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1.
Gynecol Oncol ; 140(1): 114-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26549108

RESUMO

OBJECTIVE: Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. METHODS: We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. RESULTS: From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. CONCLUSIONS: This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Agendamento de Consultas , Neoplasias Ovarianas/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Satisfação do Paciente
2.
Eur Neuropsychopharmacol ; 18(3): 194-9, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17683915

RESUMO

Previous studies have shown that nitrous oxide (N(2)O)-induced antinociception is sensitive to antagonism by blockade of opioid receptors and also by inhibition of nitric oxide (NO) production. The present study was conducted to determine whether these occur within the same brain site. Mice were stereotaxically implanted with microinjection cannulae in the periaqueductal gray (PAG) area of the midbrain. In saline-pretreated mice, exposure to 70% N(2)O resulted in a concentration-dependent antinociceptive effect in the mouse abdominal constriction test. Pretreatment with an opioid antagonist in the PAG significantly antagonized the antinociceptive effect. Pretreatment with an inhibitor of NO production in the PAG also significantly antagonized the antinociceptive effect. These findings suggest that N(2)O acts in the PAG via an NO-dependent, opioid receptor-mediated mechanism to induce antinociception.


Assuntos
Analgésicos não Narcóticos/farmacologia , Mesencéfalo/metabolismo , Óxido Nítrico/fisiologia , Óxido Nitroso/farmacologia , Substância Cinzenta Periaquedutal/metabolismo , Receptores Opioides/efeitos dos fármacos , Animais , Relação Dose-Resposta a Droga , Masculino , Mesencéfalo/efeitos dos fármacos , Camundongos , Microinjeções , Naltrexona/análogos & derivados , Naltrexona/farmacologia , Medição da Dor/efeitos dos fármacos , Substância Cinzenta Periaquedutal/efeitos dos fármacos
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