When analysts write about patients, they find themselves in a position of conflict. Their first loyalty is to their patients and maintaining confidentiality. However, they are also committed to advancing scientific knowledge in the psychoanalytic field. The attitudes and practices of 36 analysts residing outside the USA, who published articles ...

BACKGROUND: Although most health departments recognize the need for programs to reduce the risk of cardiovascular disease (CVD) among older, low-income women, they face numerous barriers to successfully implementing such programs. This paper explores counselors' attitudes and beliefs about patients and perceived barriers to implementing the North Carolina Well-Integrated Screening ...

BACKGROUND: A growing number of homebound frail older adults have multiple chronic diseases with frequent flare ups of acute episodes. A physician house call program affiliated with a nonprofit community health system was deployed as a strategy to improve quality of care for homebound patients. PROGRAM DESCRIPTION: A medical team ...

PURPOSE: Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program ...

Based on casual conversations among those working in dialysis units, dialysis facility staff often face situations created by difficult or disruptive patients, yet relatively little is known about these situations. A computer interactive session at a national meeting in April 2000 was used to gather information on this topic from ...

OBJECTIVE: To evaluate return-to-work status 1 year after a physical deconditioning program in manual laborers with chronic low back pain. METHODS: In this open prospective study, a questionnaire was sent to 125 patients and their physicians (115 men and 10 women, mean age 40 years). Mean sick leave duration at ...

OBJECTIVE: Problem-based learning (PBL) relies upon trigger material, often a paper case, to stimulate self-directed enquiry and group discussion. We describe the process of writing a PBL case based upon a patient's narrative account of her experiences of psychiatric illness, and the possible benefits of that collaboration for the patient, ...

GOALS OF WORK: As medical care for cancer has become more specialized in diagnosis, treatment has become more technical and fragmented. In order to help cancer patients and their families, we developed a coordinated program called the Stanford Cancer Supportive Care Program (SCSCP) at the Center for Integrative Medicine at ...

OBJECTIVES: To compare patient enrollment in six clinical studies using shared coverage (24 emergency department [ED] rooms-two students share enrollment responsibility) with enrollment using split coverage (12 rooms each per student). The academic associate (AA) program uses undergraduate students to collect data for clinical studies in the ED by providing ...

BACKGROUND: Much research on gender differences in medicine has centered on women as better communicators, more egalitarian, more patient-centered, and more involved with psychosocial problems, preventive care, and female-specific problems. Hardly any research has examined the interaction between the doctor's gender and the patient's gender. The authors examined students' perceptions ...

PURPOSE: To understand which specific student behaviors predict performance ratings from standardized patients and behavioral scientist preceptors. METHOD: In 1996-98, objective, real-time ratings of student verbal and nonverbal behaviors were conducted on 75 videotaped interviews between second-year medical students and standardized patients at University of North Carolina at Chapel Hill ...

Care for patients is the best way to learn medicine and medical methods and skills. But the availability of real patients for learners is limited. Often the appropriate patient is missed or he can not be demonstrated to all students because of practical or ethical problems. A possible solution is ...

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have ...

Improving the quality of care for patients with chronic illness has become a high priority. Implementing training programs in disease management (DM) so the next generation of physicians can manage chronic illness more effectively is challenging. Residency training programs have no specific mandate to implement DM training. Additional barriers at ...

Traditional preoperative education programs have demonstrated the beneficial effects for orthopaedic patients. However, attending preoperative education classes became too difficult for patients, their families, and their friends who traveled great distances from their homes in rural Kentucky. A multidisciplinary continuous quality improvement team from University of Kentucky Chandler Medical Center ...

In Japan, admission to a psychiatric facility for people with schizophrenia is usually for life. We developed a rehabilitation program aimed at discharging these patients into the Tokyo community. This paper describes the results for the 224 patients. Using an inpatient ward at the Tokyo Musashino Hospital, patients were enrolled ...

Continuous ambulatory peritoneal dialysis (CAPD) training programs have become fundamental patient education programs in renal centers providing peritoneal dialysis (PD) services. Several key topics must be addressed in setting up a CAPD training program: Health care and organizational issues, Multidisciplinary team approach, Evidence-based practice, Pre-training patient assessment, Patient training Program ...

BACKGROUND: Evidence is now evolving of the importance of team management for patients with chronic heart failure. This includes education, patient self-care and physical exercise training. How such programs should be implemented is still under discussion. AIM: To assess the efficacy of an in-hospital rehabilitation clinic-based program, we studied its ...

Clinical study on six spinal cord-injured subjects. The performance of two automatic gait-pattern adaptation algorithms for automated treadmill training rehabilitation of locomotion (called DJATA1 and DJATA2) was tested and compared in this study. To test the performance of the two algorithms and to evaluate the corresponding patient satisfaction. We also ...

Aerobic exercise training is used for rehabilitation in patients with chronic obstructive pulmonary disease (COPD), although it has little effect on muscle weakness and atrophy. Resistance training may be a useful addition to aerobic programs for these patients. The purpose of the present study was to investigate the effects of ...

BACKGROUND: Our objective was to assess knowledge about hypertension, its medical consequences in hospitalized patients with hypertension and in their relatives, and to evaluate the usefulness of a simple education program to improve such knowledge. METHOD: As part of a cohort study, six clinical physicians reviewed the medical charts of ...

The feasibility and accuracy of an Internet-based system for teleauscultation was evaluated in 103 cardiac patients, who were auscultated by the same cardiologist with a conventional stethoscope and with an Internet-based method, using an electronic stethoscope and transmitting heart and lung sounds between computer work stations. In 92% of patients, ...

This study was designed to develop and validate a computerized exercise intervention program using the transtheoretical model (TTM) for Korean patients with type 2 diabetes mellitus (DM). This computerized program was web-based and developed by designing a flow chart. An expert group (n=24), who validated the content of the computerized ...

OBJECTIVES: To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs. DESIGN AND SETTING: Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs. PARTICIPANTS: ...

BACKGROUND: Because home hemodialysis has long been a common Australian support modality, the advent of home-based nocturnal hemodialysis (NHD) in Canada stimulated the extension of our existing home- and satellite-based conventional hemodialysis (CHD) programs to NHD. As a result, the first government-funded, home-based, 6-nights-per-week NHD program in Australia began in ...

PURPOSE: Student exposure to illness-related theatrical performances holds intriguing educational possibilities. This project explored uses of theatrical performance within the context of medical education. METHOD: Two 1-person shows, dramatically addressing AIDS and ovarian cancer, were presented to audiences totalling approximately 150 medical students, faculty, community doctors, staff and patients. RESULTS: ...

This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological ...

The Milwaukee County General Assistance Medical Program implemented strategies to improve the delivery of care to its patients that include patient education and a Nurse Telephone Line. The partnership between a county-funded program and an academic health center has been very productive and resulted in improvements to the program that ...

This article describes one hospital's approach to developing an inpatient integrative therapies program and the foundation for a broader integrative healthcare vision. Since the program's inception, additional evidence has accumulated in the literature supporting the impact of integrative therapies strategies on patients' quality of life during inpatient stays. These findings ...

It is the aim of the teaching hospitals to provide the trainees and the supervising clinician-faculty with an environment conducive to teaching and learning without compromising the quality of patient care in any way. In contrast to the traditional learning in a classroom, clinical learning includes all activities undertaken by ...

BACKGROUND: A number of studies have shown that the communication style of GPs has a significant impact on their ability to recognize and manage psychiatric disorders. Italian training programmes do exist, but none have been evaluated for effectiveness. METHODS: Nine established GPs participated in a training programme consisting of twelve ...

Representing the largest published sample size of therapeutic touch (TT) outcomes to date, data from this continuous quality improvement (CQI) clinical study suggests that TT, when provided in the clinical setting, promotes comfort, calmness, and well-being among hospitalized patients. In addition, patients are highly satisfied with TT. The newly developed ...

The purpose of this study was to assess patient literacy and the readability of patient education brochures from the American Academy of Electrodiagnostic Medicine and Muscular Dystrophy Association. Materials with the appropriate readability and suitability are more likely to provide instruction patients will understand. The readability of the brochure was ...

Psychosocial evaluation of potential organ donors ensures that these patients are prepared for donation and that their psychosocial issues have been addressed. The determination that the decision to donate an organ has been made voluntarily by a competent individual is a primary concern for living donor transplant programs, which must ...

OBJECTIVE: To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. METHOD: A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by ...

PURPOSE: Narrative and problem-solving versions of the same virtual patient's case were created for teaching communication skills to medical students. This qualitative study explored how students experienced the virtual patient. METHOD: In 1998-1999 in-depth, free-form interviews and follow-ups were conducted with 12 third-year medical students at Monash University in Australia. ...

There are many options for perioperative pain control available to surgeons. Given these options, adequate levels of analgesia should be achieved and maintained in all surgical patients. Data suggest that analgesia may be improved by combining different analgesic approaches. To avoid high-dose requirements, dose-dependent adverse effects, and potential toxicity associated ...

The cancer patient's journey not only includes a threat to one's life, but the need to face many medical and emotional challenges. The free Cancer Supportive Care Program (CSCP) within the Center for Integrative Medicine Clinic at Stanford University Hospital and Clinics has been identified as a successful model for ...

The purpose of this research was to explore the changes that occurred in dental students' counseling techniques as a result of training in Brief Motivational Interviewing (BMI). A randomized pretest, posttest design was used with eleven students in each group. Baseline and posttraining measures of students' counseling techniques and the ...

Although a wide variety of medical treatments for neurocardiogenic syncope have been proposed, therapy has largely been emperic based on the mechanisms commonly believed to lead to neurocardiogenic fainting. To determine the utility and efficacy of drug therapy and an orthostatic self-training program in the prevention of tilt-induced neurocardiogenic syncope, ...

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to ...

OBJECTIVE: This case study describes how a completely paralyzed patient, diagnosed with severe cerebral palsy, was trained over a period of several months to use an electroencephalography (EEG)-based brain-computer interface (BCI) for verbal communication. METHODS: EEG feedback training was performed in the patient's home (clinic), supervised from a distant laboratory ...

The purpose of this project was to develop an outcomes-based measurement tool that could be used to screen patients for learning barriers. A comprehensive, objective tool to assess for patient learning barriers was developed and implemented in an outpatient, Stage II Cardiac Rehabilitation program. Definitions for seven barriers to learning, ...

The impact of a therapist's planned medical break is described and discussed, using attachment theory. The break is compared to Ainsworth's strange situation test and the responses of patients with avoidant, ambivalent and disorganised patterns of attachment are explored. The paper examines patients' responses at the point where news of ...

We analyzed the impact of a program that provides indigent patients with free primary care on inpatient admissions, emergency room (ER) visits, and resulting charges in 91 patients before and after admittance into the program. There was a decrease in ER visits after enrolling in the program (1.89 versus 0.83 ...

The Children's Hospital of Denver has an internationally renowned outpatient-inpatient treatment program for children, adolescents, and young adults with eating disorders (EDs). A unique feature of this ED program is its inpatient location on a medical unit. The nurses are medically trained, yet their patients with EDs have complex emotional ...

Telemedicine is said to be helpful to both patients and providers, but we need real-world examples to demonstrate its effectiveness. This paper presents such an example. Royal Brompton, under the Tele-remedy Program of EC Telecom, conducted a project with the Children's Hospital of Athens, Greece, to provide remote diagnosis management ...

BACKGROUND: Despite significant communication gaps between patients and physicians, there has been little effort to initiate and evaluate teaching programs. We investigated whether a communication skills training (CST) could be effectively conducted for Japanese oncologists. METHODS: Fifty-eight oncologists participated in the CST. We evaluated the program by measuring participant-rated confidence ...

Medical care for geriatric patients requires physician training that promotes the acquisition of attitudes, knowledge and skills that will permit future practitioners to meet the health needs of increasing numbers of aged patients. MCW has strengthened its traditional curriculum by focusing on student attitudes in the early pre-clinical years through ...

To address some of the shortcomings to providing timely and convenient education and support to patients with COPD, especially in the management of dyspnea, the Internet was considered a viable medium to deliver a previously tested program at a distance to reach more patients. Older COPD patients were able to ...