Aftercare

In the last few decades there has been a considerable increase in the number of cancer survivors. Health policy makers would like to see cancer follow-up care moved from secondary to primary care. Between 2008 and 2010, a qualitative study among primary health care professionals was performed to get more insight into the way they care for cancer survivors. Analysed was whether a coordinating role in cancer survivorship care would fit in with the practical logic underlying the way the general practitioners work. In their everyday work, general practitioners are used to provide care in a reactive way. Based on this habitus, they classify their patients into 'not special' and 'special' ones. Since general practitioners label cancer survivors as 'not special,' they expect these patients to take the initiative to ask for help and present their complaints in a clear and complete way. Their habitus as a gatekeeper implies that they are reticent about referring patients to other primary health care professionals. In regard to 'not special' patients, such as cancer survivors, general practitioners appear to build on the patients' own strengths. The emphasis on a wait-and-see attitude in contemporary Dutch general practice, as well as the general practitioners' role as a gatekeeper are at odds with the proactive and holistic approach inherent to a coordinating role in cancer follow-up. Therefore, we assume that it will be difficult for general practitioners to shape a pivotal role in this care.

Children are not just 'small adults'. They have specific physical, psychological and social requirements that must be identified and addressed to optimise their well-being in the perioperative period. The healthcare practitioner should be trained to understand the needs of the paediatric patient in hospital, including the ever increasing need to take into account cultural differences. Hospital policy should include a preoperative preparation programme, specially aimed at the paediatric population, where parental involvement is encouraged throughout.

To examine the types of help women received with breastfeeding both in the hospital and at home and the reasons why women stopped breastfeeding earlier than intended. A descriptive design with open-ended questions. After participant recruitment in the postpartum hospital room, data were collected by phone 8 weeks after delivery. Three hundred seventy-nine women planning to breastfeed for at least 8 weeks after uncomplicated delivery. Breastfeeding status at 8 weeks postpartum; report of help with breastfeeding in the hospital and at home. Sixty-eight percent of women were still breastfeeding at 8 weeks, although 37% of those reported supplementing with formula. Of those who had stopped, the most common reason was insufficient milk supply. Other reasons included painful nipples and latch problems, personal reasons, returning to work or school, and drugs/illness of the mother or baby. Most women received help with breastfeeding in the hospital, but only 55% received help with breastfeeding after hospital discharge. The primary reasons for early cessation of breastfeeding are amenable to nursing intervention. Every opportunity should be taken to address these issues both in the hospital and through follow-up calls.

Traditional psychoanalytic theory prescribes total patient-analyst separation after termination to facilitate mourning the loss of the analyst. This paper provides a rationale derived from contemporary (especially relational/interpersonal) theory for an alternative conception of termination and follow-up based on the central role of the analyst as a real person involved in a mutually caring patient-analyst relationship. Patient-analyst follow-up may provide numerous positive benefits: The patient may reexperience the analyst's caring, may reinvigorate helpful introjections of the analyst, and may have additional opportunity to deal with unresolved idealization of the analyst. The analyst may learn about the patient's unpredictable, inevitable post-termination changes, positive and negative, and improve his or her understanding of the course and outcome of treatment.

Type 1 diabetes mellitus (T1DM) results from autoimmune destruction of insulin-producing beta cells and is characterised by the presence of insulitis and &and beta-cell autoantibodies. Up to one third of patients develop an autoimmune polyglandular syndrome. Fifteen to 30% of T1DM subjects have autoimmune thyroid disease (Hashimoto's or Graves' disease), 5 to 10% are diagnosed with autoimmune gastritis and/or pernicious anaemia (AIG /PA), 4 to 9% present with coeliac disease (CD), 0.5% have Addison's disease (AD), and 2 to 10% show vitiligo. These diseases are characterised by the presence of autoantibodies against thyroid peroxidase (for Hashimoto's thyroiditis), TSH receptor (for Graves' disease), parietal cell or intrinsic factor (for AIG /PA), tissue transglutaminase (for CD), and 21-hydroxylase (for AD). Early detection of antibodies and latent organ-specific dysfunction is advocated to alert physicians to take appropriate action in order to prevent full-blo...

COPE, a program designed to help chronic psychiatric patients make the transition from institutionalization to independent living in the community, emphasizes both in-hospital training the systematic aftercare as two points on a continuum of treatment. The program includes four training phases, with each phase based upon the skills acquired in the preceding one. The residents are thereby assured of having the necessary skills for progressing to more complex tasks as they proceed through the program. During the last phase, support by the mental health system is gradually replaced by help from community support systems.

Mechanisms of behavioral change that support positive addiction treatment outcomes in individuals with co-occurring alcohol-use disorders and cognitive impairment remain largely unknown. This article combines person- and variable-centered approaches to examine the interrelated influence of cognitive impairment and social support on stability of and changes in drinking behaviors of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) outpatients and aftercare clients (N = 1,726) during the first year after their entry into treatment. Latent class analysis identified homogeneous groups of clients based on the nature and extent of social support for abstinence or drinking at treatment entry. Cognitive impairment and drinking outcomes were compared across latent classes, and the interaction between impairment and social support on drinking outcomes was examined using mixture probit regression. Three independent social support classes (frequent positive, limited positiv...