RESUMEN
In spite of a referral letter as an important document for communicating between physicians, whether it could also be useful as a source of information for patients has not yet established. We included cancer patients in palliative care setting, all of whom completed a standardized questionnaire regarding their opinion concerning the utility of a referral letter as a source of information and its requirements to achieve a better understanding. Completed questionnaires were received from 50 cancer patients. Ninety-four percent of participants agreed that a referral letter could be of great importance for procuring medical information to them. There was only minor divergence among the participants respecting age, gender, or education. Particular requirements were diagnosis, treatment plan, prognosis, list of drugs, and contact data of involved physicians. Additional important topics were laboratory values, alternatives to current therapy, side effects and supportive therapy, and advices regarding lifestyle and naturopathy. The majority of patients also concluded to accept technical terms in doctor's letters if a glossary supported their comprehension. The majority of patients prefer a concise description of medical information in a referral letter. This form of a letter would boost patients' involvement and help them transfer medical information to other therapists or relatives.
Asunto(s)
Comunicación , Comprensión , Neoplasias/terapia , Cuidados Paliativos , Educación del Paciente como Asunto , Derivación y Consulta/normas , Terminología como Asunto , Acceso a la Información , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Planificación de Atención al Paciente , Médicos , Pronóstico , Encuestas y CuestionariosRESUMEN
The Internet offers an easy and quick access to a vast amount of patient information. However, several studies point to the poor quality of many websites and the resulting hazards of false information. The aim of this study was to assess quality of information on thyroid cancer. A patients' search for information about thyroid cancer on German websites was simulated using the search engine Google and the patient portal "Patienten-Information.de". The websites were assessed using a standardized instrument with formal and content aspects from the German Cancer Society. Supporting the results of prior studies that analysed patient information on the Internet, the data showed that the quality of patient information on thyroid cancer is highly heterogeneous depending on the website providers. The majority of website providers are represented by media and health providers other than health insurances, practices and professionals offering patient information of relatively poor quality. Moreover, most websites offer patient information of low-quality content. Only a few trustworthy, high-quality websites exist. Especially Google, a common search engine, focuses more on the dissemination of information than on quality aspects. In order to improve the patient information from the Internet, the visibility of high-quality websites must be improved. For that, education programs to improve patients' eHealth literacy are needed. A quick and easy evaluation tool for online information suited for patients should be implemented, and patients should be taught to integrate such a tool into their research process.
Asunto(s)
Información de Salud al Consumidor/normas , Internet/normas , Neoplasias de la Tiroides/epidemiología , Alfabetización en Salud , Humanos , Seguro de Salud , Motor de BúsquedaRESUMEN
BACKGROUND: With growing complexity of diagnostics and therapy, as well as increasing involvement of patients in the decision-making process, there is more and more demand for second opinions in oncology. This literature review aims at analyzing the benefits and risks involved, as well as the tools needed to establish a structured program for second opinion within a modern healthcare system. METHODS: A systematic literature search was performed using MEDLINE and Embase and the databases SocINDEX, ERIC and CINAHL. Thirteen articles met the inclusion criteria and offered a relevant insight into the topic of second opinions. RESULTS: Depending on the study, between 6.5 and 36 % of patients search for a second opinion, due to a variety of reasons. Changes in diagnosis, treatment recommendations or prognosis as a result of the second opinion occurred in 12-69 % of cases. In 43-82 % of cases, the original diagnosis or treatment was verified. Patient satisfaction was high, and the second opinion was deemed as helpful and reassuring in most cases. Yet, data on patient-relevant outcomes or on the quality of the second opinion are missing. CONCLUSION: In general, outcome data on second opinion are divergent and scarce. Yet, with patients' demand for second opinion and influence of second opinion on treatment decisions, a structured, high quality and transparent second-opinion program seems mandatory. Such a program may support patient-physician communication and improve the flow of information, as well as decision-making. Its evaluation should be independent from the provider of the second opinion.
Asunto(s)
Medicina Basada en la Evidencia , Neoplasias/terapia , Derivación y Consulta , Actitud del Personal de Salud , Humanos , Satisfacción del Paciente , Relaciones Médico-Paciente , Médicos/psicologíaRESUMEN
PURPOSE: In traumatic brain injury, diffusion-weighted and diffusion tensor imaging of the brain are essential techniques for determining the pathology sustained and the outcome. Postmortem cross-sectional imaging is an established adjunct to forensic autopsy in death investigation. The purpose of this prospective study was to evaluate postmortem diffusion tensor imaging in forensics for its feasibility, influencing factors and correlation to the cause of death compared with autopsy. METHODS: Postmortem computed tomography, magnetic resonance imaging, and diffusion tensor imaging with fiber tracking were performed in 10 deceased subjects. The Likert scale grading of colored fractional anisotropy maps was correlated to the body temperature and intracranial pathology to assess the diagnostic feasibility of postmortem diffusion tensor imaging and fiber tracking. RESULTS: Optimal fiber tracking (>15,000 fiber tracts) was achieved with a body temperature at 10°C. Likert scale grading showed no linear correlation (P > 0.7) to fiber tract counts. No statistically significant correlation between total fiber count and postmortem interval could be observed (P = 0.122). Postmortem diffusion tensor imaging and fiber tracking allowed for radiological diagnosis in cases with shearing injuries but was impaired in cases with pneumencephalon and intracerebral mass hemorrhage. CONCLUSIONS: Postmortem diffusion tensor imaging with fiber tracking provides an exceptional in situ insight "deep into the fibers" of the brain with diagnostic benefit in traumatic brain injury and axonal injuries in the assessment of the underlying cause of death, considering influencing factors for optimal imaging technique.
Asunto(s)
Lesiones Encefálicas/patología , Imagen de Difusión Tensora , Fibras Nerviosas/patología , Adolescente , Adulto , Anciano , Axones/patología , Temperatura Corporal , Encéfalo/patología , Estudios de Factibilidad , Femenino , Patologia Forense , Humanos , Masculino , Persona de Mediana Edad , Cambios Post Mortem , Estudios Prospectivos , Sustancia Blanca/patología , Adulto JovenRESUMEN
The presence of humic substances (HS) has previously been shown to alter sorption properties of multi-walled carbon nanotubes (MWCNTs). To systematically study this process, three alkane pairs were selected as molecular probe sorbates. The influence of HS on sorption affinity, sorption linearity, and the dominant sorption mode (i.e., ad- or absorption) by MWCNTs was investigated. The addition of HS led to a continuous decrease in sorption affinity and an increase in sorption linearity with increasing HS addition. Furthermore, the comparison of distribution coefficients of n- and cycloalkanes showed that the dominant sorption mode remains to be adsorption regardless of the presence of HS on MWCNT surface. From this, it can be concluded that instead of a change in sorption mode to absorption of sorbates into HS-coated MWCNT, HS blocks high-energy sorption sites for subsequently added sorbates and that sorbates continuously sorb on the MWCNT surface.
Asunto(s)
Alcanos/química , Sustancias Húmicas/análisis , Nanotubos de Carbono/química , Adsorción , Modelos Químicos , Técnicas de Sonda MolecularRESUMEN
The accurate prediction of distribution coefficients of organic compounds from water to carbon-based nanomaterials (CNM) is of major importance for the understanding of environmental processes and a risk assessment of released CNM. Poly-parameter linear free-energy relationships (ppLFER) have previously been shown to offer such an accurate prediction of sorption processes. The aim of this study was to identify and quantify the contribution of individual molecular interactions to overall sorption by multi-walled carbon nanotubes (MWCNTs). To this end, a large data set of experimental sorption isotherms by MWCNTs of 20 aliphatic and 14 aromatic compounds covering various relevant molecular interactions was produced. A thermodynamic cycle was used to obtain MWCNT-air distribution coefficients (KMWCNT/a) for the interpretation of direct sorbate-MWCNTs interactions. The thereby derived ppLFER log KMWCNT/a = (0.59 ± 0.59)E + (2.23 ± 0.59)S + (3.90 ± 0.67)A + (3.23 ± 0.71)B + (0.98 ± 0.17)L - (0.05 ± 0.50) shows the contribution of non-specific interactions, represented by the hexadecane-air partitioning constant (L), and specific interactions related to the solute polarity (S) as well as the H-bond interactions (A, B). Measured MWCNT-water distribution coefficients were clearly more accurately calculated by the ppLFER equations (R(2) 0.85-0.86) compared to the classical prediction by single parameter model based on the octanol-water partitioning constant (R(2) 0.64-0.78). In addition, the ppLFER presented here allow a more accurately prediction of sorption by MWCNTs compared to literature ppLFER, especially for aliphatic compounds and at environmentally relevant concentrations.