Neuropalliative care for the neurosurgeon: a primer

2021 ◽  
pp. 1-9
Keyword(s):  
End Of Life Care ◽  
Treatment Strategies ◽  
Poor Quality ◽  
Formal Training ◽  
Building Trust ◽  
Neurosurgical Patients ◽  
History Of ◽  
Caregiver Needs ◽  
Neurological Conditions

Many neurosurgical conditions are incurable, leading to disability or severe symptoms, poor quality of life, and distress for patients and families. The field of neuropalliative care (NPC) addresses the palliative care (PC) needs of individuals living with neurological conditions. Neurosurgeons play an important role within multidisciplinary NPC teams because of their understanding of the natural history of and treatment strategies for neurosurgical conditions, longitudinal patient-physician relationships, and responsibility for neurosurgical emergencies. Moreover, patients with neurosurgical conditions have unique PC needs given the trajectories of neurosurgical diseases, the realities of prognostication, psychosocial factors, communication strategies, and human behavior. PC improves outcomes among neurosurgical patients. Despite the importance of NPC, neurosurgeons often lack formal training in PC skills, which include identifying patients who require PC, assessing a patient’s understanding and preferences regarding illness, educating patients, building trust, managing symptoms, addressing family and caregiver needs, discussing end-of-life care, and recognizing when to refer patients to specialists. The future of NPC involves increasing awareness of the approach’s importance, delineating priorities for neurosurgeons with regard to NPC, increasing emphasis on PC skills during training and practice, expanding research efforts, and adjusting reimbursement structures to incentivize the provision of NPC by neurosurgeons.

scholarly journals Improving the quality of information on Scottish anglerfish fisheries: making use of fishers' data

2008 ◽  
Vol 65 (7) ◽  
pp. 1334-1345 ◽  
Author(s):  
H. Dobby ◽  
L. Allan ◽  
M. Harding ◽  
C. H. Laurenson ◽  
H. A. McLay
Keyword(s):  
Temporal Trends ◽  
Poor Quality ◽  
Quality Of Information ◽  
Commercial Catch ◽  
Size Category ◽  
History Of ◽  
Scientific Technical ◽  
Catch Rates ◽  
Management Advice

Abstract Dobby, H., Allan, L., Harding, M., Laurenson, C. H., and McLay, H. A. 2008. Improving the quality of information on Scottish anglerfish fisheries: making use of fishers’ data. – ICES Journal of Marine Science, 65: 1334–1345. In recent years, the International Council for the Exploration of the Sea (ICES) Working Group on the Assessment of Northern Shelf Demersal Stocks has been unable to provide an analytical assessment for anglerfish. One of the reasons for this has been the poor quality of the commercial catch-and-effort data, with ICES and the European Commission’s Scientific, Technical, and Economic Committee for Fisheries (STECF) stressing the need for reliable information on which to base estimates of stock status. In response, and following consultation with the fishing industry, an anglerfish tallybook project was implemented in Scotland as part of a long-term approach to providing better data. Tallybooks are completed on a haul-by-haul basis. Skippers record catches of anglerfish (by size category) and other species where possible, together with information on haul location, duration, and depth. Individual vessel catch rates are calculated and used to provide insights into temporal trends in the stock and the spatial distribution of the fishery. The history of the fishery and management advice are summarized, and an overview of the tallybook project is provided. Catch rates are analysed using a generalized additive modelling approach which incorporates seasonal, annual, spatial, and vessel-dependent effects. The results show increased catch rates between 2006 and 2007.

scholarly journals P645 Mental health, work presenteeism and exercise in IBD patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S577-S577
Author(s):  
M Sciberras ◽  
C Nascimento ◽  
T Tabone ◽  
K Karmiris ◽  
P Nikolaou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Demographic Data ◽  
International Study ◽  
Poor Quality ◽  
Psychiatric Medication ◽  
Active Involvement ◽  
Significant Difference ◽  
Previous Medication ◽  
History Of

Abstract Background IBD has been shown to increase the rates of anxiety and depression amongst diagnosed individuals, with a prevalence rate of approximately 15- 20%. Chronic diseases such as IBD can have a significant impact on productivity at work (presenteeism). This can lead to emotional distress, poor quality of life and cost effects on employers. The primary aim of the study was to assess the prevalence of psychological problems, exercise levels and presenteeism at work among IBD patients. Methods This was a multicentre international study whereby IBD patients (>18 years) in clinical remission over the last year, were asked to answer an anonymous questionnaire. Demographic data, type of IBD, current and previous medication, admissions to hospital, history of psychiatric referrals, Stanford Presenteeism Scale (SPS-6), Godin Score (exercise related score) were collected. Exclusion criteria included patients with IBD flares requiring corticosteroids in the previous 12 months. Results 573 patients (CD: n=318) from 8 European Centres and Israel participated in the study. The mean patient age was 39.9 years (SD+/- 13.0). 21.6% were smokers and 48.5% were non-smokers. The rest were ex-smokers. 10.9% of patients had a diagnosis of depression/anxiety prior to the diagnosis of IBD, whereas this increased to 20.6% post-IBD diagnosis, this being significantly commoner in the CD cohort (23.0%, p<0.05) and in females (55.8%, p<0.05). 37.7% of patients had been to a psychiatrist or a psychologist (41% of CD, p<0.05) with 11.7% of patients being on psychiatric medication (14.5% of CD, p<0.05). Low presenteeism at work was evident in 34.7%, with no statistically significant difference between UC and CD patients (p=0.5). 39.9% had a Godin Exercise Score being in the active range, 38.8% had a sedentary/insufficient exercise score. The rest were moderately active. Patients diagnosed with depression/anxiety had a more sedentary lifestyle. Conclusion In our study 37.7% of patients were referred for psychological help. This can have several effects including poor presenteeism at work (34.7%) and reduced efficiency. These issues are commoner in patients with CD than in UC. Active involvement of a psychologist/ psychiatrist as part of the IBD team should be routine as to improve the patient’s quality of life.

scholarly journals Can an open displaced tibial fracture be treated without surgery? a treatment discussion: a case report

2021 ◽  
Vol 7 (3) ◽  
pp. 667
Author(s):  
Sara Elisa Diniz ◽  
João Vale ◽  
Pedro Neves
Keyword(s):  
Open Fracture ◽  
Tibial Fracture ◽  
Soft Tissues ◽  
Previous History ◽  
Poor Quality ◽  
Tissue Necrosis ◽  
History Of ◽  
The One ◽  
Analyze Case

<p class="abstract">The authors present a case of a 70-year-old female with left tibial open fracture (Gustillo-Anderson type II) with previous history of trauma of the same limb, from which resulted a Morel-Lavallée injury complicated with extensive tissue necrosis. Considering the sequel condition of soft tissues (scarring and extensive fibrosis), conservative treatment was taken and successful result was achieved. In this case the biggest concern was not the traumatic tissue damage caused by the fall, but the poor quality of tissues already existent before this event. Although surgical treatment is the gold standard in these cases, we must analyze case by case the risk benefit of each procedure and choose the one we believe is the best for the patient.</p>

Psychological Implications of Health Disparities

2021 ◽  
pp. 67-95
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Healthcare Workers ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Physical And Mental Health ◽  
Care Workers ◽  
History Of ◽  
Psychologically Impaired

The psychological implications of health disparities are damaging as humans of different religions, genders, races, cultures, and socioeconomic backgrounds seek entry into healthcare systems and receive poor quality of treatment related to health care workers' and healthcare providers' conscious and unconscious biases. Linguistics, a cultural aspect of diversity, also impacts healthcare disparities, as language barriers affect health literacy. Psychologically impaired by both perceived and overt expressions of discrimination, affected persons can develop discomfort in seeking health care treatment secondary to a history of maltreatment by healthcare workers and providers. However, this pattern of maltreatment can be altered when healthcare workers are educated about unconscious biases and how, if not brought to awareness and removed from the daily interactions with others, they impact the physical and mental health of generations of people.

scholarly journals Working-Class Housing in Birmingham During the Industrial Revolution

1986 ◽  
Vol 31 (1) ◽  
pp. 80-94
Author(s):  
Eric Hopkins
Keyword(s):  
Nineteenth Century ◽  
Working Class ◽  
Urban Population ◽  
Industrial Revolution ◽  
Poor Quality ◽  
Housing Conditions ◽  
Working Classes ◽  
History Of ◽  
The Town

It is not too much to say that over the last twenty years the history of working-class housing in the nineteenth century has been transformed. Many older historians, of course, took it for granted that the quality of houses built to meet the needs of the fast-growing urban population was uniformly bad, a testimony to the avarice of builders and landlords alike. Beliefs of this kind owed much to Engels, and to the Hammonds writing earlier this century about the life of the town labourter. One of the first suggestions that these views were really an over-simplified description of housing conditions came from Professor Ashworth in the 1950's, who pointed out that it was quite wrong to suppose that all nineteenth-century towns developed on the same lines, a kind of Coketown endlessly repeated. While not denying that there was a great deal of poor-quality building, more recently historians have made it clear that newer town housing of the late eighteenth and early nineteenth centuries was not necessarily worse than housing built earlier on, or worse than rural housing built at the same time; that new building varied in construction and amenities in the same town, and from town to town; that the skilled working classes were likely to live in better-quality housing than the unskilled; and that the segregation of working-class housing from middle-class housing, and of the better-off working classes from the labouring classes, again varied from town to town.

scholarly journals The Relationship between Non-Communicable Diseases History and Health-Related Quality of Life

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Ajeng Tias Endarti ◽  
Agus Handito
Keyword(s):  
Quality Of Life ◽  
Poor Quality ◽  
Communicable Diseases ◽  
Joint Disease ◽  
Shortness Of Breath ◽  
Non Communicable Diseases ◽  
Related Quality ◽  
Health Related ◽  
History Of

Disaster-prone population is vulnerable for suffering non-communicable diseases (NCDs) which become risk factors for poor quality of life (QoL). The study aims at investigating the effect of history of NCDs to the QoL. QoL was measured by WHODAS. NCDs with prevalence more than 1% were involved in analysis. Those NCDs included shortness of breath, diabetes, hypertension, joint disease and stroke. Among 1,872 respondents of Riskesdas, 7.7% of them have a poor QoL, suffering hypertension (8.7%), shortness of breath (7.3%) and asthma (6.9%). Risks of poor QoL six times higher among those with a history of PTM (PORadj 5.987; 95% CI 4.210-8.514) after adjusted by age, gender, education, socioeconomic status and region of residence. Stroke gives the greatest impact with POR 25.00 (95% CI 10.406 to 60.063). We recommend that the promotion and prevention of NCDs should be integrated with both mitigation-related and community resilience activities to disasters.

Successful treatment of recurrent hepatic encephalopathy with revision of transjugular intrahepatic portasystemic shunt and embolisation of splenorenal shunt

2021 ◽  
Vol 14 (6) ◽  
pp. e242368
Author(s):  
Padmini Krishnamurthy ◽  
Ammar Ahmad
Keyword(s):  
Hepatic Encephalopathy ◽  
Left Renal Vein ◽  
Splenic Vein ◽  
Poor Quality ◽  
Covered Stent ◽  
Splenorenal Shunt ◽  
Gonadal Vein ◽  
Portasystemic Shunt ◽  
History Of

We present a case of 64-year-old US veteran who developed recurrent hepatic encephalopathy (HE) following transjugular intrahepatic portasystemic shunt (TIPSS) procedure. The patient had a history of metabolic syndrome and cirrhosis due to non-alcoholic steatohepatitis. He had undergone sleeve gastrectomy 1 year earlier with preoperative TIPSS placement. He developed recurrent symptoms of HE despite optimising his medications, resulting in poor quality of life and multiple hospitalisations. A liver Doppler ultrasound and CT scan of the abdomen was obtained which showed a patent TIPSS and a prominent shunt between the splenic vein and left renal vein via the left gonadal vein. This was treated with reduction of TIPSS, by placement of a covered stent in an hourglass configuration within the existing TIPSS stent and simultaneous embolisation of the splenorenal shunt by interventional radiology. The patient had complete resolution of symptoms following the procedure without any recurrence of HE.

Some Familial and Clinical Characteristics of Female Suicidal Psychiatric Patients

1981 ◽  
Vol 138 (5) ◽  
pp. 381-390 ◽  
Author(s):  
John Birtchnell
Keyword(s):  
Suicide Attempt ◽  
Suicidal Behaviour ◽  
Clinical Characteristics ◽  
Psychiatric Patients ◽  
Poor Quality ◽  
History Of ◽  
Severity Of Depression ◽  
To Come ◽  
Suicidal Patients

SummaryThe study compares 72 female psychiatric patients who had a history of suicide attempt with 122 who had neither attempted nor contemplated suicide. Of these 194 women, 128 had experienced the death of their mothers before the age of 11, but the proportions of early bereaved and not early bereaved who were suicidal were similar. Not even the events which followed bereavement affected suicidal behaviour, but the suicidal patients tended to come from larger sibships. Poor quality of the marriage and, for the early bereaved only, having three or more children related significantly to suicidal behaviour. The suicidal women were significantly more often described as dependent. Suicidal behaviour was not differentiated on the endogenous/neurotic depressive dichotomy but it was significantly related to severity of depression.

Predictors of Poor Quality of Life 1 Year After Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 256-264 ◽  
Author(s):  
Zahrah Taufique ◽  
Teresa May ◽  
Emma Meyers ◽  
Cristina Falo ◽  
Stephan A. Mayer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Subarachnoid Hemorrhage ◽  
Cognitive Rehabilitation ◽  
Sickness Impact Profile ◽  
Multivariable Analysis ◽  
Population Based ◽  
Poor Quality ◽  
History Of ◽  
Grade 3

ABSTRACT BACKGROUND: Risk factors for poor quality of life (QOL) after subarachnoid hemorrhage (SAH) remain poorly described. OBJECTIVE: To identify the frequency and predictors of poor QOL 1 year after SAH. METHODS: We studied 1-year QOL in a prospectively collected cohort of 1181 consecutively admitted SAH survivors between July 1996 and May 2013. Patient clinical, radiographic, surgical, and acute clinical course information was recorded. Reduced QOL (overall, physical, and psychosocial) at 1 year was assessed with the Sickness Impact Profile and defined as 2 SD below population-based normative Sickness Impact Profile values. Logistic regression leveraging multiple imputation to handle missing data was used to evaluate reduced QOL. RESULTS: Poor overall QOL was observed in 35% of patients. Multivariable analysis revealed that nonwhite ethnicity, high school education or less, history of depression, poor clinical grade (Hunt-Hess Grade ≥3), and delayed infarction were predictors of poor overall and psychosocial QOL. Poor physical QOL was additionally associated with older age, hydrocephalus, pneumonia, and sepsis. At 1 year, patients with poor QOL had increased difficulty concentrating, cognitive dysfunction, depression, and reduced activities of daily living. More than 91% of patients with poor QOL failed to fully return to work. These patients frequently received physical rehabilitation, but few received cognitive rehabilitation or emotional-behavioral support. CONCLUSION: Reduced QOL affects as many as one-third of SAH survivors 1 year after SAH. Delayed infarction is the most important in-hospital modifiable factor that affects QOL. Increased attention to cognitive and emotional difficulties after hospital discharge may help patients achieve greater QOL.

scholarly journals Prevalence and Associated Factors of Poor Quality of Sleep among Prisoners in Mettu Town Prison, Oromia, South West Ethiopia, 2019

2020 ◽  
Vol 13 (1) ◽  
pp. 94-100
Author(s):  
Zakir Abdu ◽  
Mohammedamin Hajure
Keyword(s):  
Alcohol Use ◽  
Sleep Quality ◽  
Associated Factors ◽  
Poor Quality ◽  
Poor Sleep ◽  
Quality Of Sleep ◽  
Urban Residence ◽  
Poor Sleep Quality ◽  
History Of

Background: Sleep is one of the basic needs of human beings and is important to their health; sleeping problem has a wide range of causes, including medical and psychological. However, evidence on the burden of sleep problems in low-income countries is lacking. When compared to the general population, the risks of having poor sleep quality are substantially higher in prisoners. However, the prevalence of poor sleep quality among prisoners at national level is not known. Objective: To assess the prevalence and associated factors of poor quality of sleep among prisoners in Mettu town prison, 2019. Methods: A cross-sectional study design was employed with 310 prisoners selected by a systematic random sampling method. Data was collected by a face to face interview using the Pittsburgh Sleep Quality Index (PSQI). Data analysis was done using SPSS version 20. Results: The study revealed that 77.1% (n= 239) of participants had poor sleep quality. Marital status: single (AOR=0.11, 95%CI=0.05, 0.26), widowed and divorced (AOR=0.11, 95%CI=0.03, 0.37), history of previous incarceration (AOR=4.8, 95%CI=2.0, 11.79), urban residence (AOR=2.65, 95%CI=1.12, 6.27), unable to read and write and read (AOR=6.10, 95%CI=1.43, 25.9) and lifetime alcohol use (AOR=8.45, 95%CI=3.88, 18.36) had significant association with poor sleep quality. Conclusion: This study has shown that the prevalence of poor sleep quality among prisoners was very high. Marital status: single, widowed and divorced, history of previous incarceration, urban residence, cannot write and read and lifetime alcohol use found to have an impact on the prevalence of poor sleep quality.

Sign in / Sign up

Export Citation Format

Share Document