Highlights of other VA research programs: prosthetics.
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Bureaucratization and specialization threaten to undermine personalized care. Will humanism and public service be sacrificed for the ethos of business?
The efficacy of self-recording of blood pressure in the management of hypertension was assessed in a randomized clinical trial involving 140 persons who had been receiving antihypertensive therapy for a year or more, but whose diastolic blood pressure had remained at 95 mm Hg or higher. To control for the increased attention implicit in self-recording, which might affect blood pressure, the patients were assigned at random to one of the four groups: self-recording and monthly home visits, self-recording only, monthly home visits only, and neither self-recording nor monthly home visits. This design also permitted assessment of the effect of home visits. During the 6-month experiment no significant differences were apparent between the groups in either compliance or diastolic blood pressure. However, both self-recording and monthly home visits produced a reduction in blood pressure among patients who admitted to difficulty remembering to take their pills; a reduction was not seen among patients who said they had no such difficulty. This confirmed an earlier observation suggesting that this easily identified group of patients may be the most responsive to intervention programs.
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100 patients requiring dialysis were trained between 1970 and 1975. Up to 31. 12. 1975, 56 patients were on home dialysis, 10 on the self-care program and 6 were freshly trained. Training usually lasts 8 weeks. The training course is briefly presented and the supervision of home dialysis patients after discharge from training is described. The possibility of vacation plays an important role in social rehabilitation. Since the spring of 1976, the hospital has operated a camping dialysis bus, the use of which is reported.
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Patients who have undergone colectomy can be divided into two groups: 1. patients with mainly psychosomatic diseases (ulcerative colitis, ileitis terminalis Crohn) and 2. patients with mainly neoplastic diseases of the colon or rectum. The patients of the first group suffer from their symptoms for a longer time and often want to undergo an operation. Although they have considerable personality changes in a neurotic sense they tolerate the operation better than the patients of the second group. These are suddenly confronted with the fact that an operation is necessary. The physician is confronted with depressive reactions of the patients. A satisfying relationship between the patient and his doctor has to be regarded as the basis of the treatment. Additional psychopharmacotherapy, special psychotherapeutic training or/and self-help-groups, e.g. the International Ostomy Association (IOA), can then be considered.