RESUMEN
Numerous publications highlight the need for critically evaluating medical information on the Internet. This review identifies Internet resources specifically dedicated to end-of-life care. An annotated review of key web-based resources is presented. The Internet has the potential to catalyze the doctor-patient relationship toward true "partnership." Physicians and patients will benefit from using a focused research strategy.
Asunto(s)
Servicios de Información/organización & administración , Internet/organización & administración , Cuidado Terminal/organización & administración , Capacitación de Usuario de Computador , Humanos , Almacenamiento y Recuperación de la Información/métodosRESUMEN
Breaking bad news is one of a physician's most difficult duties, yet medical education typically offers little formal preparation for this daunting task. Without proper training, the discomfort and uncertainty associated with breaking bad news may lead physicians to emotionally disengage from patients. Numerous study results show that patients generally desire frank and empathetic disclosure of a terminal diagnosis or other bad news. Focused training in communication skills and techniques to facilitate breaking bad news has been demonstrated to improve patient satisfaction and physician comfort. Physicians can build on the following simple mnemonic, ABCDE, to provide hope and healing to patients receiving bad news: Advance preparation--arrange adequate time and privacy, confirm medical facts, review relevant clinical data, and emotionally prepare for the encounter. Building a therapeutic relationship-identify patient preferences regarding the disclosure of bad news. Communicating well-determine the patient's knowledge and understanding of the situation, proceed at the patient's pace, avoid medical jargon or euphemisms, allow for silence and tears, and answer questions. Dealing with patient and family reactions-assess and respond to emotional reactions and empathize with the patient. Encouraging/validating emotions--offer realistic hope based on the patient's goals and deal with your own needs.
Asunto(s)
Rol del Médico/psicología , Relaciones Médico-Paciente , Médicos de Familia/psicología , Enfermo Terminal/psicología , Actitud del Personal de Salud , Competencia Clínica/normas , Emociones , Humanos , Satisfacción del Paciente , Médicos de Familia/normasAsunto(s)
Parto Obstétrico , Primer Periodo del Trabajo de Parto/fisiología , Resultado del Embarazo , Caminata , Femenino , Humanos , Satisfacción del Paciente , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Reproducibilidad de los Resultados , Factores de Tiempo , Caminata/fisiología , Caminata/psicologíaAsunto(s)
Terapia de Reemplazo de Estrógeno , Esperanza de Vida , Posmenopausia , Neoplasias de la Mama/etiología , Estudios de Cohortes , Simulación por Computador , Enfermedad Coronaria/etiología , Femenino , Fracturas de Cadera/etiología , Humanos , Cadenas de Markov , Persona de Mediana Edad , Modelos Biológicos , Análisis de Regresión , Factores de RiesgoRESUMEN
We studied the effect of increased ventricular pressure on heart growth in the stage 21 (3.5-day) chick embryo. Ventricular pressure was increased by constricting the conotruncus with a loop of 10-0 nylon tied in an overhand knot. The embryos were reincubated, and physiology and cellular morphology were evaluated at successive stages of development, stages 21, 24, 27, and 29. Ventricular pressure was measured with a servo-null pressure system, and cardiac output was measured with a 20-MHz pulsed Doppler velocity meter. Ventricular and embryo dry weights were measured on an electronic microbalance, myocyte organelle composition was measured by a point counting technique, and cell growth response was measured by DNA and protein assay. The conotruncal loop increased ventricular pressure in experimental compared with control embryos, i.e., at stage 24, 2.88 +/- 0.13 vs. 1.96 +/- 0.05 (SE) mmHg (P less than 0.05), respectively, without affecting cardiac output. Ventricular dry weight increased in experimental vs. control embryos, i.e., at stage 24, 114 +/- 7 vs. 85 +/- 4 micrograms (P less than 0.05), respectively, whereas embryo weights were similar between the two groups. The difference in ventricular weights was due to myocyte hyperplasia, since organelle proportion of myofibrils and mitochondria, DNA-to-protein ratio, and myocyte area were similar in experimental voice control embryos. Thus the adjustment of myocardial mass to ventricular work occurs even during the earliest stages of embryonic development. Cardiac growth and morphogenesis are parallel but separable processes.
Asunto(s)
Presión Sanguínea , Corazón/embriología , Animales , Embrión de Pollo , ADN/análisis , Corazón/fisiología , Proteínas/análisisRESUMEN
We evaluated wet and dry ventricular and embryo weights, hemodynamic parameters of ventricular function, and myocardial myocyte organelle composition in the developing chick embryo. Phasic and dP/dt ventricular pressure were measured with a servo null pressure system, and phasic, mean, and dV/dt dorsal aortic velocities were measured with a 20-MHz pulsed-Doppler meter. Ventricular and embryo weight increased geometrically with development, but at different rates, so that the ventricle-to-embryo weight ratio decreased from 0.02 to 0.001 just prior to hatching. Ventricular systolic and end-diastolic pressure increased from 1.31 +/- 0.05/0.33 +/- 0.03 mmHg at stage 18 to 3.45 +/- 0.10/0.82 +/- 0.03 mmHg at stage 29, while dP/dt increased from 23.04 +/- 1.32 to 79.55 +/- 3.69 mmHg/s over the same period. Dorsal aortic dV/dt increased from 878 +/- 17 to 2.076 +/- 65 mm/s2 from stage 18 to 29. Myocyte percent volume of myofibrils increased from 16.7 +/- 0.9% at stage 18 to 23.6 +/- 1.1% at stage 27 and diminished to 18.4 +/- 0.8% at stage 29. Mitochondrial percent myocyte volume remained constant at about 11%. These data define the parameters of normal ventricular function and morphology during embryonic development in the chick.