Chronic pelvic pain is a condition which receives less attention in men than in women. It is often difficult to diagnose and more difficult to treat. The new classification of prostatitis and its variants has introduced the term ‘chronic pelvic pain syndrome’ which underlines the difficulties in dealing with this disorder which may represent a variety of chronically painful conditions with a large functional component. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.

Background: Chronic myeloproliferative disorders (CMPD) seem to be associated with an increased risk for pulmonary hypertension (PH). Case Report: A patient with history of chronic idiopathic myelofibrosis (CIMF) presented with progressive dyspnea (New York Heart Association class III). Until this time he had not received specific treatment for CIMF. Echocardiography and rightheart catheterization confirmed PH. Further diagnostic procedures excluded a specific cause of PH. Therefore, primary PH was assumed. 2 years later he presented again with progressive dyspnea due to a progress of PH. A few days later the patient died from acute posterior myocardial infarction. Pathologic examination of the lung showed an obstruction of the small vessels by conglomerates of megakaryocytes. Discussion: We conclude that PH developed secondarily due to CMPD. PH should be suspected in patients with CMPD and should influence the decision for treatment of CMPD. / Hintergrund: Chronische myeloproliferative Erkrankungen (CMPD) scheinen mit einem erhöhten Risiko für pulmonale Hypertonie (PH) assoziiert zu sein. Kasuistik: Ein Patient mit chronisch idiopathischer Myelofibrose (CIMF) wurde aufgrund einer progressiven Belastungsdyspnoe (New York Heart Association Stadium III) überwiesen. Bis zu diesem Zeitpunkt erhielt er keine spezifische Behandlung seiner CIMF. Echokardiographie und Rechtsherzkatheter ergaben das Vorliegen einer PH. Eine spezifische Ursache der PH konnte zunächst ausgeschlossen werden. Somit wurde das Vorliegen einer primären PH vermutet. 2 Jahre später wurde der Patient mit erneut verschlechterter Belastungsdyspnoe vorgestellt, wobei ein Progress der PH feststellbar war. Einige Tage später verstarb der Patient an einem Hinterwandinfarkt. Die Autopsie des Lungengewebes zeigte einen Verschluss der kleinen Lungengefäße durch Konglomerate von Megakaryozyten. Diskussion: Die Entwicklung der PH ist bei diesem Patienten als Folge der CMPD einzuschätzen. Das Vorliegen einer PH bei Patienten mit CMPD sollte die Entscheidung zu spezifischen therapeutischen Maßnahmen hinsichtlich der CMPD beeinflussen. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Frequent absences resulting from a chronic illness can disrupt adolescent school involvement, impacting academic achievement and psychosocial development as a result. This study explores whether certified child life specialists (CCLSs) could be a resource for parents as they address their adolescents' academic disruptions. Specifically, this study assesses an online training program designed to increase CCLSs' knowledge and self-efficacy as related to adolescents' academic adjustment following frequent absences. This knowledge and skill based training was designed as a three part module with sections including: academic considerations, psychosocial considerations, and availability of school resources in promoting successful adolescent academic adjustment. 62 CCLSs were recruited to participate and complete measures evaluating knowledge, in relation to content included in each module, and self-efficacy, involving communication with parents in regards to adolescent academic adjustment. T-tests were conducted to determine whether there were differences in reports of self-efficacy and knowledge following participation in the intervention between and within the treatment and control groups. Results indicate statistical significance for enhanced knowledge and self-efficacy for the treatment group at post-test. Therefore, the outcomes from this study support the effectiveness of brief online training in fostering knowledge and feelings of efficacy for CCLSs in a context not typically included in child life education or certification. As a result, findings from this study may be used to expand intervention programs in the clinical setting to provide more comprehensive psychosocial care to adolescents diagnosed with a chronic illness.

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Bakgrund: Aktuell forskning om kroniskt bäckenbottensmärtsyndrom (CP/CPPS) visar brist på behandlingsalternativ som adekvat lindrar symtomen. Män och kvinnor med diagnosen CP/CPPS upplever vanligtvis ett långvarigt symtomförlopp som uppkommer både fysiskt och mentalt. CP/CPPS påverkar patientens livskvalitet och diagnosen i sig påverkas av sjuksköterskan och sjuksköterskans roll inom den personcentrerade vården. Metod: En litteraturöversikt av kvalitativ ansats genomfördes för att analysera kvalitativa intervjudata som avsåg patientupplevelser av CP/CPPS.Resultat: Analysen resulterade i fyra teman: Patienter med en CP/CPPS-diagnos upplever svårigheter i sina sexuella relationer; Patienter upplever ofta en känslomässig påverkan på grund av CP/CPPS-relaterade symtom såsom ångest eller katastroftänkande; CP/CPPS orsakar social isolering som påverkar patienternas dagliga liv; Vårdrelaterade känslor av hjälplöshet och hopplöshet upplevs av CP/CPPS-patienter där patienter känner att deras problem inte ses eller hörs av medicinska leverantörer, vilket får dem att känna en brist av kontroll över sina liv. Konklusion: Patientupplevelser av CP/CPPS manifesteras negativt, vilket resulterar i en minskning av livskvalitet. För att kunna förstå och försöka hjälpa patienten i sin kamp med CP/CPPS, krävs först en förförståelse för hur de negativa manifestationerna av CP/CPPS flätas samman och förvärras genom en ömsesidig påverkan. / Background: Current research about Chronic Pelvic Pain Syndrome (CP/CPPS) shows a lack of treatment options that give adequate results. Men and women diagnosed with CPPS usually experience a long course of symptoms which manifest in different ways, both physically and mentally. CP/CPPS has strong ties to patient quality of life and the diagnosis is impacted by the nurse and the nurse’s role within person-centred care. Method: A literature review was carried out to analyse qualitative interview data that pertained to patient experiences of CP/CPPS. Results: The analysis resulted in four themes: Patients with a CP/CPPS diagnosis experience difficulties in their sexual relationships; Patients often experience an emotional impact due to CP/CPPS related symptoms such as anxiety or catastrophic thinking; CP/CPPS causes social withdrawal which impacts patients’ daily life; Care-related helplessness and hopelessness are experienced by CP/CPPS patients whereby patients feel that their issues were not being seen or heard by medical providers which caused them to feel a loss of control over their lives. Conclusion: Patient experiences of CP/CPPS manifest themselves negatively and have an impact on a patient’s well-being, life world and even relationships both personal and within care. To understand and attempt to aid patients in their struggle with CP/CPPS, there first requires a pre-understanding of how the negative manifestations of CP/CPPS intertwine and exacerbate one another.

Objective: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with heart failure, yet little is known about the impact of this condition in patients with acute decompensated heart failure (ADHF), especially from a more generalizable, community-based perspective. The primary objective of this study was to describe the in-hospital and post discharge mortality and treatment of patients hospitalized with ADHF according to COPD status. Methods: The study population consisted of patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 4 study years: 1995, 2000, 2002, and 2004. Results: Of the 9,748 patients hospitalized with ADHF during the years under study, 35.9% had a history of COPD. The average age of this population was 76.1 years, 43.9% were men, and 93.3% were white. At the time of hospital discharge, patients with COPD were less likely to have received evidence-based heart failure medications, including beta-blockers and ACE inhibitors/angiotensin receptor blockers, than patients without COPD. Multivariable adjusted in-hospital death rates were similar for patients with and without COPD. However, among patients who survived to hospital discharge, patients with COPD had a significantly higher risk of dying at 1 (adjusted RR 1.10; 95% CI 1.06, 1.14) and 5-years (adjusted RR 1.40; 95% CI 1.28, 1.42) after hospital discharge than patients who were not previously diagnosed with COPD. Conclusions: COPD is a common co-morbidity in patients hospitalized with ADHF and is associated with a worse long-term prognosis. Further research is required to understand the complex interactions of these diseases and to ensure that patients with ADHF and COPD receive optimal treatment modalities.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Chronic illnesses, including non-communicable diseases (NCDs), continue to be a public health concern, globally, and contribute to the high burden of diseases. These health challenges have led to the introduction of community health workers (CHWs) in both developed and developing countries as a way of dealing with these challenges. It is more than five years since ward-based outreach teams (WBOTs) were introduced into the Julesburg area in order to respond to the needs of the community, based on the government’s focus on quadruple burden of diseases. The researcher is aware of the increasing workload, unclear roles and responsibilities, different approaches to CHWs’ work taken, and the ever-changing focus of their work, based on the community needs and diseases that the community faces at a particular time. It is for this reason that the researcher is interested in understanding the CHWs’ experiences and the manner in which they cope with challenges when working in their ever-changing environment, workload, work focus and roles and responsibilities. Methods: A qualitative exploratory, descriptive and contextual study approach was used; data was collected using focus group discussions with CHWs and one-on-one interviews with key informants, using their supervisors to gather more information that could not have been shared by CHWs. Result: The findings from the focus group discussions revealed that the CHWs have a high workload, while receiving stipend and are not permanently employed. CHWs have had experiences that make them feel unimportant and not needed, as well as enduring poor working conditions without sufficient personal protective equipment (PPE). Even though they experience dissatisfaction, they are passionate about continuing with their community-based work for many years, evidenced by those who have up to 22 years of service.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19599号 / 医博第4106号 / 新制||医||1014(附属図書館) / 32635 / 京都大学大学院医学研究科医学専攻 / (主査)教授 柳田 素子, 教授 妹尾 浩, 教授 浅野 雅秀 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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