Geriatric Medicine concepts: Trajectory of illness, Life course approach and comprehensive Geriatric assessment

@#Globally, there is an increase in older people. Clinicians, particularly primary care physicians, will need to equip themselves with knowledge and have a general approach for management of older people. In this paper, the following geriatric principles and concepts are covered: the trajectory of illness and the life course approach, multifactorial diagnoses and attributable risk, and comprehensive geriatric assessment. The illness trajectory concept enables clinicians to recognize where the patient is at, predict their likely prognosis and offer appropriate treatment decisions, balanced between aggressive curative intent and symptomatic management. The life course approach provides a model for planning intervention, which usually needs cooperation with other specialties. It is a worthwhile reminder for clinicians that older people tend to present with atypical symptoms, with multiple contributing factors towards their illness. Comprehensive geriatric assessment enables the clinician to gather sufficient information to complete clinical decision making for older people.

Psychosocial factors related to postmastectomy pain syndrome among women with breast cancer: Cross-sectional study

Background@#An insight on the association of psychosocial factors with postmastectomy pain syndrome (PMPS) can help in the holistic management of patients with PMPS. @*Objective@#To determine the proportion of patients with PMPS among those who underwent mastectomy for breast cancer and identify factors associated with the syndrome. @*Design@#Cross-sectional study. @*Setting@#Outpatient Unit in Southern Philippines Medical Center. @*Participants@#45 women who had mastectomy for breast cancer. @*Main outcome measures@#Proportion of patients with PMPS; prevalence odds ratios (POR) of having PMPS for selected factors. @*Main results@#The patients had a mean age of 53.18 ± 8.09 years, mean BMI of 23.57 ± 2.65, and--on average--were 27.09 ± 35.76 months postmastectomy upon entry into the study. Of the 45 patients, 22 (48.89%) had PMPS. Univariate POR of having PMPS were significantly high for patients who: had distant metastasis (POR=5.56; 95% CI 1.27 to 24.29; p=0.0227), experienced premastectomy breast pain (POR=35.70; 95% CI 6.14 to 207.52; p<0.0001), were in late-stage family life cycle (POR=9.18; 95% CI 1.02 to 82.22; p=0.0476), and were in late-stage family illness trajectory (POR=4.96; 95% CI 1.39 to 17.70; p=0.0137). @*Conclusion@#In this study, 48.89% of patients had PMPS. Factors associated with PMPS include: having distant metastases, having premastectomy breast pain, being in late-stage family life cycle, and being in late-stage family illness trajectory.

Masculinidades emergentes a través de la trayectoria del padecimiento: implicaciones para el cuidado de la salud de varones que viven con VIH / Emerging masculinities across the pathway of the disease: Implications for the health care of men living with HIV

Resumen Se realizaron entrevistas a profundidad a doce varones para comprender el sentido que atribuyen a su vivencia con el VIH y la forma en que construyen su masculinidad, en relación con los ideales hegemónicos presentes en su contexto sociocultural. Los resultados indican que durante el transcurso del padecimiento existe una transformación de su masculinidad, pues, al reconocer la vulnerabilidad física, social y emocional que conlleva el diagnóstico de VIH, construyen una masculinidad emergente que permite mantener el autocuidado y normalizar la vida con el padecimiento. Los elementos de esta masculinidad emergente deben ser comprendidos por los servicios de salud y considerados durante el tratamiento para facilitar su atención integral.

Abstract Twelve in-depth interviews with men were conducted in order to understand the meaning they attribute to their experience with HIV and how they construct their masculinity in relation to the hegemonic ideals present in their sociocultural context. The results indicate that during the course of illness there is a transformation of their masculinity, thus recognizing the physical, social and emotional vulnerability that involves the diagnosis of HIV, allows them to build an emergent masculinity that keeps the self-care and the normalization of life with illness. The elements of this emerging masculinity must be understood by health services and considered during treatment to facilitate comprehensive care.

Experiences of patients prior to operation with recurrent glioma based on the Corbin and Strauss chronic illness trajectory framework:a qualitative study / 中国实用护理杂志

Objective To understand the experiences of patients prior to operation with recurrent glioma based on the Corbin and Strauss chronic illness trajectory framework. Methods Fourteen patients participated in the semi-structure interviews.Data were analyzed with Colaizzi′s phenomenologica l procedure. Results Based on the Corbin and Strauss chronic illness trajectory framework, experiences of patients prior to operation with recurrent glioma were extracted. (1) Illness-related work including severe symptoms of illness and lack of knowledge of illness. (2) Biographical work including loss of biography and identity of self. (3) Everyday life work including change of social roles, complicated mood combined negative experience and positive experience, heavy economic burden. Conclusions Nursing staff should attach importance to experiences of patients, and provide targeted interventions for successful operations and recovery of physical and spiritual healing.