Patients feedback

Other information including patient feedback, past experience, word of nK)uth... 

The focus on measuring the measurable quite often translates into a reductionist approach and the desire to identify a single indicator which will measure the health of an organisation. The recent introduction of the Friends and Family test in NHS organisations is a good example of reductionism. The test elicits patient feedback on a single question would you recommend this service to a friend or family The question itself is ambiguous and is therefore... 

Patient Feedback - What Effect Does it Have on Patient Safety Culture ... 

University Hospital Zurich has been conducting patient surveys for more than 10 years now. In addition, its patient advice service deals directly with complaints and praise from patients and, where appropriate, makes contact with the patients concerned. The data acquired via the surveys and also via this direct patient feedback are made available to the various specialist units. This feedback makes clinical staff more aware of patients problems and expectations and also of what procedures and stractures are proving to be effective. It can also be used to plug and eliminate deficits in patient care as perceived by patients. 

A major complaint of clinical sites is the difficulty and time required for data entry (when they have to enter the data through a keyboard) and the effort required to resolve queries, which are often returned weeks or even months after a patient visit. Machine-read data, whether collected by optical mark read or SmartPen , ensure that data are both entered and validated, with queries returned, in a matter of minutes after they are recorded. Coupled with a quick feedback loop, this system ensures that query rates are typically about one-tenth those for web-based EDC systems and even lower for paper-and-hand entry systems. This system also highlights recurring problems and areas of potential improvement that may impair study timeliness and quality. 

Normally, circulating glucocorticoids (of which cortisol is the most prominent in humans) cause feedback inhibition of ACTH release so that cortisol secretion is, to some extent, self-limiting. However, many patients suffering from major depression have an increased concentration of plasma cortisol but reduced ACTH secretion. The latter abnormality seems to be partly due to a reduction in the number of CRF receptors in the pituitary, although it is thought that decreased ACTH secretion could provoke the adrenal hyperplasia which is common in depression. This would result in excessive secretion of cortisol and contribute to the inhibition of ACTH release (Musselman and Nemeroff 1993). 

Also, a high proportion of depressed patients do not show the reduction in cortisol secretion which is seen when normal subjects are challenged with the synthetic glucocorticoid, dexamethasone, that normally decreases further release through feedback... 

The answer is b. (tlardman, p 229. Katzung, p 168.) Terazosin blocks a receptors in arterioles and venules It is 0 -selective. Perhaps this selectivity permits NE to exert unopposed negative feedback on its own release because of little or no effect on presynaptic a.2 receptors. Alpha blockers reduce arterial pressure in both resistance and capacitance vessels andT thereforet are quite effective in reducing blood pressure when a patient is in the upright position... 

Patients have metabolic acidosis caused by excessive formation of 5-oxoproline (pyroglutamic acid Fig. 40-6, reaction 2). This occurs because the diminution of intracellular glutathione relieves the feedback inhibition on the y-glutamylcysteine synthetase pathway (reaction 1), thereby augmenting the concentration of y-glutamylcys-teine and the subsequent conversion of this dipeptide to cysteine and 5-oxoproline in the cyclotransferase pathway (reaction 4). 

In depressed patients, cortical-hypothalamic-pituitary-adrenal axis hyperactivity can be explained by the hypersecretion of CRF, and secondary pituitary and adrenal gland hypertrophy. Impaired negative feedback at various CNS sites, including the hippocampus and pituitary are also likely to contribute. Downregulation of hippocampal mineralocorticoid receptors and expression is reported in depressed suicides [50]. In bipolar disorder, hyperactivity of the cortical-hypothalamic-pituitary-adrenal axis has been observed [51]. This increase in cortical-hypothalamic-pituitary-adrenal axis activity has also been observed in mixed mood states, mania and in depression in rapidcycling patients. Partial reversal of HPA overactivity is associated with treatment and recovery from depression. 

Reports of the effects of Li+ upon the thyroid gland and its associated hormones are the most abundant of those concerned with the endocrine system. Li+ inhibits thyroid hormone release, leading to reduced levels of circulating hormone, in both psychiatric patients and healthy controls [178]. In consequence of this, a negative feedback mechanism increases the production of pituitary TSH. Li+ also causes an increase in hypothalamic thyroid-releasing hormone (TRH), probably by inhibiting its re-... 

Recent in vitro hybridization studies in the rat have demonstrated that t)rpical antidepressants increase the density of glucocorticoid receptors. Such an effect could increase the negative feedback mechanism and thereby reduce the s)mthesis and release of cortisol. In support of this hypothesis, there is preliminary clinical evidence that metyrapone (and the steroid s)mthesis inhibitor ketoconazole) may have antidepressant effects. Recently several lipophilic antagonists of corticotrophin releasing factor (CRT) type 1 receptor, which appears to be hyperactive in the brain of depressed patients, have been shown to be active in animal models of depression. Clearly this is a potentially important area for antidepressant development. 

In older patients with goiter due to iodine deficiency there is a risk of provoking hyperthyroidism by increasing iodine intake (p. 247) During chronic maximal stimulation, thyroid follicles can become independent of TSH stimulation ( autonomic tissue"). If the iodine supply is increased, thyroid hormone production increases while TSH secretion decreases due to feedback inhibition. The activity of autonomic tissue, however, persists at a high level thyroxine is released in excess, resulting in iodine-induced hyperthyroidism. 

In line with perceptual distortions and mood congruent hallucinations, patients with affective disorders frequently demonstrate mood congruent biases in information processing. Depressed patients are oversensitive to negative feedback and perceived failure during memory recall tests, being more likely than matched controls to make an error following a previously identified error (Elliott et al., 1996). However, the most reliably reported bias is in memory... 

Abnormality in the regulatory feedback mechanism may explain the overactivity of the HPA axis seen in depressed patients, since a lack of dexam-ethasone suppression of cortisol secretion is observed (Carroll et al., 1981). In addition, despite a hypercortisolaemia, depressive patients generally do not demonstrate Cushingoid features, possibly because of a reduction in the function of corticosteroid receptors. It has therefore been hypothesised that the primary abnormality in depression may thus be an impairment of corticosteroid receptor function (Barden et al., 1995). 

TSH is approved for medical use as a diagnostic aid in the detection of thyroid cancer/thyroid remnants in post-thyroidectomy patients. Thyroid cancer is relatively rare, exhibiting the highest incidence in adults, particularly females. First-line treatment is surgical removal of all or most of the thyroid gland (thyroidectomy). This is followed by thyroid hormone suppression therapy, which entails administration of T3 or T4 at levels sufficient to maintain low seum TSH levels through the negative feedback mechanism mentioned earlier. TSH suppression is required... 

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