0%), followed by loss of function (15.9%), work-related (8.3%), permanent disability (7.8%). NHS patients were significantly more unsure of expectations (19.7% vs 4.5%, p<.001) and less frequently raised concerns (39.0% vs 18.8%, p<.001). NHS patients had significantly worse Oswestry Disability Index (ODI) scores (46.8% vs 42.0% p<.001), were more depressed (PHQ-9: 11.5 vs 8.9, p<.001) and anxious (GAD-7: 8.2 vs 5.9, p<.001). Private patients were significantly more likely to report problems sleeping (79.4% vs 51.0%, p<.001). Patients concerned about permanent disability had significantly worse ODI (51.0% vs 42.7%, p<.001), PHQ-9 (12.6 vs 10.2 p=.013) and GAD-7 (9.0 vs 7.1, p=.017) scores. Conclusions This study identified patient expectations and concerns in spinal outpatient clinic in both healthcare sectors. Future work should explore these findings in context with clinical outcome.

Stakeholders in Higher Education Accreditation: A Bibliometric Analysis

2021 ◽  
Vol 1 (2) ◽  
pp. 112-120
Author(s):  
Dindin Nasrudin ◽  
Endah Kurnia Yuningsih ◽  
Mila Faizatul Millah
Keyword(s):  
Higher Education ◽  
Bibliometric Analysis ◽  
Selection Process ◽  
Vital Role ◽  
Journal Articles ◽  
Work Related ◽  
Research Theme ◽  
Future Work ◽  
The Relationship

The existence of stakeholders in accreditation at every level of education plays a vital role. Their opinions determine the quality of an institution. This paper aims to show research trends related to the part of stakeholders in university accreditation. The method used is a bibliometric analysis of the Scopus database using VOSviewer software. The researcher selected eight hundred ten documents from journal articles and conference proceedings in English through the selection process. The results of the co-occurrence analysis show 4 clusters of related keyword groups. Four keywords that are very influential in the research theme are quality assurance with 142 occurrences, accreditation with 83 occurrences, stakeholders with 28 occurrences, and assessment with 24 occurrences. The relationship between concepts within one cluster and between clusters is shown through network visualization. By visualizing overlays, future work related to stakeholders in higher education accreditation can be mapped, including topics on organizational culture, governance, change management, partnership, and employability. This study concludes that bibliometric analysis through VOSviewer is proven to be able to show trends and future work for stakeholder research in higher education.

scholarly journals X-Linked Hypophosphatemia: A New Era in Management

2020 ◽  
Vol 4 (12) ◽  
Author(s):  
Kathryn Dahir ◽  
Mary Scott Roberts ◽  
Stan Krolczyk ◽  
Jill H Simmons
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Treatment Options ◽  
Human Monoclonal Antibody ◽  
Loss Of Function ◽  
Active Vitamin ◽  
New Era ◽  
Dihydroxyvitamin D ◽  
Conventional Management ◽  
Phex Gene

Abstract X-linked hypophosphatemia (XLH) is a rare, hereditary, progressive musculoskeletal disease that often causes pain and short stature, as well as decreased physical function, mobility, and quality of life. Hypophosphatemia in XLH is caused by loss of function mutations in the phosphate-regulating endopeptidase homolog X-linked (PHEX) gene, resulting in excess levels of the phosphate-regulating hormone fibroblast growth factor 23 (FGF23), which leads to renal phosphate wasting and decreased serum 1,25-dihydroxyvitamin D production. Historically, treatment options were limited to oral phosphate and active vitamin D analogues (conventional management) dosed several times daily in an attempt to improve skeletal mineralization by increasing serum phosphorus. The recent approval of burosumab, a fully human monoclonal antibody to FGF23, has provided a new, targeted treatment option for patients with XLH. This review summarizes our current understanding of XLH, the safety and efficacy of conventional management and burosumab, existing recommendations for managing patients, and unanswered questions in the field.

Surgery for Lung Cancer and the Consequences for the Swallow

2016 ◽  
Vol 1 (13) ◽  
pp. 162-168
Author(s):  
Pippa Hales ◽  
Corinne Mossey-Gaston
Keyword(s):  
Lung Cancer ◽  
Treatment Options ◽  
Vocal Cord Palsy ◽  
Subsequent Treatment ◽  
Physiological Reserve ◽  
Palliative Phase ◽  
And Function ◽  
The Impact ◽  
Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

Impairment Tutorial: Rating Facial Disfigurement After an Injury

1998 ◽  
Vol 3 (4) ◽  
pp. 6-6
Author(s):  
Marc T. Taylor
Keyword(s):  
Current Work ◽  
Workers Compensation ◽  
Loss Of Function ◽  
Facial Disfigurement ◽  
Work Related ◽  
Work Related Injury ◽  
Compensation Claim ◽  
Impairment Ratings

Abstract This article discusses two important cases that involve the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). First, in Vargas v Industrial Com’n of Arizona, a claimant had a pre-existing non–work-related injury to his right knee as well as a work-related injury, and the issue was apportionment of the pre-existing injury. The court held that, under Arizona's statute, the impairment from the pre-existing injury should be subtracted from the current work-related impairment. In the second case, Colorado courts addressed the issue of apportionment in a workers’ compensation claim in which the pre-existing injury was asymptomatic at the time of the work-related injury (Askey v Industrial Claim Appeals Office). In this case, the court held that the worker's benefits should not be reduced to account for an asymptomatic pre-existing condition that could not be rated accurately using the AMA Guides. The AMA Guides bases impairment ratings on anatomic or physiologic loss of function, and if an examinee presents with two or more sequential injuries and calculable impairments, the AMA Guides can be used to apportion between pre-existing and subsequent impairments. Courts often use the AMA Guides to decide statutorily determined benefits and are subject to interpretation by courts and administrative bodies whose interpretations may vary from state to state.

Letter to the Editor: The Continuing Challenge of Evaluating RSD Impairment and Disability

1998 ◽  
Vol 3 (5) ◽  
pp. 8-10
Author(s):  
Robert L. Knobler ◽  
Charles N. Brooks ◽  
Leon H. Ensalada ◽  
James B. Talmage ◽  
Christopher R. Brigham
Keyword(s):  
Disability Evaluation ◽  
Body Part ◽  
Loss Of Function ◽  
Regulatory Requirements ◽  
Major Cardiac Event ◽  
Clinical Scenarios ◽  
Impairment Score ◽  
Occupational Activities ◽  
The Difference

Abstract The author of the two-part article about evaluating reflex sympathetic dystrophy (RSD) responds to criticisms that a percentage impairment score may not adequately reflect the disability of an individual with RSD. The author highlights the importance of recognizing the difference between impairment and disability in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): impairment is the loss, loss of use, or derangement of any body part, system, or function; disability is a decrease in or the loss or absence of the capacity to meet personal, social, or occupational demands or to meet statutory or regulatory requirements because of an impairment. The disparity between impairment and disability can be encountered in diverse clinical scenarios. For example, a person's ability to resume occupational activities following a major cardiac event depends on medical, social, and psychological factors, but nonmedical factors appear to present the greatest impediment and many persons do not resume work despite significant improvements in functional capacity. A key requirement according to the AMA Guides is objective documentation, and the author agrees that when physicians consider the disability evaluation of people, more issues than those relating to the percentage loss of function should be considered. More study of the relationships among impairment, disability, and quality of life in patients with RSD are required.

Raynaud’s phenomenon and digital ischaemia - pharmacologic approach and alternative treatment options

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 201-212 ◽  
Author(s):  
Birgit Linnemann ◽  
Matthias Erbe
Keyword(s):  
Quality Of Life ◽  
Angiotensin Receptor Blockers ◽  
Raynaud’S Phenomenon ◽  
Treatment Options ◽  
Raynaud's Phenomenon ◽  
Tissue Loss ◽  
Receptor Antagonists ◽  
Skin Ulcers ◽  
Digital Ischaemia

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

Chronic Ischemic Monomelic Neuropathy after Arteriovenous Fistula Creation: A Unique Presentation of Vascular Steal

2020 ◽  
Vol 3 (2) ◽  
pp. 147-150
Author(s):  
Kaczynski RE ◽  
Asaad Y ◽  
Valentin-Capeles N ◽  
Battista J
Keyword(s):  
Arteriovenous Fistula ◽  
Complete Loss ◽  
Dialysis Access ◽  
Loss Of Function ◽  
Access Site ◽  
Surgical Ligation ◽  
Arteriovenous Access ◽  
Vascular Steal ◽  
Steal Syndrome

We discuss a case of a 58 year old male who presented for left upper extremity steal syndrome including ischemic monomelic neuropathy (IMN) 1.5 months after arteriovenous fistula creation. He presented after three surgical attempts to salvage his fistula with rest pain, complete loss of function with contracture of the 4th and 5th digits, and loss of sensation in the ulnar distribution for more than three weeks. At our institution, he underwent surgical ligation of the distal fistula and creation of a new fistula proximally, resulting in complete resolution of his vascular steal symptoms almost immediately despite the chronicity prior to surgical presentation. Our patient provides a unique perspective regarding dialysis access salvage versus patient quality of life. The patients’ functional status and pain levels should take precedence over salvage of an arteriovenous access site, and early ligation of the access should be completed prior to chronic IMN development. However, if a patient presents late along the IMN course, we recommend strong consideration of access ligation in order to attempt to regain the full neurovascular function of the extremity as we experienced in our patient.

ADOECIMENTO DE PROFESSORES UNIVERSITÁRIOS COM DIAGNÓSTICO DE TRANSTORNO AFETIVO BIPOLAR UMA REVISÃO DE LITERATURA

REVISTA FIMCA ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 1-6
Author(s):  
Pâmela Gomes Artioli ◽  
Natiely Souza Lima ◽  
Camila Silva
Keyword(s):  
Higher Education ◽  
Bipolar Disorder ◽  
Bipolar Affective Disorder ◽  
Physical Work ◽  
Education Professionals ◽  
Work Related ◽  
Analysis Technique ◽  
Work Routine ◽  
Teaching Area

Introdução: Com o passar dos anos, além de doenças laborais físicas, surge um novo cenário de doenças emocionais que vem afetando gradativamente profissionais da área da docência a pesquisa em questão visou identificar os transtornos mentais que mais provocam afastamento de docentes em instituições de ensino superior, (com ênfase no transtorno bipolar), onde contribuiu para se aprofundar a análise de fatores relacionados a esse tipo de transtorno. Objetivos: os objetivos deste estudo, são de realizar análise crática e reflexiva quanto ao número elevado de professores de ensino superior com o Transtorno Afetivo Bipolar, e a relação dos fatores associados a este impedimento dos profissionais, destacar também questões relativas à saúde mental, e identificar quais são as consequências que implicam na rotina de trabalho desses professores e o aumento de docentes com diagno?stico de Transtorno Bipolar. Materiais e Métodos: Quanto à fundamentação teórica, trata-se de um referencial bibliográfico ao passo que utiliza de literaturas científicas disponibilizadas por meio eletrônico. Utilizando-se como técnica de análise de dados a análise de conteúdo interpretativa. Os critérios de inclusão que foram usados são: publicações em português, entre os anos de 2000 a 2018 disponíveis na íntegra. Conclusão: Por fim chegou-se ao entendimento de que além da sobrecarga os docentes remanescentes, o adoecimento crescente dos profissionais da educação compromete a qualidade de vida desses profissionais. Introduction: Over the years, in addition to physical work-related illnesses, a new scenario of emotional diseases emerges that has gradually affected professionals in the teaching area. The research in question aimed at identifying the mental disorders that cause the most withdrawal of teachers in higher education institutions, (with emphasis on bipolar disorder), where it contributed to deepen the analysis of factors related to this type of disorder. Objectives: The objectives of this study are to perform a critical and reflexive analysis regarding the high number of teachers of higher education with Bipolar Affective Disorder, and the relation of the factors associated with this impediment of the professionals, also highlight issues related to mental health, and identify what are the consequences that imply in the work routine of these teachers and the increase of teachers diagnosed with Bipolar Disorder. Materials and Methods: Regarding the theoretical basis, it is a bibliographical reference while using scientific literatures made available electronically. The analysis of interpretive content was used as data analysis technique. The inclusion criteria that were used are: publications in Portuguese, between the years 2000 to 2018 available in full. Conclusion: Finally, it was understood that in addition to overloading the remaining teachers, the growing sickness of education professionals compromises the quality of life of these professionals.

Thrombopoietin Receptor Agonists in Children with Immune Thrombocytopenia: A New Therapeutic Era

2020 ◽  
Vol 20 ◽  
Author(s):  
Giuseppe Lassandro ◽  
Valentina Palladino ◽  
Giovanni Carlo Del Vecchioa ◽  
Viviana Valeria Palmieri ◽  
Paola Carmela Corallo ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Treatment Options ◽  
Thrombopoietin Receptor Agonists ◽  
Receptor Agonists ◽  
Thrombopoietin Receptor ◽  
Related Quality ◽  
Health Related

Background and Objective: Immune thrombocytopenia (ITP) is a common bleeding disorder in childhood. The management of ITP in children is controversial, requiring personalized assessment of patients and therapeutic choices. Thrombopoietin receptor agonists (TPO-RAs), eltrombopag and romiplostim, have been shown to be safety and effective for the treatment of pediatric ITP. The aim of our research is defining the role of thrombopoietin receptor agonists in the management of pediatric ITP. Method: This review focuses on the use of TPO-RAs in pediatric ITP, in randomized trials and in clinical routine, highlighting their key role in management of the disease. Results: Eltrombopag and romiplostim appear effective treatment options for children with ITP. Several clinical studies have assessed that the use of TPO-RAs increases platelet count, decreases bleeding symptoms and improves health-related quality of life. Moreover, TPO-RAs are well tolerated with minor side effects. Conclusion: Although TPO-RAs long term efficacy and safety still require further investigations, their use is gradually expanding in clinical practice of children with ITP.

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