RESUMEN
OBJECTIVE: To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. METHODS: Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. RESULTS: Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. CONCLUSION: The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions.
Asunto(s)
Enfermedad Crónica , Terapia Cognitivo-Conductual/métodos , Hospitales Comunitarios , Pacientes Ambulatorios/psicología , Dolor , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Resultado del Tratamiento , Reino UnidoRESUMEN
BACKGROUND: Fast food consumption has increased dramatically in the general population over the last 25 years. However, little is known about the prevalence and nutritional implications of fast food consumption among patients receiving hemodialysis. METHODS: By using a cross-sectional study design, we obtained data on fast food consumption and nutrient intake (from four separate 24-hour dietary recalls) and nutritional parameters (from chart abstraction) for 194 randomly selected patients from 44 hemodialysis facilities in northeast Ohio. RESULTS: Eighty-one subjects (42%) reported consuming at least one fast food meal or snack in 4 days. Subjects who consumed more fast food had higher kilocalorie, carbohydrate, total fat, saturated fat, and sodium intakes. For example, kilocalorie per kilogram intake per day increased from 18.9 to 26.1 with higher frequencies of fast food consumption (P = .003). Subjects who consumed more fast food also had higher serum phosphorus levels and interdialytic weight gains. CONCLUSION: Fast food is commonly consumed by patients receiving hemodialysis and is associated with a higher intake of kilocalories, carbohydrates, fats, and sodium and adverse changes in phosphorus and fluid balance. Further work is needed to understand the long-term benefits and risks of fast food consumption among patients receiving hemodialysis.