Understanding the patients' perspective of emotional support to significantly improve overall patient satisfaction.

This article presents the results of a research study that laid out important considerations for organizations to improve their patient satisfaction scores. It addresses a dimension of patient satisfaction that appears to garner little attention in healthcare contexts: emotional support. Though the literature strongly suggests that emotional support is correlated to overall patient satisfaction, few organizations have systematically attempted to understand the elements of outstanding emotional support. Research at a community teaching hospital in Ontario has shed light on the essential components of emotional support. In this article, a typology of emotional support is offered. With a better understanding of the components of emotional support, organizations may be able to undertake actions that could potentially improve patient satisfaction scores and, in turn, the overall quality of patient care.

Chronic disease: shifting the focus of healthcare in Canada.

The pressure on the Canadian healthcare system to deliver quality and cost-effective care is escalating at a time of an increasing prevalence of chronic diseases. The healthcare system's traditional focus on acute care falls short of meeting the needs of those suffering from chronic diseases, which represent a sizeable portion of the population. This article highlights the impending issues and explores how shifting the focus of healthcare can have a profound impact on meeting the needs of those suffering from chronic diseases in the province of Ontario.

Management of complex chronic disease: facing the challenges in the Canadian health-care system.

This paper discusses the challenges that those living with complex chronic disease present to the Canadian health-care system. The literature suggests home care and the management of complex chronic disease can together ease many of the present and future pressures facing the health-care system in dealing with this new health-care phenomenon. A review of current literature and dialogue with key informants reveals that the current level of investment and the present policy environment are not sustainable to support the health-care system. In this paper, changes to policy and resource allocation to the home care sector are suggested to help manage complex chronic disease and thus improve the effectiveness of the Canadian health-care system. A case is made for a reorganization and increased commitment to the home care sector for a more efficient and patient-centred health-care delivery system.

Race, culture and psychiatry: a history of transcultural psychiatry.

The term 'transcultural psychiatry' has encompassed changing notions of race, culture and psychiatry and, as a result, it is a difficult concept to define. For a long time psychiatrists and social scientists have been commenting on how the psyches and psychiatric illnesses differ in non-White populations. However, transcultural psychiatry was not created as a distinct discipline until after World War II. This article will attempt to tell the story of transcultural psychiatry, charting its genesis in the aftermath of World War II, and then go on to describe how it has taken different forms in response to developments within psychiatry and wider sociocultural changes.

Antidepressants for treating depression in dementia.

BACKGROUND: The use of antidepressants for patients with dementia accompanied by depressive symptoms is widespread, but their clinical efficacy is uncertain. Many of the individual trials of antidepressants have been too small to provide precise estimates of the moderate benefits that might realistically be expected. Combining the information from all appropriate trials may provide a better estimate of the likely effects of treatment.Objectives To determine whether antidepressants are clinically effective and acceptable for the treatment of patients with depression and also dementia.Search methods The CDCIG Specialized Register was last searched on 27 April 2005. This register contains records from major health care databases and many ongoing trials databases and is updated regularly.Medical information departments of pharmaceutical companies were asked to search their databases for any relevant clinical trials. Where necessary authors of trials were approached with requests for additional information.Selection criteria All relevant unconfounded, double-blind, randomized trials comparing any antidepressant drug with placebo, for patients diagnosed as having dementia and depression, according to established criteria.Data collection and analysis Two reviewers extracted data independently and settled any differences by agreement.Main results There were seven included studies with a total of 1140 subjects of which 769 met inclusion criteria. Four included studies reported sufficiently detailed results to enter into meta-analyses, with a total of 137 subjects. Two of these studies investigated the properties of drugs not commonly used in this population with only two studies (Petracca 2001 and Lyketsos 2003) using the more common selective serotonin reuptake inhibitors (SSRIs). Lyketsos 2003 produced two significant differences in favour of treatment in the Cornell Scale for Depression in Dementia (CSDD) at 12 weeks and in the psychiatrists' global rating. However, the CSDD was not used in any of the other studies and no statistical differences were found with the other measures used in the meta-analysis. The meta-analysis of the number of patients suffering at least one adverse event, one event of the nervous system, one event of the gastrointestinal system and one event of dry mouth at 6 to 12 weeks showed a significant difference in favour of placebo. There were no other significant results.Authors' conclusions Available evidence offers weak support to the contention that antidepressants are effective for patients with depression and dementia.However, only four studies are included in the meta-analysis relating to efficacy, and sample sizes are small.Moreover, only two included studies investigated the properties of the more commonly used SSRIs and no studies investigated the properties of newer classes of antidepressants (e.g. selective noradrenergic reuptake inhibitors). This review draws attention to the paucity of research and evidence in this area.