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D Robin Taylor, Calvin J Lightbody
The provision of healthcare is being challenged by a 'perfect storm' of forces including an increasing population with multiple comorbidities, high expectations and resource limitations, and in the background, the pre-eminence of the 'curative medical model'. Non-beneficial (futile) treatments are wasteful and costly. They have a negative impact on quality of life especially in the last year of life. Among professionals, frequent encounters with futility cause moral distress and demoralisation. The factors that drive non-beneficial treatments include personal biases, patient-related pressures and institutional imperatives...
April 2018: Postgraduate Medical Journal
Katherine Townsend
No abstract text is available yet for this article.
February 2018: Lancet Oncology
J Strahler, S Fischer
OBJECTIVE: Vital exhaustion (VE) is characterised by unusual fatigue, increased irritability, and a feeling of demoralisation. It has been found a major risk factor for cardiovascular diseases, and one that is independent of subclinical or clinical manifestations of coronary heart disease or lifestyle-related risk factors. Stress-induced alterations in the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system may mediate the link between VE and increased cardiovascular risk...
March 1, 2018: Physiology & Behavior
Luigi Grassi, David Spiegel, Michelle Riba
Cancer is a devastating disease causing significant psychological problems among patients and their families. In the past few decades, there have been growing implementation and dissemination of screening methods for the psychological consequences of cancer, including distress, depression, anxiety, post-traumatic stress, and demoralisation. Also, guidelines for the management of psychological distress have been developed and endorsed by a number of scientific cancer associations. This review examines some of the most significant related issues, also focusing on recent advances in psychosocial and psychopharmacological interventions as a part of a mandatory, integrated, and comprehensive approach to cancer care...
2017: F1000Research
Olly Bannon, Emma Greenwood
: In recent years the RVH Emergency Department (ED) had been under intense pressure and public scrutiny. This led to a demoralised workforce who had become disengaged with quality improvement (QI). QI projects had become an exercise in data collection with little focus on improving care for patients.Two consultants undertook training in QI and then decided to develop a QI project aiming to empower staff and embed QI as daily practice. An ED QI steering group of interested multidisciplinary members was formed and devised an improvement plan to increase staff engagement with QI...
December 2017: Emergency Medicine Journal: EMJ
Brittany M Bogle, Nona Sotoodehnia, Anna M Kucharska-Newton, Wayne D Rosamond
OBJECTIVE: Vital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS: The ARIC Study is a predominately biracial cohort of men and women, aged 45-64 at baseline, initiated in 1987 through random sampling in four US communities...
March 2018: Heart: Official Journal of the British Cardiac Society
F S S Gray
At the outbreak of the First World War there was insufficient dental provision for serving military personnel. No army dental specialists were available overseas when the troops joined the British Expeditionary Force (BEF). However, the pain of toothache together with the ensuing limited mastication was debilitating and demoralising for the British soldiers. The result was that men were being withdrawn from the front for treatment at base hospitals. This was limited to extractions by medical officers, which frequently incurred unnecessary loss of dentition when restorative work would have been preferable...
June 9, 2017: British Dental Journal
James Bell, Rob van der Waal, John Strang
BACKGROUND: Six recent randomised control trials (RCTs) have suggested that supervised injectable heroin (SIH) can be effective in patients who persist in street heroin use during methadone treatment. However, short-term randomised control trials have limitations in assessing the effectiveness of treatments for addictive disorders, which are chronic and relapsing disorders of motivation. These RCTs particularly fail to capture the process of the SIH treatment and the diversity of influence and change over time...
July 2017: Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie
Aubrey D N J de Grey
No abstract text is available yet for this article.
June 2017: Rejuvenation Research
David Zigmond
No abstract text is available yet for this article.
September 2016: British Journal of General Practice: the Journal of the Royal College of General Practitioners
Guy Shefer, Claire Henderson, Mary Frost-Gaskin, Richard Pacitti
Many countries belonging to the Organisation for Economic Co-operation and Development (OECD) have seen a considerable increase in the number of disability benefits recipients (DBRs), in addition to an increase in the proportion of people with mental illness. As in other countries, changes to the welfare benefits system in England were made in order to reduce the number of DBRs. Many people lost their benefit payments, although a considerable number had them reinstated after appeal. Our aim was to investigate the impact of the process on DBRs whose disability was related to mental health and who won their appeal...
October 2016: Community Mental Health Journal
Alexandra Hillman
This article draws on concepts of morality and demoralisation to understand the problematic nature of relationships between staff and patients in public health services. The article uses data from a case study of a UK hospital Emergency Department to show how staff are tasked with the responsibility of treating and caring for patients, while at the same time their actions are shaped by the institutional concerns of accountability and resource management. The data extracts illustrate how such competing agendas create a tension for staff to manage and suggests that, as a consequence of this tension, staff participate in processes of 'effacement' that limit the presence of patients and families as a moral demand...
February 2016: Social Theory & Health: STH
Debbie Hocking, Suresh Sundram
BACKGROUND: Demoralisation syndrome (DS) has been advanced as a construct that features hopelessness, meaninglessness, and existential distress. Demoralisation and DS have predominantly been considered secondary only to illness; hence there is scant research on demoralisation or DS in populations affected by extreme environmental stress. AIMS: The current study aimed to determine the prevalence of demoralisation, its predictors, and the relevance of DS in a community-based forced-migrant population...
November 2015: Comprehensive Psychiatry
(no author information available yet)
No abstract text is available yet for this article.
2015: BMJ: British Medical Journal
Irene Bobevski, Heather Rowe, David M Clarke, Dean P McKenzie, Jane Fisher
BACKGROUND: Demoralisation is a psychological state occurring in stressful life situations where a person feels unable to respond effectively to their circumstances, characterised by feelings of distress, subjective incompetence, helplessness and hopelessness. The period after the birth of a first baby is a time of great changes and disruptions to many aspects of the mother's physical, psychological and social functioning. This can lead to feelings of distress, a sense of incompetence and helplessness...
2015: BMC Pregnancy and Childbirth
Primus Che Chi, Patience Bulage, Henrik Urdal, Johanne Sundby
OBJECTIVES: Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services...
2015: PloS One
Skye T Dong, Phyllis N Butow, Allison Tong, Meera Agar, Frances Boyle, Benjamin C Forster, Martin Stockler, Melanie R Lovell
PURPOSE: Patients with advanced cancer typically experience multiple concurrent symptoms, which have a detrimental impact on patient outcomes. No studies to date have qualitatively explored advanced cancer patients' perceptions of multiple symptoms in oncology and palliative care settings. Understanding the experience of multiple symptoms can inform integrated clinical pathways for treating, assessing and reducing symptom burden. This study aims to describe the beliefs, attitudes and experiences of patients with multiple symptoms in advanced cancer...
March 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Kat Macey, Angela Gregory, David Nunns, Roshan das Nair
BACKGROUND: Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment...
June 20, 2015: BMC Women's Health
Vibian Angwenyi, Kwaku-Poku Asante, Abdoulaye Traoré, Lawrence Gyabaa Febir, Charlotte Tawiah, Anthony Kwarteng, Alphonse Ouédraogo, Sodiomon Bienvenue Sirima, Seth Owusu-Agyei, Egeruan Babatunde Imoukhuede, Jayne Webster, Daniel Chandramohan, Sassy Molyneux, Caroline Jones
BACKGROUND: Clinical trials conducted in Africa often require substantial investments to support trial centres and public health facilities. Trial resources could potentially generate benefits for routine health service delivery but may have unintended consequences. Strengthening ethical practice requires understanding the potential effects of trial inputs on the perceptions and practices of routine health care providers. This study explores the influence of malaria vaccine trials on health service delivery in Ghana, Kenya and Burkina Faso...
2015: PloS One
Michelle DiGiacomo, Joanne Lewis, Jane Phillips, Marie Nolan, Patricia M Davidson
BACKGROUND: The feminisation of ageing and increasing number of widowed women in contemporary society has significant implications. Older women are at risk of poor health, social, and economic outcomes upon widowhood. The aim of the study was to describe women's experiences in the period soon after their husbands' death, including their financial issues and concerns, and the ways in which these experiences impacted on the transition to widowhood late in life. METHODS: This was a longitudinal study using serial in-depth semi-structured interviews with 21 community-dwelling women over the age of 65 in Australia...
2015: BMC Women's Health
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