Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Synthesising practice guidelines for the development of community-based exercise programmes after stroke

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Multiple guidelines are often available to inform practice in complex interventions. Guidance implementation may be facilitated if it is tailored to particular clinical issues and contexts. It should also aim to specify all elements of interventions that may mediate and modify effectiveness, including both their content and delivery. We conducted a focused synthesis of recommendations from stroke practice guidelines to produce a structured and comprehensive account to facilitate the development of community-based exercise programmes after stroke.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul

Клинически значимые варианты анатомии ветвления чревного ствола и прилежащих к нему лимфоузлов

ЛИМФАТИЧЕСКИЕ УЗЛЫ /АНАТОМАНГИОГРАФИЯ /ИСПАРТЕРИОГРАФИЯ /ИСПВАЗОГРАФИЯ /ИСПРЕНТГЕНОАНГИОГРАФИЯ /ИСПМАГНИТНОГО РЕЗОНАНСА ИЗОБРАЖЕНИЕ /ИСПМР-ТОМОГРАФИЯ /ИСПТОМОГРАФИЯ, ЯМР /ИСПЯМР-ИЗОБРАЖЕНИЕ /ИСПЯМР-ТОМОГРАФИЯ /ИСПМАГНИТНО-РЕЗОНАНСНАЯ АНГИОГРАФИЯ /ИСПАНГИОГРАФИЯ МАГНИТНО-РЕЗОНАНСНАЯ /ИСПМРИ-АНГИОГРАФИЯ /ИСПАРТЕРИИ /АНАТОМПЕЧЕНОЧНАЯ АРТЕРИЯ /АНАТОМСЕЛЕЗЕНОЧНАЯ АРТЕРИЯ /АНАТОМДИАГНОСТИКАКРОВЕНОСНЫЕ СОСУДЫ /АНАТОМ /АНОМАЛАОРТА БРЮШНАЯ /АНАТОМСЕРДЕЧНО-СОСУДИСТАЯ СИСТЕМА /АНАТОМЛЕВАЯ ЖЕЛУДОЧНАЯ АРТЕРИЯЛУЧЕВАЯ ВИЗУАЛИЗАЦИЯСИНДРОМ КОМПРЕССИИ ЧРЕВНОГО СТВОЛАВЕТВЛЕНИЯ ЧРЕВНОГО СТВОЛАЧРЕВНЫЙ СТВО

O processo de constru??o do direito penal moderno : a efic?cia do laudo criminol?gico

Made available in DSpace on 2015-04-14T14:47:49Z (GMT). No. of bitstreams: 1 401468.pdf: 131737 bytes, checksum: 615f85105ddb3edd48479c36d8c7fe8b (MD5) Previous issue date: 2008-01-14A presente pesquisa det?m por objeto analisar o papel dos laudos criminol?gicos no contexto da execu??o penal brasileira a partir da constru??o e crise do Direito Penal moderno. Para al?m da exigibilidade dos laudos na atual ordem jur?dica, busca-se questionar se s?o fact?veis os fins oficialmente declarados, de revelar o m?rito do apenado e, assim, a viabilidade de sua ressocializa??o, de forma a servir como material essencial de apoio ao julgador ao tratar de incidentes da execu??o como a progress?o de regime e o livramento condicional. A viol?ncia, como ?rea de concentra??o, est? presente tanto quando se trata da atua??o estatal na repress?o dos delitos, como quando se cuida da criminalidade em si. A linha de pesquisa Pol?tica Criminal, Estado e Limita??o do Poder Punitivo ? o fio condutor da an?lise dos laudos criminol?gicos como instrumento de avalia??o do delinq?ente, porquanto, no texto, s?o tratados como forma de o Estado punitivo atuar sobre a pessoa do condenado, limitando a possibilidade de reingresso ? sociedade livre