Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine.

Science.gov (United States)

Manning, Blaine T; Bohl, Daniel D; Hannon, Charles P; Redondo, Michael L; Christian, David R; Forsythe, Brian; Nho, Shane J; Bach, Bernard R

2018-04-01

Midlevel providers (eg, nurse practitioners and physician assistants) have been integrated into orthopaedic systems of care in response to the increasing demand for musculoskeletal care. Few studies have examined patient perspectives toward midlevel providers in orthopaedic sports medicine. To identify perspectives of orthopaedic sports medicine patients regarding midlevel providers, including optimal scope of practice, reimbursement equity with physicians, and importance of the physician's midlevel provider to patients when initially selecting a physician. Cross-sectional study; Level of evidence, 3. A total of 690 consecutive new patients of 3 orthopaedic sports medicine physicians were prospectively administered an anonymous questionnaire prior to their first visit. Content included patient perspectives regarding midlevel provider importance in physician selection, optimal scope of practice, and reimbursement equity with physicians. Of the 690 consecutive patients who were administered the survey, 605 (87.7%) responded. Of these, 51.9% were men and 48.1% were women, with a mean age of 40.5 ± 15.7 years. More than half (51.2%) perceived no differences in training levels between physician assistants and nurse practitioners. A majority of patients (62.9%) reported that the physician's midlevel provider is an important consideration when choosing a new orthopaedic sports medicine physician. Patients had specific preferences regarding which services should be physician provided. Patients also reported specific preferences regarding those services that could be midlevel provided. There lacked a consensus on reimbursement equity for midlevel practitioners and physicians, despite 71.7% of patients responding that the physician provides a higher-quality consultation. As health care becomes value driven and consumer-centric, understanding patient perspectives on midlevel providers will allow orthopaedic sports medicine physicians to optimize efficiency and patient

Functional MRI examination of empathy for pain in people with schizophrenia reveals abnormal activation related to cognitive perspective-taking but typical activation linked to affective sharing

Science.gov (United States)

Vistoli, Damien; Lavoie, Marie-Audrey; Sutliff, Stephanie; Jackson, Philip L.; Achim, Amélie M.

2017-01-01

Background Schizophrenia is associated with important disturbances in empathy that are related to everyday functioning. Empathy is classically defined as including affective (sharing others’ emotions) and cognitive (taking others’ cognitive perspectives) processes. In healthy individuals, studies on empathy for pain revealed specific brain systems associated with these sets of processes, notably the anterior middle cingulate (aMCC) and anterior insula (AI) for affective sharing and the bilateral temporoparietal junction (TPJ) for the cognitive processes, but the integrity of these systems in patients with schizophrenia remains uncertain. Methods Patients with schizophrenia and healthy controls performed a pain empathy task while undergoing fMRI scanning. Participants observed pictures of hands in either painful or nonpainful situations and rated the level of pain while imagining either themselves (self) or an unknown person (other) in these situations. Results We included 27 patients with schizophrenia and 21 healthy controls in our analyses. For the pain versus no pain contrast, patients showed overall typical activation patterns in the aMCC and AI, with only a small part of the aMCC showing reduced activation compared with controls. For the other versus self contrast, patients showed an abnormal modulation of activation in the TPJ bilaterally (extending to the posterior superior temporal sulcus, referred to as the TPJ/pSTS). Limitations The design included an unnecessary manipulation of the visual perspective that reduced the number of trials for analysis. The sample size may not account for the heterogeneity of schizophrenia. Conclusion People with schizophrenia showed relatively intact brain activation when observing others’ pain, but showed abnormalities when asked to take the cognitive perspectives of others. PMID:28556774

Informal work and formal plans: articulating the active role of patients in cancer trajectories

DEFF Research Database (Denmark)

Dalsted, Rikke Juul; Hølge-Hazelton, Bibi; Brostrøm Kousgaard, Marius

2012-01-01

Introduction: Formal pathway models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer ...... participation. When looking at integrated care from the perspective of patients, the development of a more holistic and personalized approach is needed....

Informal work and formal plans: Articulating the active role of patients in cancer trajectories

DEFF Research Database (Denmark)

Dalsted, R.; Hølge-Hazelton, Bibi; Kousgaard, MB

2013-01-01

Formal pathways models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer trajectories........ When looking at integrated care from the perspective of patients, the development of a more holistic and personalized approach is needed....

A patient-centered perspective on cancer survivorship.

Science.gov (United States)

Zebrack, Brad

2015-04-15

Survivorship is a complicated notion because people often confuse a process of survivorship with a mythic identity of being a cancer survivor. This confusion may be a distraction to addressing the real-life struggles and challenges experienced by all people diagnosed with cancer. A more expansive perspective of survivorship, one that attends to patients' physical, psychological, social, spiritual, and existential challenges throughout a continuum of care, would be more in line with what is known empirically about people's experiences with cancer. In an effort to gain a patient-centered perspective on cancer, and one that emphasizes multiple dimensions of cancer survivorship, the author reports findings from a non-scientific social media poll (via Facebook and personal emails) in which survivors and colleagues working in the field of cancer survivorship answered the question: What does cancer survivorship mean to you? The comments are enlightening and useful for guiding the development of a patient-centered, and, thus, more comprehensive, approach to caring for people affected by cancer.

Client-centred practice from the perspective of Danish patients with hand-related disorders

DEFF Research Database (Denmark)

Hansen, Alice Ørts; Kristensen, Hanne Kaae; Cederlund, Ragnhild

2018-01-01

on domains for item generation. RESULTS: Patients found that information was paramount in understanding their situation and to feel empowered and motivated. They attached importance to participation in decision making so that rehabilitation was considered meaningful. Moreover, they thought rehabilitation...... should be individualized by taking their life situations and personalities into account. Six domains were found to be central to client-centred practice: patient participation in decision making, client-centred education, evaluation of outcomes from patient's perspective, emotional support, cooperation...... to information and require health professionals' support to manage their activities of everyday life. Patients with hand-related disorders ask for participation and shared decision making in rehabilitation planning....

Involvement of patients' perspectives on treatment with noninvasive ventilation in patients with chronic obstructive pulmonary disease

DEFF Research Database (Denmark)

Christensen, Helle Marie; Huniche, Lotte; Titlestad, Ingrid L

2018-01-01

and hospitalisation. CONCLUSION: Investigation of patient perspectives generated results that were highly productive in facilitating multidisciplinary collaboration and in developing and sustaining new management strategies. Critical psychological practice research facilitated ongoing development of clinical practice...... is needed to develop treatment practices in respiratory medicine. METHOD: This study is based on critical psychological practice research. DESIGN: A co-researcher group comprising diverse health professionals was set up and headed by the principal researcher. The group convened seven times over 12 months......AIMS AND OBJECTIVES: To clarify chronic obstructive pulmonary disease patients' perspectives on treatment with noninvasive ventilation and develop management strategies for the treatment based on these perspectives. BACKGROUND: The effect of treating chronic obstructive pulmonary disease patients...

Unravelling adherence to prophylaxis in haemophilia : A patients' perspective

NARCIS (Netherlands)

Schrijvers, L. H.; Kars, M. C.; Beijlevelt-van der Zande, M.; Peters, M.; Schuurmans, M. J.; Fischer, K.

Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to

RhinAsthma patient perspective: A Rasch validation study.

Science.gov (United States)

Molinengo, Giorgia; Baiardini, Ilaria; Braido, Fulvio; Loera, Barbara

2018-02-01

In daily practice, Health-Related Quality of Life (HRQoL) tools are useful for supplementing clinical data with the patient's perspective. To encourage their use by clinicians, the availability of tools that can quickly provide valid results is crucial. A new HRQoL tool has been proposed for patients with asthma and rhinitis: the RhinAsthma Patient Perspective-RAPP. The aim of this study was to evaluate the psychometric robustness of the RAPP using the Item Response Theory (IRT) approach, to evaluate the scalability of items and test whether or not patients use the items response scale correctly. 155 patients (53.5% women, mean age 39.1, range 16-76) were recruited during a multicenter study. RAPP metric properties were investigated using IRT models. Differential item functioning (DIF) was used for gender, age, and asthma control test (ACT). The RAPP adequately fitted the Rating Scale model, demonstrating the equality of the rating scale structure for all items. All statistics on items were satisfactory. The RAPP had adequate internal reliability and showed good ability to discriminate among different groups of participants. DIF analysis indicated that there were no differential item functioning issues for gender. One item showed a DIF by age and four items by ACT. The psychometric evaluation performed using IRT models demonstrated that the RAPP met all the criteria to be considered a reliable and valid method of measurement. From a clinical perspective, this will allow physicians to confidently interpret scores as good indicators of Quality of Life of patients with asthma.

Field visual perspective during autobiographical memory recall is less frequent among patients with schizophrenia.

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Potheegadoo, Jevita; Berna, Fabrice; Cuervo-Lombard, Christine; Danion, Jean-Marie

2013-10-01

There is growing interest in clinical research regarding the visual perspective adopted during memory retrieval, because it reflects individuals' self-attitude towards their memories of past personal events. Several autobiographical memory deficits, including low specificity of personal memories, have been identified in schizophrenia, but visual perspective during autobiographical memory retrieval has not yet been investigated in patients. The aim of this study was therefore to investigate the visual perspective with which patients visualize themselves when recalling autobiographical memories and to assess the specificity of their memories which is a major determinant of visual perspective. Thirty patients with schizophrenia and 30 matched controls recalled personal events from 4 life periods. After each recall, they were asked to report their visual perspective (Field or Observer) associated with the event. The specificity of their memories was assessed by independent raters. Our results showed that patients reported significantly fewer Field perspectives than comparison participants. Patients' memories, whether recalled with Field or Observer perspectives, were less specific and less detailed. Our results indicate that patients with schizophrenia adopt Field perspectives less frequently than comparison participants, and that this may contribute to a weakened sense of the individual of being an actor of his past events, and hence to a reduced sense of self. They suggest that this may be related to low specificity of memories and that all the important aspects involved in re-experiencing autobiographical events are impaired in patients with schizophrenia. © 2013 Elsevier B.V. All rights reserved.

Family caregiving challenges in advanced colorectal cancer: patient and caregiver perspectives.

Science.gov (United States)

Mosher, Catherine E; Adams, Rebecca N; Helft, Paul R; O'Neil, Bert H; Shahda, Safi; Rattray, Nicholas A; Champion, Victoria L

2016-05-01

Family caregivers of advanced colorectal cancer patients may be at increased risk for psychological distress. Yet their key challenges in coping with the patient's illness are not well understood. Soliciting both patient and caregiver perspectives on these challenges would broaden our understanding of the caregiving experience. Thus, the purpose of this research was to identify caregivers' key challenges in coping with their family member's advanced colorectal cancer from the perspective of patients and caregivers. Individual, semi-structured qualitative interviews were conducted with 23 advanced colorectal cancer patients and 23 primary family caregivers. Interview data were analyzed via thematic analysis. In nearly all cases, patient and caregiver reports of the caregiver's key challenge were discrepant. Across patient and caregiver reports, caregivers' key challenges included processing emotions surrounding the patient's initial diagnosis or recurrence and addressing the patient's practical and emotional needs. Other challenges included coping with continual uncertainty regarding the patient's potential functional decline and prognosis and observing the patient suffer from various physical symptoms. Findings suggest that eliciting the perspectives of both patients and caregivers regarding caregivers' challenges provides a more comprehensive understanding of their experience. Results also point to the need to assist caregivers with the emotional and practical aspects of caregiving.

PATIENT-REPORTED OUTCOMES (PROs): PUTTING THE PATIENT PERSPECTIVE IN PATIENT-CENTERED OUTCOMES RESEARCH

Science.gov (United States)

Snyder, Claire F.; Jensen, Roxanne E.; Segal, Jodi B.; Wu, Albert W.

2013-01-01

Patient-centered outcomes research (PCOR) aims to improve care quality and patient outcomes by providing information that patients, clinicians, and family members need regarding treatment alternatives, and emphasizing patient input to inform the research process. PCOR capitalizes on available data sources and generates new evidence to provide timely and relevant information and can be conducted using prospective data collection, disease registries, electronic medical records, aggregated results from prior research, and administrative claims. Given PCOR’s emphasis on the patient perspective, methods to incorporate patient-reported outcomes (PROs) are critical. PROs are defined by the U.S. Food & Drug Administration as “Any report coming directly from patients… about a health condition and its treatment.” However, PROs have not routinely been collected in a way that facilitates their use in PCOR. Electronic medical records, disease registries, and administrative data have only rarely collected, or been linked to, PROs. Recent technological developments facilitate the electronic collection of PROs and linkage of PRO data, offering new opportunities for putting the patient perspective in PCOR. This paper describes the importance of and methods for using PROs for PCOR. We (1) define PROs; (2) identify how PROs can be used in PCOR, and the critical role of electronic data methods for facilitating the use of PRO data in PCOR; (3) outline the challenges and key unanswered questions that need to be addressed for the routine use of PROs in PCOR; and (4) discuss policy and research interventions to accelerate the integration of PROs with clinical data. PMID:23774513

[Perspectives on patient competence in psychiatry: cognitive functions, emotions and values].

Science.gov (United States)

Ruissen, A; Meynen, G; Widdershoven, G A M

2011-01-01

Informed consent, a central concept in the doctor-patient relationship, is only valid if it is given by a competent patient. To review the literature on competence or decision-making capacity in psychiatry. We studied the international literature and relevant Dutch material such as health acts and medical guidelines. We found a consensus in the literature about the assessment criteria and the basic principles, but we did not find any consensus about the exact definition of competence. We review a number of perspectives on competence. The conceptualisations of competence, particularly in the field of psychiatry, are still being debated. The best known clinical tool to assess patients’ capacities to make treatment decisions is the MacArthur Competence Assessment Tool (MacCAT). There are three perspectives on competence: a cognitive perspective, a perspective concerning emotions and a perspective relating to values. Further research is needed in order to make the conceptual debate on competence relevant to psychiatric practice.

The Complexity of the Patient Perspective of Living with Atrial Fibrillation

DEFF Research Database (Denmark)

Høgh, Vibeke; Riahi, Sam; Delmar, Charlotte

2017-01-01

data on information related to the context of the patient’s daily life, family life and work life. The example provided in the article illustrates how the qualitative and quantitative information work as a synergy. Together, information gained from participant observations, on the challenge......The patients’ perspective is by nature complex. Investigating the patients’ perspective, which is important for the quality of care for patients living with atrial fibrillation, therefore calls for complex research processes. This article aims to illuminate the complexity of the patients......’ perspective of living with atrial fibrillation by combining qualitative and quantitative data sources and methods. Related to a one-year patient journey of living with paroxysmal atrial fibrillation it is here illustrated how scores from questionnaires can be explored by supporting the scores with qualitative...

Shifting the perspective after the patient's response to an interpretation.

Science.gov (United States)

Peräkylä, Anssi

2010-12-01

Psychoanalytic interpretation is normally understood as a sequence of two utterances: the analyst gives an interpretation and the patient responds to it. This paper suggests that, in the interpretative sequence, there is also a third utterance where psychoanalytic work takes place. This third interpretative turn involves the analyst's action after the patient's response to the interpretation. Using conversation analysis as method in the examination of audio-recorded psychoanalytic sessions, the paper will explicate the psychoanalytic work that gets done in third interpretative turns. Through it, the analyst takes a stance towards the patient's understandings of the interpretation, which are shown in the patient's response to the interpretation. The third interpretative turns on one hand ratify and accept the patient's understandings, but, in addition to that, they also introduce a shift of perspective relative to them. In most cases, the shift of perspective is implicit but sometimes it is made explicit. The shifts of perspective bring to the foreground aspects or implications of the interpretation that were not incorporated in the patient's response. They recast the description of the patient's experience by showing new layers or more emotional intensity in it. The results are discussed in the light of Faimberg's concept of listening to listening and Schlesinger's concept of follow-up interpretation. Copyright © 2010 Institute of Psychoanalysis.

Waiting for surgery from the patient perspective

Directory of Open Access Journals (Sweden)

Tracey Carr

2009-10-01

Full Text Available Tracey Carr1, Ulrich Teucher2, Jackie Mann4, Alan G Casson31Health Sciences, 2Department of Psychology, 3Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 4Acute Care, Saskatoon Health Region, Saskatoon, Saskatchewan, CanadaAbstract: The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.Keywords: wait time, scheduled surgery, patient perspective, literature review

Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management.

Science.gov (United States)

Gélinas, Céline; Arbour, Caroline; Michaud, Cécile; Robar, Lauren; Côté, José

2013-11-01

Pain is a major stressor for critically ill patients. To maximize pain relief, non-pharmacological interventions are an interesting avenue to explore. The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the intensive care unit (ICU). A qualitative descriptive design was used. Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi-structured discussion guide, participants were asked to share their perspective about non-pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive-behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment. A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non-pharmacological interventions were discussed. The top four non-pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning. Four non-pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. While more evidence is required to conclude to their effectiveness, ICU nurses can

Patient Preferences in Regulatory Benefit-Risk Assessments: A US Perspective.

Science.gov (United States)

Johnson, F Reed; Zhou, Mo

Demands for greater transparency in US regulatory assessments of benefits and risks, together with growing interest in engaging patients in Food and Drug Administration regulatory decision making, have resulted in several recent regulatory developments. Although Food and Drug Administration's Center for Drug Evaluation and Research (CDER) and Center for Devices and Radiological Health (CDRH) have established patient-engagement initiatives, CDRH has proposed guidelines for considering quantitative data on patients' benefit-risk perspectives, while CDER has focused on a more qualitative approach. We summarize two significant studies that were developed in collaboration and consultation with CDER and CDRH. CDER encouraged a patient advocacy group to propose draft guidance on engaging patient and caregiver stakeholders in regulatory decision making for Duchenne muscular dystrophy. CDRH sponsored a discrete-choice experiment case study to quantify obese respondents' perspectives on "meaningful benefits." CDRH and CDER issued draft guidance in May and June 2015, respectively, on including patient-preference data in regulatory submissions. Both organizations face challenges. CDER is working on integrating qualitative data into existing evidence-based review processes and is exploring options for therapeutic areas not included on a priority list. CDRH has adopted an approach that requires patient-preference data to satisfy standards of valid scientific evidence. Although that strategy could facilitate integrating patient perspectives directly with clinical data on benefits and harms, generating such data requires building capacity. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Survivorship Care Plan Information Needs: Perspectives of Safety-Net Breast Cancer Patients.

Science.gov (United States)

Burke, Nancy J; Napoles, Tessa M; Banks, Priscilla J; Orenstein, Fern S; Luce, Judith A; Joseph, Galen

2016-01-01

Despite the Institute of Medicine's (IOM) 2005 recommendation, few care organizations have instituted standard survivorship care plans (SCPs). Low health literacy and low English proficiency are important factors to consider in SCP development. Our study aimed to identify information needs and survivorship care plan preferences of low literacy, multi-lingual patients to support the transition from oncology to primary care and ongoing learning in survivorship. We conducted focus groups in five languages with African American, Latina, Russian, Filipina, White, and Chinese medically underserved breast cancer patients. Topics explored included the transition to primary care, access to information, knowledge of treatment history, and perspectives on SCPs. Analysis of focus group data identified three themes: 1) the need for information and education on the transition between "active treatment" and "survivorship"; 2) information needed (and often not obtained) from providers; and 3) perspectives on SCP content and delivery. Our data point to the need to develop a process as well as written information for medically underserved breast cancer patients. An SCP document will not replace direct communication with providers about treatment, symptom management and transition, a communication that is missing in participating safety-net patients' experiences of cancer care. Women turned to peer support and community-based organizations in the absence of information from providers. "Clear and effective" communication of survivorship care for safety-net patients requires dedicated staff trained to address wide-ranging information needs and uncertainties.

Terminally ill patients as customers: the patient's perspective.

Science.gov (United States)

Seibel, Katharina; Valeo, Sara Celestina; Xander, Carola; Adami, Sandra; Duerk, Thorsten; Becker, Gerhild

2014-01-01

Consumerism in health care defines patients as self-determined, rational customers. Yet, it is questionable whether vulnerable patients, such as the terminally ill, also fulfill these criteria. Vulnerable contexts and the patient's perspective on being a customer remain relatively unexplored. The present study addresses this research gap by analyzing terminally ill patients' views on being customers. To explore the ways in which patients in palliative care refer to themselves as patients/customers, and how the patients' concepts of self-determination are related to their attitudes toward the patient/customer role. Qualitative interviews were conducted. Data were analyzed in three steps: narrative analysis, thematic content analysis, and typology construction. Researchers recruited 25 patients via the Department of Palliative Care, University Medical Center Freiburg, Germany. In many ways, palliative patients contradict the image of a self-determined customer. The palliative patient role is characterized by the concept of relational self-determination rather than an unrestricted self-determination. Self-attribution as a customer still occurs when positively associated with a person-centered, individualized treatment. Thus, the customer and patient role overlap within the palliative care setting because of the focus on the individual. The idealized customer role cannot be arbitrarily applied to all medical fields. Palliative patients are dependent on the physician, regardless of whether the customer or patient role is preferred. Hence, self-determination must be understood in relational terms, and physicians must recognize their crucial role in promoting patients' self-determination in the context of shared decision-making.

The patient perspective in research on major depression

Directory of Open Access Journals (Sweden)

Cuijpers Pim

2011-05-01

Full Text Available Abstract Although thousands of studies have examined the genetics, epidemiology, etiology, biology, treatment and prevention of major depressive disorder, we still lack very basic knowledge about what patients with depressive disorders need. Despite the thousands of studies that have been conducted on major depression and the hundreds of randomized trials that have examined the effects of treatments, many patients still do not know how to cope with the daily problems caused by depressive disorders. In this Commentary the need for more research on the perspectives of patients is described. This research should guide treatment studies as well as basic research much more than it currently does. This perpective is especially important to understand and solve the undertreatment of depression, one of the major problems in this area. Up to 50% of depressed patients do not seek treatment, resulting in huge avoidable disease burden and economic costs. In order to solve this problem we need a better understanding of the problems patients encounter in daily life, and what factors contribute to the reasons for seeking treatment or not. Research from the patients' perspective is also necessary to meet the currently unmet information needs of patients, including information about the nature and causes of depression, stigma, medication, treatment and coping with the daily problems of having depression.

Harmed patients gaining voice: challenging dominant perspectives in the construction of medical harm and patient safety reforms.

Science.gov (United States)

Ocloo, Josephine Enyonam

2010-08-01

Patient safety is a central issue in healthcare. In the United Kingdom, where there is more accurate information on National Health Service (NHS) hospitals than on primary care or the private sector, the evidence on adverse incidents shows that avoidable medical harm is a major concern. This paper looks at the occurrence of medical harm and argues that in the construction of patient safety reforms, it is important to be aware of alternative narratives about issues of power and accountability from harmed patients and self-help groups, that challenge dominant perspectives on the issues. The paper draws upon evidence from two sources. First, the paper draws on experiences of self-help groups set up as a result of medical harm and part of a campaigning network, where evidence was gathered from 14 groups over more than 2 years. In addition, data were obtained from 21 individuals affected by harm that attended a residential workshop called the Break Through Programme; 18 questionnaires were completed from participants and a written narrative account of their experiences and observational data were gathered from a range of workshop sessions. Looking at the issues from harmed patients' perspectives, the research illustrates that a model of medical harm focussing predominantly upon the clinical markers and individual agency associated with a medical model operates to obscure a range of social processes. These social processes, connected to the power and dominance of the medical profession and the activities of a wider state, are seen to be a major part of the construction of harm that impacts upon patients, which is further compounded by its concealment. Understanding the experiences of harmed patients is therefore seen as an important way of generating knowledge about the medical and social processes involved in harm, that can lead to a broader framework for addressing patient safety. Copyright 2010 Elsevier Ltd. All rights reserved.

Perspectives for cognitive rehabilitation of patients with diabetes mellitus

Directory of Open Access Journals (Sweden)

Mariia Matveeva

2016-12-01

Full Text Available Currently, the problem of cognitive dysfunction is becoming increasingly important due to the raising demand for effective intellectual activity in modern society. One of the most significant causes of cognitive dysfunction is dismetabolic nature of the disorder, such as diabetes mellitus, which has recently been gaining prevalence. Much of the resistance of clinical symptoms of diabetic encephalopathy to conventional therapy requires a search for new approaches for solving this problem. Cognitive rehabilitation as a correctional technique has proved a positive effect in terms of the treatment of neurodegenerative diseases of different nature.This review present the ways for correction of cognitive impairment using the method of cognitive rehabilitation in patients with diabetes, its methodology, mechanisms of action and perspectives.

A Patient-Centered Perspective on Cancer Survivorship

Directory of Open Access Journals (Sweden)

Brad Zebrack

2015-04-01

Full Text Available Survivorship is a complicated notion because people often confuse a process of survivorship with a mythic identity of being a cancer survivor. This confusion may be a distraction to addressing the real-life struggles and challenges experienced by all people diagnosed with cancer. A more expansive perspective of survivorship, one that attends to patients’ physical, psychological, social, spiritual, and existential challenges throughout a continuum of care, would be more in line with what is known empirically about people’s experiences with cancer. In an effort to gain a patient-centered perspective on cancer, and one that emphasizes multiple dimensions of cancer survivorship, the author reports findings from a non-scientific social media poll (via Facebook and personal emails in which survivors and colleagues working in the field of cancer survivorship answered the question: What does cancer survivorship mean to you? The comments are enlightening and useful for guiding the development of a patient-centered, and, thus, more comprehensive, approach to caring for people affected by cancer.

Perspectives of patients and professionals on the use of patient reported outcome measures in primary care

DEFF Research Database (Denmark)

Porter, Ian; Gangannagaripalli, Jaheeda; Davey, Antoinette

2017-01-01

/or healthcare professional’s perspectives on the clinical utility of using PROMs in clinical practice. Results: 19 studies met the inclusion criteria (4 after 2012), 11 of which were conducted in the UK, reporting on the views of professionals (8), patients (5), and both (7). The majority of studies (12...... communication it was also noted that they undermined the human element of consultations, along with professional intuition and judgement. Burden on GP time was also noted. Conclusions: Patients and professionals highlighted a number of benefits of using PROMs in clinical practice, particularly in terms......A71 Perspectives of patients and professionals on the use of patient-reported outcome measures in primary care: a systematic review of qualitative studies Background: Although the use of patient-reported outcome measures (PROMs) in healthcare settings has increased substantially over recent years...

Validating Rheumatoid Arthritis Remission Using the Patients' Perspective

DEFF Research Database (Denmark)

Rasch, Linda A; Boers, Maarten; Hill, Catherine L

2017-01-01

OBJECTIVE: The Outcome Measures in Rheumatology (OMERACT) working group on the patients' perspective on remission in rheumatoid arthritis (RA) has been working on this topic since 2010. At OMERACT 2016, progress and preliminary data on validity of measurement instruments for pain, fatigue...

Active and successful aging: a European policy perspective.

Science.gov (United States)

Foster, Liam; Walker, Alan

2015-02-01

Over the past two decades, "active aging" has emerged in Europe as the foremost policy response to the challenges of population aging. This article examines the concept of active aging and how it differs from that of "successful aging." In particular, it shows how active aging presents a more holistic, life course-oriented approach than successful aging. We provide a critical perspective on active aging too by, first, tracing its emergence in Europe and then showing how, in practice, it has been dominated by a narrow economic or productivist perspective that prioritizes the extension of working life. It has also been gender blind. Nonetheless, it is argued that an active aging approach has the potential to enable countries to respond successfully to the challenges of population aging because of its comprehensive focus and emphasis on societal as well as individual responsibility. Finally, we set out the basic principles that need to be followed if the full potential of active aging is to be achieved. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Should palliative care patients' hope be truthful, helpful or valuable? An interpretative synthesis of literature describing healthcare professionals' perspectives on hope of palliative care patients

NARCIS (Netherlands)

Olsman, Erik; Leget, Carlo; Onwuteaka-Philipsen, Bregje; Willems, Dick

2014-01-01

Healthcare professionals' perspectives on palliative care patients' hope influence communication. However, these perspectives have hardly been examined. To describe healthcare professionals' perspectives on palliative care patients' hope found in the literature. The interpretative synthesis

Physical activity in patients with stable coronary heart disease: an international perspective.

Science.gov (United States)

Stewart, Ralph; Held, Claes; Brown, Rebekkah; Vedin, Ola; Hagstrom, Emil; Lonn, Eva; Armstrong, Paul; Granger, Christopher B; Hochman, Judith; Davies, Richard; Soffer, Joseph; Wallentin, Lars; White, Harvey

2013-11-01

Despite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global clinical outcomes trial evaluating the lipoprotein phospholipaseA2 inhibitor darapladib. Prior to randomization, 15 486 (97.8%) participants from 39 countries completed a lifestyle questionnaire. Total physical activity was estimated from individual subject self-reports of hours spend each week on mild, moderate, and vigorous exercise, corresponding approximately to 2, 4, and 8 METS, respectively. Multivariate logistic regression evaluated clinical and demographic variables for the lowest compared with higher overall exercise levels, and for individuals who decreased rather than maintained or increased activity since diagnosis of CHD. The least active 5280 subjects (34%) reported exercise of ≤ 24 MET.h/week. A total of 7191 subjects (46%) reported less exercise compared with before diagnosis of CHD. The majority of participants were either 'not limited' or 'limited a little' walking 100 m (84%), climbing one flight of stairs (82%), or walking 1 km/1/2; mile (68%), and physical activity and decreasing exercise after diagnosis of CHD included more co-morbid conditions, poorer general health, fewer years of education, race, and country (P physical activity was only partly explained by cardiovascular symptoms. Potentially modifiable societal and health system factors are important determinants of physical inactivity in patients with chronic CHD.

Should palliative care patients' hope be truthful, helpful or valuable? An interpretative synthesis of literature describing healthcare professionals' perspectives on hope of palliative care patients

NARCIS (Netherlands)

Olsman, E.; Leget, C.; Onwuteaka-Philipsen, B.D.; Willems, D.

2014-01-01

Background: Healthcare professionals? perspectives on palliative care patients? hope influence communication. However, these perspectives have hardly been examined. Aim: To describe healthcare professionals? perspectives on palliative care patients? hope found in the literature. Design: The

Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Patient Education.

Science.gov (United States)

Kantor, Daniel; Bright, Jeremy R; Burtchell, Jeri

2018-06-01

A diagnosis of multiple sclerosis (MS) is life-altering. Because the course of MS is heterogeneous, patients may face uncertainty in terms of long-term physical and cognitive challenges, potential loss of employment, and the risk of social isolation. Patients often turn to the Internet and social media for information about MS and its management, and to seek out fellow patients and support groups. Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient education. We consider the access that these conduits provide not only to other patients with MS but also to a wealth of disease-related information online. These themes are further illustrated with first-hand experiences of the patient author and her physician. We also explore the impact of the Internet and social media on the education and support of patients with MS from the healthcare professional's (HCP's) perspective, including opportunities for HCPs to promote disease education among their patients, and the advantages that arise from patients being better informed about their disease. The rise of the Internet and social media has changed the patient experience, helping patients to support each other, to educate themselves proactively about their condition, and to participate more actively in decisions relating to disease management than perhaps was the case historically. Funding Novartis Pharmaceuticals Corporation.

Individual dosimetry of workers and patients: implementation and perspectives; La dosimetrie individuelle des travailleurs et de patients: mise en oeuvre et perspectives

Energy Technology Data Exchange (ETDEWEB)

Rannou, A.; Aubert, B.; Lahaye, Th.; Scaff, P.; Casanova, Ph.; Van Bladel, L.; Queinnec, F.; Valendru, N.; Jehanno, J.; Grude, E.; Berard, Ph.; Desbree, A.; Kafrouni, H.; Paquet, F.; Vanhavere, F.; Bridier, A.; Ginestet, Ch.; Magne, S.; Donadille, L.; Bordy, J.M.; Bottollier-Depois, J.F.; Barrere, J.L.; Ferragut, A.; Metivier, H.; Gaillard-Lecanu, E

2008-07-01

These days organised by the section of the technical protection of the S.F.R.P. review the different techniques of dosimetry used in France and Europe, and present the future orientations.The different interventions are as follow: Individual exposures of the workers: historic assessment and perspectives; medical exposure: where are the doses; legal obligations in individual dosimetry: which are the objective and the need on the subject; the dosimetry follow-up of workers by the S.I.S.E.R.I. system: assessment and perspectives; impact of the norm ISO 20553 on the follow-up of internal exposure; the implementation of the patient dose measurement in Belgium; techniques of passive dosimetry used in Europe; Supervision radiation protection at EDF: long term and short term approach; Comparison active and passive dosimetry at Melox; methodology for the choice of new neutron dosemeters; the working group M.E.D.O.R.: guide of internal dosimetry for the use of practitioners; O.E.D.I.P.E.: tool of modeling for the personalized internal dosimetry; the use of the Monte-Carlo method for the planning of the cancer treatment by radiotherapy becomes a reality; the works of the committee 2 of the ICRP; passive dosimetry versus operational dosimetry: situation in Europe; Implementation of the in vivo dosimetry in a radiotherapy department: experience of the Gustave Roussy institute; experience feedback on the in vivo measures in radiotherapy, based on the use of O.S.L. pellets; multi points O.S.L. instrumentation for the radiation dose monitoring in radiotherapy; dosimetry for extremities for medical applications: principle results of the European contract C.O.N.R.A.D.; references and perspectives in dosimetry; what perspectives for numerical dosimetry, an example: Sievert; system of dose management: how to answer to needs; the last technical evolutions in terms of electronic dosimetry in nuclear power plant; the fourth generation type reactors: what dosimetry. (N.C.)

Completing the third person's perspective on patients' involvement in medical decision-making: approaching the full picture.

Science.gov (United States)

Kasper, Jürgen; Hoffmann, Frauke; Heesen, Christoph; Köpke, Sascha; Geiger, Friedemann

2012-01-01

Shared decision making is based on the idea of cooperation and partnership between patients and doctors. In this concept both parties may initiate and perform specific decision-making steps. However, the common observation-based instruments focus solely on doctors' behaviour. Content and quality of information provided to involve patients in medical decisions are hardly considered in evaluation of SDM. This study investigates the advantages of a revised observer inventory taking into account these aspects. Based on the OPTION scale, a more comprehensive observation-based inventory was developed, additionally considering both the patient-sided indicators for patient involvement and the criteria of evidence-based patient information. The inventory comprises three scales (doctor, patient, doctor-patient dyad) and 15 indicators each. Rater training and re-analyses of 76 consultations previously analysed using the OPTION scale were conducted. Convergent validities were calculated between the observer-based scales and the patients' ratings on the Shared Decision Making Questionnaire, the Decisional Conflict Scale and the Control Preference Scale. Interrater reliabilities of the revised scales were high (r=.87 to .74) and even higher when only the dyadic perspective was coded (.86). The revised inventory provided additional information on the involvement taking place. No substantive correlations were found between observation-based and patients' subjective judgments. The observers' perspective on patient involvement needs to consider patient activities. Inconsistencies of patients' and observers' judgements concerning patient participation need further investigation. Copyright © 2012. Published by Elsevier GmbH.

[Medical treatment of NANBYO from patients' perspective].

Science.gov (United States)

Ito, Tateo

2013-01-01

NANBYO policy which has practiced since 1972 has been discussing for making fundamental reform. As a part of a plan to reform, "Total Supports for Persons with Disabilities Act" executed. The target of this act is included with NANBYO patients. Regarding to the enforcement of the act, there are major changes as follows; 1) Regional government has a responsibility to set up the support project for NANBYO patients, 2) Welfare policy will be altered by a change in the definition of disability (the target of welfare for the disabled is not only patients who have fixed disabilities but have changed (e.g. NANBYO), 3) NANBYO patients will be regarded as a target for job assistance under the act. In this abstract, the author raises the fundamental issues as "Society where NANBYO patients can live is equal to that where all people can live", from patient's perspective.

Time perspective, personality and smoking, body mass, and physical activity: an empirical study.

Science.gov (United States)

Adams, Jean; Nettle, Daniel

2009-02-01

Time perspective describes how individuals conceptualize and value future events, and may be related to health behaviours. Research to date has focused on addictive behaviours, used a variety of different measures of time perspective, and not explored the role of personality. This work aimed to: explore the relationships between: five previously used measures of time perspective; time perspective and the broad domains of the five-factor model of personality; and time perspective and smoking, body mass, and physical activity after controlling for socio-demographics and personality. Cross-sectional self-report data were collected using a web based survey. Participants (N=423) were recruited via local community internet message boards in US urban areas. The survey collected information on: delay discount rate, the Consideration of Future Consequences Scale (CFCS), the future scale of the Zimbardo Time Perspective Inventory (ZTPI), subjective probability of living to age 75, and time period for financial planning, the five-factor personality inventory, smoking, body mass index (BMI), and physical activity. After controlling for socio-demographics, most markers of time perspective were significantly correlated with each other, but the strength of correlations was rarely strong. Conscientiousness, Neuroticism, Agreeableness, and Openness were associated with some markers of time perspective. After controlling for socio-demographic and personality domains, only CFCS score was associated with smoking status and BMI. There is some overlap between previously used markers of time perspective and the five-factor personality domains but this is neither strong nor consistent. Smoking and BMI, but not physical activity, are associated with CFCS, but not other measures of time perspective.

Identifying the 'right patient': nurse and consumer perspectives on verifying patient identity during medication administration.

Science.gov (United States)

Kelly, Teresa; Roper, Cath; Elsom, Stephen; Gaskin, Cadeyrn

2011-10-01

Accurate verification of patient identity during medication administration is an important component of medication administration practice. In medical and surgical inpatient settings, the use of identification aids, such as wristbands, is common. In many psychiatric inpatient units in Victoria, Australia, however, standardized identification aids are not used. The present paper outlines the findings of a qualitative research project that employed focus groups to examine mental health nurse and mental health consumer perspectives on the identification of patients during routine medication administration in psychiatric inpatient units. The study identified a range of different methods currently employed to verify patient identity, including technical methods, such as wristband and photographs, and interpersonal methods, such as patient recognition. There were marked similarities in the perspectives of mental health nurses and mental health consumers regarding their opinions and preferences. Technical aids were seen as important, but not as a replacement for the therapeutic nurse-patient encounter. © 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.

Patients' perspective of the design of provider-patients electronic communication services.

Science.gov (United States)

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

2014-06-12

Information Delivery is one the most important tasks in healthcare practice. This article discusses patient's tasks and perspectives, which are then used to design a new Effective Electronic Methodology. The system design methods applicable to electronic communication in the healthcare sector are also described. The architecture and the methodology for the healthcare service portal are set out in the proposed system design.

Quality of life and time perspective in inflammatory bowel disease patients.

Science.gov (United States)

Laguette, Vanessa; Apostolidis, Themis; Dany, Lionel; Bellon, Nelly; Grimaud, Jean-Charles; Lagouanelle-Simeoni, Marie-Claude

2013-12-01

Numerous studies have shown the impact of inflammatory bowel disease (IBD) on patient quality of life (QoL), but no research has yet examined the impact of time's experience in the assessment of QoL in IBD. Our goal is to explore the links between QoL and time perspective (TP) and the role of TP as a determinant of QoL. Data were collected from 156 patients who completed a questionnaire comprising a generic measure (SF-12) and a specific measure (Inflammatory Bowel Disease Questionnaire) of QoL, a measure of TP (ZTPI) and a collection of socio-demographic and medical data. Correlational analyses illustrated the links between TP and QoL. Regression analyses revealed that records of Past-negative and Present-hedonistic perspectives predicted QoL. Past-negative time perspective seemed to have a deleterious impact, while a Present-hedonistic time perspective predicted a better QoL, and this was irrespective of the level of severity of the disease. These results suggest the importance of considering TP as a determinant of psychological QoL. They corroborate earlier findings on the relationship between TP and QoL associated with other pathologies. The past-negative register, which indicates rumination, tells us about the importance of considering the psychological experience of time in order to improve the QoL of patients.

Using a biopsychosocial perspective in the treatment of fibromyalgia patients.

Science.gov (United States)

Turk, Dennis C; Adams, Leah M

2016-05-01

Fibromyalgia (FM) is a complex illness that manifests in different ways across individuals. Given that there are currently no known cures for FM, like treatment for other chronic diseases, interventions focus on learning strategies to alleviate symptom severity, to cope with and manage residual symptoms of the illness and to maximize health-related quality of life despite symptoms. In this article, we highlight the need for providers to adopt a biopsychosocial perspective for understanding and addressing patients with FM, noting that biological, psychosocial and behavioral factors function interdependently to affect a person's experience and adaptation. A cognitive-behavioral approach, which incorporates a biopsychosocial perspective, is detailed, along with specific treatment considerations for helping patients with FM manage their symptoms.

Prescribing Outdoor Physical Activity to Children: Health Care Providers’ Perspectives

Science.gov (United States)

Christiana, Richard W.; James, J. Joy; Battista, Rebecca A.

2017-01-01

Little evidence exists on health care provider (HCP) prescriptions for children’s outdoor physical activity (PA). Semistructured interviews were conducted with 15 children’s HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included. PMID:29152542

Prescribing Outdoor Physical Activity to Children: Health Care Providers' Perspectives.

Science.gov (United States)

Christiana, Richard W; James, J Joy; Battista, Rebecca A

2017-01-01

Little evidence exists on health care provider (HCP) prescriptions for children's outdoor physical activity (PA). Semistructured interviews were conducted with 15 children's HCPs to explore perspectives on outdoor PA prescription programs for children and barriers to implementation. Thematic analytic techniques were used to analyze the data. Most participants reported an awareness of health benefits to children being in the outdoors. Ten themes emerged from the data related to 3 thematic categories: (1) current strategies that HCPs are using to promote PA among children, (2) barriers that HCPs see to prescribing outdoor PA, and (3) potential strategies for promoting outdoor PA among children. Assessment of the local outdoor PA environment and resource development must be done prior to a prescription program. HCPs should be skilled in conducting conversations and setting goals related to outdoor PA tailored to the patient. Developing a system for follow-up with patients on established goals should also be included.

Individual dosimetry of workers and patients: implementation and perspectives

International Nuclear Information System (INIS)

Rannou, A.; Aubert, B.; Lahaye, Th.; Scaff, P.; Casanova, Ph.; Van Bladel, L.; Queinnec, F.; Valendru, N.; Jehanno, J.; Grude, E.; Berard, Ph.; Desbree, A.; Kafrouni, H.; Paquet, F.; Vanhavere, F.; Bridier, A.; Ginestet, Ch.; Magne, S.; Donadille, L.; Bordy, J.M.; Bottollier-Depois, J.F.; Barrere, J.L.; Ferragut, A.; Metivier, H.; Gaillard-Lecanu, E.

2008-01-01

These days organised by the section of the technical protection of the S.F.R.P. review the different techniques of dosimetry used in France and Europe, and present the future orientations.The different interventions are as follow: Individual exposures of the workers: historic assessment and perspectives; medical exposure: where are the doses; legal obligations in individual dosimetry: which are the objective and the need on the subject; the dosimetry follow-up of workers by the S.I.S.E.R.I. system: assessment and perspectives; impact of the norm ISO 20553 on the follow-up of internal exposure; the implementation of the patient dose measurement in Belgium; techniques of passive dosimetry used in Europe; Supervision radiation protection at EDF: long term and short term approach; Comparison active and passive dosimetry at Melox; methodology for the choice of new neutron dosemeters; the working group M.E.D.O.R.: guide of internal dosimetry for the use of practitioners; O.E.D.I.P.E.: tool of modeling for the personalized internal dosimetry; the use of the Monte-Carlo method for the planning of the cancer treatment by radiotherapy becomes a reality; the works of the committee 2 of the ICRP; passive dosimetry versus operational dosimetry: situation in Europe; Implementation of the in vivo dosimetry in a radiotherapy department: experience of the Gustave Roussy institute; experience feedback on the in vivo measures in radiotherapy, based on the use of O.S.L. pellets; multi points O.S.L. instrumentation for the radiation dose monitoring in radiotherapy; dosimetry for extremities for medical applications: principle results of the European contract C.O.N.R.A.D.; references and perspectives in dosimetry; what perspectives for numerical dosimetry, an example: Sievert; system of dose management: how to answer to needs; the last technical evolutions in terms of electronic dosimetry in nuclear power plant; the fourth generation type reactors: what dosimetry. (N.C.)

Active and Successful Aging: A European Policy Perspective

OpenAIRE

Foster, Liam; Walker, Alan

2014-01-01

Over the past two decades, "active aging" has emerged in Europe as the foremost policy response to the challenges of population aging. This article examines the concept of active aging and how it differs from that of "successful aging." In particular, it shows how active aging presents a more holistic, life course-oriented approach than successful aging. We provide a critical perspective on active aging too by, first, tracing its emergence in Europe and then showing how, in practice, it has b...

Physical activity in patients with stable coronary heart disease: an international perspective

OpenAIRE

Stewart, Ralph; Held, Claes; Brown, Rebekkah; Vedin, Ola; Hagstrom, Emil; Lonn, Eva; Armstrong, Paul; Granger, Christopher B.; Hochman, Judith; Davies, Richard; Soffer, Joseph; Wallentin, Lars; White, Harvey

2013-01-01

Aims Despite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global clinical outcomes trial evaluating the lipoprotein phospholipaseA2 inhibitor darapladib. Methods and results Prior to randomization, 15 486 (97.8%) participants from 39 countries c...

[Swimming, physical activity and health: a historical perspective].

Science.gov (United States)

Conti, A A

2015-01-01

Swimming, which is the coordinated and harmonic movement of the human body inside a liquid medium by means of the combined action of the superior and inferior limbs, is a physical activity which is diffused throughout the whole world and it is practiced by healthy and non-healthy subjects. Swimming is one of the physical activities with less contraindications and, with limited exceptions, can be suggested to individuals of both sexes and of every age range, including the most advanced. Swimming requires energy both for the floating process and for the anterograde progression, with a different and variable osteo-arthro-muscular involvement according to the different styles. The energetic requirement is about four times that for running, with an overall efficiency inferior to 10%; the energetic cost of swimming in the female subject is approximately two thirds of that in the male subject. The moderate aerobic training typical of swimming is useful for diabetic and hypertensive individuals, for people with painful conditions of rachis, as also for obese and orthopaedic patients. Motor activity inside the water reduces the risk of muscular-tendinous lesions and, without loading the joints in excess, requires the harmonic activation of the whole human musculature. Swimming is an activity requiring multiple abilities, ranging from a sense of equilibrium to that of rhythm, from reaction speed to velocity, from joint mobility to resistance. The structured interest for swimming in the perspective of human health from the beginning of civilization, as described in this contribution, underlines the relevance attributed to this activity in the course of human history.

Risk Profile in a Sample of Patients with Breast Cancer from the Public Health Perspective

Directory of Open Access Journals (Sweden)

Sorina IRIMIE

2010-12-01

Full Text Available Cancer represents a major public health and economical burden in developed countries and has emerged as a major public health problem in developing countries, matching its effect in industrialized nations. Although there have been recent declines in breast cancer mortality rates in some European Union countries, breast cancer remains of key importance to public health in Europe. Now days there is increasing recognition of the causative role of lifestyle factors, as smoking, diet, alcohol consumption, or lake of physical activity. The present study aimed to appreciate the presence and magnitude of modifiable risk factors for breast cancer in a sample of patients diagnosed with the disease, and to outline a risk profile liable to be changed in the intention of reducing the global risk. Risk factors have been investigated in 65 patients diagnosed with breast cancer using a questionnaire for breast cancer risk factors evaluation. The high risk profile was identified as taking shape for urban environment, modulated by the impact of overweight-obesity, smoking, reproductive factors and environmental exposure to different chemical substances. From the public health perspective, the control of overweight and obesity comes out in the foreground of preventive activities. Public health approaches emphasize on inexpensive, practical methods and in this perspective the approach of obesity should focus on the alteration of environmental context, promoting healthy eating and increased physical activity which could have a positive, independent impact on breast cancer risk

Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills.

Science.gov (United States)

Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora

2016-01-01

Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

Caregivers' difficulties in activating long-term mental illness patients with low self-esteem.

Science.gov (United States)

Erdner, A; Magnusson, A

2012-03-01

The aim of the study was to describe psychiatric caregivers' perceptions of self-esteem and activities for patients with long-term mental illness. The study design used a qualitative approach, based on an open lifeworld perspective. A total of 13 caregivers at four psychiatric hospital units in a large Swedish city were interviewed about their views on patients' physical activity and/or other pastimes, as well as their self-esteem and its bearing on the patients' well-being. According to the caregivers, it is up to the patients themselves to decide what they wish to occupy themselves with. In the same time the caregivers' opinions are that patients have difficulties to occupy themselves. The caregivers believe that patients' disability is based in a lack of self-esteem, commitment and capacity to realize their wishes. The caregivers in this study argue that activities are valuable for self-esteem and physical health of people with long-term mental illness. The caregivers consider that it is the patient's responsibility to initiate their needs of activities. This means that the caregivers do not use their knowledge about the importance of activities for the patient's health. Search terms: activity, caregivers, mental illness. © 2011 Blackwell Publishing.

Informal work and formal plans: articulating the active role of patients in cancer trajectories

Directory of Open Access Journals (Sweden)

Rikke Juul Dalsted

2012-12-01

Full Text Available Introduction: Formal pathways models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer trajectories.  Methods and theory: An in-depth case study of patient trajectories at a Danish hospital and surrounding municipality using individual interviews with patients. Theory about trajectory and work by Strauss was included.  Results: Patients continuously took initiatives to organize their treatment and care. They initiated processes in the trajectories, and acquired information, which they used to form their trajectories.  Patients presented problems to the healthcare professionals in order to get proper help when needed.  Discussion: Work done by patients was invisible and not perceived as work. The patients' requests were not sufficiently supported in the professional organisation of work or formal planning. Patients' insertion and use of information in their trajectories challenged professional views and working processes. And the design of the formal pathway models limits the patients´ active participation. When looking at integrated care from the perspective of patients, the development of a more holistic and personalized approach is needed. Introduction: Formal pathway models outline that patients should receive information in order to experience a coherent journey but do not describe an active role for patients or their relatives. The aim of this is paper is to articulate and discuss the active role of patients during their cancer trajectories. Methods and theory: An in-depth case study of patient trajectories at a Danish hospital and surrounding municipality using individual interviews with patients. Theory about trajectory and work by Strauss was included. Results: Patients continuously took initiatives to organize their

Treatment goals in addiction healthcare: The perspectives of patients and clinicians

NARCIS (Netherlands)

Joosten, E.A.G.; Weert-van Oene, G.H. de; Sensky, T.; Staak, C.P.F. van der; Jong, C.A.J. de

2011-01-01

Background: Little is known about the perspectives of either patients or clinicians regarding treatment goals in addiction healthcare. In general, treatment goals involve abstinence or at least reduction of substance use. Aim: To examine and compare the treatment goals indicated by both patients and

Provider’s Perspectives on the Impact of Immigration and Customs Enforcement (ICE) Activity on Immigrant Health

Science.gov (United States)

Hacker, Karen; Chu, Jocelyn; Arsenault, Lisa; Marlin, Robert P.

2013-01-01

Introduction Increasing Immigration and Customs Enforcement (ICE) activities such as raids, detention and deportation may be affecting the health and well-being of immigrants. This study sought to understand the impact of ICE activities on immigrant health from the perspective of health care providers. Methods An online survey of primary care and emergency medicine providers was conducted to determine whether ICE activity was negatively affecting immigrant patients. Results Of 327 providers surveyed, 163 responded (50%) and 156 (48%) met criteria for inclusion. Seventy-five (48%) of them observed negative effects of ICE enforcement on the health or health access of immigrant patients. Forty-three providers gave examples of the impact on emotional health, ability to comply with health care recommendations and access. Conclusions Health care providers are witnessing the negative effects of ICE activities on their immigrant patients’ psychological and physical health. This should be considered an important determinant of immigrant health. PMID:22643614

Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

Directory of Open Access Journals (Sweden)

Jia Lee, PhD, RN

2010-12-01

Conclusions: There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

Patient education: perspective of adolescents with a chronic disease.

Science.gov (United States)

Kyngäs, Helvi

2003-09-01

The purpose of this study was to describe patient education from the perspective of adolescents. Data were collected by interviewing adolescents who had asthma, epilepsy, juvenile rheumatoid arthritis, and insulin-dependent diabetes mellitus. The sample consisted of 40 Finnish adolescents aged between 13 and 17 years. The interview data were analysed with methods of content analysis. From the perspective of adolescents with a chronic disease, patient education can be divided into the following categories: routine programmes, problematic planning issues, atmosphere of patient education session and written patient education material. Some features of ideal patient education also emerged. In a routine programme, patient education was based on the professional knowledge of the physicians and nurses rather than the needs of the adolescents. It was provided at a time that was good for the nurses or physicians. The level of education was not compatible with each developmental level of the adolescent. Problematic planning issues included a poorly outlined plan of education and a lack of systematic and continuous education. Educational communication consisted of dialogue between the adolescent and the educator. An encouraging atmosphere developed when the educators motivated the adolescents, respected them and their opinions and encouraged them to express their feelings, to ask questions and to relate experiences. Also, it was important that the adolescents' opinions were respected. In ideal patient education, the sessions had been planned well beforehand based on the adolescents' needs and written patient education material. Ideal patient education helped adolescents to acquire skills to take care of themselves and provided information on how to adjust to different situations and problems. The results provided useful insight into patient education and served to raise awareness of the problems and difficulties experienced by adolescents with a chronic disease.

Physical Activity Promotion in Call Centres: Employers' Perspectives

Science.gov (United States)

Renton, Sheila J.; Lightfoot, Nancy E.; Maar, Marion A.

2011-01-01

This study followed a predominantly qualitative approach to explore the perspectives of employers in Sudbury, Ontario, Canada, call centres (CCs) regarding physical activity (PA) promotion in workplaces, by identifying current practices and employers' motivation to promote PA, as well as perceived facilitators and barriers. In-depth interviews…

Third molar surgery: the patient's and the clinician's perspective

Directory of Open Access Journals (Sweden)

Jerjes Waseem

2009-10-01

Full Text Available Abstract Background In this report, the problems of third molar surgery have been reviewed from the perspective of both patient and clinician; additionally an overall analysis of preoperative imaging investigations was carried out. Specifically, three main areas of interest were investigated: the prediction of surgical difficulty and potential complications; the assessment of stress and anxiety and finally the assessment of postoperative complications and the surgeon's experience. Findings In the first study, the prediction of surgical difficulty and potential injury to the inferior alveolar nerve was assessed. This was achieved by examining the patient's orthopantomograms and by using the Pederson Difficulty Index (PDI. Several radiological signs were identified and a classification tree was created to help predict the incidence of such event. In the second study, a prospective assessment addressing the patient's stress and anxiety pre-, intra- and postoperatively was employed. Midazolam was the active drug used against placebo. Objective and subjective parameters were assessed, including measuring the cortisol level in saliva. Midazolam was found to significantly reduce anxiety levels and salivary cortisol was identified as an accurate anxiety marker. In the third study, postoperative complications and the surgeon's experience were examined. Few patients in this study suffered permanent nerve dysfunction. Junior surgeons reported a higher complication rate particularly in trismus, alveolar osteitis, infection and paraesthesia over the distributions of the inferior alveolar and lingual nerves. In apparent contrast, senior surgeons reported higher incidence of postoperative bleeding. Discussion These studies if well employed can lead to favourable alteration in patient management and might have a positive impact on future healthcare service.

Patients' perspectives on how idiopathic pulmonary fibrosis affects the quality of their lives

Directory of Open Access Journals (Sweden)

Gould Michael K

2005-10-01

Full Text Available Abstract Background Idiopathic pulmonary fibrosis (IPF is a debilitating lung disease with a survival of only three to five years from the time of diagnosis. Due to a paucity of studies, large gaps remain in our understanding of how IPF affects the quality of patients' lives. In only one other study did investigators ask patients directly for their perspectives on this topic. Further, currently there is no disease-specific instrument to measure health-related quality of life (HRQL in patients with IPF. A carefully constructed measurement instrument, sensitive to underlying change, is needed for use in clinical trials and longitudinal studies of patients with IPF. Before developing such an instrument, researchers must improve their understanding of the relevant effects of IPF on patients' lives. On a broader scale, to provide the best care for people with IPF, clinicians must appreciate – from patients' perspectives – how this disease affects various aspects of their lives. Methods We used focus groups and individual in-depth interviews with 20 IPF patients to collect their perspectives on how IPF affects their lives (with a focus on the quality of their lives. We then analyzed these perspectives and organized them into a conceptual framework for describing HRQL in patients with IPF. Next, we examined how well certain existing measurement instruments – which have been administered to IPF patients in prior studies – covered the domains and topics our patients identified. Results In our framework, we identified 12 primary domains: symptoms, IPF therapy, sleep, exhaustion, forethought, employment and finances, dependence, family, sexual relations, social participation, mental and spiritual well-being, mortality. Each domain is composed of several topics, which describe how IPF affects patients' lives. When we compared the content of our conceptual framework with the existing instruments, we found the coverage of the existing instruments to

Unravelling adherence to prophylaxis in haemophilia: a patients' perspective.

Science.gov (United States)

Schrijvers, L H; Kars, M C; Beijlevelt-van der Zande, M; Peters, M; Schuurmans, M J; Fischer, K

2015-09-01

Given the lifelong therapy in haemophilia patients, insight in non-adherence behaviour from a patient perspective is important to understand patients' difficulties with the following treatment recommendations. The aim of this study was to clarify the process underlying adherence (behaviour) to prophylactic treatment, from a patients' perspective. To develop a grounded theory, a qualitative study using individual in-depth interviews was performed to understand experiences, perceptions and beliefs concerning adherence to prophylaxis. From two Dutch treatment centres, 21 adults with haemophilia using prophylaxis were interviewed. Patients were asked how they experience their task to administer prophylaxis and how they adhere to this. The interviews were transcribed, coded and analysed in an iterative process, leading to the development of the grounded theory. Adherence was determined by the position of prophylaxis in life. The position of prophylaxis was determined by the perception of prophylaxis and the ability to exert prophylaxis. Patients' perception was influenced by two main factors: acceptance of haemophilia and feeling/fearing symptoms. The ability to exert prophylaxis was influenced by understanding haemophilia and prophylaxis and planning/infusion skills. The combination of different perceptions and skills led to four main positions of prophylaxis in life: (i) prophylaxis integrated in life, (ii) prophylaxis according to doctors' advice, struggling with irregular situations, (iii) prophylaxis is too much to handle, (iv) prophylaxis is a confrontation with illness. The adherence level gradually decreased from position 1 to 4. This information can be used to design tailored interventions to promote adherence. © 2015 John Wiley & Sons Ltd.

The treatment of 'difficult' patients in a secure unit of a specialized psychiatric hospital : The patient's perspective

NARCIS (Netherlands)

N. Kool-Goudzwaard; Bauke van Koekkoek; C.J. Gamel; M. Bos; B. Meijel

2012-01-01

The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called 'difficult' patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to

Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective

NARCIS (Netherlands)

Bode, C.; Taal, E.; Emons, P.A.A.; Galetzka, M.; Rasker, J.J.; Laar, M.A.F.J. van de

2008-01-01

This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were

Limited results of group self-management education for rheumatoid arthritis patients and their partners: Explanations from the patient perspective.

NARCIS (Netherlands)

Bode, Christina; Taal, Erik; Emons, P.A.A.; Galetzka, Mirjam; Rasker, Johannes J.; van de Laar, Mart A F J

2008-01-01

This study aimed to identify the reasons for limited results of group self-management for RA patients and their partners from the patient perspective. Semi-structured interviews with ten male and ten female patients who had participated in group self-management with or without their partner were

Including patients’ perspectives in patient information leaflets: A polyocular approach

DEFF Research Database (Denmark)

Fage-Butler, Antoinette Mary

2013-01-01

Existing research reveals that patients’ perspectives are missing from mandatory patient information leaflets (PILs). At the same time, there is overwhelming consensus that they should be included in this genre, and a corresponding need for potential approaches to tackle this problem. This paper ...

Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis.

Science.gov (United States)

Tippens, Kimberly M; Chao, Maria T; Connelly, Erin; Locke, Adrianna

2013-10-29

Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences of patients at community acupuncture clinics and whether quality of care is compromised through this high-volume model. The aim of this study was to assess patients' perspectives on the care received through community acupuncture clinics. The investigators conducted qualitative, thematic analysis of written comments from an observational, cross-sectional survey of clients of the Working Class Acupuncture clinics in Portland, Oregon. The survey included an open-ended question for respondents to share comments about their experiences with community acupuncture. Comments were received from 265 community acupuncture patients. Qualitative analysis of written comments identified two primary themes that elucidate patients' perspectives on quality of care: 1) aspects of health care delivery unique to community acupuncture, and 2) patient engagement in health care. Patients identified unique aspects of community acupuncture, including structures that facilitate access, processes that make treatments more comfortable and effective and holistic outcomes including physical improvements, enhanced quality of life, and empowerment. The group setting, community-based locations, and low cost were highlighted as aspects of this model that allow patients to access acupuncture. Patients' perspectives on the values and experiences unique to community acupuncture offer insights on the quality of care received in these settings. The group setting, community-based locations, and low cost of this model potentially reduce access barriers for those who might not

Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery.

Science.gov (United States)

Williams, Wesley; McKinney, Christopher; Martinez, Larry; Benson, Carmela

2016-01-01

This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders. Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider's (Recovery Markers Inventory [RMI]) and patient's (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI. A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p a retrospective, non-comparative design, and did not adjust for multiplicity Conclusions: The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug's use as schizophrenia treatment from a recovery-oriented perspective.

Communicating cancer treatment information using the Web: utilizing the patient's perspective in website development

NARCIS (Netherlands)

Hopmans, W.; Damman, O.C.; Timmermans, D.R.M.; Haasbeek, C.J.A.; Slotman, B.J.; Senan, S.

2014-01-01

Background: Online cancer information can support patients in making treatment decisions. However, such information may not be adequately tailored to the patient's perspective, particularly if healthcare professionals do not sufficiently engage patient groups when developing online information. We

The treatment of ‘difficult’ patients in a secure unit of a specialized psychiatric hospital: the patient's perspective

NARCIS (Netherlands)

C.J. Gamel; B. Koekkoek; prof Berno van Meijel; M. Bos; Nienke Kool

2011-01-01

The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called ‘difficult’ patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to

Putting a face on medical errors: a patient perspective.

Science.gov (United States)

Kooienga, Sarah; Stewart, Valerie T

2011-01-01

Knowledge of the patient's perspective on medical error is limited. Research efforts have centered on how best to disclose error and how patients desire to have medical error disclosed. On the basis of a qualitative descriptive component of a mixed method study, a purposive sample of 30 community members told their stories of medical error. Their experiences focused on lack of communication, missed communication, or provider's poor interpersonal style of communication, greatly contrasting with the formal definition of error as failure to follow a set standard of care. For these participants, being a patient was more important than error or how an error is disclosed. The patient's understanding of error must be a key aspect of any quality improvement strategy. © 2010 National Association for Healthcare Quality.

Patient and provider perspectives on improving the linkage of HIV ...

African Journals Online (AJOL)

This study examined barriers and facilitators to the linkage of HIV-positive pregnant women from antenatal care (ANC) to long-term HIV care from patient and provider perspectives, following the implementation of a collaborative quality improvement project in Eastern Uganda. It also solicited recommendations for improving ...

Patient's perspectives important for early anti-tumor necrosis factor treatment in inflammatory bowel disease

NARCIS (Netherlands)

J.E. Baars (Judith); C.A. Siegel (Corey); E.J. Kuipers (Ernst); C.J. van der Woude (Janneke)

2009-01-01

textabstractBackground/Aim: We hypothesized that limited information is given to patients on the risks and benefits of individual therapy, and feedback is lacking to verify if patients correctly interpreted the given information. We assessed the perspectives of patients with inflammatory bowel

PATIENT WEB PORTALS AND PATIENT-PROVIDER RELATIONSHIPS: A SUMMARY PERSPECTIVE.

Science.gov (United States)

Caldwell, Hannah D; Minkoff, Neil B; Murthy, Kalyani

2017-01-01

Patient Web portals (PWPs) have been gaining traction as a means to collect patient-reported outcomes and maintain quality patient care between office visits. PWPs have the potential to impact patient-provider relationships by rendering additional channels for communication outside of clinic visits and could help in the management of common chronic medical conditions. Studies documenting their effect in primary care settings are limited. This perspective aims to summarize the benefits and drawbacks of using PWPs in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma, focusing on communication, disease management, compliance, potential barriers, and the impact on patient-provider dynamic. After a review of these topics, we present potential future directions. We conducted an exploratory PubMed search of the literature published from inception through December 2015, and focused our subsequent searches specifically to assess benefits and drawbacks of using PWPs in the management of diabetes mellitus, hypertension, and asthma. Our search revealed several potential benefits of PWP implementation in the management of chronic conditions with regards to patient-provider relationships, such as improved communication, disease management, and compliance. We also noted drawbacks such as potentially unreliable reporting, barriers to use, and increased workload. PWPs offer opportunities for patients to report symptoms and outcomes in a timely manner and allow for secure online communication with providers. Despite the drawbacks noted, the overall benefits from successful PWP implementation could improve patient-provider relationships and help in the management of chronic conditions, such as diabetes mellitus, hypertension, and asthma.

Limited Time from the Diabetes Patients' Perspective: Need for Conversation with the Eye Specialist.

Science.gov (United States)

Marahrens, Lydia; Ziemssen, Focke; Fritsche, Andreas; Ziemssen, Tjalf; Kern, Raimar; Martus, Peter; Roeck, Daniel

2016-01-01

Facing the lack of time, busy retina consultants should be aware of how the patients would prefer that time is spent and whether they wish the specialist to talk more at the expense of other medical activities. 810 persons with diabetes were asked to divide the time of 10 min between examination, consultation and treatment when envisioning a real-life scenario of diabetic retinopathy (NCT02311504). With the increasing duration of diabetes, patients wanted significantly more time for diagnostics (p = 0.028), while age was found to be associated with less time for treatment (p = 0.009). Female subjects tended to prefer only little more time for talking (p = 0.051) in comparison with males, who slightly favored therapy (p = 0.025). The large majority recognized the need for diagnostics in their allocation of time. If individual patients are confronted with the health care perspective of time constraints, this might improve the understanding of prioritization. © 2016 S. Karger AG, Basel.

Obesity in primary care: a qualitative synthesis of patient and practitioner perspectives on roles and responsibilities.

Science.gov (United States)

Henderson, Emily

2015-04-01

Obesity is a top-priority global health issue; however, a clear way to address obesity in primary care is not yet in view. To conduct a meta-ethnography of patient and primary care practitioner perspectives of roles and responsibilities in how to address obesity in the UK, to inform evidence-based services that are acceptable to, and appropriate for, patients and practitioners. Qualitative synthesis applying meta-ethnographic methods according to the Noblit and Hare monograph. Database searches in MEDLINE(®), Social Sciences Citation Index(®), CINAHL, and Health Management Information Consortium were limited to 1997-2012 to examine recent perspectives. Full articles of practitioner and/or patient perspectives on obesity services in primary care were reviewed, and included semi-structured or unstructured interviews and focus groups, and participant observations. Nine studies were synthesised with perspectives from patients (n = 105) and practitioners (n = 144). Practitioners believe that patients are responsible for obesity, and that primary care should not help, or is poorly equipped to do so. Patients 'take responsibility' by 'blaming' themselves, but feel that practitioners should demonstrate more leadership. The empowerment of patients to access health services is reliant on the empowerment of practitioners to take an unambiguous position. Primary care has the potential either to perpetuate or counter obesity-related stigma. There needs to be a firm decision as to what role primary care will take in the prevention and treatment of obesity. To remain ambiguous runs the risk of losing patients' confidence and adding to a growing sense of futility. © British Journal of General Practice 2015.

Is patient autonomy a critical determinant of quality of life in Korea? End-of-life decision making from the perspective of the patient.

Science.gov (United States)

Mo, Ha Na; Shin, Dong Wook; Woo, Jae Ha; Choi, Jin Young; Kang, Jina; Baik, Young Ji; Huh, Yu Rae; Won, Joo Hee; Park, Myung Hee; Cho, Sang Hee

2012-04-01

We aimed to investigate the current practice of the involvement in decision making from the perspectives of terminal cancer patients, and to explore its possible associations with quality of life and quality of death in Korea. A multi-center, cross-sectional survey was performed on 93 terminal cancer patients. The questionnaire solicited their opinions regarding participation in treatment decision making, as well as quality of life (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire for Palliative Care) and quality of death (Good Death Inventory-Patient Version). A total of 78.5% of the patients had awareness of their terminal status, while 21.5% did not; 42.4% stated that they knew their condition and shared the decision-making responsibility with the medical staff and their family, while 21.7% made decisions on their own, and 35.9% left the decision-making responsibility to others. Patients who were aware of their illness and who actively participated in the decision making did not score higher than others on outcome measures of quality of life and quality of death. Moreover, the former even showed lower scores in some domains, including the 'physical and psychological comfort' (4.99 versus 5.61, p = 0.03), 'environmental comfort' (5.51 versus 6.04, p = 0.08), and 'emotional functioning' (55.70 versus 71.01, p = 0.06). in Korea, patient autonomy is not a universally accepted value from the perspectives of terminal cancer patients, nor is patient involvement in decision making always conducive to high quality of life or quality of death. The level of information and the pace at which it is provided should be tailored to each individual's ability, preference, need, and culture.

Intermediate term evaluation of tension-free vaginal tape outcome: Patient's perspective

International Nuclear Information System (INIS)

Farrukh, A.; Doyle, P.M.

2006-01-01

Various new sling techniques for surgical treatment of female urinary stress incontinence have evolved over the last decade and several reports indicate high objective cure rates and fewer complications compared to traditional major procedures. We conducted a study to determine the subjective outcome and satisfaction from a patient's perspective, based on their own responses to a symptom-specific health related postal questionnaire after five year five years of having Tension-free vaginal tape surgery (TVT, Gynecare, UK). Data were collected from 70 women. The end-point was improvement or cure from stress incontinence and its affect on their disease related quality of life. A significant improvement in continence was reported by 80 percent of treated women. The responses also allowed these women to appreciate the difference TVT had made on their daily activities with a definite positive impact on quality of life. (author)

Alcoholic liver disease patients' perspective of a coping and physical activity-oriented rehabilitation intervention after hepatic encephalopathy.

Science.gov (United States)

Mikkelsen, Maria Rudkjaer; Hendriksen, Carsten; Schiødt, Frank Vinholt; Rydahl-Hansen, Susan

2016-09-01

To identify and describe the impact of a coping and physical activity-oriented rehabilitation intervention on alcoholic liver disease patients after hepatic encephalopathy in terms of their interaction with professionals and relatives. Patients who have experienced alcohol-induced hepatic encephalopathy have reduced quality of life, multiple complications, and social problems, and rehabilitation opportunities for these patients are limited. A grounded theory study and an evaluation study of a controlled intervention study. Semi-structured interviews were conducted with 10 alcoholic liver disease patients who were diagnosed with hepatic encephalopathy and participated in a coping and physical activity-oriented rehabilitation intervention. Richard S. Lazarus's theory of stress and coping inspired the interview guide. The significance of a coping and physical activity-oriented rehabilitation intervention on alcoholic liver disease patients' ability to cope with problems after surviving alcohol-induced hepatic encephalopathy in terms of their interaction with professionals and relatives was characterised by the core category 'regain control over the diseased body'. This is subdivided into three separate categories: 'the experience of being physically strong', 'togetherness' and 'self-control', and they impact each other and are mutually interdependent. Alcoholic liver disease patients described the strength of the rehabilitation as regaining control over the diseased body. Professionals and relatives of patients with alcoholic liver disease may need to focus on strengthening and preserving patients' control of their diseased body by facilitating the experience of togetherness, self-control and physical strength when interacting with and supporting patients with alcoholic liver disease. A coping and physical activity-oriented rehabilitation intervention may help alcoholic liver disease patients to regain control over their diseased body and give patients the experience

LVAD patients' and surrogates' perspectives on SPIRIT-HF: An advance care planning discussion.

Science.gov (United States)

Metzger, Maureen; Song, Mi-Kyung; Devane-Johnson, Stephanie

2016-01-01

To describe LVAD patients' and surrogates' experiences with, and perspectives on SPIRIT-HF, an advance care planning (ACP) intervention. ACP is important for patients with LVAD, yet little is known about their experiences or those of their surrogates who have participated in ACP discussions. We used qualitative content analysis techniques to conduct a secondary analysis of 28 interviews with patients with LVAD (n = 14) and their surrogates (n = 14) who had participated in an RCT pilot study of SPIRIT-HF. Main themes from the data include: 1) sharing their HF stories was very beneficial; 2) participating in SPIRIT-HF led to greater peace of mind for patients and surrogates; 3) "one size does not fit all" when it comes to timing of ACP discussions. An understanding patient and surrogate perspectives may inform clinicians' approach to ACP discussions. Copyright © 2016 Elsevier Inc. All rights reserved.

Older Patients' Perspectives on Quality of Serious Illness Care in Primary Care.

Science.gov (United States)

Abu Al Hamayel, Nebras; Isenberg, Sarina R; Hannum, Susan M; Sixon, Joshua; Smith, Katherine Clegg; Dy, Sydney M

2018-01-01

Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. To explore older patients' perspectives on the quality of serious illness care in primary care. Qualitative interview study. Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic's quality improvement initiative. We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians' perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

Family joint activities in a cross-national perspective

Directory of Open Access Journals (Sweden)

Kuntsche Emmanuel

2007-05-01

Full Text Available Abstract Background Parents and children joint activities are considered to be an important factor on healthy lifestyle development throughout adolescence. This study is a part of the Cross-National Survey on Health Behaviour in School-aged Children – World Health Organization Collaborative Study (HBSC. It aims to describe family time in joint activities and to clarify the role of social and structural family profile in a cross-national perspective. Methods The research was carried out according to the methodology of the HBSC study using the anonymous standardized questionnaire. In total, 17,761 students (8,649 boys and 9,112 girls aged 13 and 15 years from 6 European countries (Czech Republic, Finland, Greenland, Lithuania, Spain, and Ukraine were surveyed in the 2001–2002 school-year. The evaluation of joint family activity is based on 8 items: (1 watching TV or a video, (2 playing indoor games, (3 eating meals, (4 going for a walk, (5 going places, (6 visiting friends or relatives, (7 playing sports, (8 sitting and talking about things (chatting. Results Students from Spain and Ukraine reported spending the most time together with their families in almost all kinds of joint activities, whereas students from Greenland and Finland reported spending the least of this time. Boys were more likely than girls to be spending time together with family. Joint family activity goes into decline in age from 13 to 15 years. Variability of family time in a cross-national perspective was relatively small and related to children age category. Considering national, gender and age differences of studied population groups, we found that the distribution of joint family activities tends to be dispersed significantly by family structure (intact/restructured family and family wealth. Conclusion Our study compares children and parent joint activities in European countries and reveals differences and similarities in these patterns between countries. The findings

Family joint activities in a cross-national perspective.

Science.gov (United States)

Zaborskis, Apolinaras; Zemaitiene, Nida; Borup, Ina; Kuntsche, Emmanuel; Moreno, Carmen

2007-05-30

Parents and children joint activities are considered to be an important factor on healthy lifestyle development throughout adolescence. This study is a part of the Cross-National Survey on Health Behaviour in School-aged Children--World Health Organization Collaborative Study (HBSC). It aims to describe family time in joint activities and to clarify the role of social and structural family profile in a cross-national perspective. The research was carried out according to the methodology of the HBSC study using the anonymous standardized questionnaire. In total, 17,761 students (8,649 boys and 9,112 girls) aged 13 and 15 years from 6 European countries (Czech Republic, Finland, Greenland, Lithuania, Spain, and Ukraine) were surveyed in the 2001-2002 school-year. The evaluation of joint family activity is based on 8 items: (1) watching TV or a video, (2) playing indoor games, (3) eating meals, (4) going for a walk, (5) going places, (6) visiting friends or relatives, (7) playing sports, (8) sitting and talking about things (chatting). Students from Spain and Ukraine reported spending the most time together with their families in almost all kinds of joint activities, whereas students from Greenland and Finland reported spending the least of this time. Boys were more likely than girls to be spending time together with family. Joint family activity goes into decline in age from 13 to 15 years. Variability of family time in a cross-national perspective was relatively small and related to children age category. Considering national, gender and age differences of studied population groups, we found that the distribution of joint family activities tends to be dispersed significantly by family structure (intact/restructured family) and family wealth. Our study compares children and parent joint activities in European countries and reveals differences and similarities in these patterns between countries. The findings underline the role of family structure (intact

Biofeedback in Partial Weight Bearing: Usability of Two Different Devices from a Patient's and Physical Therapist's Perspective.

Science.gov (United States)

van Lieshout, Remko; Pisters, Martijn F; Vanwanseele, Benedicte; de Bie, Rob A; Wouters, Eveline J; Stukstette, Mirelle J

2016-01-01

Partial weight bearing is frequently instructed by physical therapists in patients after lower-limb trauma or surgery. The use of biofeedback devices seems promising to improve the patient's compliance with weight-bearing instructions. SmartStep and OpenGo-Science are biofeedback devices that provide real-time feedback. For a successful implementation, usability of the devices is a critical aspect and should be tested from a user's perspective. To describe the usability from the physical therapists' and a patients' perspective of Smartstep and OpenGo-Science to provide feedback on partial weight bearing during supervised rehabilitation of patients after lower-limb trauma or surgery. In a convergent mixed-methods design, qualitative and quantitative data were collected. Usability was subdivided into user performance, satisfaction and acceptability. Patients prescribed with partial weight bearing and their physical therapists were asked to use SmartStep and OpenGo-Science during supervised rehabilitation. Usability was qualitatively tested by a think-aloud method and a semi-structured interview and quantitatively tested by the System-Usability-Scale (SUS) and closed questions. For the qualitative data thematic content analyses were used. Nine pairs of physical therapists and their patients participated. The mean SUS scores for patients and physical therapists were for SmartStep 70 and 53, and for OpenGo-Science 79 and 81, respectively. Scores were interpreted with the Curved Grading Scale. The qualitative data showed that there were mixed views and perceptions from patients and physical therapists on satisfaction and acceptability. This study gives insight in the usability of two biofeedback devices from the patient's and physical therapist's perspective. The overall usability from both perspectives seemed to be acceptable for OpenGo-Science. For SmartStep, overall usability seemed only acceptable from the patient's perspective. The study findings could help

Modulation of brain activity during action observation: influence of perspective, transitivity and meaningfulness.

Directory of Open Access Journals (Sweden)

Sébastien Hétu

Full Text Available The coupling process between observed and performed actions is thought to be performed by a fronto-parietal perception-action system including regions of the inferior frontal gyrus and the inferior parietal lobule. When investigating the influence of the movements' characteristics on this process, most research on action observation has focused on only one particular variable even though the type of movements we observe can vary on several levels. By manipulating the visual perspective, transitivity and meaningfulness of observed movements in a functional magnetic resonance imaging study we aimed at investigating how the type of movements and the visual perspective can modulate brain activity during action observation in healthy individuals. Importantly, we used an active observation task where participants had to subsequently execute or imagine the observed movements. Our results show that the fronto-parietal regions of the perception action system were mostly recruited during the observation of meaningless actions while visual perspective had little influence on the activity within the perception-action system. Simultaneous investigation of several sources of modulation during active action observation is probably an approach that could lead to a greater ecological comprehension of this important sensorimotor process.

Communication skills in healthcare: academic, clinician and patient perspectives

OpenAIRE

CHARLOTTE ABYNA INDERMAUR DENNISTON

2018-01-01

This PhD explores healthcare communication skills from the perspectives of academics, clinicians and patients. We know that communication is key to effective healthcare and this research has revealed new approaches for teaching and learning these skills. Findings indicate that we need to consider multiple stakeholders in the design of communication education, we need to develop healthcare professionals’ skills at assessing their own communication and asking for feedback, and workplace teachin...

Interprofessional collaborative teamwork facilitates patient centred care: a student practitioner's perspective.

Science.gov (United States)

Osbiston, Mark

2013-05-01

Interprofessional teamwork and collaboration are essential for facilitating perioperative patient centred care. Operating department practitioners (ODPs) and nurses are registered professional 'practitioner' members of the perioperative team. Standards of conduct, communication skills, ethical principles and confidentiality legislation associated with documented patient information underpin and guide perioperative practitioner practice. This article will discuss, from a student's theoretical and practice experience perspective, the registered professional 'practitioner' role in the context of the interprofessional team.

To total amount of activity. And beyond: Perspectives on measuring physical behavior

NARCIS (Netherlands)

J.B.J. Bussmann (Hans); H.J.G. van den Berg-Emons (Rita)

2013-01-01

textabstractThe aim of this paper is to describe and discuss some perspectives on definitions, constructs, and outcome parameters of physical behavior. The paper focuses on the following constructs: Physical activity and active lifestyle vs. sedentary behavior and sedentary lifestyle; Amount of

A qualitative study assessing patient perspectives in the process of decision-making on disease modifying therapies (DMT's) in multiple sclerosis (MS).

Science.gov (United States)

Ceuninck van Capelle, Archibald de; Meide, Hanneke van der; Vosman, Frans J H; Visser, Leo H

2017-01-01

Physicians commonly advise patients to begin disease modifying therapies (DMT's) shortly after the establishment of a diagnosis of Multiple Sclerosis (MS) to prevent further relapses and disease progression. However, little is known about the meaning for patients going through the process of the diagnosis of MS and of making decisions on DMT's in early MS. To explore the patient perspective on using DMT's for MS. Methods: Ten participants with a recent (approach. The analysis revealed the following themes: (1) Constant confrontation with the disease, (2) Managing inevitable decline, (3) Hope of delaying the progression of the disease, and, (4) The importance of social support. The themes show that patients associate the recommendation to begin DMT's (especially injectable DMT's) with views about their bodies as well as their hopes about the future. Both considering and adhering to treatment are experienced by patients as not only matters of individual and rational deliberation, but also as activities that are lived within a web of relationships with relatives and friends. From the patient perspective, the use of DMT's is not a purely rational and individual experience. More attention to the use of DMT's as relational and lived phenomena will improve the understanding of the process of decision-making for DMT's in MS.

Holism and embodiment in nursing: using Goethean science to join 2 perspectives on patient care.

Science.gov (United States)

Mason, Deanna M

2014-01-01

Holism is a central concept in nursing theory, yet recently, embodiment has become prominent in the literature. Epistemological foundations from modern and contemporary philosophy are discussed and their relationship to nursing practice is explored to investigate the concepts of holism and embodiment. Nurses practice holistic care within the patient encounter while patients live an embodied experience. This creates inherent dissonance in the nurse-patient interaction. Goethean science is presented as a way to reconcile this discrepancy, to allow the nurse to better understand the patient's embodiment and, by default, his or her own embodiment. A new perspective of how nursing practice can use Goethean science and an embodied perspective are presented as a means to actualize Carper's fundamental pattern of knowing of personal knowledge within the nurse-patient interaction. With this approach, the nurse is able to examine the phenomenon of the patient with the patient to explore the essential nature that makes the patient who he or she is and what he or she is trying to become. During this exploration, the nurse uses the senses, language, and a critical mind to do what no machine or test could-to see the underlying meaningfulness and internal coherence of the patient. The intuitive revelation would expose nursing interventions simultaneously. Moving beyond the myopic perspective of how to keep "person" central to the nursing metaparadigm, nursing is beginning to see the embodiment of the patient as a means for understanding and providing care for patients. The challenge that remains is for nurses to see their own embodiment and reflect on if or how it is at odds with the necessity of providing holistic care to patients.

Perspective and agency during video gaming influences spatial presence experience and brain activation patterns

Directory of Open Access Journals (Sweden)

Havranek Michael

2012-07-01

Full Text Available Abstract Background The experience of spatial presence (SP, i.e., the sense of being present in a virtual environment, emerges if an individual perceives himself as 1 if he were actually located (self-location and 2 able to act in the virtual environment (possible actions. In this study, two main media factors (perspective and agency were investigated while participants played a commercially available video game. Methods The differences in SP experience and associated brain activation were compared between the conditions of game play in first person perspective (1PP and third person perspective (3PP as well as between agency, i.e., active navigation of the video game character (active, and non-agency, i.e., mere passive observation (passive. SP was assessed using standard questionnaires, and brain activation was measured using electroencephalography (EEG and sLORETA source localisation (standard low-resolution brain electromagnetic tomography. Results Higher SP ratings were obtained in the 1PP compared with the 3PP condition and in the active compared with the passive condition. On a neural level, we observed in the 1PP compared with the 3PP condition significantly less alpha band power in the parietal, the occipital and the limbic cortex. In the active compared with the passive condition, we uncovered significantly more theta band power in frontal brain regions. Conclusion We propose that manipulating the factors perspective and agency influences SP formation by either directly or indirectly modulating the ego-centric visual processing in a fronto-parietal network. The neuroscientific results are discussed in terms of the theoretical concepts of SP.

A focus group study of patient's perspective and experiences of type 2 diabetes and its management in Jordan.

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Jarab, Anan S; Mukattash, Tareq L; Al-Azayzih, Ahmad; Khdour, Maher

2018-03-01

Diabetes is increasingly becoming a major health problem in Jordan and glycemic goals are often not achieved. To explore the patients' perspectives regarding type 2 diabetes and its management in order to "fine-tune" future pharmaceutical care intervention programs. Focus groups method was used to explore views from individuals with type 2 diabetes attending outpatient diabetes clinic at the Royal Medical Services Hospital. All interviews were recorded, transcribed and analyzed using a thematic analysis approach. A total of 6 focus groups, with 6 participants in each one, were conducted. Participants in the present study demonstrated a great information needs about diabetes and the prescribed treatment. Medication regimen characteristics including rout of administration, number of prescribed medications and dosage frequency in addition to perceived side effects represented the major barriers to medication adherence. In addition to demonstrating negative beliefs about the illness and the prescribed medications, participants showed negative attitudes and low self-efficacy to adhere to necessary self-care activities including diet, physical activity and self-monitoring of blood glucose. Future pharmaceutical care interventions designed to improve patients' adherence and health outcomes in patients with type 2 diabetes should consider improving patients' understanding of type 2 diabetes and its management, simplifying dosage regimen, improving patient's beliefs and attitudes toward type 2 diabetes, prescribed medications and different self-care activities in addition to improving patient's self efficacy to perform different treatment recommendations.

E-cigarettes in patients with COPD: current perspectives.

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Morjaria, J B; Mondati, E; Polosa, R

2017-01-01

Conventional cigarette smoking is known to result in significant COPD morbidity and mortality. Strategies to reduce and/or stop smoking in this highly vulnerable patient group are key public health priorities to reduce COPD morbidity and mortality. Unfortunately, smoking cessation efforts in patients with COPD are poor and there is a compelling need for more efficient approaches to cessation for patients with COPD. Electronic cigarettes (ECs) are devices that use batteries to vaporize nicotine. They may facilitate quit attempts and cessation in many smokers. Although they are not risk free, ECs are much less harmful than tobacco smoking. Hence, the use of ECs in vulnerable groups and in patients with challenges to abstain or multiple relapses to this habit may be promising. To date, little is known about health consequences of EC use among COPD smokers and whether their regular use has any effects on subjective and objective COPD outcomes. In the current review, we discuss the current perspectives and literature on the role of ECs in abstaining from conventional smoking and the effects of ECs on the respiratory tract in patients with COPD.

Involving patients in health technology funding decisions: stakeholder perspectives on processes used in Australia.

Science.gov (United States)

Lopes, Edilene; Street, Jackie; Carter, Drew; Merlin, Tracy

2016-04-01

Governments use a variety of processes to incorporate public perspectives into policymaking, but few studies have evaluated these processes from participants' point of view. The objective of this study was twofold: to understand the perspectives of selected stakeholders with regard to involvement processes used by Australian Advisory Committees to engage the public and patients; and to identify barriers and facilitators to participation. Twelve semi-structured interviews were conducted with representatives of different stakeholder groups involved in health technology funding decisions in Australia. Data were collected and analysed using a theoretical framework created by Rowe and Frewer, but adapted to more fully acknowledge issues of power and influence. Stakeholder groups disagreed as to what constitutes effective and inclusive patient involvement. Barriers reported by interviewees included poor communication, a lack of transparency, unworkable deadlines, and inadequate representativeness. Also described were problems associated with defining the task for patients and their advocates and with the timing of patient input in the decision-making process. Interviewees suggested that patient participation could be improved by increasing the number of patient organizations engaged in processes and including those organizations at different stages of decision making, especially earlier. The different evaluations made by stakeholder groups appear to be underpinned by contrasting conceptions of public involvement and its value, in line with Graham Martin's work which distinguishes between 'technocratic' and 'democratic' public involvement. Understanding stakeholders' perspectives and the contrasting conceptions of public involvement could foster future agreement on which processes should be used to involve the public in decision making. © 2015 John Wiley & Sons Ltd.

What patients really think about asthma guidelines: barriers to guideline implementation from the patients' perspective.

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Lingner, H; Burger, B; Kardos, P; Criée, C P; Worth, H; Hummers-Pradier, E

2017-01-11

Treatment of asthma does not always comply with asthma guidelines (AG). This may be rooted in direct or indirect resistance on the doctors' and/or patients' side or be caused by the healthcare system. To assess whether patients' concepts and attitudes are really an implementation barrier for AG, we analysed the patients' perspective of a "good asthma therapy" and contrasted their wishes with current recommendations. Using a qualitative exploratory design, topic centred focus group (FG) discussions were performed until theoretical saturation was reached. Inclusion criteria were an asthma diagnosis and age above 18. FG sessions were recorded audio-visually and analysed via a mapping technique and content analysis performed according to Mayring (supported by MAXQDA®). Participants' speech times and the proportion of time devoted to different themes were calculated using the Videograph System® and related to the content analysis. Thirteen men and 24 women aged between 20 and 77 from rural and urban areas attended five FG. Some patients had been recently diagnosed with asthma, others years previously or in childhood. The following topics were addressed: (a) concern about or rejection of therapy components, particularly corticosteroids, which sometimes resulted in autonomous uncommunicated medication changes, (b) lack of time or money for optimal treatment, (c) insufficient involvement in therapy choices and (d) a desire for greater empowerment, (e) suboptimal communication between healthcare professionals and (f) difficulties with recommendations conflicting with daily life. Primarily, (g) participants wanted more time with doctors to discuss difficulties and (h) all aspects of living with an impairing condition. We identified some important patient driven barriers to implementing AG recommendations. In order to advance AG implementation and improve asthma treatment, the patients' perspective needs to be considered before drafting new versions of AG. These issues

Prescribing and using self-injectable antiretrovirals: How concordant are physician and patient perspectives?

OpenAIRE

Cohen Calvin; Fisher Martin; Youle Michael; Kulasegaram Ranjababu; Fumaz Carmina R; Clotet Bonaventura; Katlama Christine; Kovacs Colin; Horne Robert; Slim Jihad; Shalit Peter; Cooper Vanessa; Tsoukas Christos

2009-01-01

Abstract Background The selection of agents for any treatment regimen is in part influenced by physician and patient attitudes. This study investigated attitudinal motivators and barriers to the use of self-injectable antiretroviral agents among physicians and patients and measured the degree of concordance between physician and patient perspectives. Methods Attitudes toward prescribing and usage of self-injectable antiretroviral therapy (SIAT) were assessed by structured interview in 2 cohor...

Impact of simultaneous pancreas-kidney transplantation: patients' perspectives.

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Isla Pera, P; Moncho Vasallo, J; Guasch Andreu, O; Ricart Brulles, Mj; Torras Rabasa, A

2012-01-01

Few qualitative studies of simultaneous pancreas-kidney transplantation (SPK Tx) have been published. The aims of this study were to explore from the perspective of patients, the experience of living with diabetes mellitus type 1 (T1DM), suffering from complications, and undergoing SPK Tx with good outcome; and to determine the impact of SPK Tx on patients and their social and cultural environment. We performed a focused ethnographic study. Twenty patients were interviewed. Data were analyzed using content analysis and constant comparison following the method proposed by Miles and Huberman. A functioning SPK Tx allowed renal replacement therapy and insulin to be discontinued. To describe their new situation, patients used words and phrases such as "miracle", "being reborn" or "coming back to life". Although the complications of T1DM, its surgery and treatment, and associated psychological problems did not disappear after SPK Tx, these were minimized when compared with the pretransplantation situation. For patients, SPK Tx represents a recovery of their health and autonomy despite remaining problems associated with the complications of T1DM and SPK Tx. The understanding of patients' existential framework and their experience of disease are key factors for planning new intervention and improvement strategies.

The impact of total laryngectomy: the patient's perspective.

LENUS (Irish Health Repository)

Noonan, Brendan J

2012-02-01

PURPOSE\\/OBJECTIVES: To describe the experiences of patients who had total laryngectomy from their perspective. RESEARCH APPROACH: Descriptive, qualitative study.Setting: Participants\\' homes or investigator\\'s hospital office. PARTICIPANTS: 10 patients after total laryngectomy. METHODOLOGIC APPROACH: Data were collected by semistructured, open-ended interviews during a period of six months, with an interview topic guide built on the framework of the literature review. Data were analyzed with descriptive content analysis. Trustworthiness of the study was enhanced through the use of verbatim quotations, audible data analysis trail, and a reflexive approach. MAIN RESEARCH VARIABLES: Patients\\' experiences of undergoing total laryngectomy. FINDINGS: Patients who have undergone a total laryngectomy report difficulties and concerns that are largely functional and psychological. The functional difficulties reported included descriptions of altered swallow, excess phlegm, speech difficulties, weak neck muscles, and altered energy levels. The psychological concerns reported included descriptions of depression, regrets, and personal resolve. CONCLUSIONS: As a group, patients experience a broad range of problems well after completion of treatment, reinforcing the need for rehabilitation management for prolonged periods after surgery. INTERPRETATION: Nurses are suitably positioned to support this group of patients across the disease management trajectory, from the initial preoperative period to the postoperative period and through to the rehabilitative period and beyond.

Patient retention at dental school clinics: a marketing perspective.

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Makarem, Suzanne C; Coe, Julie M

2014-11-01

The purpose of this investigation was to examine the drivers of patient retention at dental school clinics from a services marketing perspective. An analysis of patient characteristics at Virginia Commonwealth University School of Dentistry, screened between August 2010 and July 2011 (N=3604), was performed using descriptive statistics, cross-tabulations, and a binary logistic regression. The main findings were that 42 percent of patients in the study were retained and that no response to communication efforts (36 percent) and financial problems (28 percent) constituted the most common reasons for non-retention. Older age, having insurance, and living within a sixty-mile radius were significant drivers of retention (pskills to better service them, and consequently increasing retention. This will lead to providing a continuum of care and student education and to ensuring the sustainability and quality of the school's educational programs.

Advocacy for active transport: advocate and city council perspectives

Directory of Open Access Journals (Sweden)

Rosenby Marieah

2010-01-01

Full Text Available Abstract Background Effective advocacy is an important part of efforts to increase population participation in physical activity. Research about effective health advocacy is scarce, however, the health sector can learn from the experiences and knowledge of community advocates and those who are on the receiving end of this advocacy. The aim of this study is to explore advocacy for active transport from the perspectives of community advocates and representatives from City councils. Methods Cycling and walking advocates were identified from the local contact list of Cycling Advocates Network and Living Streets Aotearoa. Semi-structured telephone interviews were conducted with cycle and walking advocates from throughout New Zealand. Advocates also nominated a suitable council officer at their local City council to be interviewed. Interviews were recorded and transcribed and categories of responses for each of the questions created. Results Several processes were used by advocates to engage with council staff, including formal council submissions, meetings, stakeholder forums and partnership in running community events promoting active transport. Several other agencies were identified as being influential for active transport, some as potential coalition partners and others as potential adversaries. Barriers to improving conditions for active transport included a lack of funding, a lack of will-power among either council staff or councillors, limited council staff capacity (time or training and a culture of providing infrastructure for motor vehicles instead of people. Several suggestions were made about how the health sector could contribute to advocacy efforts, including encouraging political commitment, engaging the media, communicating the potential health benefits of active transport to the general public and being role models in terms of personal travel mode choice and having workplaces that support participation in active transport

Perspectives from the Patient and the Healthcare Professional in Multiple Sclerosis: Social Media and Participatory Medicine.

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Kantor, Daniel; Bright, Jeremy R; Burtchell, Jeri

2018-06-01

When faced with a diagnosis of multiple sclerosis (MS), patients often turn to the Internet and social media to find support groups, read about the experiences of other people affected by MS and seek their advice, and research their condition and treatment options to discuss with their healthcare professionals (HCPs). Here, we examine the use of social media and the Internet among patients with MS, considering its impact on patient empowerment and patient participation in treatment decision-making and MS research. These themes are exemplified with first-hand experiences of the patient author. We also explore the impact of the Internet and social media on the management of patients from the perspective of HCPs, including new opportunities for HCPs to engage in participatory medicine and to improve communication with and among patients. We consider both the benefits afforded to and the potential pitfalls faced by HCPs when interacting with their patients via these routes, and discuss potential concerns around privacy and confidentiality in the use of the Internet and social media in the clinical context. Communication online is driving the evolution of the patient-HCP relationship, and is empowering patients to participate more actively in the decision-making process relating to the provision of their health care. Funding Novartis Pharmaceuticals Corporation.

Patient Perspectives on Acquiring Spectacles: A Cambodian Experience.

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Ormsby, Gail Melva; Grant-Skiba, Dawn; Naidoo, Kovin; Keeffe, Jill E

2016-01-01

To assess the perspectives of patients who acquired spectacles from an eye unit/vision center in Cambodia. A sample (n = 62) of patients was selected across 4 provinces: Prey Veng, Siem Reap, Battambang, and Takeo. The Patient Spectacle Satisfaction Survey covering demographic and semistructured questions regarding patient satisfaction, style, and costs incurred was used to collect data. Information was transcribed and translated into English and analyzed by thematic coding using NVivo. Although there were more women seeking eye health care treatment, there was no significant age difference. Patient satisfaction levels were high although the patients had to pay for transportation, registration, and the glasses themselves. A total of 60 patients (96.7%) stated they would recommend the refractive service center to others. Despite a high level of awareness of eye disease such as cataract, only 2 in 10 people could accurately identify cataract as a major cause of poor vision or blindness. Most of the people (52%) blamed bad vision or blindness on dust or other foreign objects getting into the eye, old age (31%), or poor hygiene (16%). Most people will pay eye care costs once barriers to seeking treatment have been broken via education and encouragement. Satisfaction of wearing spectacles was associated with improved vision; style, color, and fit of the spectacles; and protection from sunlight and dust. The proximity of and easy access to health facilities influenced patient desire to seek treatment.

Evaluating University Physical Activity Courses from Student and Instructor Perspectives

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Beaudoin, Christina; Parker, Tonya; Tiemersma, Karol; Lewis, Colleen

2018-01-01

This article presents the results of a survey of student and faculty perspectives within a university-level instructional physical activity (PA) program. The results revealed that students enrolled in the courses primarily for enjoyment and to stay fit. A majority of students ranked the quality of instruction as excellent, were interested in new…

The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.

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Ridd, Matthew; Shaw, Alison; Lewis, Glyn; Salisbury, Chris

2009-04-01

The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required. To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients. Systematic review and thematic synthesis of qualitative studies. Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach. From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related. A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.

Patients' perspectives on the medical primary-secondary care interface: systematic review and synthesis of qualitative research.

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Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

2015-10-15

To synthesise the published literature on the patient experience of the medical primary-secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients' perspectives of the medical primary-secondary care interface. International primary-secondary care interface. EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients' perspectives of the medical primary-secondary care interface. The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary-secondary care interface from the patients' perspective emerged: barriers to care, communication, coordination, and 'relationships and personal value'. Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. PROSPERO CRD42014009486. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Mini-guts in a dish: Perspectives of adult Cystic Fibrosis (CF) patients and parents of young CF patients on organoid technology.

Science.gov (United States)

Boers, Sarah N; de Winter-de Groot, Karin M; Noordhoek, Jacquelien; Gulmans, Vincent; van der Ent, Cornelis K; van Delden, Johannes J M; Bredenoord, Annelien L

2018-03-06

Organoid technology enables the cultivation of human tissues in a dish. Its precision medicine potential could revolutionize the Cystic Fibrosis (CF) field. We provide a first thematic exploration of the patient perspective on organoid technology to set the further research agenda, which is necessary for responsible development of this ethically challenging technology. 23 semi-structured qualitative interviews with 14 Dutch adult CF patients and 12 parents of young CF patients to examine their experiences, opinions, and attitudes regarding organoid technology. Four themes emerged: (1) Respondents express a close as well as a distant relationship to organoids; (2) the open-endedness of organoid technology sparks hopes and concerns, (3) commercial use evokes cautiousness. (4) Respondents mention the importance of sound consent procedures, long-term patient engagement, responsible stewardship, and stringent conditions for commercial use. The precision medicine potential of organoid technology can only be realized if the patient perspective is taken adequately into account. Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Reasons for readmission in heart failure : Perspectives of patients, caregivers, cardiologists, and heart failure nurses

NARCIS (Netherlands)

Annema, Coby; Luttik, Marie-Louise; Jaarsma, Tiny

2009-01-01

OBJECTIVE: Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are

The management of low activity radioactive waste: IAEA guidance and perspectives

International Nuclear Information System (INIS)

Louvat, D.; Rowat, J.H.; Potier, J.M.

2005-01-01

This paper describes the safety standards and reports of the International Atomic Energy Agency (IAEA) applicable to the management and disposal of low activity radioactive waste and provides some historical perspective on their development. Some of the most important current issues in the area of low activity radioactive waste management are discussed in the context of related ongoing IAEA activities. At the end of the paper, a number of issues and questions are raised for consideration and discussion at this symposium. (author)

Performance monitoring and empathy during active and observational learning in patients with major depression.

Science.gov (United States)

Thoma, Patrizia; Norra, Christine; Juckel, Georg; Suchan, Boris; Bellebaum, Christian

2015-07-01

Previous literature established a link between major depressive disorder (MDD) and altered reward processing as well as between empathy and (observational) reward learning. The aim of the present study was to assess the effects of MDD on the electrophysiological correlates - the feedback-related negativity (FRN) and the P300 - of active and observational reward processing and to relate them to trait cognitive and affective empathy. Eighteen patients with MDD and 16 healthy controls performed an active and an observational probabilistic reward-learning task while event- related potentials were recorded. Also, participants were assessed with regard to self-reported cognitive and affective trait empathy. Relative to healthy controls, patients with MDD showed overall impaired learning and attenuated FRN amplitudes, irrespective of feedback valence and learning type (active vs. observational), but comparable P300 amplitudes. In the patient group, but not in controls, higher trait perspective taking scores were significantly correlated with reduced FRN amplitudes. The pattern of results suggests impaired prediction error processing and a negative effect of higher trait empathy on feedback-based learning in patients with MDD. Copyright © 2015 Elsevier B.V. All rights reserved.

Assessing changes in a patient's condition - Perspectives of intensive care nurses

DEFF Research Database (Denmark)

Kvande, Monica; Delmar, Charlotte; Lykkeslet, Else

2017-01-01

Aim To explore the phenomenon of assessing changes in patients' conditions in intensive care units from the perspectives of experienced intensive care nurses. Background Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes...... in a patient's condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient's condition and in improving patient outcomes. Design and methods This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care...... nurses. The nurses' experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen. Findings An overarching theme of ‘sensitive situational...

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives

Directory of Open Access Journals (Sweden)

Hogden A

2012-11-01

Full Text Available Anne Hogden,1 David Greenfield,1 Peter Nugus,1 Matthew C Kiernan21Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, 2Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, AustraliaBackground: Patients with amyotrophic lateral sclerosis (ALS are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients’ ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS.Methods: An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes.Results: Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients’ reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients’ personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs.Conclusion: Decision-making for symptom management and quality of life in ALS care is enhanced when the

Primary care patients' perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis.

Science.gov (United States)

Moreno-Peral, Patricia; Conejo-Cerón, Sonia; Fernández, Ana; Berenguera, Anna; Martínez-Andrés, María; Pons-Vigués, Mariona; Motrico, Emma; Rodríguez-Martín, Beatriz; Bellón, Juan A; Rubio-Valera, Maria

2015-01-01

Primary care (PC) patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP) activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities. A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society). Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources) were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills) for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists) and family and community stakeholders (teachers or gym trainers) was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic conditions were

Ocular surface squamous neoplasia in HIV-infected patients: current perspectives.

Science.gov (United States)

Rathi, Shweta Gupta; Ganguly Kapoor, Anasua; Kaliki, Swathi

2018-01-01

Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. In this article, we discuss the current perspectives of OSSN associated with HIV infection, focusing mainly on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of these tumors in patients with HIV. Upsurge in the incidence of OSSN with the HIV pandemic most severely affected sub-Saharan Africa, due to associated risk factors, such as human papilloma virus and solar ultraviolet exposure. OSSN has been reported as the first presenting sign of HIV/AIDS in 26%-86% cases, and seropositivity is noted in 38%-92% OSSN patients. Mean age at presentation of OSSN has dropped to the third to fourth decade in HIV-positive patients in developing countries. HIV-infected patients reveal large aggressive tumors, higher-grade malignancy, higher incidence of corneal, scleral, and orbital invasion, advanced-stage T4 tumors, higher need for extended enucleation/exenteration, and increased risk of tumor recurrence. Current management of OSSN in HIV-positive individuals is based on standard treatment guidelines described for OSSN in the general population, as there is little information available about various treatment modalities or their outcomes in patients with HIV. OSSN can occur at any time in the disease course of HIV/AIDS, and no significant trend has been discovered between CD4 count and grade of OSSN. Furthermore, the effect of highly active antiretroviral therapy on OSSN is controversial. The current recommendation is to conduct HIV screening in all cases presenting with OSSN to rule out undiagnosed HIV infection. Patient counseling is crucial, with emphasis on regular follow-up to address high recurrence rates and early presentation to an ophthalmologist for of any symptoms in the unaffected eye. Effective evidence-based interventions are needed to allow early diagnosis

[Blood representations associated to chronic transfused patients: Symbolic interpretations and ethical perspectives].

Science.gov (United States)

Petermann, R; Pêchard, M; Gesbert, C; Assez, N

2016-09-01

Since the beginning of the 20th century, major technological developments have been made in blood transfusion. Although numerous sociological studies have been conducted on donors, few have highlighted transfused patients, and in this case, the attention has almost exclusively been focused on transfusion risks in patients. Conversely, blood representations associated with the chronically transfused patients have not really been explored in the literature. Based on interviews conducted among chronically transfused patients (patients with hemoglobinopathy, malignant hemopathy or cancer), this present study enables to understand their needs and their expectations through their symbolic representations and their interpretations of blood transfusion, raising tensions as well ethical perspectives. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Patient-Focused Benefit-Risk Analysis to Inform Regulatory Decisions: The European Union Perspective.

Science.gov (United States)

Mühlbacher, Axel C; Juhnke, Christin; Beyer, Andrea R; Garner, Sarah

Regulatory decisions are often based on multiple clinical end points, but the perspectives used to judge the relative importance of those end points are predominantly those of expert decision makers rather than of the patient. However, there is a growing awareness that active patient and public participation can improve decision making, increase acceptance of decisions, and improve adherence to treatments. The assessment of risk versus benefit requires not only information on clinical outcomes but also value judgments about which outcomes are important and whether the potential benefits outweigh the harms. There are a number of mechanisms for capturing the input of patients, and regulatory bodies within the European Union are participating in several initiatives. These can include patients directly participating in the regulatory decision-making process or using information derived from patients in empirical studies as part of the evidence considered. One promising method that is being explored is the elicitation of "patient preferences." Preferences, in this context, refer to the individual's evaluation of health outcomes and can be understood as statements regarding the relative desirability of a range of treatment options, treatment characteristics, and health states. Several methods for preference measurement have been proposed, and pilot studies have been undertaken to use patient preference information in regulatory decision making. This article describes how preferences are currently being considered in the benefit-risk assessment context, and shows how different methods of preference elicitation are used to support decision making within the European context. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Developing the Fourth Evaluation Dimension: A Protocol for Evaluation of Video From the Patient's Perspective During Major Incident Exercises.

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Haverkort, J J Mark; Leenen, Luke P H

2017-10-01

Presently used evaluation techniques rely on 3 traditional dimensions: reports from observers, registration system data, and observational cameras. Some of these techniques are observer-dependent and are not reproducible for a second review. This proof-of-concept study aimed to test the feasibility of extending evaluation to a fourth dimension, the patient's perspective. Footage was obtained during a large, full-scale hospital trauma drill. Two mock victims were equipped with point-of-view cameras filming from the patient's head. Based on the Major Incident Hospital's first experience during the drill, a protocol was developed for a prospective, standardized method to evaluate a hospital's major incident response from the patient's perspective. The protocol was then tested in a second drill for its feasibility. New insights were gained after review of the footage. The traditional observer missed some of the evaluation points, which were seen on the point-of-view cameras. The information gained from the patient's perspective proved to be implementable into the designed protocol. Use of point-of-view camera recordings from a mock patient's perspective is a valuable addition to traditional evaluation of trauma drills and trauma care. Protocols should be designed to optimize and objectify judgement of such footage. (Disaster Med Public Health Preparedness. 2017;11:594-599).

Student Views on Assessment Activities: Perspectives from Their Experience on an Undergraduate Programme

Science.gov (United States)

Healy, Margaret; McCutcheon, Maeve; Doran, John

2014-01-01

Research on assessment activities has considered student responses to specific initiatives, but broader concerns underlying these responses have not been fully explored. Using a survey methodology, this paper explores how students view assessment activities, from the perspective of their experience on a four-year undergraduate programme,…

Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care.

OpenAIRE

Chapman, S. C.; Horne, R.; Chater, A.; Hukins, D.; Smithson, W. H.

2014-01-01

BACKGROUND: Nonadherence to antiepileptic drugs (AEDs) can result in suboptimal outcomes for patients. AIM: This study aimed to assess the utility of a theory-based approach to understanding patient perspectives on AEDs and adherence. METHOD: Patients with epilepsy, identified by a GP case note review, were mailed validated questionnaires assessing their perceptions of AEDs and their adherence to them. RESULTS: Most (84.9%) of the 398 AED-treated respondents accepted the necessity of AEDs, bu...

COPD: the patient perspective

Directory of Open Access Journals (Sweden)

Jones PW

2016-02-01

Full Text Available Paul W Jones,1 Henrik Watz,2 Emiel FM Wouters,3 Mario Cazzola4 1Division of Clinical Science, St George’s, University of London, London, UK; 2Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (ARCN, Member of the German Center for Lung Research (DZL, Grosshansdorf, Germany; 3CIRO+, Department of Respiratory Medicine, Maastricht University, Maastricht, the Netherlands; 4Unit of Respiratory Clinical Pharmacology, Department of Systemic Medicine, University of Rome ‘Tor Vergata,’ Rome, Italy Abstract: Chronic obstructive pulmonary disease (COPD is a highly prevalent disease characterized by nonreversible airway obstruction. Well-characterized symptoms such as exertional dyspnea and fatigue have a negative impact on patients’ quality of life (QoL and restrict physical activity in daily life. The impact of COPD symptoms on QoL is often underestimated; for example, 36% of patients who describe their symptoms as being mild-to-moderate also admit to being too breathless to leave the house. Additionally, early morning and nighttime symptoms are a particular problem. Methods are available to allow clinicians to accurately assess COPD symptoms, including patient questionnaires. Integrated approaches to COPD management, particularly pulmonary rehabilitation, are effective strategies for addressing symptoms, improving exercise capacity and, potentially, also increasing physical activity. Inhaled bronchodilators continue to be the mainstay of drug therapy in COPD, where options can be tailored to meet patients’ needs with careful selection of the inhaled medication and the device used for its delivery. Overall, an integrated approach to disease management should be considered for improving QoL and subsequent patient outcomes in COPD. Keywords: COPD, patients, physical actiity levels, pulmonary rehabilitation

Management of hypertension in an Australian community pharmacy setting - patients' beliefs and perspectives.

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Bajorek, Beata V; LeMay, Kate S; Magin, Parker J; Roberts, Christopher; Krass, Ines; Armour, Carol L

2017-08-01

To explore patients' perspectives and experiences following a trial of a pharmacist-led service in hypertension management. A qualitative study comprising individual interviews was conducted. Patients of a community pharmacy, where a pharmacist-led hypertension management service had been trialled in selected metropolitan regions in Sydney (Australia), were recruited to the study. Emergent themes describing patients' experiences and perspectives on the service were elicited via thematic analysis (using manual inductive coding). Patients' (N = 18) experiences of the service were extremely positive, especially around pharmacists' monitoring of blood pressure and provision of advice about medication adherence. Patients' participation in the service was based on their trust in, and relationship with, their pharmacist. The perception of working in a 'team' was conveyed through the pharmacist's caring style of communication and the relaxed atmosphere of the community pharmacy. Patients felt that the community pharmacy was an obvious place for such a service because of their regular contact with the pharmacist, but was limited because the pharmacists were not able to prescribe medication. Patients were extremely positive about the role of, and their experience of, the pharmacy-based hypertension management service. Factors contributing to the patients' positive experiences provide important insights for community pharmacy practice. Good rapport with the pharmacist and a long-term relationship underpin patient engagement in such services. Restrictions on the pharmacists' scope of practice prevent their expertise, and the benefits of their accessibility as a primary point of contact, from being fully realised. © 2016 Royal Pharmaceutical Society.

Is there a mismatch between the perspectives of patients and regulators on healthcare quality? : A survey study

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Bouwman, R.; Bomhoff, M.; Robben, P.; Friele, R.D.

2018-01-01

Objectives: Internationally, healthcare quality regulators are criticized for failing to respond to patients' complaints. Patient involvement is, therefore, an important item on the policy agenda. However, it can be argued that there is a discrepancy between the patients' perspective and current

Is there a mismatch between the perspectives of patients and regulators on healthcare quality? A survey study.

NARCIS (Netherlands)

Bouwman, R.; Bomhoff, M.; Robben, P.; Friele, R.

2017-01-01

Objectives: Internationally, healthcare quality regulators are criticized for failing to respond to patients' complaints. Patient involvement is, therefore, an important item on the policy agenda. However, it can be argued that there is a discrepancy between the patients' perspective and current

Patients' perspectives on quality of life after burn.

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Kool, Marianne B; Geenen, Rinie; Egberts, Marthe R; Wanders, Hendriët; Van Loey, Nancy E

2017-06-01

The concept quality of life (QOL) refers to both health-related outcomes and one's skills to reach these outcomes, which is not yet incorporated in the burn-related QOL conceptualisation. The aim of this study was to obtain a comprehensive overview of relevant burn-specific domains of QOL from the patient's perspective and to determine its hierarchical structure. Concept mapping was used comprising a focus group (n=6), interviews (n=25), and a card-sorting task (n=24) in burn survivors. Participants sorted aspects of QOL based on content similarity after which hierarchical cluster analysis was used to determine the hierarchical structure of burn-related QOL. Ninety-nine aspects of burn-related QOL were selected from the interviews, written on cards, and sorted. The hierarchical structure of burn-related QOL showed a core distinction between resilience and vulnerability. Resilience comprised the domains positive coping and social sharing. Vulnerability included 5 domains subdivided in 13 subdomains: the psychological domain included trauma-related symptoms, cognitive symptoms, negative emotions, body perception and depressive mood; the economical domain comprised finance and work; the social domain included stigmatisation/invalidation; the physical domain comprised somatic symptoms, scars, and functional limitations; and the intimate/sexual domain comprised the relationship with partner, and anxiety/avoidance in sexual life. From the patient's perspective, QOL following burns includes a variety of vulnerability and resilience factors, which forms a fresh basis for the development of a screening instrument. Whereas some factors are well known, this study also revealed overlooked problem and resilience areas that could be considered in client-centred clinical practice in order to customize self-management support. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

New perspectives on understanding cultural diversity in nurse–patient communication.

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Crawford, Tonia; Candlin, Sally; Roger, Peter

Effective communication is essential in developing rapport with patients, and many nursing roles such as patient assessment, education, and counselling consist only of dialogue. With increasing cultural diversity among nurses and patients in Australia, there are growing concerns relating to the potential for miscommunication, as differences in language and culture can cause misunderstandings which can have serious impacts on health outcomes and patient safety (Hamilton & Woodward-Kron, 2010). According to Grant and Luxford (2011)) there is little research into the way health professionals approach working with cultural difference or how this impacts on their everyday practice. Furthermore, there has been minimal examination of intercultural nurse–patient communication from a linguistic perspective. Applying linguistic frameworks to nursing practice can help nurses understand what is happening in their communication with patients, particularly where people from different cultures are interacting. This paper discusses intercultural nurse–patient communication and refers to theoretical frameworks from applied linguistics to explain how miscommunication may occur. It illustrates how such approaches will help to raise awareness of underlying causes and potentially lead to more effective communication skills, therapeutic relationships and therefore patient satisfaction and safety.

A literature review of quality in lower gastrointestinal endoscopy from the patient perspective

OpenAIRE

Sewitch, Maida J; Gong, Shasha; Dubé, Catherine; Barkun, Alan; Hilsden, Robert; Armstrong, David

2011-01-01

BACKGROUND: Given the limited state of health care resources, increased demand for colorectal cancer (CRC) screening raises concerns about the quality of endoscopy services. Little is known about quality in colonoscopy and endoscopy from the patient perspective.OBJECTIVE: To systematically review the literature on quality that is relevant to patients who require colonoscopy or endoscopy services.METHODS: A systematic PubMed search was performed on articles that were published between January ...

Revealing School Counselors' Perspectives on Using Physical Activity and Consulting with Coaches

Science.gov (United States)

Hayden, Laura; Silva, Meghan Ray; Gould, Kaitlin

2018-01-01

This study reveals school counselors' perspectives on using physical activity and a consultative process with coaches to provide school-based support for youth. Emerging from this exploration are ways that school-based physical activity might be used to help students develop life skills and to remove barriers to systemic integration of…

Temporal perspective and other psychological factors making it difficult to adapt to requirements of treatment in chronic dialysis patients

OpenAIRE

Zawadzka, Barbara; Byrczek, Magdalena; Zawadzka, Sara

2014-01-01

Aim. The study analyzed the relationship between temporal perspective, selected personal resources, and unhealthy behavior, manifesting in problems with adherence to fluid intake restrictions, in chronic hemodialyzis patients. The authors tried to answer the question whether there is temporal perspective and other psychological factors increasing the risk of non-adaptive behaviors. Methods. Sixty-one patients, aged 23–81 years (M = 59; SD = 13,9) on chronic hemodialysis at the Departmen...

Bevacizumab in the treatment of NSCLC: patient selection and perspectives

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Russo AE

2017-12-01

Full Text Available Alessia E Russo,1 Domenico Priolo,1 Giovanna Antonelli,1 Massimo Libra,2 James A McCubrey,3 Francesco Ferraù1 1Medical Oncology Department, San Vincenzo Hospital, Taormina (Messina, Italy; 2Laboratory of Translational Oncology & Functional Genomics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 3Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, USA Abstract: Non-small-cell lung cancer (NSCLC represents about 85% of all lung cancers, and more than half of NSCLCs are diagnosed at an advanced stage. Chemotherapy has reached a plateau in the overall survival curve of about 10 months. Therefore, in last decade novel targeted approaches have been developed to extend survival of these patients, including antiangiogenic treatment. Vascular endothelial growth factor (VEGF signaling pathway plays a dominant role in stimulating angiogenesis, which is the main process promoting tumor growth and metastasis. Bevacizumab (bev; Avastin® is a recombinant humanized monoclonal antibody that neutralizes VEGF’s biologic activity through a steric blocking of its binding with VEGF receptor. Currently, bev is the only antiangiogenic agent approved for the first-line treatment of advanced or recurrent nonsquamous NSCLC in “bev-eligible” patients. The ineligibility to receive bev is related to its toxicity. In the pivotal trials of bev in NSCLC, fatal bleeding events including pulmonary hemorrhage were observed with rates higher in the chemotherapy-plus-bev group. Therefore, in order to reduce the incidence of severe pulmonary hemorrhage, numerous exclusion criteria have been characteristically applied for bev such as central tumor localization or tumor cavitation, use of anticoagulant therapy, presence of brain metastases, age of patients (elderly. Subsequent studies designed to evaluate the safety of bev have demonstrated that this agent is safe and

Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran.

Science.gov (United States)

Mohajjel-Aghdam, Alireza; Hassankhani, Hadi; Zamanzadeh, Vahid; Khameneh, Saied; Moghaddam, Sara

2013-09-01

Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective. A descriptive study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13. Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives.

Adults' future time perspective predicts engagement in physical activity.

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Stahl, Sarah T; Patrick, Julie Hicks

2012-07-01

Our aim was to examine how the relations among known predictors of physical activity, such as age, sex, and body mass index, interact with future time perspective (FTP) and perceived functional limitation to explain adults' engagement in physical activity. Self-report data from 226 adults (range 20-88 years) were collected to examine the hypothesis that a more expansive FTP is associated with engagement in physical activity. Results indicated a good fit of the data to the model χ(2) (4, N = 226) = 7.457, p = .14 and accounted for a moderate amount of variance in adults' physical activity (R(2) = 15.7). Specifically, results indicated that perceived functional limitation (β = -.140) and FTP (β = .162) were directly associated with physical activity. Age was indirectly associated with physical activity through its association with perceived functional limitation (β = -.264) and FTP (β = .541). Results indicate that FTP may play an important role in explaining engagement in health promoting behaviors across the life span. Researchers should consider additional constructs and perhaps adopt socioemotional selectivity theory when explaining adults' engagement in physical activity.

Gain versus loss framing in adherence-promoting communication targeting patients with chronic diseases: the moderating effect of individual time perspective.

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Zhao, Xiaoquan; Villagran, Melinda M; Kreps, Gary L; McHorney, Colleen

2012-01-01

This study investigated the joint effect of message framing and time perspective in adherence-promoting communication targeting patients with chronic diseases. Based on previous framing and time perspective research, it was hypothesized that the gain frame would show an advantage over the loss frame among future-oriented patients; for present-oriented patients, it was hypothesized that the framing effect would be relatively indistinct. In total, 1,108 currently nonadherent patients with chronic disease participated in an experiment where they were randomly assigned to either gain- or loss-framed messages addressing key beliefs underlying their nonadherence or a no-message control condition. Intention and attitude regarding future adherence as well as message perceptions were measured after message presentation. Results of this study generally supported the hypotheses. Message topics-whether the messages addressed patients' perceived need for medications or concerns about side effects-did not moderate the effect of framing or the interaction between framing and time perspective. Theoretical and practical implications are discussed.

Patient activation and use of an electronic patient portal.

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Ancker, Jessica S; Osorio, Snezana N; Cheriff, Adam; Cole, Curtis L; Silver, Michael; Kaushal, Rainu

2015-01-01

Electronic patient portals give patients access to personal medical data, potentially creating opportunities to improve knowledge, self-efficacy, and engagement in healthcare. The combination of knowledge, self-efficacy, and engagement has been termed activation. Our objective was to assess the relationship between patient activation and outpatient use of a patient portal. Survey. A telephone survey was conducted with 180 patients who had been given access to a portal, 113 of whom used it and 67 of whom did not. The validated patient activation measure (PAM) was administered along with questions about demographics and behaviors. Portal users were no different from nonusers in patient activation. Portal users did have higher education level and more frequent Internet use, and were more likely to have precisely 2 prescription medications than to have more or fewer. Patients who chose to use an electronic patient portal were not more highly activated than nonusers, although they were more educated and more likely to be Internet users.

Service quality of private hospitals: the Iranian patients' perspective.

Science.gov (United States)

Zarei, Asghar; Arab, Mohammad; Froushani, Abbas Rahimi; Rashidian, Arash; Ghazi Tabatabaei, S Mahmoud

2012-02-02

Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.

Guilty but good: defending voluntary active euthanasia from a virtue perspective.

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Begley, Ann Marie

2008-07-01

This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The doctor's action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached.

Ethical challenges within Veterans Administration healthcare facilities: perspectives of managers, clinicians, patients, and ethics committee chairpersons.

Science.gov (United States)

Foglia, Mary Beth; Pearlman, Robert A; Bottrell, Melissa; Altemose, Jane K; Fox, Ellen

2009-04-01

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions.

Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran

Directory of Open Access Journals (Sweden)

Sara Moghaddam

2013-08-01

Full Text Available Introduction: Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective.Methods: A cross-sectional comparative study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13.Results: Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. Conclusion: According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives.

Ocular surface squamous neoplasia in HIV-infected patients: current perspectives

Directory of Open Access Journals (Sweden)

Rathi SG

2018-03-01

Full Text Available Shweta Gupta Rathi, Anasua Ganguly Kapoor, Swathi Kaliki Operation Eyesight Universal Institute for Eye Cancer, LV Prasad Eye Institute, Hyderabad, India Abstract: Ocular surface squamous neoplasia (OSSN refers to a spectrum of conjunctival and corneal epithelial tumors including dysplasia, carcinoma in situ, and invasive carcinoma. In this article, we discuss the current perspectives of OSSN associated with HIV infection, focusing mainly on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of these tumors in patients with HIV. Upsurge in the incidence of OSSN with the HIV pandemic most severely affected sub-Saharan Africa, due to associated risk factors, such as human papilloma virus and solar ultraviolet exposure. OSSN has been reported as the first presenting sign of HIV/AIDS in 26%–86% cases, and seropositivity is noted in 38%–92% OSSN patients. Mean age at presentation of OSSN has dropped to the third to fourth decade in HIV-positive patients in developing countries. HIV-infected patients reveal large aggressive tumors, higher-grade malignancy, higher incidence of corneal, scleral, and orbital invasion, advanced-stage T4 tumors, higher need for extended enucleation/exenteration, and increased risk of tumor recurrence. Current management of OSSN in HIV-positive individuals is based on standard treatment guidelines described for OSSN in the general population, as there is little information available about various treatment modalities or their outcomes in patients with HIV. OSSN can occur at any time in the disease course of HIV/AIDS, and no significant trend has been discovered between CD4 count and grade of OSSN. Furthermore, the effect of highly active antiretroviral therapy on OSSN is controversial. The current recommendation is to conduct HIV screening in all cases presenting with OSSN to rule out undiagnosed HIV infection. Patient counseling is crucial, with emphasis on regular follow-up to address

Primary care patients' perspectives of barriers and enablers of primary prevention and health promotion-a meta-ethnographic synthesis.

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Patricia Moreno-Peral

Full Text Available Primary care (PC patients have difficulties in committing to and incorporating primary prevention and health promotion (PP&HP activities into their long-term care. We aimed to re-interpret, for the first time, qualitative findings regarding factors affecting PC patients' acceptance of PP&HP activities.A meta-ethnographic synthesis was generated following electronic and manual searches that retrieved 29 articles. Papers were reviewed and translated to produce a re-interpretation of the extracted concepts. The factors affecting PC patients' receptiveness to PP&HP activities were framed in a four-level ecological model (intrapersonal, interpersonal, institutional and environment and society. Intrapersonal factors (patients' beliefs/attitudes, knowledge, skills, self-concept, motivation and resources were the most numerous, with almost 25 different factors. Public health education to modify erroneous beliefs and values regarding PP&HP could encourage a transition to healthier lifestyles. Health care professionals' abilities to communicate and involve patients in the decision-making process can act as facilitators. Biopsychosocial training (with emphasis on communication skills for health professionals must start with undergraduates. Increased consultation time, the use of reminders, follow-up visits and tools for communicating risk and motivating patients could be applied at the intrapersonal level. Collaborative care involving other health professionals (nutritionists or psychotherapists and family and community stakeholders (teachers or gym trainers was important in developing healthier habits. Patients also cited barriers related to the built environment and socioeconomic difficulties that highlighted the need for policies promoting social justice and equity. Encouraging PP&HP using social marketing strategies and regulating media to control its impact on health were also cited. Only the perspectives of PC patients in the context of chronic

Service quality of hospital outpatient departments: patients' perspective.

Science.gov (United States)

Zarei, Ehsan

2015-01-01

Assessment of patient perceptions of health service quality as an important element in quality assessments has attracted much attention in recent years. The purpose of this paper is to assess the service quality of hospital outpatient departments affiliated to Shahid Beheshti University of Medical Sciences from the patients' perspective. This cross-sectional study was conducted in 2014 in Tehran, Iran. The study samples included 500 patients who were selected by multi-stage random sampling from four hospitals. The data collection instrument was a questionnaire consisting of 50 items, and the validity and reliability of the questionnaire were confirmed. For data analysis, exploratory and confirmatory factor analysis, Friedman test, and descriptive statistics were used through LISREL 8.54 and SPSS 18 applications. Eight significant factors were extracted for outpatient service quality, which explained about 67 per cent of the total variance. Physician consultation, information provided to the patient, and the physical environment of the clinic were the three determining factors of the quality of outpatient services. The highest and lowest perceptions were related to physician consultation and perceived waiting time dimension, respectively. The mean score of patients' perception of outpatient service quality was 3.89 (±0.60). About 59.5 per cent of patients assessed the quality of outpatient services as good, 38.2 per cent as moderate, and 2.3 per cent as poor. Practical implications - The instrument developed for this study is valid and reliable, and it can help hospital managers to identify the areas needing improvement and correction. According to the findings of this study, the majority of patients had a positive experience with outpatient departments of teaching hospitals, and the services provided in these centres were of adequate quality, based on patient assessments.

Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships: A Multicenter Study.

Science.gov (United States)

Schlegel, Claudia; Bonvin, Raphael; Rethans, Jan-Joost; Van der Vleuten, Cees

2016-08-01

The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs. The study was conducted using a qualitative research design, with semistructured individual in-depth interviews to understand the reactions, values, and perceptions that underlie and influence SP behavior. To cover SP perspectives from more than 1 SP program, a total of 15 SPs from 8 different nursing schools and medical schools in Switzerland were asked to participate. Standardized patients feel motivated, engaged, and willing to invest effort in their task and do not mind demands increasing as long as the social environment in SP programs is supportive. The role of the SP trainer and the use of feedback are considered very important. Standardized patient programs require concepts in which the SP perspective has been integrated to better serve SPs' well-being. Standardized patients are valuable partners in the training of health professionals-we need to take care of them.

Patient's and health care provider's perspectives on music therapy in palliative care - an integrative review.

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Schmid, W; Rosland, J H; von Hofacker, S; Hunskår, I; Bruvik, F

2018-02-20

The use of music as therapy in multidisciplinary end-of-life care dates back to the 1970s and nowadays music therapy (MT) is one of the most frequently used complementary therapy in in-patient palliative care in the US. However existing research investigated music therapy's potential impact mainly from one perspective, referring to either a quantitative or qualitative paradigm. The aim of this review is to provide an overview of the users' and providers' perspectives on music therapy in palliative care within one research article. A systematic literature search was conducted using several databases supplemented with a hand-search of journals between November 1978 and December 2016. Inclusion criteria were: Music therapy with adults in palliative care conducted by a certified music therapist. Both quantitative and qualitative studies in English, German or a Scandinavian language published in peer reviewed journals were included. We aimed to identify and discuss the perspectives of both patients and health care providers on music therapy's impact in palliative care to forward a comprehensive understanding of it's effectiveness, benefits and limitations. We investigated themes mentioned by patients within qualitative studies, as well as commonly chosen outcome measures in quantitative research. A qualitative approach utilizing inductive content analysis was carried out to analyze and categorize the data. Twelve articles, reporting on nine quantitative and three qualitative research studies were included. Seven out of the nine quantitative studies investigated pain as an outcome. All of the included quantitative studies reported positive effects of the music therapy. Patients themselves associated MT with the expression of positive as well as challenging emotions and increased well-being. An overarching theme in both types of research is a psycho-physiological change through music therapy. Both quantitative as well as qualitative research showed positive changes in

[Discontinuation of potentially inappropriate medications at the end of life: perspectives from patients, their relatives, and physicians

NARCIS (Netherlands)

Geijteman, E.C.; Tempelman, M.M.; Dees, M.K.; Huisman, B.A.H.; Perez, R.S.; Zuylen, L. van; Heide, A. van der

2017-01-01

OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life

Patient neglect in 21st century health-care institutions: a community health psychology perspective.

Science.gov (United States)

Reader, Tom W; Gillespie, Alex; Mannell, Jenevieve

2014-01-01

Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.

Older People's Perspectives on Health, Physical Activity and Nutritional Behaviors

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Leila Alizadeh

2015-12-01

Full Text Available Background: Approaches for investigating health-promoting lifestyle generally focus on physical activ­ity and regular diet. To explore the perspectives of Iranian elders regarding health, healthy eating and physical activity (PA this study was conducted in 2012. Methods: Participants in this qualitative study were selected through purposeful sampling. Ten focus groups were conducted with 60 older adults in 3 elderly centers in Tehran. A moderator’s guideline that consisted of general and specific questions was used. Focus groups were audio recorded, transcribed verbatim and analysis was performed using conventional content analysis. Results: Participants explained their perspectives regarding health, healthy eating and PA in the follow­ing 5 categories: meaning of health was represented based on issues such as absence of pain and disor­der, complete body wellbeing, staying away from hazards, complete individual satisfaction, experiencing positive events, effective communication, faithfulness and trust in God. The healthy eating category was featured by adequate eating, age balanced diet, refraining from under or over nutrition and sensible consumption of fruits and vegetables. The PA was described - according to the level of performing outdoor activities or household tasks. Expressions about the perceived benefits and barriers of healthy eating and PA were aligned the two remaining categories. Conclusions: Participants have referred to the association between both PA and dietary practices and health. Understanding how older people define physical activity and nutritional behavior and recognition of the most important perceived benefits and barriers that might contribute to have a healthy eating or adequate PA profile could procure insight into the type of interventions that are required to promote healthy lifestyle among Iranian older adults.

The Therapeutic Approach to a Patient's Criminal Offense in a Forensic Mental Health Nurse-Patient Relationship-The Nurses' Perspectives.

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Askola, Riitta; Nikkonen, Merja; Putkonen, Hanna; Kylmä, Jari; Louheranta, Olavi

2017-07-01

The purpose of this study is to describe the therapeutic approach to a patient's criminal offense in a forensic mental health nurse-patient relationship from the nurse's perspective. Eight nurses in a Finnish forensic psychiatric hospital were interviewed, and the resultant research material was analyzed by inductive content analysis. The results revealed the process of the therapeutic approach to a patient's offense, which comprises numerous steps and various phases. For the nurse, the process of working through the offense can be divided into stages in which an attempt is made to respond to the patient's behavior and interaction in a manner that leads to working through the criminal act. © 2016 Wiley Periodicals, Inc.

Patient perspectives on Parkinson’s disease therapy in Japan and the United States: results of two patient surveys

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Hattori N

2012-07-01

Full Text Available Nobutaka Hattori,1 Kenichi Fujimoto,2 Tomoyoshi Kondo,3 Miho Murata,4 Mark Stacy51Department of Neurology, Juntendo University School of Medicine, Tokyo; 2Department of Neurology, Jichi Medical University, Tochigi; 3Department of Neurology, Wakayama Medical University, Wakayama; 4Department of Neurology, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan; 5Division of Neurology, Duke University, Durham, NC, USABackground: Despite evidence suggesting that patient attitudes towards therapy may influence treatment outcomes, the impact of these factors on treatment for Parkinson’s disease is poorly understood. These two surveys, based in Japan and the US, investigated the attitudes of patients towards antiparkinsonian medications, the complications of these therapies, and how these differ across geographies.Methods: The US PRELUDE survey collected data from May 13 to May 20, 2003, from 300 interviews with patients with Parkinson’s disease from the National Parkinson Foundation. The Japanese survey was carried out from June to December 2008 in a stepwise manner using questionnaires (n = 3548 followed by interviews with those who had consented to participate in the questionnaire (n = 407. Both surveys assessed the attitudes of patients towards therapies for Parkinson’s disease and associated complications.Results: Dyskinesia was not a major challenge of therapy for Parkinson’s disease, and wearing-off caused greater concern in the US, while hallucinations had a greater emphasis in Japan. Patients who had previously experienced dyskinesia were less concerned about this side effect than those who had not. Although pill burden was thought to be a concern in the US, Japanese patients did not indicate that pill burden would limit their drug intake. There were also discrepancies between the perspectives and concerns of patients and those of their treating physicians.Conclusion: Recognizing patient perspectives regarding therapies for

Patients' perceptions of palliative care: adaptation of the Quality from the Patient's Perspective instrument for use in palliative care, and description of patients' perceptions of care received.

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Sandsdalen, Tuva; Rystedt, Ingrid; Grøndahl, Vigdis Abrahamsen; Hov, Reidun; Høye, Sevald; Wilde-Larsson, Bodil

2015-11-02

Instruments specific to palliative care tend to measure care quality from relative perspectives or have insufficient theoretical foundation. The instrument Quality from the Patient's Perspective (QPP) is based on a model for care quality derived from patients' perceptions of care, although it has not been psychometrically evaluated for use in palliative care. The aim of this study was to adapt the QPP for use in palliative care contexts, and to describe patients' perceptions of the care quality in terms of the subjective importance of the care aspects and the perceptions of the care received. A cross-sectional study was conducted between November 2013 and December 2014 which included 191 patients (73% response rate) in late palliative phase at hospice inpatient units, hospice day-care units, wards in nursing homes that specialized in palliative care and homecare districts, all in Norway. An explorative factor analysis using principal component analysis, including data from 184 patients, was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's alpha and paired t-tests were used to describe patients' perceptions of their care. The QPP instrument was adapted for palliative care in four steps: (1) selecting items from the QPP, (2) modifying items and (3) constructing new items to the palliative care setting, and (4) a pilot evaluation. QPP instrument specific to palliative care (QPP-PC) consists of 51 items and 12 factors with an eigenvalue ≥1.0, and showed a stable factor solution that explained 68.25% of the total variance. The reliability coefficients were acceptable for most factors (0.79-0.96). Patients scored most aspects of care related to both subjective importance and actual care received as high. Areas for improvement were symptom relief, participation, continuity, and planning and cooperation. The QPP-PC is based on a theoretical model of quality of care, and has its roots in patients' perspectives. The instrument was

Descriptions of health states associated with increasing severity and frequency of hypoglycemia: a patient-level perspective

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Harris SB

2013-09-01

Full Text Available Stewart B Harris,1 Kamlesh Khunti,2 Mona Landin-Olsson,3 Claus B Galbo-Jørgensen,4 Mette Bøgelund,4 Barrie Chubb,5 Jens Gundgaard,6 Marc Evans71Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; 2Diabetes Research Unit, University of Leicester, Leicester, UK; 3Department of Medicine, Helsingborg Hospital, Lund University, Lund, Sweden; 4Incentive, Holte Stationsvej, Holte, Denmark; 5EU Health Economics and Outcomes Research, Novo Nordisk Ltd, Crawley, UK; 6Health Economics and HTA, Novo Nordisk A/S, Søborg, Denmark; 7Department of Diabetes, University Hospital Llandough, Cardiff, UKAims: We sought to develop descriptions of health states associated with daytime and nocturnal hypoglycemia in a structured fashion from the patient's perspective under different combinations of severity and frequency of hypoglycemic events.Methods: An expert meeting followed by two patient focus groups was used to develop comprehensive descriptions of acute consequences of severe and non-severe, daytime and nocturnal hypoglycemia. Patients with diabetes (type 1 = 85, type 2 = 162 from a survey panel then validated these descriptions and assessed how often they worried and took different actions to prevent hypoglycemia. Severity and frequency of hypoglycemia were compared with respect to how often people worried and took actions to prevent an event. The effect of hypoglycemia on 35 different life activities was quantitatively compared for patients who had and had not experienced a severe hypoglycemic event.Results: At least 95% of respondents agreed that the detailed patient-level descriptions of health states accurately reflected their experience of severe and non-severe, daytime and nocturnal hypoglycemia, thereby validating these descriptions. Respondents who had experienced a severe hypoglycemic event were generally more adversely affected in their worries and actions and life events than those who experienced only non

Media hype: Patient and scientific perspectives on misleading medical news.

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Robledo, Israel; Jankovic, Joseph

2017-09-01

In this age of digital technology, Internet, and social media we are increasingly subjected to an information and disinformation overload. This includes not only political and economic information but also medical news, which is often presented as a "new discovery", "miracle cure" or some other press hyperbole. In this viewpoint article we present patient and scientific perspectives some recent episodes of medical hype related to Parkinson's disease research, including proposed therapies such as nilotinib, marijuana, stem cells and other controversial therapies that have attracted the mainstream and social media. We conclude by emphasizing the importance of vigilance on the part of patients and physicians when interpreting these often exaggerated and/or unfounded health claims. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Collagenase Clostridium histolyticum in the treatment of Peyronie’s disease: patient selection and perspectives

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Kuhlmann PK

2017-03-01

Full Text Available Paige K Kuhlmann,1 Kenneth J DeLay,2 James Anaissie,2 Wayne JG Hellstrom,2 Faysal A Yafi3 1University of Missouri-Columbia School of Medicine, Columbia, MO, 2Department of Urology, Tulane University School of Medicine, New Orleans, LA, 3Department of Urology, University of California Irvine, Orange, CA, USA Abstract: The safety and efficacy of the use of collagenase Clostridium histolyticum (CCH for the treatment of Peyronie’s disease has been confirmed over the past several years. However, identification of the ideal patient population for use of this treatment is not well established. Multiple studies have attempted to delineate various patient-specific factors that may predict response to treatment with CCH, with the intent of enhancing patient selection. To date, these include baseline curvature severity, duration of disease, disease phase at presentation, plaque calcification, baseline erectile function, plaque size, age, comorbid diabetes, previous penile trauma, responsiveness to first treatment cycle, baseline penile shortening or pain, prior treatment with intralesional injection, compliance with plaque modeling, and atypical curvature. In addition, other studies have sought to explore various aspects of treatment with CCH that may affect patient perspective of treatment. They have focused on patient-reported outcomes, female partner considerations, cost of treatment, and potential confounders of patient satisfaction. This review provides a summary and analysis of currently available literature on topics of patient selection and perspectives in regard to treatment of Peyronie’s disease with CCH. Keywords: Peyronie’s disease, collagenase Clostridium histolyticum, Peyronie’s disease questionnaire, curvature deformity, intralesional injection, erectile function

Understanding barriers to glycaemic control from the patient's perspective

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Janes R

2013-06-01

Full Text Available INTRODUCTION: To better understand barriers to glycaemic control from the patient's perspective. METHODS: An interpretative phenomenological approach was used to study the experiences of 15 adults with Type 2 diabetes. Participants each gave a semi-structured interview of their experiences of living with diabetes. Interviews were transcribed, and themes extracted and organised using a patientcentred framework. FINDINGS: Participants' stories confirmed many of the barriers in the literature, particularly those related to context, such as family, finances, work. Barriers also related to negative emotional reactions to diabetes: fear of new events (diagnosis, starting pills/insulin; guilt about getting diabetes and not controlling it; and shame about having diabetes. Barriers also related to unscientific beliefs and personal beliefs. There were additional barriers related to poor clinician-patient relationships. Overall, participants had a poor understanding of diabetes, and complained that their clinician simply 'told them what to do'. CONCLUSION: Using a patient-centred approach, this study identified many barriers to glycaemic control. We suggest that a key barrier is clinician ignorance of their patients' fears, beliefs, expectations, context; of what constitutes a positive therapeutic relationship; and of the limitations of a biomedical approach to patient non-adherence. Faced with both a worsening diabetes epidemic and increasing health care workforce shortages, clinicians urgently need to understand that it is they, not their patients, who must change their approach if diabetes care is to be improved.

A question of balance: Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity.

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Eli, Karin; Howell, Kyndal; Fisher, Philip A; Nowicka, Paulina

2016-04-01

Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied. The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives. We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity. The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status. Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Oncology healthcare professionals' perspectives on the psychosocial support needs of cancer patients during oncology treatment.

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Aldaz, Bruno E; Treharne, Gareth J; Knight, Robert G; Conner, Tamlin S; Perez, David

2017-09-01

This study explored oncology healthcare professionals' perspectives on the psychosocial support needs of diverse cancer patients during oncology treatment. Six themes were identified using thematic analysis. Healthcare professionals highlighted the importance of their sensitivity, respect and emotional tact during appointments in order to effectively identify and meet the needs of oncology patients. Participants also emphasised the importance of building rapport that recognises patients as people. Patients' acceptance of treatment-related distress and uncertainty was described as required for uptake of available psychosocial supportive services. We offer some practical implications that may help improve cancer patients' experiences during oncology treatment.

ACTIVITIES RESULTS AIMED AT IMPROVED MEDICAL ASSISTANCE TO THE VASCULAR PATIENTS IN TOMSK REGION

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D. M. Plotnikov

2013-01-01

Full Text Available Acute disorders of cerebral circulation remain serious medical and social problem associated with high disability and mortality rates. Since 2011 Tomsk oblast is a participating member of the medical campaign aimed at improved medical services to the vascular patients. The preliminary implementation data analysis for 2012 revealed improvement of most of the indices of medical support to patients suffering from acute cerebral circulation; increased number of the in-patient cases (Regional Vascular Center and primary vascular department, decreased lethality rates from strokes, specifically hemorrhagic cases. Strict observance of the Regulations on Medical Assistance for stroke patients and the using of modern methods of therapy allowed to decrease hospital mortality in the Primary Vascular Departments and early mortality in the Regional Vascular Center. The active implementation of neurorehabilitation approaches resulted in the increased number of patients who do not require third parties’ assistance. Analysis of the work of the departments helped to identifying current problems and perspectives of further development of special medical care for stroke patients.

Communication between physicians and cancer patients about complementary and alternative medicine: exploring patients' perspectives.

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Tasaki, Katsuya; Maskarinec, Gertraud; Shumay, Dianne M; Tatsumura, Yvonne; Kakai, Hisako

2002-01-01

The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease. Copyright 2002 John Wiley & Sons, Ltd.

Adolescent Perspectives on Patient-Provider Sexual Health Communication: A Qualitative Study.

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Hoopes, Andrea J; Benson, Samantha K; Howard, Heather B; Morrison, Diane M; Ko, Linda K; Shafii, Taraneh

2017-10-01

Adolescents in the United States are disproportionately affected by sexually transmitted infections and unintended pregnancy. Adolescent-centered health services may reduce barriers to health care; yet, limited research has focused on adolescents' own perspectives on patient-provider communication during a sexual health visit. Twenty-four adolescents (14-19 years old) seeking care in a public health clinic in Washington State participated in one-on-one qualitative interviews. Interviews explored participants' past experiences with medical providers and their preferences regarding provider characteristics and communication strategies. Interviews revealed that (1) individual patient dynamics and (2) patient-provider interaction dynamics shape the experience during a sexual health visit. Individual patient dynamics included evolving level of maturity, autonomy, and sexual experience. Patient-provider interaction dynamics were shaped by adolescents' perceptions of providers as sources of health information who distribute valued sexual health supplies like contraception and condoms. Participant concerns about provider judgment, power differential, and lack of confidentiality also emerged as important themes. Adolescents demonstrate diverse and evolving needs for sexual health care and interactions with clinicians as they navigate sexual and emotional development.

Physical activity perceptions, context, barriers, and facilitators from a Hispanic child's perspective

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Ross, Sharon E. Taverno; Francis, Lori A.

2016-01-01

Background In order to develop effective physical activity interventions and to address the burden of obesity in Hispanic children, qualitative studies are needed to build descriptive theory and expand the state of the science. The purpose of this study is to describe physical activity perceptions, context, facilitators, and barriers from the perspective of Hispanic immigrant-origin children. Method This in-depth, ethnographic study included 14, 6- to 11-year old, first- and second- generation Hispanic children recruited from an afterschool program in Southeastern Pennsylvania, USA. Methods included child observation, field notes, semi-structured interviews, and a PhotoVoice activity. Transcripts and field notes were coded and analyzed using the constant comparison method to identify overarching themes and patterns in the data. Results Data analysis yielded four overarching themes regarding children's perspectives on physical activity. Children engaged in a variety of physical activities and sedentary behaviors, which differed by physical (e.g., park, outside home, and afterschool programs) and social (e.g., parents, siblings, and friends) contexts. Children discussed specific benefits of physical activity. Children's negative attitudes toward physical activity were related to physical discomfort, low athletic competence, and safety concerns. Children perceived physical activity and play to be one in the same, and “fun” was identified as a primary driver of physical activity preferences. The facilitators and barriers to physical activity were related to specific parent/home, school, and neighborhood factors. Conclusion Findings from this study suggest that an emphasis on fun and active play, while taking into account family and neighborhood context, may be a desirable intervention approach in Hispanic immigrant-origin children. This study lays the groundwork for future studies to further explore some of the themes identified here to better understand children

Physical activity perceptions, context, barriers, and facilitators from a Hispanic child's perspective

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Sharon E. Taverno Ross

2016-08-01

Full Text Available Background: In order to develop effective physical activity interventions and to address the burden of obesity in Hispanic children, qualitative studies are needed to build descriptive theory and expand the state of the science. The purpose of this study is to describe physical activity perceptions, context, facilitators, and barriers from the perspective of Hispanic immigrant-origin children. Method: This in-depth, ethnographic study included 14, 6- to 11-year old, first- and second- generation Hispanic children recruited from an afterschool program in Southeastern Pennsylvania, USA. Methods included child observation, field notes, semi-structured interviews, and a PhotoVoice activity. Transcripts and field notes were coded and analyzed using the constant comparison method to identify overarching themes and patterns in the data. Results: Data analysis yielded four overarching themes regarding children's perspectives on physical activity. Children engaged in a variety of physical activities and sedentary behaviors, which differed by physical (e.g., park, outside home, and afterschool programs and social (e.g., parents, siblings, and friends contexts. Children discussed specific benefits of physical activity. Children's negative attitudes toward physical activity were related to physical discomfort, low athletic competence, and safety concerns. Children perceived physical activity and play to be one in the same, and “fun” was identified as a primary driver of physical activity preferences. The facilitators and barriers to physical activity were related to specific parent/home, school, and neighborhood factors. Conclusion: Findings from this study suggest that an emphasis on fun and active play, while taking into account family and neighborhood context, may be a desirable intervention approach in Hispanic immigrant-origin children. This study lays the groundwork for future studies to further explore some of the themes identified here to better

Patients' perspective on deactivation of the implantable cardioverter-defibrillator near the end of life

DEFF Research Database (Denmark)

Pedersen, Susanne S.; Chaitsing, Rismy; Szili-Torok, Tamas

2013-01-01

(67%) completed the survey. Most patients (68%) were aware that it is possible to turn the ICD off, and 95% believed it is important to inform patients about the possibility. Of the patients completing the survey, 84% indicated a choice for or against deactivation. Psychological morbidity......Recent guidelines have emphasized the importance of discussing the issue of deactivation near the end of life with patients with an implantable cardioverter-defibrillator (ICD). Few studies have examined the patient perspective and patients' wishes. We examined patients' knowledge and wishes...... for information; and the prevalence and correlates of a favorable attitude toward deactivation. Three cohorts of ICD patients (n = 440) extracted from our institutional database were asked to complete a survey that included a vignette about deactivation near the end of life. Of the 440 patients approached, 294...

Medical Student Perspectives of Active Learning: A Focus Group Study.

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Walling, Anne; Istas, Kathryn; Bonaminio, Giulia A; Paolo, Anthony M; Fontes, Joseph D; Davis, Nancy; Berardo, Benito A

2017-01-01

Phenomenon: Medical student perspectives were sought about active learning, including concerns, challenges, perceived advantages and disadvantages, and appropriate role in the educational process. Focus groups were conducted with students from all years and campuses of a large U.S. state medical school. Students had considerable experience with active learning prior to medical school and conveyed accurate understanding of the concept and its major strategies. They appreciated the potential of active learning to deepen and broaden learning and its value for long-term professional development but had significant concerns about the efficiency of the process, the clarity of expectations provided, and the importance of receiving preparatory materials. Most significantly, active learning experiences were perceived as disconnected from grading and even as impeding preparation for school and national examinations. Insights: Medical students understand the concepts of active learning and have considerable experience in several formats prior to medical school. They are generally supportive of active learning concepts but frustrated by perceived inefficiencies and lack of contribution to the urgencies of achieving optimal grades and passing United States Medical Licensing Examinations, especially Step 1.

Patient perspectives on delays in diagnosis and treatment of cancer: a qualitative analysis of free-text data.

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Parsonage, Rachel K; Hiscock, Julia; Law, Rebecca-Jane; Neal, Richard D

2017-01-01

Earlier cancer diagnosis is crucial in improving cancer survival. The International Cancer Benchmarking Partnership Module 4 (ICBP4) is a quantitative survey study that explores the reasons for delays in diagnosis and treatment of breast, colorectal, lung, and ovarian cancer. To further understand the associated diagnostic processes, it is also important to explore the patient perspectives expressed in the free-text comments. To use the free-text data provided by patients completing the ICBP4 survey to augment the understanding of patients' perspectives of their diagnostic journey. Qualitative analysis of the free-text data collected in Wales between October 2013 and December 2014 as part of the ICBP4 survey. Newly-diagnosed patients with either breast, ovarian, colorectal, or lung cancer were identified from registry data and then invited by their GPs to participate in the survey. A thematic framework was used to analyse the free-text comments provided at the end of the ICBP4 survey. Of the 905 patients who returned a questionnaire, 530 included comments. The free-text data provided information about patients' perspectives of the diagnostic journey. Analysis identified factors that acted as either barriers or facilitators at different stages of the diagnostic process. Some factors, such as screening, doctor-patient familiarity, and private treatment, acted as both barriers and facilitators depending on the context. Factors identified in this study help to explain how existing models of cancer diagnosis (for example, the Pathways to Treatment Model) work in practice. It is important that clinicians are aware of how these factors may interact with individual clinical cases and either facilitate, or act as a barrier to, subsequent cancer diagnosis. Understanding and implementing this knowledge into clinical practice may result in quicker cancer diagnoses. © British Journal of General Practice 2017.

Patient participation in ERS guidelines and research projects: the EMBARC experience

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James D. Chalmers

2017-09-01

To understand the different ways in which patients can contribute to clinical guidelines, research projects and educational activities. To understand the barriers and potential solutions to these barriers from a physician’s perspective, in order to ensure meaningful patient involvement in clinical projects. To understand the barriers and potential solutions from a patient’s perspective, in order to meaningfully involve patients in clinical projects.

E-cigarettes in patients with COPD: current perspectives

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Morjaria JB

2017-11-01

Full Text Available JB Morjaria,1,2 E Mondati,3,4 R Polosa3–5 1Department of Respiratory Medicine, Royal Brompton and Harefield Hospital Foundation Trust, Harefield Hospital, Harefield, 2Department of Respiratory Medicine, Imperial College, London, UK; 3Department of Clinical and Experimental Medicine, 4Department of Internal and Emergency Medicine, 5Centro per la Prevenzione e Cura del Tabagismo (CPCT, “Policlinico-V. Emanuele,” University of Catania, Catania, Italy Abstract: Conventional cigarette smoking is known to result in significant COPD morbidity and mortality. Strategies to reduce and/or stop smoking in this highly vulnerable patient group are key public health priorities to reduce COPD morbidity and mortality. Unfortunately, smoking cessation efforts in patients with COPD are poor and there is a compelling need for more efficient approaches to cessation for patients with COPD. Electronic cigarettes (ECs are devices that use batteries to vaporize nicotine. They may facilitate quit attempts and cessation in many smokers. Although they are not risk free, ECs are much less harmful than tobacco smoking. Hence, the use of ECs in vulnerable groups and in patients with challenges to abstain or multiple relapses to this habit may be promising. To date, little is known about health consequences of EC use among COPD smokers and whether their regular use has any effects on subjective and objective COPD outcomes. In the current review, we discuss the current perspectives and literature on the role of ECs in abstaining from conventional smoking and the effects of ECs on the respiratory tract in patients with COPD. Keywords: smoking cessation, electronic cigarette, COPD, tobacco harm reduction 

Patient perspectives on the optimal start of renal replacement therapy.

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Henry, Shayna L; Munoz-Plaza, Corrine; Garcia Delgadillo, Jazmine; Mihara, Nichole K; Rutkowski, Mark P

2017-09-01

Healthcare systems and providers are encouraged to prepare their patients with advanced chronic kidney disease (CKD) for a planned start to renal replacement therapies (RRT). Less well understood are the socioemotional experiences surrounding the optimal start of RRT versus suboptimal haemodialysis (HD) starts with a central catheter. To characterise the experiences of patients beginning RRT. Qualitative, semi-structured phone interviews. A total of 168 patients with stage 5 CKD initiating RRT in an integrated, capitated learning healthcare system. Qualitative data from patients were collected as part of a quality improvement initiative to better understand patient-reported themes concerning preparation for RRT, patients' perceptions of their transition to dialysis and why sub-optimal starts for RRT occur within our healthcare system. Dual review and verification was used to identify key phrases and themes within and across each domain, using both deductive a priori codes generated by the interview guide and grounded discovery of emergent themes. From the patient perspective, preparing for RRT is an experience rooted in deep feelings of fear. In addition, a number of key factors contributed to patients' preparation (or failure to prepare) for RRT. While the education provided by our system was viewed as adequate overall, patients often felt that their emotional and psychosocial needs went unmet, regardless of whether or not, they experienced an optimal dialysis start. Future efforts should incorporate additional strategies for helping patients with advanced CKD achieve emotional and psychological safety while preparing for RRT. © 2017 European Dialysis and Transplant Nurses Association/European Renal Care Association.

An evolving perspective on physical activity counselling by medical professionals.

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McPhail, Steven; Schippers, Mandy

2012-04-23

Physical inactivity is a modifiable risk factor for many chronic conditions and a leading cause of premature mortality. An increasing proportion of adults worldwide are not engaging in a level of physical activity sufficient to prevent or alleviate these adverse effects. Medical professionals have been identified as potentially powerful sources of influence for those who do not meet minimum physical activity guidelines. Health professionals are respected and expected sources of advice and they reach a large and relevant proportion of the population. Despite this potential, health professionals are not routinely practicing physical activity promotion. Medical professionals experience several known barriers to physical activity promotion including lack of time and lack of perceived efficacy in changing physical activity behaviour in patients. Furthermore, evidence for effective physical activity promotion by medical professionals is inconclusive. To address these problems, new approaches to physical activity promotion are being proposed. These include collaborating with community based physical activity behaviour change interventions, preparing patients for effective brief counselling during a consultation with the medical professional, and use of interactive behaviour change technology. It is important that we recognise the latent risk of physical inactivity among patients presenting in clinical settings. Preparation for improving patient physical activity behaviours should commence before the consultation and may include physical activity screening. Medical professionals should also identify suitable community interventions to which they can refer physically inactive patients. Outsourcing the majority of a comprehensive physical activity intervention to community based interventions will reduce the required clinical consultation time for addressing the issue with each patient. Priorities for future research include investigating ways to promote successful referrals

An evolving perspective on physical activity counselling by medical professionals

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McPhail Steven

2012-04-01

Full Text Available Abstract Background Physical inactivity is a modifiable risk factor for many chronic conditions and a leading cause of premature mortality. An increasing proportion of adults worldwide are not engaging in a level of physical activity sufficient to prevent or alleviate these adverse effects. Medical professionals have been identified as potentially powerful sources of influence for those who do not meet minimum physical activity guidelines. Health professionals are respected and expected sources of advice and they reach a large and relevant proportion of the population. Despite this potential, health professionals are not routinely practicing physical activity promotion. Discussion Medical professionals experience several known barriers to physical activity promotion including lack of time and lack of perceived efficacy in changing physical activity behaviour in patients. Furthermore, evidence for effective physical activity promotion by medical professionals is inconclusive. To address these problems, new approaches to physical activity promotion are being proposed. These include collaborating with community based physical activity behaviour change interventions, preparing patients for effective brief counselling during a consultation with the medical professional, and use of interactive behaviour change technology. Summary It is important that we recognise the latent risk of physical inactivity among patients presenting in clinical settings. Preparation for improving patient physical activity behaviours should commence before the consultation and may include physical activity screening. Medical professionals should also identify suitable community interventions to which they can refer physically inactive patients. Outsourcing the majority of a comprehensive physical activity intervention to community based interventions will reduce the required clinical consultation time for addressing the issue with each patient. Priorities for future research

A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients.

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Garcia, Danilo; Granjard, Alexandre; Lundblad, Suzanna; Archer, Trevor

2017-01-01

Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence) necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients' life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. A t -test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but only the past positive and present hedonistic

Measurement of Quality of Educational Hospital Services by the SERVQUAL Model: The Iranian Patients' Perspective.

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Rezaei, Satar; Matin, Behzad Karami; Moradi, Khalil; Bijan, Behroz; Fallahi, Masoud; Shokati, Behnam; Saeidi, Hamid

2016-03-01

The main mission of hospitals in any health system is to deliver high quality healthcare for patients and meet their needs and expectations. The aim of the current study was to assess the quality of the service of educational hospitals affiliated with Kermanshah University of Medical Sciences in 2015, from the perspective of patients. In this cross-sectional study, the perspectives of 400 patients were assessed about the quality of the services provided by educational hospitals in Kermanshah (western Iran) in 2015. The quality was assessed by the SERVQUAL questionnaire with five dimensions, i.e., tangibility, reliability, responsiveness, assurance, and empathy. In addition, the Wilcoxon test and the Kruskal-Wallis test were used to explore any association between the dependent variable and explanatory variables. The data were analyzed using Stata V.12 software. There were negative gaps in all five dimensions. The highest and lowest gaps in the mean score were found in the assurance (-0.88) and responsiveness (-0.56) dimensions. The patients ranked responsiveness as the most important dimension of the quality of healthcare. There were gaps between the patients' perceptions and their expectation about the five dimensions that were studied based on the SERVQUAL model. Also, it is recommended that improving the quality of healthcare is possible by various policies, such as good responsiveness, access to health workers, and delivering healthcare in less time.

Evaluating sequelae after head and neck cancer from the patient perspective with the help of the International Classification of Functioning, Disability and Health.

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Tschiesner, Uta; Linseisen, Elisabeth; Coenen, Michaela; Rogers, Simon; Harreus, Ulrich; Berghaus, Alexander; Cieza, Alarcos

2009-03-01

Functioning is recognized increasingly as an important study outcome with head and neck cancer (HNC). The International Classification of Functioning, Disability and Health, as adopted by the World Health Organization in 2001, is based on a comprehensive bio-psycho-social view. The objective of this study was to evaluate functioning from the patient perspective and to classify the results using the comprehensive view of the ICF. Patients with HNC were interviewed on their problems in daily life using qualitative methodology. Sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. All individual interviews were digitally recorded and transcribed verbatim. Interview texts were divided into meaning units and the concepts contained in the meaning units were linked to the ICF according to established linking rules. The transcribed data were analyzed and linked by a second health professional and the degree of consensus was calculated using kappa statistics. Concordance of identified ICF categories among different tumor locations was also measured with kappa statistics. Until saturation was reached, 18 patients were interviewed: seven patients with oral cancer, five with hypopharyngeal cancer and six with laryngeal cancer. Thousand four hundred and sixty-two (1,462) different concepts were translated into the ICF using 104 different, second-level ICF categories. These ICF categories are presented in detail. From the patient perspective, the ICF components (a) Body functions, (b) Activities and participation and (c) contextual Environmental factors are equally represented, while (d) Body structures show by far the least number of categories. The concordance between different tumor locations rages between 0.53 and 0.58 (confidence interval 0.42-0.70). The degree of consensus in the linking process was 0.58 (confidence interval 0.45-0.73). The ICF classification can display problems with functioning following HNC sufficiently

Activity Sets in Multi-Organizational Ecologies : A Project-Level Perspective on Sustainable Energy Innovations

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Gerrit Willem Ziggers; Kristina Manser; Bas Hillebrand; Paul Driessen; Josée Bloemer

2014-01-01

Complex innovations involve multi-organizational ecologies consisting of a myriad of different actors. This study investigates how innovation activities can be interpreted in the context of multi-organizational ecologies. Taking a project-level perspective, this study proposes a typology of four

Taste at first (person) sight: Visual perspective modulates brain activity implicitly associated with viewing unhealthy but not healthy foods.

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Basso, Frédéric; Petit, Olivia; Le Bellu, Sophie; Lahlou, Saadi; Cancel, Aïda; Anton, Jean-Luc

2018-06-12

Every day, people are exposed to images of appetizing foods that can lead to high-calorie intake and contribute to overweight and obesity. Research has documented that manipulating the visual perspective from which eating is viewed helps resist temptation by altering the appraisal of unhealthy foods. However, the neural basis of this effect has not yet been examined using neuroimaging methods. Moreover, it is not known whether the benefits of this strategy can be observed when people, especially overweight, are not explicitly asked to imagine themselves eating. Last, it remains to be investigated if visual perspective could be used to promote healthy foods. The present work manipulated camera angles and tested whether visual perspective modulates activity in brain regions associated with taste and reward processing while participants watch videos featuring a hand grasping (unhealthy or healthy) foods from a plate during functional magnetic resonance imagining (fMRI). The plate was filmed from the perspective of the participant (first-person perspective; 1PP), or from a frontal view as if watching someone else eating (third-person perspective; 3PP). Our findings reveal that merely viewing unhealthy food cues from a 1PP (vs. 3PP) increases activity in brain regions that underlie representations of rewarding (appetitive) experiences (amygdala) and food intake (superior parietal gyrus). Additionally, our results show that ventral striatal activity is positively correlated with body mass index (BMI) during exposure to unhealthy foods from a 1PP (vs. 3PP). These findings suggest that unhealthy foods should be promoted through third-person (video) images to weaken the reward associated with their simulated consumption, especially amongst overweight people. It appears however that, as such, manipulating visual perspective fails to enhance the perception of healthy foods. Their promotion thus requires complementary solutions. Copyright © 2018. Published by Elsevier Ltd.

Perspectives on the Contribution of Social Science to Adapted Physical Activity: Looking Forward, Looking Back

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Causgrove Dunn, Janice; Cairney, John; Zimmer, Chantelle

2016-01-01

In this article, we reflect on the contributions of the social sciences to the field of adapted physical activity by examining the theories and methods that have been adopted from the social science disciplines. To broaden our perspective on adapted physical activity and provide new avenues for theoretical and empirical exploration, we discuss and…

Making doctor‐patient communication more effective from a patient’s perspective : A European mixed‐method study in general medicine settings

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Mazzi, Maria Angela

2017-01-01

The thesis investigated what in the eye of European citizens and primary care patients matters in doctor-patient communication. To include the public’s perspective in evaluating the communication quality of doctors is fundamental as patients often report quality problems in the area of communication

Activity-based costs of blood transfusions in surgical patients at four hospitals.

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Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

2010-04-01

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

Patient perspectives on answering questions about sexual orientation and gender identity: an integrative review.

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Bjarnadottir, Ragnhildur I; Bockting, Walter; Dowding, Dawn W

2017-07-01

To examine patients' perceptions of being asked about their sexual orientation and gender identity in the healthcare setting. Health disparities exist in the lesbian, gay, bisexual and transgender population, but further research is needed to better understand these disparities. To address this issue, experts recommend the routine collection of sexual orientation and gender identity data in health care. Nurses on the front line of patient care play a key role in the collection of these data. However, to enable nurses to conduct such assessments it is important to understand the perspective of the patients on being asked about their sexual orientation and gender identity in a healthcare setting. An integrative review was conducted using the methodology proposed by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546). Six electronic databases were searched, and two reviewers independently reviewed papers for inclusion. Papers were included if they were empirical studies, peer-reviewed papers or reports, assessing patient perspectives on discussing sexual orientation and gender identity in the healthcare setting. Twenty-one relevant studies that met the inclusion criteria were identified. A majority of the studies indicated patients' willingness to respond to, and a perceived importance of, questions about sexual orientation and gender identity. However, fears of homophobia and negative consequences hindered willingness to disclose this information. This review indicates that in most cases patients are willing to answer routine questions about their sexual orientation in the healthcare setting and perceive them as important questions to ask. The findings of this review have implications for nurses looking to incorporate questions about sexual orientation into their routine patient assessment. The findings indicate that care providers need to be mindful of heteronormative assumptions and take steps to ensure they are knowledgeable about lesbian, gay

A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients

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Danilo Garcia

2017-09-01

Full Text Available Background Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients’ life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. Method A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. Results A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but

End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

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Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M

2015-05-01

End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business. © The Author(s) 2014.

Patient perspectives on the impact of Crohn’s disease: results from group interviews

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Norton BA

2012-07-01

Full Text Available Beth-Ann Norton,1 Rosemarie Thomas,2 Kathleen G Lomax,2 Sharon Dudley-Brown31Massachusetts General Hospital, Boston, MA, USA; 2Abbott Laboratories, Abbott Park, IL, USA; 3Johns Hopkins University, Schools of Medicine and Nursing, Baltimore, MD, USAAim: To understand the impact of Crohn’s disease (CD on various aspects of daily life from the perspective of patients living with CD. Awareness of the disease and biologic therapies, patient satisfaction and adherence, and physician (provider relationships were also assessed.Background: CD is a chronic, inflammatory, autoimmune disorder of the gastrointestinal tract that substantially impacts patients’ physical and emotional well-being. For patients eligible for biologic therapy, anti-tumor necrosis factor agents represent an important addition to the available therapies for CD.Methods: The study sample included biologic-naïve and biologic-experienced patients who had self-reported moderate to severe CD, were under the care of a specialist, and agreed to film a video diary and participate in a focus group. Data from the videos and group interviews were collected from May to June of 2009 and summarized qualitatively by grouping similar answers and quotations.Results: Of the 44 participants who submitted video diaries, 23 were biologic-experienced and 21 were biologic-naïve. Participants stated that CD caused fear and embarrassment, that they were reluctant to share the full impact of CD with family and providers, and that they relied on their provider for treatment decisions. Many participants accepted a new state of normalcy if their current medication helped their most bothersome symptoms without providing sustained remission. Participants receiving biologic therapy generally were more informed, more satisfied, and more likely to adhere to treatment regimens.Conclusion: Participants’ responses suggest a need for more patient education and more collaborative relationships between patients and

Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry.

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Ruissen, A M; Abma, T A; Van Balkom, A J L M; Meynen, G; Widdershoven, G A M

2016-03-01

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder (OCD), and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient's autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient's and the therapist's perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist's approach, who used motivational interventions with a view to appealing to the patient's responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions.

Prioritization and willingness to pay for bariatric surgery: the patient perspective.

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Gill, Richdeep S; Majumdar, Sumit R; Wang, Xiaoming; Tuepah, Rebecca; Klarenbach, Scott W; Birch, Daniel W; Karmali, Shahzeer; Sharma, Arya M; Padwal, Raj S

2014-02-01

Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients' perspectives regarding prioritization for surgery. We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. The 99 respondents had mean age of 44.7 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs (p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity (p Lower priority was assigned to patients at the extremes of age (p = 0.006), on social assistance (p paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery.

Informal Interpreting in General Practice: Comparing the perspectives of General Practitioners, migrant patients and family interpreters.

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Zendedel, R.; Schouten, B.C.; van Weert, J.C.M.; van den Putte, B.

Objective To explore differences in perspectives of general practitioners, Turkish-Dutch migrant patients and family interpreters on interpreters’ role, power dynamics and trust in interpreted GP consultations. Methods 54 semi-structured in-depth interviews were conducted with the three parties

Trainee Perspectives of the Effectiveness of Active Learning in a Legal Education Context

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Rachael Hession

2013-04-01

Full Text Available This article explores whether active learning techniques can be effectively introduced to large group lectures in the context of legal professional training. It is limited to the perspective of the students (trainee solicitors. It is evident from research literature that a student-centred approach in the form of active learning techniques engages students and is considered a more effective form of teaching than the traditional lecturing style generally adopted at higher level education. There is a distinctive gap in the research literature relating to professional education. This article discusses a small scale qualitative study which adopted an action research methodology to determine the effectiveness of active learning techniques in this particular context. The study was confined to the introduction of two particular techniques, an in-class computation exercise and a re-cap technique, to the traditional lecture format. The views of a small focus group of trainee solicitors from the Law Society’s of Ireland Professional Practice Course were engaged. Findings from this study indicate that active learning techniques are effective in achieving learning outcomes from a trainees’ perspective. The author concludes that limitations of the use of the techniques can be overcome. Important directions for future research include in-depth analysis of the effectiveness of the techniques in preparing trainee solicitors for the professional role.

Improving awareness, accountability, and access through health coaching: qualitative study of patients' perspectives.

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Liddy, Clare; Johnston, Sharon; Irving, Hannah; Nash, Kate; Ward, Natalie

2015-03-01

To assess patients' experiences with and perceptions of health coaching as part of their ongoing care. A qualitative research design using semistructured interviews that were recorded and transcribed verbatim.Setting Ottawa, Ont. Eleven patients (> 18 years of age) enrolled in a health coaching pilot program who were at risk of or diagnosed with type 2 diabetes. Patients' perspectives were assessed with semistructured interviews. Interviews were conducted with 11 patients at the end of the pilot program, using a stratified sampling approach to ensure maximum variation. All patients found the overall experience with the health coaching program to be positive. Patients believed the health coaching program was effective in increasing awareness of how diabetes affected their bodies and health, in building accountability for their health-related actions, and in improving access to care and other health resources. Patients perceive one-on-one health coaching as an acceptable intervention in their ongoing care. Patients enrolled in the health coaching pilot program believed that there was an improvement in access to care, health literacy, and accountability,all factors considered to be precursors to behavioural change.

Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review.

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Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Phillips, Christine B; Wiles, Robert B; Wilson, Donna M

2017-12-01

End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.

Responsibility and expectations in antiretroviral therapy--patients' versus doctors' perspective.

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Largu, Maria Alexandra; Dorobăţ, Carmen; Oprea, L; Astărăstoae, V; Manciuc, Carmen

2015-01-01

This paper aims to uncover what patients really expect form ART, and also what infectious diseases doctors expect from a patient's ART regime, thus exploring an important side of adherence to ART. From July to November 2014 we have conducted a qualitative study regarding both patients' and doctors' expectations form the ART. We interviewed 30 patients and 4 doctors. We used semi-structured interviews that were conducted in the Psychosocial Compartment of the HIV/AIDS Regional Center in Iasi. The patients we interviewed came from all 6 counties in the Moldova area. Age varied from 16 years to 59 years; 55% were female and 45% male. 30% came from a rural area. The most common expectations that patients have regarding ART are: "to help me live", "not to make me feel sick", "to be easy to take (not to big, not a lot)", "not to show on the outside what I have on the inside". The infectious diseases doctors that we interviewed work in the HIV/AIDS Regional Center in Iasi. Their expectations regarding an ART regimen for patients were: "to reduce HIV viral load", "to increase CD4 cell count" and "to have minimal impact on the proper functioning of other organs". Patients consider themselves the only factors responsible for their own ART adherence in 56.6% of cases; 20% consider the doctor to be responsible for their adherence, 16.6% feel that their family, friends, and spouse are responsible, and 6.6% (2 patients) couldn't answer. Infectious diseases doctors considered that patients are 100% responsible for adhering to the antiretroviral therapy. In order to assure adherence to the ART it is important to explore both the doctor and the patient's perspective and to find ways to find a common ground in building a healthy relationship.

Time perspective and the theory of planned behavior: moderate predictors of physical activity among central Appalachian adolescents.

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Gulley, Tauna; Boggs, Dusta

2014-01-01

The purpose of this study was to determine how well time perspective and the Theory of Planned Behavior (TPB) predicted physical activity among adolescents residing in the central Appalachian region of the United States. A descriptive, correlational design was used. The setting was a rural high school in central Appalachia. The sample included 185 students in grades 9 through 12. Data were collected in school. Variables included components of the TPB, time perspective, and various levels of exercise. Data were analyzed using Pearson's correlation coefficients and multiple regression analysis. The TPB was a moderate predictor of exercise frequency among central Appalachian adolescents, accounting for 42% of the variance. Time perspective did not add to the predictive ability of the TPB to predict exercise frequency in this sample. This study provides support for the TPB for predicting frequency of exercise among central Appalachian adolescents. By understanding the role of the TPB in predicting physical activity among adolescents, nurse practitioners will be able to adapt intervention strategies to improve the physical activity behaviors of this population. Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Establishing the values for patient engagement (PE) in health-related quality of life (HRQoL) research: an international, multiple-stakeholder perspective.

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Haywood, Kirstie; Lyddiatt, Anne; Brace-McDonnell, Samantha J; Staniszewska, Sophie; Salek, Sam

2017-06-01

Active patient engagement is increasingly viewed as essential to ensuring that patient-driven perspectives are considered throughout the research process. However, guidance for patient engagement (PE) in HRQoL research does not exist, the evidence-base for practice is limited, and we know relatively little about underpinning values that can impact on PE practice. This is the first study to explore the values that should underpin PE in contemporary HRQoL research to help inform future good practice guidance. A modified 'World Café' was hosted as a collaborative activity between patient partners, clinicians and researchers: self-nominated conference delegates participated in group discussions to explore values associated with the conduct and consequences of PE. Values were captured via post-it notes and by nominated note-takers. Data were thematically analysed: emergent themes were coded and agreement checked. Association between emergent themes, values and the Public Involvement Impact Assessment Framework were explored. Eighty participants, including 12 patient partners, participated in the 90-min event. Three core values were defined: (1) building relationships; (2) improving research quality and impact; and (3) developing best practice. Participants valued the importance of building genuine, collaborative and deliberative relationships-underpinned by honesty, respect, co-learning and equity-and the impact of effective PE on research quality and relevance. An explicit statement of values seeks to align all stakeholders on the purpose, practice and credibility of PE activities. An innovative, flexible and transparent research environment was valued as essential to developing a trustworthy evidence-base with which to underpin future guidance for good PE practice.

Integrating Customer Intimacy Into Radiology to Improve the Patient Perspective: The Case of Breast Cancer Screening.

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Chhor, Chloe M; Mercado, Cecilia L

2016-02-01

The customer intimacy business model has emerged as a key operational approach for health care organizations as they move toward patient-centered care. The question arises how the customer intimacy approach can be implemented in the clinical setting and whether it can help practitioners address problems and improve quality of care. Breast cancer screening and its emphasis on the patient perspective provides an interesting case study for understanding how the customer intimacy approach can be integrated into radiologic practice to improve the patient experience.

Long-acting reversible contraception for adolescents and young adults: patient and provider perspectives.

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Kavanaugh, Megan L; Frohwirth, Lori; Jerman, Jenna; Popkin, Ronna; Ethier, Kathleen

2013-04-01

To describe and explore provider- and patient-level perspectives regarding long-acting reversible contraception (LARC) for teens and young adults (ages 16-24). Data collection occurred between June and December 2011. We first conducted telephone interviews with administrative directors at 20 publicly funded facilities that provide family planning services. At 6 of these sites, we conducted a total of 6 focus group discussions (FGDs) with facility staff and 48 in-depth interviews (IDIs) with facility clients ages 16-24. Staff in the FGDs did not generally equate being a teen with ineligibility for IUDs. In contrast to staff, one-quarter of the young women did perceive young age as rendering them ineligible. Clients and staff agreed that the "forgettable" nature of the methods and their duration were some of LARC's most significant advantages. They also agreed that fear of pain associated with both insertion and removal and negative side effects were disadvantages. Some aspects of IUDs and implants were perceived as advantages by some clients but disadvantages by others. Common challenges to providing LARC-specific services to younger patients included extra time required to counsel young patients about LARC methods, outdated clinic policies requiring multiple visits to obtain IUDs, and a perceived higher removal rate among young women. The most commonly cited strategy for addressing many of these challenges was securing supplementary funding to support the provision of these services to young patients. Incorporating young women's perspectives on LARC methods into publicly funded family planning facilities' efforts to provide these methods to a younger population may increase their use among young women. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. All rights reserved.

Historical Perspective About the Nursing Care of the Mental Patient

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Loide Ferreira

2014-10-01

Full Text Available The concept of caring in nursing has changed throughout the years. Nursing has developed to meet the needs of the population and to adapt at the same time to scientific knowledge, which has taken another dimension, and technical demand. Every field in nursing gains new formas as it evolves, namely the mental health and psychiatric fields. We start by describing the dominant beliefs of society in the past regarding mental health. We will then talk about mental patients in Portugal from the 16th Century on (1539-1850 and how they were cared for, underlining the first psychiatric institution - Rilhafoles Hospital. We will elaborate on the more common treatments in psychiatry, the purposes they served and how the nursing staff intervened in their application. Finally, we will put the evolution of nursing care to the mental patients into perspective, from the begining of the 20th century, as well as the development of nursing schools in the field of mental and psychiatric health.

Ranking of patient and surgeons' perspectives for endpoints in randomized controlled trials--lessons learned from the POVATI trial [ISRCTN 60734227].

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Fischer, Lars; Deckert, Andreas; Diener, Markus K; Zimmermann, Johannes B; Büchler, Markus W; Seiler, Christoph M

2011-10-01

Surgical trials focus mainly on mortality and morbidity rates, which may be not the most important endpoints from the patient's perspective. Evaluation of expectations and needs of patients enrolled in clinical trials can be analyzed using a procedure called ranking. Within the Postsurgical Pain Outcome of Vertical and Transverse Abdominal Incision randomized trial (POVATI), the perspectives of participating patients and surgeons were assessed as well as the influence of the surgical intervention on patients' needs. All included patients of the POVATI trial were asked preoperatively and postoperatively to rank predetermined outcome variables concerning the upcoming surgical procedure (e.g., pain, complication, cosmetic result) hierarchically according to their importance. Preoperatively, the surgeons were asked to do the same. One hundred eighty two out of 200 randomized patients (71 females, 111 males; mean age 59 years) returned the ranking questionnaire preoperatively and 152 patients (67 females, 85 males; mean age 60 years) on the day of discharge. There were no differences between the two groups with respect to the distribution of ranking variables (p > 0.05). Thirty-five surgeons (7 residents, 6 fellows, and 22 consultants) completed the same ranking questionnaire. The order of the four most important ranking variables for both patients and surgeons were death, avoiding of postoperative complications, avoiding of intraoperative complications, and pain. Surgeons ranked the variable "cosmetic result" significantly as more important compared to patients (p = 0.034, Fisher's exact test). Patients and surgeons did not differ in ranking predetermined outcomes in the POVATI trial. Only the variable "cosmetic result" is significantly more important from the surgeon's than from the patient's perspective. Ranking of outcomes might be a beneficial tool and can be a proper addition to RCTs.

Robotic Exoskeletons: A Perspective for the Rehabilitation of Arm Coordination in Stroke Patients

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Jarrassé, Nathanaël; Proietti, Tommaso; Crocher, Vincent; Robertson, Johanna; Sahbani, Anis; Morel, Guillaume; Roby-Brami, Agnès

2014-01-01

Upper-limb impairment after stroke is caused by weakness, loss of individual joint control, spasticity, and abnormal synergies. Upper-limb movement frequently involves abnormal, stereotyped, and fixed synergies, likely related to the increased use of sub-cortical networks following the stroke. The flexible coordination of the shoulder and elbow joints is also disrupted. New methods for motor learning, based on the stimulation of activity-dependent neural plasticity have been developed. These include robots that can adaptively assist active movements and generate many movement repetitions. However, most of these robots only control the movement of the hand in space. The aim of the present text is to analyze the potential of robotic exoskeletons to specifically rehabilitate joint motion and particularly inter-joint coordination. First, a review of studies on upper-limb coordination in stroke patients is presented and the potential for recovery of coordination is examined. Second, issues relating to the mechanical design of exoskeletons and the transmission of constraints between the robotic and human limbs are discussed. The third section considers the development of different methods to control exoskeletons: existing rehabilitation devices and approaches to the control and rehabilitation of joint coordinations are then reviewed, along with preliminary clinical results available. Finally, perspectives and future strategies for the design of control mechanisms for rehabilitation exoskeletons are discussed. PMID:25520638

What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives.

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Hogden, Anne; Greenfield, David; Nugus, Peter; Kiernan, Matthew C

2012-01-01

Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients' ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS. An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes. Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients' reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients' personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs. Decision-making for symptom management and quality of life in ALS care is enhanced when the patient's personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health

International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments

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Eszter Kovacs

2014-11-01

Full Text Available Background The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.

Perspectives of patients and physicians about neuroendocrine tumors. A qualitative study

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Manolios, Emilie; Rebours, Vinciane; Revah-Levy, Anne; Ruszniewski, Philippe

2018-01-01

Purpose Gastrointestinal neuroendocrine tumors (NETs) are rare, complex to manage, and often have a chronic course. Qualitative methods are a tool of choice for focusing on patients' and physicians’ points of view especially when dealing with a complex and rare disease. Nonetheless, they remain undeveloped in research related to NETs. This study aimed to explore the experience of NETs among both patients and their physicians and to cross their perspectives for the purpose of finding pathways to improving care. Results Our analysis found two themes: (1) the questions raised by this disease, and (2) the complex experience of this singular disease. Our findings underlined the experience of confusion found among patients regarding the patient's unusual somatic experience and around the question of vocabulary, i.e. the naming of the disease and the semantic field of severity in the medical discourse. Conclusion Means for reducing the confusion that patients experience in this disease are needed. The explanations that the physician offers to the patient must clarify the issues related to NETs. We therefore propose a statement that all physicians can use to support patients diagnosed with neuroendocrine tumors to clear up potential confusion. Methods We conducted a qualitative study, based on 40 semi-structured interviews, in a specialized department of gastro-pancreatology. Participants, purposively selected until data saturation, came from two different sub-samples: (i) patients with a metastatic NETs (N = 20) and (ii) their referring physicians (N = 10). The data were examined by thematic analysis. PMID:29581833

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

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Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Patients' and families' perspectives of patient safety at the end of life: a video-reflexive ethnography study.

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Collier, Aileen; Sorensen, Ros; Iedema, Rick

2016-02-01

The aim of this study was to investigate patients' and families' perspectives of safety and quality in the setting of a life-limiting illness. Data reported here were generated from a qualitative study using video-reflexive ethnographic methodology. Data were collected over 18 months and generated through participant observation, shadowing of clinicians, field-interviews and semi-structured interviews with patients and families. The study was conducted at two hospital sites in Sydney, Australia and in patients' homes. Patients with an advanced life-limiting illness (n = 29) ranging in age between 27 and 89 years and family members (n = 5) participated in the study. Patient safety remains important to dying patients and families. For dying people, iatrogenic harm is not regarded as 'one off' incidents. Rather, harm is experienced as a result of an unfolding series of negative events. Critically, iatrogenic harm is emotional, social and spiritual and not solely technical-clinical misadventure and is inextricably linked with feeling unsafe. Thus, patient safety extends beyond narrowly defined technical-clinical parameters to include interpersonal safety. Current approaches to patient safety do not address fully the needs of dying patients and their families. Patients and their families regard poor communication with and by health professionals to be harmful in and of itself. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Activity report 2015 Commission Perspectives du Reseau

International Nuclear Information System (INIS)

Ricour, Olivia

2016-01-01

This document contains the activity report for 2015 of the Commission Perspectives du Reseau which has been set up by RTE to be the main body for organising a dialogue with all the actors of the energy sector and civil society about challenges and stakes of the electric power system on the medium and on the long term. It describes how this body aims at sharing knowledge and expertise of all stakeholders (publications, European platform for data transparency), at being a place for debating and enriching the understanding of tomorrow's important stakes for the power system (discussion of the issue of greenhouse gas emissions with an analysis of the impact of the CO 2 price signal on emissions by the European electricity system and results of the e-Highway 2050 European project). The road-map of the Commission works for 2016 is provided, as well as a list of members

Perspectives of patients with type 1 or insulintreated type 2 diabetes on self-monitoring of blood glucose : a qualitative study

NARCIS (Netherlands)

Hortensius, Johanna; Kars, Marijke C.; Wierenga, Willem S.; Kleefstra, Nanne; Bilo, Henk J. G.; van der Bijl, Jaap J.

2012-01-01

Background: Self-monitoring of blood glucose (SMBG), including self-regulation, is an important tool to achieve good glycemic control. However, many patients measure their glucose concentrations less often than is recommended. This study investigates patients' perspectives of SMBG and all relevant

Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens

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Lambert-Kerzner A

2015-07-01

Full Text Available Anne Lambert-Kerzner,1,2 Edward P Havranek,2,3 Mary E Plomondon,1,2 Katherine M Fagan,1 Marina S McCreight,1 Kelty B Fehling,1 David J Williams,2 Alison B Hamilton,4 Karen Albright,2 Patrick J Blatchford,2 Renee Mihalko-Corbitt,5 Chris L Bryson,6 Hayden B Bosworth,7 Miriam A Kirshner,7 Eric J Del Giacco,5 P Michael Ho1,2 1Department of Cardiology, Veterans Health Administration (VA Eastern Colorado Health Care System, Denver, CO, 2School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, 3Cardiology, Denver Health Medical Center, Denver, CO, 4Health Services Research, Veterans Health Administration (VA Greater Los Angeles Healthcare System, Los Angeles, CA, 5Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, 6Health Services Research, Veterans Health Administration (VA Puget Sound Health Care System, Seattle, WA, 7Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA Purpose: Poor adherence to cardioprotective medications after acute coronary syndrome (ACS hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients’ perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients’ perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization. Patients and methods: Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were

Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective.

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Gfrerer, Lisa; Lans, Jonathan; Faulkner, Heather R; Nota, Sjoerd; Bot, Arjan G J; Austen, William Gerald

2018-01-01

Candidates for migraine surgery are chronic pain patients with significant disability. Currently, migraine-specific questionnaires are used to evaluate these patients. Analysis tools widely used in evaluation of better understood pain conditions are not typically applied. This is the first study to include a commonly used pain questionnaire, the Pain Self-Efficacy Questionnaire (PSEQ) that is used to determine patients' pain coping abilities and function. It is an important predictor of pain intensity/disability in patients with musculoskeletal pain, as low scores have been associated with poor outcome. Ninety patients were enrolled prospectively and completed the Migraine Headache Index and PSEQ preoperatively and at 12 months postoperatively. Scores were evaluated using paired t tests and Pearson correlation. Representative PSEQ scores for other pain conditions were chosen for score comparison. All scores improved significantly from baseline (p migraine surgery was higher than seen in other pain conditions after treatment (112 percent). Preoperative PSEQ scores did not influence postoperative outcome. The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions. It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome and should not be used to determine eligibility for migraine surgery. Therapeutic, IV.

International critical perspectives

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Sambrook, S.A.; Poell, R.F.

2014-01-01

The Problem Critical perspectives on human resource development (HRD) have emerged, across Europe and America, hailed as the future of the field. However, we note the paucity of critical perspectives globally, the problematic dominance of critical HRD activities in Western sites of theory and

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective.

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Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta

2017-12-01

Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of the lifeworld" enables the patient to feel trust. Trust in the early chain of healthcare entails caregivers' ability to pay attention to both medical and existential issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

To total amount of activity ..... and beyond: Perspectives on measuring physical behaviour

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Johannes B.J. Bussmann

2013-07-01

Full Text Available The aim of this paper is to describe and discuss some perspectives on definitions, constructs and outcome parameters of physical behaviour. The paper focuses on the following constructs: Physical activity & active lifestyle vs. sedentary behaviour & sedentary lifestyle; Amount of physical activity vs. amount of walking; Detailed body posture & movement data vs. overall physical activity data; Behavioural context of activities; Quantity vs. quality; Physical behaviour vs. physiological response.Subsequently, the following outcome parameters provided by data reduction procedures are discussed: Distribution of length of bouts; Variability in bout length; Time window; Intensity and intensity threshold.The overview indicates that physical behaviour is a multi-dimensional construct, and it stresses the importance and relevance of constructs and parameters other than total amount of physical activity.It is concluded that the challenge for the future will be to determine which parameters are most relevant, valid and responsive. This is a matter for physical behaviour researchers to consider, that is critical to multi-disciplinary collaboration.

eHealth for inflammatory bowel disease self-management - the patient perspective.

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Con, Danny; Jackson, Belinda; Gray, Kathleen; De Cruz, Peter

2017-09-01

Electronic health (eHealth) solutions may help address the growing pressure on IBD outpatient services as they encompass a component of self-management. However, information regarding patients' attitudes towards the use of eHealth solutions in IBD is lacking. The aim of this study was to evaluate eHealth technology use and explore the perspectives of IBD patients on what constitutes the ideal eHealth solution to facilitate self-management. A mixed methods qualitative and quantitative analysis of the outcomes of a discussion forum and an online survey conducted at a tertiary hospital in Melbourne, Australia between November 2015 and January 2016 was undertaken. Eighteen IBD patients and parents participated in the discussion forum. IBD patients expressed interest in eHealth tools that are convenient and improve access to care, communication, disease monitoring and adherence. Eighty six patients with IBD responded to the online survey. A majority of patients owned a mobile phone (98.8%), had access to the internet (97.7%), and felt confident entering data onto a phone or computer (73.3%). Most patients (98.8%) were willing to use at least one form of information and communication technology to help manage their IBD. Smartphone apps and internet websites were the two most preferred technologies to facilitate IBD self-management. This study demonstrates the willifngness of patients to engage with eHealth as a potential solution to facilitate IBD self-management. Future development and testing of eHealth solutions should be informed by all major stakeholders including patients to maximise their uptake and efficacy to facilitate IBD self-management.

Consumer Quality Index Chronic Skin Disease (CQI-CSD): a new instrument to measure quality of care from the patient's perspective

NARCIS (Netherlands)

van Cranenburgh, O. D.; Krol, M. W.; Hendriks, M. C. P.; de Rie, M. A.; Smets, E. M. A.; de Korte, J.; Sprangers, M. A. G.

2015-01-01

Assessing quality of care from the patient's perspective is considered to be highly relevant. As a standardized instrument in dermatology was lacking, we developed a patient experience questionnaire regarding chronic skin disease care: the Consumer Quality Index Chronic Skin Disease (CQI-CSD). (i)

"They Are Talking About Me, but Not with Me": A Focus Group Study to Explore the Patient Perspective on Interprofessional Team Meetings in Primary Care.

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van Dongen, Jerôme Jean Jacques; de Wit, Maarten; Smeets, Hester Wilhelmina Henrica; Stoffers, Esther; van Bokhoven, Marloes Amantia; Daniëls, Ramon

2017-08-01

The number of people with multiple chronic conditions receiving primary care services is growing. To deal with their increasingly complex health care demands, professionals from different disciplines need to collaborate. Interprofessional team (IPT) meetings are becoming more popular. Several studies describe important factors related to conducting IPT meetings, mostly from a professional perspective. However, in the light of patient-centeredness, it is valuable to also explore the patients' perspective. The aim was to explore the patients' perspectives regarding IPT meetings in primary care. A qualitative study with a focus group design was conducted in the Netherlands. Two focus group meetings took place, for which the same patients were invited. The participants, chronically ill patients with experience on interprofessional collaboration, were recruited through the regional patient association. Participants discussed viewpoints, expectations, and concerns regarding IPT meetings in two rounds, using a focus group protocol and selected video-taped vignettes of team meetings. The first meeting focused on conceptualization and identification of themes related to IPT meetings that are important to patients. The second meeting aimed to gain more in-depth knowledge and understanding of the priorities. Discussions were audio-taped and transcribed verbatim, and analyzed by means of content analysis. The focus group meetings included seven patients. Findings were divided into six key categories, capturing the factors that patients found important regarding IPT meetings: (1) putting the patient at the center, (2) opportunities for patients to participate, (3) appropriate team composition, (4) structured approach, (5) respectful communication, and (6) informing the patient about meeting outcomes. Patients identified different elements regarding IPT meetings that are important from their perspective. They emphasized the right of patients or their representatives to take part

Patient perspectives on quality of life after penile cancer.

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Mortensen, Gitte Lee; Jakobsen, Jakob Kristian

2013-07-01

Penile cancer (PC) is a rare, but ominous disease. In 50-60% of squamous cell carcinomas of the penis, human papilloma virus infection, particularly with types 16 and 18, is part of the pathogenesis. Depending on cancer invasiveness, PC is treated with local resection of the glans and partial or total penectomy. This quality of life (QoL) study aimed at obtaining in-depth knowledge about patients' experiences with PC. A literature study was carried out to identify relevant topics for a semi-structured interview. Qualitative interviews with four former PC patients were transcribed verbatim and analysed using a medical anthropological approach. The analysis focused on the ways patients frame their disease experiences and relate the physical, sexual and emotional disease impact. Varying degrees of amputation affected the participants' sexual capabilities. Still, three participants (aged 66-72 years) said that their partner relationships were not negatively affected by the disease. In contrast, the impact on sexual function and self-esteem had been devastating to the fourth participant (aged 44 years) who was single and worried about the disease impeding his chance of finding love in life. For all participants, having had a potentially fatal disease put the physical disease impact into perspective. PC may greatly impact the psycho-sexual QoL of PC patients, particularly at a younger age and depending on their partnership status. Disease impact appears to be related to age, overall life situation and the cancer experience. The study was funded by an unrestricted research grant from Sanofi Pasteur MSD. not relevant.

Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

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Thorpe O

2014-01-01

Full Text Available Olivia Thorpe, Saravana Kumar, Kylie JohnstonInternational Centre for Allied Health Evidence, The Samson Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, AustraliaBackground: Chronic obstructive pulmonary disease (COPD is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.Methods: This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.Results: A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness environment-related (weather, transport, and finance, and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and "feeling better".Conclusion: This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is

An Exploration of the Use of a Sensory Room in a Forensic Mental Health Setting: Staff and Patient Perspectives.

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Wiglesworth, Sophie; Farnworth, Louise

2016-09-01

Despite the increased use of sensory rooms, there is little published evidence related to their benefits. The purpose of this study was to explore staff and patient perspectives of the use of a sensory room in an Australian forensic mental health setting. Staff and patients on a forensic hospital unit were recruited for this study. Focus group data was obtained from the perspective of the healthcare staff. A sensory assessment identified patients' sensory preferences. The details of the patients sensory room use and stress experienced before and after using the sensory room were recorded. The results showed a mean decrease in stress that was attributed to the use of the sensory room. Stress reducing benefits of sensory room use may improve a patient's experience within a forensic mental health facility while applying a recovery approach. As a limitation of the study, patient stress was rated on an un-validated scale. Further research is needed for greater insight and evidence in evaluating the use of sensory rooms in forensic mental health settings in reducing stress. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Do time perspective and sensation-seeking predict quitting activity among smokers? Findings from the International Tobacco Control (ITC) Four Country Survey.

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Hall, Peter A; Fong, Geoffrey T; Yong, Hua-Hie; Sansone, Genevieve; Borland, Ron; Siahpush, Mohammad

2012-12-01

Personality factors such as time perspective and sensation-seeking have been shown to predict smoking uptake. However, little is known about the influences of these variables on quitting behavior, and no prior studies have examined the association cross-nationally in a large probability sample. In the current study it was hypothesized that future time perspective would enhance - while sensation-seeking would inhibit - quitting activity among smokers. It was anticipated that the effects would be similar across English speaking countries. Using a prospective cohort design, this cross-national study of adult smokers (N=8845) examined the associations among time perspective, sensation-seeking and quitting activity using the first three waves of data gathered from the International Tobacco Control Four Country Survey (ITC-4), a random digit dialed telephone survey of adult smokers from the United Kingdom, United States, Canada and Australia. Findings revealed that future time perspective (but not sensation-seeking) was a significant predictor of quitting attempts over the 8-month follow-up after adjusting for socio-demographic variables, factors known to inhibit quitting (e.g., perceived addiction, enjoyment of smoking, and perceived value of smoking), and factors known to enhance quitting (e.g., quit intention strength, perceived benefit of quitting, concerns about health effects of smoking). The latter, particularly intention, were significant mediators of the effect of time perspective on quitting activity. The effects of time perspective on quitting activity were similar across all four English speaking countries sampled. If these associations are causal in nature, it may be the case that interventions and health communications that enhance future-orientation may foster more quit attempts among current smokers. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

The PROactive innovative conceptual framework on physical activity

NARCIS (Netherlands)

Dobbels, Fabienne; de Jong, Corina; Drost, Ellen; Elberse, Janneke; Feridou, Chryssoula; Jacobs, Laura; Rabinovich, Roberto; Frei, Anja; Puhan, Milo A.; de Boer, Willem I.; van der Molen, Thys; Williams, Kate; Pinnock, Hillary; Troosters, Thierry; Karlsson, Niklas; Kulich, Karoly; Ruedell, Katja

2014-01-01

Although physical activity is considered an important therapeutic target in chronic obstructive pulmonary disease (COPD), what "physical activity" means to COPD patients and how their perspective is best measured is poorly understood. We designed a conceptual framework, guiding the development and

Burden of a multiple sclerosis relapse: the patient's perspective.

Science.gov (United States)

Oleen-Burkey, Merrikay; Castelli-Haley, Jane; Lage, Maureen J; Johnson, Kenneth P

2012-01-01

Relapses are a common feature of relapsing-remitting multiple sclerosis (RRMS) and increasing severity has been shown to be associated with higher healthcare costs, and to result in transient increases in disability. Increasing disability likely impacts work and leisure productivity, and lowers quality of life. The objective of this study was to characterize from the patient's perspective the impact of a multiple sclerosis (MS) relapse in terms of the economic cost, work and leisure productivity, functional ability, and health-related quality of life (HR-QOL), for a sample of patients with RRMS in the US treated with immunomodulatory agents. A cross-sectional, web-based, self-report survey was conducted among members of MSWatch.com, a patient support website now known as Copaxone.com. Qualified respondents in the US had been diagnosed with RRMS and were using an immunomodulatory agent. The survey captured costs of RRMS with questions about healthcare resource utilization, use of community services, and purchased alterations and assistive items related to MS. The Work and Leisure Impairment instrument and the EQ-5D were used to measure productivity losses and HR-QOL (health utility), respectively. The Goodin MS neurological impairment questionnaire was used to measure functional disability; questions were added about relapses in the past year. Of 711 qualified respondents, 67% reported having at least one relapse during the last year, with a mean of 2.2 ± 2.3 relapses/year. Respondents who experienced at least one relapse had significantly higher mean annual direct and indirect costs compared with those who did not experience a relapse ($US38 458 vs $US28 669; p = 0.0004) [year 2009 values]. Direct health-related costs accounted for the majority of the increased cost ($US5201; 53%) and were mainly due to increases in hospitalizations, medications, and ambulatory care. Indirect costs, including informal care and productivity loss, accounted for the

Image management and communication in patient care: perspectives on implementation and impact.

Science.gov (United States)

Greberman, M; Mun, S K

1989-02-01

Image management and communication (IMAC) systems are automated and integrated systems that capture digital medical images and related patient information and transmit them electronically, display them for interpretation, and store them for future retrieval. The IMAC system concept includes images and relevant information from all clinical sources. The First International Conference on Image Management and Communication in Patient Care (IMAC 89) provides a forum for expert presentations, poster sessions, and discussion and debate among all attendees interested in the implementation and impact of IMAC systems. Plenary sessions provide an international perspective and explore the role of image-based information in patient care, approaches to improved IMAC systems, current technical barriers, quality of care issues, evaluation approaches, and scenarios for the future. Invited participants are from North America, Europe, Japan, Australia, and the WHO. Conference organizers are working with numerous professional organizations and representatives of meetings which focus on IMAC-related technology to complement, and not duplicate, the contribution of other groups.

Patients' perspectives on statin therapy for treatment of hypercholesterolaemia: a qualitative study.

Science.gov (United States)

Tolmie, Elizabeth P; Lindsay, Grace M; Kerr, Susan M; Brown, Malcom R; Ford, Ian; Gaw, Allan

2003-07-01

Health Care Practitioners' attempts to implement secondary prevention targets for coronary heart disease (CHD) may be restricted by low rates of persistence with statin therapy. There is a need to understand why some patients, despite having established CHD and elevated cholesterol, do not comply with their prescribed statin regimen. To explore patients' perspectives on compliance with statin therapy. Primary care, West of Scotland. The research approach was qualitative. Thirty-three patients prescribed statin therapy and identified as having different patterns of compliance (poor moderate and good) were interviewed. The in-depth interviews were conducted on a one to one basis. Patients prescribed statin therapy for less than three months were excluded. Data were analysed thematically with the assistance of QSR Nudist. From analysis of the narrative data, two broad categories, i.e. 'Patient-health care provider communication' and 'Health beliefs' were identified. These categories encompassed six main themes: 'Initiation of therapy'; 'Subsequent feedback'; 'Sources of misconceptions'; 'Unconditional acceptance'; 'Conditional acceptance'; 'Deferment and Rejection'. Acceptance of and compliance with statin therapy appeared to be associated with the provision, interpretation and feedback of information during patient-practitioner consultations, and patients' beliefs about personal health status, cholesterol, and recommended cholesterol-lowering strategies. Patients' beliefs and understanding about cholesterol, and the role of cholesterol modifying strategies should be determined prior to the initiation of therapy and at appropriate intervals thereafter.

Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective.

Science.gov (United States)

Goeree, Ron; Chiva-Razavi, Sima; Gunda, Praveen; Graham, Christopher N; Miles, LaStella; Nikoglou, Efthalia; Jugl, Steffen M; Gladman, Dafna D

2018-02-01

The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses

Designing For Democracy: Using Design Activism to Re-negotiate the Roles and Rights for Patients

DEFF Research Database (Denmark)

Knutz, Eva; Markussen, Thomas; Mårbjerg Thomsen, Signe

2014-01-01

there are already a number of approaches available which in one way or the other address the relationship between design, democracy and power. We provide an account of participatory design, adversarial design and design activism thereby pointing towards design’s potential for re-distributing power and authority......In this paper we focus on ‘patient-democracy’ and ‘shared decision-making’ seen from the perspective of design practice and design research. In the research on democracy in healthcare it is rarely questioned what forms of democracy underlies these concepts. We have examined three different theories...... of democracy and the democratic practices that belong to each of these. For designers working to increase patient democracy it is of vital importance to be able to distinguish different structures underlying democratic practices and to work out methods for prototyping democracy. In design research...

Challenges in tuberculosis care in Western Uganda: Health care worker and patient perspectives

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Ashley Wynne

2014-01-01

Full Text Available Uganda is one of the high burden countries that contribute 80% of the world’s tuberculosis (TB burden. Health care worker and patient perspectives provide valuable insight into gaps between policy and practice within tuberculosis control program. This study was part of a larger mixed-methods study to explore knowledge and stigma around HIV, TB and TB/HIV co-infection. We conducted a secondary analysis of the qualitative data. Findings related to challenges faced by health care workers and patients. Patient’s identified delays in diagnosis and financial burden associated with TB treatment. Health care workers called for more training on TB and TB/HIV co-infection, and identified poor referral practices between health units and lack of program funding resulting in the abandonment of DOTS programs. Training for health care workers is needed to better manage TB/HIV co-infected patients. Overall health system strengthening is needed, including referral systems tracking patients between health centers.

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

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Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

2015-01-01

As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification. PMID:26246834

Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective.

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Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

2015-01-01

As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

Intra-individual variability in tinnitus patients : current thoughts and perspectives.

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Dauman, N; Erlandsson, S; Lundlin, L; Dauman, R

2015-04-01

Most tinnitus studies have attempted to compare groups of individuals, thus revealing inter-individuals differences, i.e., variations between compared subjects. For methodological reasons, inter-individual studies cannot take into account the variability of tinnitus experience, which has been known for decades to be relevant in daily practice with tinnitus patients. The concept of intra-individual variability has been promoted in the research literature, in order to shed light on this aspect of individual perception. In previous studies, unrelated to hearing, the concept of intra-individual variability implied inclusion of the environment (i.e., physical and social interactions) as a factor of individual performance. In tinnitus research, we believe that the concept of variability (within a person) could find a place beside the concept of variation (between groups of subjects). In this paper, four perspectives of tinnitus experiences from the clinical and research fields are described: (1) ENT consultation; (2) short-term group psychotherapy; (3) psychodynamic psychotherapy; and (4) clinical psychological research. Intra-individual variability stresses the importance of defining tinnitus in a dynamic way, contrary to the current definition of tinnitus as the perception of sound(s). In clinical practice, it is useful to embrace the perspective of the perceiver of tinnitus, and to include social and cultural circumstances as well as audiological/physical changes.

Using behavioural activation in the treatment of depression: a control theory perspective.

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McEvoy, P; Law, A; Bates, R; Hylton, K; Mansell, W

2013-12-01

Behavioural activation is an intervention that can be used to counteract the typical patterns of withdrawal, avoidance and inactivity that characterize depression. This paper examines the processes of change that may occur during behavioural activation from the perspective of control theory. Some of the key concepts that are associated with control theory are introduced and the process of change that may occur during behavioural activation is illustrated using two case studies. The case studies provide anecdotal evidence which supports the hypothesis that the effective implementation of behavioural activation may depend upon clients being able to retain or regain the sense of control that they value. The differences between a control-theory-based approach and more orthodox behavioural and cognitive approaches are highlighted and the implications of these differences are discussed. Flexible approaches that are informed by control theory, may offer a useful alternative to the more established behavioural and cognitive approaches towards behavioural activation. © 2012 John Wiley & Sons Ltd.

Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals' perspectives

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Wong Eliza LY

2011-05-01

Full Text Available Abstract Background Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong. Methods Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly. Results The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients. Conclusions An effective chronic disease management model should involve patients in stable

Reversible perspective and splitting in time.

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Hart, Helen Schoenhals

2012-01-01

The element of time--the experience of it and the defensive use of it--is explored in conjunction with the use of reversible perspective as a psychotic defense. Clinical material from a long analysis illustrates how a psychotic patient used the reversible perspective, with its static splitting, to abolish the experience of time. When he improved and the reversible perspective became less effective for him, he replaced it with a more dynamic splitting mechanism using time gaps. With further improvement, the patient began to experience the passage of time, and along with it the excruciating pain of separation, envy, and loss.

Physical activity cardio-surgical patients

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Joanna Stocka

2017-01-01

Full Text Available Health Behaviors are one of the most important factors that determine health. Physical activity plays an important role in the prevention of diseases i.e. hypertension, coronary artery disease, diabetes type 2, stroke and overweight and obesity. In the study this in the clinic of cardiac surgery University Hospital # 1 in Bydgoszcz in the period from October to November 2016 uses the International physical activity questionnaire (IPAQ.  Encouraging patients coronary artery bypass grafting for physical activity before the procedure should be to educate patients about the importance of traffic before the operations and promote health promoting behaviors i.e.. correct diet and maintain a proper body weight, control blood pressure and glucose levels, and appropriate form traffic adapted to the needs and capabilities of the patient.

Identification of Patient Safety Risks Associated with Electronic Health Records: A Software Quality Perspective.

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Virginio, Luiz A; Ricarte, Ivan Luiz Marques

2015-01-01

Although Electronic Health Records (EHR) can offer benefits to the health care process, there is a growing body of evidence that these systems can also incur risks to patient safety when developed or used improperly. This work is a literature review to identify these risks from a software quality perspective. Therefore, the risks were classified based on the ISO/IEC 25010 software quality model. The risks identified were related mainly to the characteristics of "functional suitability" (i.e., software bugs) and "usability" (i.e., interface prone to user error). This work elucidates the fact that EHR quality problems can adversely affect patient safety, resulting in errors such as incorrect patient identification, incorrect calculation of medication dosages, and lack of access to patient data. Therefore, the risks presented here provide the basis for developers and EHR regulating bodies to pay attention to the quality aspects of these systems that can result in patient harm.

Lack of individualized perspective: a qualitative study of diabetes care for immigrants in Sweden.

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Brämberg, Elisabeth Björk; Dahlborg-Lyckhage, Elisabeth; Määttä, Sylvia

2012-06-01

This study describes the care provided by a diabetes nurse specialist, and the care needs expressed by people with type 2 diabetes mellitus and an immigrant background. Clinical encounters between a diabetes nurse specialist and 10 people diagnosed with type 2 diabetes mellitus were observed and analyzed by means of qualitative content analysis. One theme, "the diabetes nurse specialist as the conductor of the visit", and four categories emerged from the findings, illustrating the power imbalance between the patients and the diabetes nurse specialist, as well as the lack of an individual perspective. Shifting from a medical perspective to one of openness towards the people's experiences provides a possibility for caregivers to empower patients suffering from type 2 diabetes mellitus. The medical perspective seemed to steer the visit towards curative activities. Thus, technique-centered care should be developed by including individualized care. © 2012 Blackwell Publishing Asia Pty Ltd.

[Psychotherapy of patients with brain lesions: an integrative model based on neuropsychological and psychodynamic perspectives].

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Ouss-Ryngaert, Lisa

2010-12-01

Our model of psychotherapy for patients with brain lesions is based on an integrative approach of psychobehavioral symptoms, especially from the neuropsychological and psychodynamic perspectives. Adjustment of technical modalities and aims of psychoanalytical therapy is required for these patients. The analysis of the influence of cognitive disorders on transference and contre-transference plays a major role, including the role of procedural processes in changes in the intersubjective relationship between the patient and the therapist. Two vignettes are presented to illustrate our model, which respects the integrity of the cognitive and psychodynamic approaches and can be implemented by only one therapist, using alternatively each lecture, or by a working team bringing to light the different aspects of the same symptom.

Exploring the patient perspective of fatigue in adults with visual impairment: a qualitative study.

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Schakel, Wouter; Bode, Christina; van der Aa, Hilde P A; Hulshof, Carel T J; Bosmans, Judith E; van Rens, Gerardus H M B; van Nispen, Ruth M A

2017-08-03

Fatigue is an often mentioned symptom by patients with irreversible visual impairment. This study explored the patient perspective of fatigue in visually impaired adults with a focus on symptoms of fatigue, causes, consequences and coping strategies. Two large Dutch low vision multidisciplinary rehabilitation organisations. 16 visually impaired adults with severe symptoms of fatigue selected by purposive sampling. A qualitative study involving semistructured interviews. A total of four first-level codes were top-down predetermined in correspondence with the topics of the research question. Verbatim transcribed interviews were analysed with a combination of a deductive and inductive approach using open and axial coding. Participants often described the symptoms of fatigue as a mental, daily and physical experience. The most often mentioned causes of fatigue were a high cognitive load, the intensity and amount of activities, the high effort necessary to establish visual perception, difficulty with light intensity and negative cognitions. Fatigue had the greatest impact on the ability to carry out social roles and participation, emotional functioning and cognitive functioning. The most common coping strategies were relaxation, external support, socialising and physical exercise and the acceptance of fatigue. Our results indicate that low vision-related fatigue is mainly caused by population specific determinants that seem different from the fatigue experience described in studies with other patient populations. Fatigue may be central to the way patients react, adapt and compensate to the consequences of vision loss. These findings indicate a need for future research aimed at interventions specifically tailored to the unique aspects of fatigue related to vision loss. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Collage technique may provide new perspectives for Alzheimer patients by exploring messages from their inner world.

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Meguro, Mitsue; Ishizaki, Junichi; Meguro, Kenichi

2009-01-01

Although the collage art technique has been introduced as a psychotherapeutic method, it has not been fully applied in dementia. To analyze characteristics of the collage articles produced by patients with Alzheimer's disease (AD). Twenty AD patients were asked to select and place several clippings as they wished. The MMSE was used for cognitive assessments. Simplification and poor organization in their articles were found. The themes of one patient were found to change according to behavior. We discussed the images of the articles, especially spiritual images in the early stage and family images in the later stage. We concluded that the collage technique could provide new perspectives for dementia patients by exploring messages from their inner world.

A Commentary on Perceived Need from Indian Perspective

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Ankur Joshi

2016-09-01

Full Text Available The current Indian health –care scenario is overwhelmed not only with burden of diseases but also with quality of care and expenditures.  The structure of this paper is interwoven around a storyline about a patient and narrations of the active actors involved in the journey of illness including patient himself. The narrations are followed by a commentary as an attempt to decipher the deeper meaning of narration from the population perspectives. The essential aim of this exercise is to establish the necessity of generalist care from a qualitative view-point in Indian context.

Patient Involvement Can Affect Clinicians’ Perspectives and Practices of Infection Prevention and Control

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Mary Wyer

2017-01-01

Full Text Available This study, set in a mixed, adult surgical ward of a metropolitan teaching hospital in Sydney, Australia, used a novel application of video-reflexive ethnography (VRE to engage patients and clinicians in an exploration of the practical and relational complexities of patient involvement in infection prevention and control (IPC. This study included individual reflexive sessions with eight patients and six group reflexive sessions with 35 nurses. VRE usually involves participants reflecting on video footage of their own (and colleagues’ practices in group reflexive sessions. We extended the method here by presenting, to nurses, video clips of their clinical interactions with patients, in conjunction with footage of the patients themselves analyzing the videos of their own care, for infection risks. We found that this novel approach affected the nurses’ capacities to recognize, support, and enable patient involvement in IPC and to reflect on their own, sometimes inconsistent, IPC practices from patients’ perspectives. As a “post-qualitative” approach, VRE prioritizes participants’ roles, contributions, and learning. Invoking affect as an explanatory lens, we theorize that a “safe space” was created for participants in our study to reflect on and reshape their assumptions, positionings, and practices.

The centrality of the nurse-patient relationship: A Scandinavian perspective.

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Uhrenfeldt, Lisbeth; Sørensen, Erik Elgaard; Bahnsen, Iben Bøgh; Pedersen, Preben Ulrich

2018-04-06

To address aspects of importance in the nurse-patient relationship, as conceptualised within the Scandinavian healthcare context. An experiment in Beth Israel Hospital uncovered a set of core values (ontology) that were wiped away by stronger forces. Despite this, some of the ideas impacted the development of nursing thought and values in the Scandinavian countries, partly because they connected with deeper social values and also because investment was being put into explicitly identifying and understanding the core elements of nursing (ontology) and how to provide evidence that they found were important (epistemology). From that beginning and through the work of key thought leaders, Scandinavian nursing is ready to embark on a new phase, which could be helped by the Fundamentals of Care framework. This discursive position study offers insights from a public healthcare setting, influenced by values such as equal rights to equal care and/or cure. This study presents two complementing perspectives: an ontological and an epistemological, on establishing caring relationships. There are different pathways to follow in building person-oriented care; however, the nursing approach is both ontologically and epistemologically grounded and based on dialogue. Patients meet different nurses, the meeting may be short and, routine actions may be on the agenda. However, nurses must engage with patients' experiences and knowledge, in order to add to patients' present and future well-being with their person-oriented care. © 2018 John Wiley & Sons Ltd.

South Asian and Middle Eastern patients' perspectives on medicine-related problems in the United Kingdom.

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Alhomoud, Faten; Dhillon, Soraya; Aslanpour, Zoe; Smith, Felicity

2015-08-01

There has been little research which specifically examines medicine use among South Asian (SA) and Middle Eastern (ME) groups, although evidence suggests that medicine-related needs may be poorly met for these groups. To describe medicine-related problems (MRPs) experienced by SA and ME patients from their perspectives and identify possible contributory factors that may be specific to their cultures. The data were collected in seven pharmacies in London, United Kingdom (UK). The study was a qualitative study. Patients were from SA and ME origins, aged over 18 and prescribed three or more regular medicines. Patients were identified when presenting with a prescription. The data were collected in 80 face-to-face semi-structured interviews using Gordon's MRPs tool. Interviews were audiotaped, transcribed verbatim and analysed thematically using Gordon's coding frame and Nvivo 10 software. Describing MRPs experienced by SA and ME patients from their perspectives and identifying possible contributory factors that may be specific to their cultures. Results Eighty participants (61 % male) had mean (SD) age 58 (13.4) years and a mean (SD) of 8 (4) medicines. Interviews revealed that several factors contributed to the development of MRPs; some appeared to be specific to SA and ME cultures and others were similar to the general population. The factors that were reported to be specific to SA and ME groups comprised religious practices and beliefs, use of non-prescription medicines, extent of family support, and travelling abroad--to patient's homeland or to take religious journeys. Illiteracy, language and communication barriers, lack of translated resources, perceptions of healthcare providers, and difficulty consulting a doctor of the same gender may also contribute to the problems. Many of these factors could be expected to influence patient's safety, adherence, and informed decision-making. This study demonstrated that SA and ME patients have their own problems and needs

Understanding the challenges to facilitating active learning in the resident conferences: a qualitative study of internal medicine faculty and resident perspectives.

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Sawatsky, Adam P; Zickmund, Susan L; Berlacher, Kathryn; Lesky, Dan; Granieri, Rosanne

2015-01-01

In the Next Accreditation System, the Accreditation Council for Graduate Medical Education outlines milestones for medical knowledge and requires regular didactic sessions in residency training. There are many challenges to facilitating active learning in resident conferences, and we need to better understand resident learning preferences and faculty perspectives on facilitating active learning. The goal of this study was to identify challenges to facilitating active learning in resident conferences, both through identifying specific implementation barriers and identifying differences in perspective between faculty and residents on effective teaching and learning strategies. The investigators invited core residency faculty to participate in focus groups. The investigators used a semistructured guide to facilitate discussion about learning preferences and teaching perspectives in the conference setting and used an 'editing approach' within a grounded theory framework to qualitative analysis to code the transcripts and analyze the results. Data were compared to previously collected data from seven resident focus groups. Three focus groups with 20 core faculty were conducted. We identified three domains pertaining to facilitating active learning in resident conferences: barriers to facilitating active learning formats, similarities and differences in faculty and resident learning preferences, and divergence between faculty and resident opinions about effective teaching strategies. Faculty identified several setting, faculty, and resident barriers to facilitating active learning in resident conferences. When compared to residents, faculty expressed similar learning preferences; the main differences were in motivations for conference attendance and type of content. Resident preferences and faculty perspectives differed on the amount of information appropriate for lecture and the role of active participation in resident conferences. This study highlights several

The PROactive innovative conceptual framework on physical activity.

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Dobbels, Fabienne; de Jong, Corina; Drost, Ellen; Elberse, Janneke; Feridou, Chryssoula; Jacobs, Laura; Rabinovich, Roberto; Frei, Anja; Puhan, Milo A; de Boer, Willem I; van der Molen, Thys; Williams, Kate; Pinnock, Hillary; Troosters, Thierry; Karlsson, Niklas; Kulich, Karoly; Rüdell, Katja

2014-11-01

Although physical activity is considered an important therapeutic target in chronic obstructive pulmonary disease (COPD), what "physical activity" means to COPD patients and how their perspective is best measured is poorly understood. We designed a conceptual framework, guiding the development and content validation of two patient reported outcome (PRO) instruments on physical activity (PROactive PRO instruments). 116 patients from four European countries with diverse demographics and COPD phenotypes participated in three consecutive qualitative studies (63% male, age mean±sd 66±9 years, 35% Global Initiative for Chronic Obstructive Lung Disease stage III-IV). 23 interviews and eight focus groups (n = 54) identified the main themes and candidate items of the framework. 39 cognitive debriefings allowed the clarity of the items and instructions to be optimised. Three themes emerged, i.e. impact of COPD on amount of physical activity, symptoms experienced during physical activity, and adaptations made to facilitate physical activity. The themes were similar irrespective of country, demographic or disease characteristics. Iterative rounds of appraisal and refinement of candidate items resulted in 30 items with a daily recall period and 34 items with a 7-day recall period. For the first time, our approach provides comprehensive insight on physical activity from the COPD patients' perspective. The PROactive PRO instruments' content validity represents the pivotal basis for empirically based item reduction and validation. ©ERS 2014.

Awake craniotomy. A patient`s perspective.

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Bajunaid, Khalid M; Ajlan, Abdulrazag M

2015-07-01

To report the personal experiences of patients undergoing awake craniotomy for brain tumor resection. We carried out a qualitative descriptive survey of patients` experiences with awake craniotomies for brain tumor resection. The survey was conducted through a standard questionnaire form after the patient was discharged from the hospital. Of the 9 patients who met the inclusion criteria and underwent awake craniotomy, 3 of those patients reported no recollection of the operation. Five patients had auditory recollections from the operation. Two-thirds (6/9) reported that they did not perceive pain. Five patients remembered the head clamp fixation, and 2 of those patients classified the pain from the clamp as moderate. None of the patients reported that the surgery was more difficult than anticipated. Awake craniotomy for surgical resection of brain tumors was well tolerated by patients. Most patients reported that they do not recall feeling pain during the operation. However, we feel that further work and exploration are needed in order to achieve better control of pain and discomfort during these types of operations.

Brain Injury and Severe Eating Difficulties at Admission-Patient Perspective Nine to Fifteen Months after Discharge

DEFF Research Database (Denmark)

Kjærsgaard, Annette

2017-01-01

The purpose of this pilot study was to explore and interpret the way that individuals with acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties, experienced eating nine to fifteen months after discharge. Four individuals with acquired brain injury were ...... the patient perspective of adapting to and developing new strategies for activities related to eating, however, further prospective, longitudinal research in a larger scale and with repeated interviews is needed....... interviewed via qualitative semi-structured interviews. An explorative study was conducted to study eating difficulties. Qualitative content analysis was used. Four main themes emerged from the analysis: personal values related to eating, swallowing difficulties, eating and drinking, meals and social life...... the ability to eat reduced or lost completely, even temporarily, was unexpected and difficult, and caused strong emotional reactions, even 18 months after injury. Time spent using a feeding tube had a negative, but not persistent, impact on quality-of-life. The preliminary findings provide knowledge regarding...

Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

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Winkelmayer, Wolfgang C.; Wheeler, David C.; van Biesen, Wim; Tugwell, Peter; Manns, Braden; Hemmelgarn, Brenda; Harris, Tess; Crowe, Sally; Ju, Angela; O’Lone, Emma; Evangelidis, Nicole; Craig, Jonathan C.

2017-01-01

Background and objectives Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists’ perspectives on defining and implementing patient-centered outcomes in hemodialysis. Design, setting, participants, & measurements Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. Results We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). Conclusions Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader

Patients' perspectives in the management of psoriasis: the Italian results of the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey.

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Gisondi, Paolo; Girolomoni, Giampiero

2017-08-01

The perspective of patients with psoriasis about medical care treatment goals and strategies is receiving increasing attention. Here, we performed a country-based analysis of the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey, in order to provide specific information on patients' perspective of treatment of psoriasis in Italy. This was a systematic household telephone survey recruiting subjects by random digit dialing. Household members ≥18 years were included if they had ever been diagnosed with psoriasis. About 12,785 households were screened in Italy. 132 patients were ineligible for the analysis, including patients with psoriatic arthritis. 359 patients were surveyed. About half of the patients had very mild disease with less than 1 palm skin involvement, and 38% had 1-10 palm skin disease. It is noteworthy that 48% of patients with widespread disease were not taking any medication. Patients indicated the relief of symptoms, including itching (54.9%), as the main goal for their current therapy, whereas 14.2% reported no specific expectation from their medication. Overall, 70% of patients declared to be satisfied by their therapy, in terms of primary goal reached. Our findings suggest that most psoriasis patients have mild/moderate disease in Italy, and that a portion of patients with severe disease does not receive an adequate treatment.

Antibacterial activity of probiotics in bladder tumor patients

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Molchanov R.N.

2014-09-01

Full Text Available The chronic urinary tract infection (UTI is a risk factor that worsens a natural course of bladder tumors. Using of probiotics, possessing antagonistic influence on pathogenic microflora and immunocorrection effect, for preventive maintenance and treat¬ment of a chronic UTI in bladder tumor patients is an actual and perspective direction. The goal of the research was studying antimicrobial and anti-inflammatory effect of a single bladder instillation of either lactobacilli or aerococci in bladder tumor patients. In the preoperative period a single bladder instillation with either lactobacterin or a-bacterin preparation to 35 bladder tumor patients was done. Bacteriuria, leucocyturia, lactobacilli and aerococci count in urine were measured before and in 1, 3, 6 and 24 hours after instillation. Decrease in bacteriuria level in both groups of patients was revealed. Lactobacilli and aerococci count in urine gradually decreased up to complete elimination in 24 hours (in 1 patient who received lactobacterin (12,5 % and in 9 patients who received a-bacterin. (40,9 %. Leucocyturia study did not show statistically confidence dynamics throughout the observation period in both groups. Thus, bladder instillation with lactobacterin or a-bacterin leads to suppression of uropathogenic microflora in bladder tumor patients; in the majority of patients spontaneous elimination of lactobacilli and aerococci occurs within 24 hours.

What Does ePrescribing Mean for Patients? A Case Study of the Perspectives of Hospital Renal Patients

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Lisa Lee

2015-11-01

Full Text Available BACKGROUND: Hospital ePrescribing systems are expected to improve quality of care for patients, yet the perspectives of patients themselves have seldom been explored in the context of ePrescribing deployments.OBJECTIVE: We sought to understand the significance of ePrescribing for patients through a case study of renal in-patients on a hospital ward, before and after the introduction of an ePrescribing system.METHODS: Three data sources were drawn on as part of the case study: interviews with representatives from national patient groups (n = 10, in-patients on a renal ward (n = 11 pre-implementation; n = 12 post-implementation and fieldnotes (n = 25 of observations made on the case study ward. Data were analysed thematically focusing on: (1 perceived benefits of ePrescribing; (2 patient awareness and understanding of the medications prescribed and (3 patient views on medicines reconciliation at admission and discharge.RESULTS: While ePrescribing was viewed positively overall, its implementation in the case study site failed to address the lack of patient involvement in the prescribing process and poor medication counselling upon discharge. Importantly, the limited impact of the ePrescribing system in these particular areas appeared to be the result of institutional and cultural practices rather than solely technological factors.CONCLUSIONS: The introduction of ePrescribing systems offers new opportunities to improve sharing of knowledge and communication with all those involved in the patient’s care pathways, including patients, carers and healthcare professionals across diverse care settings. Achieving this will, first and foremost, require significant cultural and policy shifts in how the patient’s role is perceived by clinicians in relation to medicines management.

Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective.

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Davis, R; Murphy, M F; Sud, A; Noel, S; Moss, R; Asgheddi, M; Abdur-Rahman, I; Vincent, C

2012-08-01

Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre-transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre-transfusion checking behaviours. A cross-sectional design was employed assessing willingness to participate in pre-transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1-7. One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Mean scores for patients' willingness to participate in safety-relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4.96-6.27 to 4.53-6.66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Overall, both patients and healthcare professionals view patient involvement in transfusion-related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety. © 2012 The Authors. Transfusion Medicine © 2012 British Blood Transfusion Society.

Patients' Perspectives on and Experiences of Home Exercise Programmes Delivered with a Mobile Application.

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Abramsky, Hillary; Kaur, Puneet; Robitaille, Mikale; Taggio, Leanna; Kosemetzky, Paul K; Foster, Hillary; Gibson Bmr Pt MSc PhD, Barbara E; Bergeron, Maggie; Jachyra, Patrick

2018-01-01

Purpose: We explored patients' perspectives on home exercise programmes (HEPs) and their experiences using a mobile application designed to facilitate home exercise. Method: Data were generated using qualitative, semi-structured, face-to-face interviews with 10 participants who were receiving outpatient physiotherapy. Results: Establishing a therapeutic partnership between physiotherapists and patients enabled therapists to customize the HEPs to the patients' lifestyles and preferences. Analysis suggests that using the mobile application improved participants' ability to integrate the HEP into their daily life and was overwhelmingly preferred to traditional paper handouts. Conclusions: The results suggest that efforts to engage patients in HEPs need to take their daily lives into account. To move in this direction, sample exercise prescription questions are offered. Mobile applications do not replace the clinical encounter, but they can be an effective tool and an extension of delivering personalized HEPs in an existing therapeutic partnership.

Time perspective, socioeconomic status, and psychological distress in chronic pain patients.

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Dany, Lionel; Roussel, Philippe; Laguette, Vanessa; Lagouanelle-Simeoni, Marie-Claude; Apostolidis, Themis

2016-01-01

Time perspective (TP) is a fundamental dimension of the psychological construction of time. It refers to a subjective experience and can be defined as the relationship that individuals and groups have with the present, past, and future. Studies have shown that it is interesting to take into account TP in the field of health, especially for the study of the psychological distress (PD) of individuals faced with aversive situations. We conducted a research, which aimed to explore the relationship between TP and PD in patients with chronic pain. A total of 264 first-time patients (72.3% women; mean age = 49 years) at CHU Timone (Marseille) pain center answered a questionnaire included TP, socioeconomic status, pain beliefs (PB), pain characteristics, and sociodemographic characteristics. Using hierarchical regression analyses adjusted to the characteristics of pain, sociodemographic characteristics, and PB, we can observe significant relationships between different components of TP, socioeconomic status, and PD. These results emphasize the importance of TP as psychosocial variable in the analysis of PD in patients with chronic pain. These results also lead us to point out the role of the socioeconomic status that predicts levels of PD.

Constructions of the patient in healthcare communications: six patient figures.

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Pors, Anja Svejgaard

2016-01-01

The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations. The paper provides an analysis of four documents collected as part of an ethnographic case study regarding "The Perspective of the Patient" - a Danish Hospital's patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis. The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns. This study contributes to qualitative research in organizational health communication by combining two subfields - patient-centredness and health communication - in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization.

Can asthma control be improved by understanding the patient's perspective?

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Østrem Anders

2007-05-01

Full Text Available Abstract Background Clinical trials show that asthma can be controlled in the majority of patients, but poorly controlled asthma still imposes a considerable burden. The level of asthma control achieved reflects the behaviour of both healthcare professionals and patients. A key challenge for healthcare professionals is to help patients to engage in self-management behaviours with optimal adherence to appropriate treatment. These issues are particularly relevant in primary care, where most asthma is managed. An international panel of experts invited by the International Primary Care Respiratory Group considered the evidence and discussed the implications for primary care practice. Discussion Causes of poor control Clinical factors such as exposure to triggers and concomitant rhinitis are important but so are patient behavioural factors. Behaviours such as smoking and nonadherence may reduce the efficacy of treatment and patients' perceptions influence these behaviours. Perceptual barriers to adherence include doubting the need for treatment when symptoms are absent and concerns about potential adverse effects. Under-treatment may also be related to patients' underestimation of the significance of symptoms, and lack of awareness of achievable control. Implications Three key implications for healthcare professionals emerged from the debate. First, the need for simple tools to assess asthma control. Two approaches considered were the monitoring of biometric markers of control and questionnaires to record patient-reported outcomes. Second, to understand the reasons for poor control for individual patients, identifying both clinical (e.g. rhinitis and behavioural factors (e.g. smoking and nonadherence to treatment. Third was the need to incorporate, within asthma review, an assessment of patient perspectives including their goals and aspirations and to elicit their beliefs and concerns about asthma and its treatment. This can be used as a basis for

The culture of patient safety from the perspective of the pediatric emergency nursing team

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Taise Rocha Macedo

Full Text Available Abstract OBJECTIVE To identify the patient safety culture in pediatric emergencies from the perspective of the nursing team. METHOD A quantitative, cross-sectional survey research study with a sample composed of 75 professionals of the nursing team. Data was collected between September and November 2014 in three Pediatric Emergency units by applying the Hospital Survey on Patient Safety Culture instrument. Data were submitted to descriptive analysis. RESULTS Strong areas for patient safety were not found, with areas identified having potential being: Expectations and actions from supervisors/management to promote patient safety and teamwork. Areas identified as critical were: Non-punitive response to error and support from hospital management for patient safety. The study found a gap between the safety culture and pediatric emergencies, but it found possibilities of transformation that will contribute to the safety of pediatric patients. CONCLUSION Nursing professionals need to become protagonists in the process of replacing the current paradigm for a culture focused on safety. The replication of this study in other institutions is suggested in order to improve the current health care scenario.

Adolescents' Perspectives on the Barriers and Facilitators of Physical Activity: A Systematic Review of Qualitative Studies

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Martins, João; Marques, Adilson; Sarmento, Hugo; Carreiro da Costa, Francisco

2015-01-01

This article examined qualitative studies of adolescents' perspectives about the facilitators and barriers of physical activity, published from 2007 to 2014. A systematic review of "Web of Science", "EBSCO", "Psychinfo" and "ERIC" databases was performed according to Preferred Reporting Items for Systematic…

Email communication in a developing country: different family physician and patient perspectives.

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Makarem, Nisrine N; Antoun, Jumana

2016-01-01

Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians' and patients' use of email within the same health care setting of a developing country. A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans.

Emergency department team communication with the patient: the patient's perspective.

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McCarthy, Danielle M; Ellison, Emily P; Venkatesh, Arjun K; Engel, Kirsten G; Cameron, Kenzie A; Makoul, Gregory; Adams, James G

2013-08-01

Effective communication is important for the delivery of quality care. The Emergency Department (ED) environment poses significant challenges to effective communication. The objective of this study was to determine patients' perceptions of their ED team's communication skills. This was a cross-sectional study in an urban, academic ED. Patients completed the Communication Assessment Tool for Teams (CAT-T) survey upon ED exit. The CAT-T was adapted from the psychometrically validated Communication Assessment Tool (CAT) to measure patient perceptions of communication with a medical team. The 14 core CAT-T items are associated with a 5-point scale (5 = excellent); results are reported as the percent of participants who responded "excellent." Responses were analyzed for differences based on age, sex, race, and operational metrics (wait time, ED daily census). There were 346 patients identified; the final sample for analysis was 226 patients (53.5% female, 48.2% Caucasian), representing a response rate of 65.3%. The scores on CAT-T items (reported as % "excellent") ranged from 50.0% to 76.1%. The highest-scoring items were "let me talk without interruptions" (76.1%), "talked in terms I could understand" (75.2%), and "treated me with respect" (74.3%). The lowest-scoring item was "encouraged me to ask questions" (50.0%). No differences were noted based on patient sex, race, age, wait time, or daily census of the ED. The patients in this study perceived that the ED teams were respectful and allowed them to talk without interruptions; however, lower ratings were given for items related to actively engaging the patient in decision-making and asking questions. Copyright © 2013 Elsevier Inc. All rights reserved.

What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals' concerns, perceived patient characteristics and perceived structural factors.

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Haussmann, Alexander; Gabrian, Martina; Ungar, Nadine; Jooß, Stefan; Wiskemann, Joachim; Sieverding, Monika; Steindorf, Karen

2018-05-09

Despite a large body of evidence showing that physical activity (PA) is beneficial to patients with cancer, healthcare professionals (HCPs) are promoting it too scarcely. Factors that hinder HCPs from promoting PA have remained understudied so far. Using a qualitative approach, this study aimed at a comprehensive description of influencing factors for HCPs' PA promotion behaviour and at identifying the reasons and mechanisms behind them. Semi-structured interviews with 30 HCPs were undertaken with a focus on concerns, patient characteristics and structural factors. Answers were analysed using thematic analysis. Results revealed that HCPs had concerns regarding a physical overexertion and psychological stress for patients with cancer. A patient's physical condition and the assumed interest in PA, often derived from former PA, turned out to be the most crucial patient characteristics influencing if PA is addressed. Structural factors relevant for PA promotion pertained to in-house structures, HCPs' workload, timing and coordination, information material for HCPs and patients and availability of exercise programs. In conclusion, this study revealed undetected concerns of HCPs and underlined the relevance of patient characteristics and structural conditions for HCPs' PA promotion towards patients with cancer. A broader perspective is needed to assess these factors in their influence on HCPs' PA promotion. © 2018 John Wiley & Sons Ltd.

Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: towards a theory of authentic caring in clinical relationships.

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Salmon, Peter; Mendick, Nicola; Young, Bridget

2011-03-01

We developed a method whereby relationships can be studied simultaneously from the perspectives of each party and researchers' observations of their dialogue. Then we used this method to study how to recognise authentic, caring clinical relationships. Participants were 20 patients who had recently received surgery for breast cancer and nine surgeons with whom they had a post-operative consultation. We audiorecorded consultations, before interviewing patients and surgeons about their perceptions of the consultation and each other. Cross-case qualitative analyses (analysing consultations and surgeon and patient interviews, respectively) were supplemented by integrative, within-case analysis. Surgeons and patients described their relationship as personal and emotional, but emotional talk was absent from consultations. For patients and surgeons, their relationship depended, instead, on surgeons' expertise and character. Our integrative approach suggested that authentic caring in these relationships lay in practitioners' conscientious execution of their role and, contrary to currently influential views, not in an explicit emotional engagement. Relationships between patients and practitioners cannot be described adequately using analyses of interactions between them. Researchers will need to triangulate between these observations and the patient and practitioner perspectives in order to understand what makes for authentically caring relationships. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Perspectives on Mobilization of Musical Knowledge during Collaborative Piano Activities: Three Cases Studies

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Samuel Henrique Cianbroni

2017-04-01

Full Text Available The present work seeks to investigate the perspectives in respect to mobilization of musical knowledge by undergraduate students engaged in collaborative piano situations. Three undergraduate piano majors were investigated during three different types of collaborative activities: instrumental ensemble, choral ensemble and solo vocal. The qualitative methodology was based on a case study for descriptions of the data collected through interviews and recordings of rehearsals, music classes, institutional exams, and public performances. The Santos model (2007 was shown to be suitable for the study, especially with regard to identifying the differences between the investigative and the self-regulated cycles, which were distinct among the research participants. The perspectives of knowledge mobilization were revealed through the various ways of perceiving and approaching the collaborative activity with which the participants were engaged, imbued with both their beliefs and demonstrated values. The present study displayed two factors: (1 the influence with which previous systematized (i.e., already learned experiences and forms of personal interest exert on this aspect of musical practice and (2 the importance of investigating what already exists in terms of practiced knowledge (and systematized in the experiences of undergraduate students with the goal to connect forms of knowledge to means of learning.

Patient perspectives on antipsychotic treatments and their association with clinical outcomes

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Hong Liu-Seifert

2010-09-01

Full Text Available Hong Liu-Seifert1, Olawale O Osuntokun1, Jenna L Godfrey2, Peter D Feldman11Lilly Research Laboratories, Indianapolis, IN, USA; 2Durham Veterans Affairs Medical Center, Durham, NC, USAAbstract: This analysis examined patient-reported attitudes toward antipsychotic medication and the relationship of these attitudes with clinical outcomes and pharmacotherapy adherence. The analysis included three randomized, double-blind studies in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition and randomly assigned to treatment with olanzapine 5–20 mg/day or another antipsychotic (haloperidol 2–20 mg/day, risperidone 2–10 mg/day, or ziprasidone 80–160 mg/day. Patient-reported improvements were significantly greater for olanzapine (n = 488 versus other treatments (haloperidol n = 145, risperidone n = 158, or ziprasidone n = 271 on multiple Drug Attitude Inventory items. A positive attitude toward medication reported by patients was significantly associated with greater clinical improvement on the Positive and Negative Syndrome Scale and lower discontinuation rates. These results suggest that patients’ perceptions of treatment benefits are associated with objective clinical measures, including reduction of symptom severity and lower discontinuation rates. Furthermore, olanzapine may be associated with more positive treatment attitudes. These findings may contribute to a better understanding of reasons for treatment adherence from patients’ own perspectives.Keywords: antipsychotic agents, medication adherence, patient satisfaction, schizophrenia, treatment efficacy

Working with Bangladeshi patients in Britain: perspectives from Primary Health Care.

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Hawthorne, Kamila; Rahman, Jasmin; Pill, Roisin

2003-04-01

The difficulties of ethnic minority communities in accessing appropriate primary care are well documented, but little is known about the experiences of Primary Health Care Teams (PHCTs) serving these communities, or their strategies to help patients overcome these difficulties. The purpose of the study was to explore the PHCT perspective of working with Bangladeshi patients. Qualitative group discussions with PHCTs were set up by four health centres in the Grangetown area of Cardiff, where a large proportion of the Bangladeshi community lives. Experiences of and attitudes to working with Bangladeshi patients were explored. Discussions were taped and transcribed for independent analysis by two researchers. Comparisons within and between PHCTs were made. PHCTs largely entered into full and frank discussions. Health visitors had made significantly more effort than others to get to know their Bangladeshi patients. This had costs in terms of time and effort, with no reduction in caseload. Cutting across this difference were common themes such as communication and cultural differences, and patients' difficulties in using NHS services appropriately, which caused disruption and frustration. While there was an awareness of the reasons for these difficulties, PHCTs generally were not able to allow for them because of the inflexibility of their workload and systems of working. Group discussions are a useful way to encourage PHCTs to reflect on their practice and share experiences. PHCTs are aware of their patients' needs and keen to explore racial awareness training and new ways of looking at how they work. However, the grind of heavy workloads makes this process unlikely without outside facilitation.

Suffering and euthanasia: a qualitative study of dying cancer patients' perspectives.

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Karlsson, Marit; Milberg, Anna; Strang, Peter

2012-05-01

Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.

Collage technique may provide new perspectives for Alzheimer patients by exploring messages from their inner world

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Mitsue Meguro

Full Text Available Abstract Although the collage art technique has been introduced as a psychotherapeutic method, it has not been fully applied in dementia. Objectives: To analyze characteristics of the collage articles produced by patients with Alzheimer's disease (AD. Methods: Twenty AD patients were asked to select and place several clippings as they wished. The MMSE was used for cognitive assessments. Results: Simplification and poor organization in their articles were found. The themes of one patient were found to change according to behavior. We discussed the images of the articles, especially spiritual images in the early stage and family images in the later stage. Conclusions: We concluded that the collage technique could provide new perspectives for dementia patients by exploring messages from their inner world.

Patient activation in Europe: an international comparison of psychometric properties and patients' scores on the short form Patient Activation Measure (PAM-13).

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Rademakers, Jany; Maindal, Helle Terkildsen; Steinsbekk, Aslak; Gensichen, Jochen; Brenk-Franz, Katja; Hendriks, Michelle

2016-10-12

To allow better assessment of patients' individual competencies for self-management, the Patient Activation Measure (PAM) has been developed in the USA. Because the American studies have shown the PAM to be a valuable tool, several European countries have translated the instrument into their native languages (Danish, Dutch, German, Norwegian). The aim was to compare the psychometric properties in studies from the different countries and establish whether the scores on the PAM vary between the studies. Data from the four separate studies were subjected to the same data cleaning procedures and statistical analyses. The psychometric properties of the instruments were established with measures of data quality and scale structure. The mean patient activation score and distribution across four predefined activation levels were described and the differences between the four studies were tested with ANOVA (unadjusted and adjusted) followed by a post-hoc Tukey HSD test and the Pearson chi-squared test respectively. The total N of the four studies was 5184. The percentage of missing values was low in all datasets, confirming the good quality of the datasets. Factor analyses revealed moderate to strong factor loadings on the first factor in all datasets. Cronbach's α was high for all version, ranging from .80 (German) to .88 (Dutch). Item-rest correlations varied between .32 and .66, indicating a moderate to strong correlation of the individual items to the sum scale. Both the mean PAM score and the distribution across activation levels differed between the four datasets. After adjustment of the PAM score, patients in Norway in particular had a higher patient activation level. The European translations of PAM-13 (into Danish, Dutch, German and Norwegian) resulted in four instruments with good psychometric capabilities for measuring patient activation. The mean PAM score and the distribution across activation levels differed between the four datasets.

Total Body Photography as an Aid to Skin Self-examination: A Patient's Perspective.

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Secker, Lisanne J; Bergman, Wilma; Kukutsch, Nicole A

2016-02-01

Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients' perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients' self-screening behaviours.

Gender differences in brain activity and the relationship between brain activity and differences in prevalence rates between male and female major depressive disorder patients: a resting-state fMRI study.

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Yao, Zhijian; Yan, Rui; Wei, Maobin; Tang, Hao; Qin, Jiaolong; Lu, Qing

2014-11-01

We examined the gender-difference effect on abnormal spontaneous neuronal activity of male and female major depressive disorder (MDD) patients using the amplitude of low-frequency fluctuation (ALFF) and the further clarified the relationship between the abnormal ALFF and differences in MDD prevalence rates between male and female patients. Fourteen male MDD patients, 13 female MDD patients and 15 male and 15 female well matched healthy controls (HCs) completed this study. The ALFF approach was used, and Pearson correlation was conducted to observe a possible clinical relevance. There were widespread differences in ALFF values between female and male MDD patients, including some important parts of the frontoparietal network, auditory network, attention network and cerebellum network. In female MDD patients, there was a positive correlation between average ALFF values of the left postcentral gyrus and the severity of weight loss symptom. The gender-difference effect leading to abnormal brain activity is an important underlying pathomechanism for different somatic symptoms in MDD patients of different genders and is likely suggestive of higher MDD prevalence rates in females. The abnormal ALFF resulting from the gender-difference effect might improve our understanding of the differences in prevalence rates between male and female MDD patients from another perspective. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

The patient perspective on absence of disease activity in rheumatoid arthritis

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van Tuyl, Lilian H D; Sadlonova, Martina; Hewlett, Sarah

2017-01-01

important aspects to inform future research. METHODS: Patients with RA from the Netherlands, the UK, Austria, Denmark, France and the USA completed a survey that contained all domains identified in our qualitative study. They rated domains for importance ('not important', 'important' or 'essential......' to characterise a period of remission) and if important or essential, whether this domain needs to be 'less', 'almost gone' or 'gone' to reflect remission. Respondents were also asked to determine their personal top 3 most important/essential domains. Frequency of specific domains in the top 3 was calculated......, and domains were sorted on the percentage of patients that evaluated a particular domain as 'essential'. RESULTS: Of 274 respondents, 75% were female, mean (SD) age 57(13) years, disease duration 12(9) years. The top 3 were as follows: pain (67%), fatigue (33%) and independence (19%); domains most frequently...

The potential of eHealth in otorhinolaryngology-head and neck surgery: patients' perspectives.

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Holderried, Martin; Ernst, C; Holderried, F; Rieger, M; Blumenstock, G; Tropitzsch, A

2017-07-01

The use of modern information and communication technologies (ICT) in daily life has significantly increased during the last several years. These essential online technologies have also found their way into the healthcare system. The use of modern ICT for health reasons can be summarized by the term 'eHealth'. Despite the potential importance of eHealth in the field of otorhinolaryngology (ORL), there is little understanding of patients' attitudes towards the deeper integration of these technologies into intersectoral care. The aim of this study was to gain a better understanding of patients' attitudes towards the use of modern ICT for intersectoral communication and information transfer in the field of ORL. Therefore, a structured interview was developed by an interdisciplinary team of otorhinolaryngologists, public health researchers, and information technology (IT) specialists. Overall, 211 ORL patients were interviewed at the Department of Otorhinolaryngology-Head and Neck Surgery, Tuebingen University Hospital, Germany, and 203 of these patients completed the interview. This study revealed ORL patients' perspectives on the potential of eHealth, especially for appointment scheduling, appointment reminders, and intersectoral communication of personal medical information. Furthermore, this study provides evidence that data security and the impacts of eHealth on the physician-patient relationship and on treatment quality warrant special attention in future research.

Sickness certification in the general practice consultation: the patients' perspective, a qualitative study.

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O'Brien, Kathryn; Cadbury, Naomi; Rollnick, Stephen; Wood, Fiona

2008-02-01

Up to a third of general practice consultations involve issuing sickness certificates. Recent research has looked at the GPs' perspective of sickness certification but there has been no in-depth research exploring patients' views of these consultations. To explore patients' views of sickness certification within general practice consultations, and how these could be improved. A qualitative study was carried out with 12 general practices in South Wales; interview study of 19 patients who had recently received a sick note from a GP. Patients rarely attended just for a sick note, more often wanting advice or an opportunity to ask questions. Patients valued continuity of care, a good doctor-patient relationship, adequate consultation time and discussion about their illness, social situation and work-related issues when consulting with their GP for a sick note. Many patients felt doctors did not have enough time or knowledge of the patient to the able to address this issue adequately and this increased feelings of anxiety. Patients did not feel that being questioned by their GP or discussing return to work threatened the doctor-patient relationship. GPs who simply give out sick notes without question or discussion are not necessarily giving the patient what they want. More time should be spent discussing work and illness-related issues. Policy makers should recognize that continuity of care a good doctor-patient relationship and adequate consultation time are important to patients and any initiatives aimed at GPs to improve return to work rates should take these into consideration.

Proteasome activity related with the daily physical activity of COPD patients

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Lee KY

2017-05-01

Full Text Available Kang-Yun Lee,1,2,* Tzu-Tao Chen,1,* Ling-Ling Chiang,1,3 Hsiao-Chi Chuang,1,3 Po-Hao Feng,1,2 Wen-Te Liu,1–3 Kuan-Yuan Chen,1 Shu-Chuan Ho1,3 1Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 2Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 3School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan *These authors contributed equally to this work Background: COPD is a debilitating disease that affects patients’ daily lives. One’s daily physical activity (DPA decreases due to multifactorial causes, and this decrease is correlated with a poor prognosis in COPD patients. Muscle wasting may at least be partly due to increased activity of the ubiquitin proteasome pathway and apoptosis.Methods: This study investigated the relationships among DPA, circulating proteasome activity, and protein carbonyl in COPD patients and healthy subjects (HSs. This study included 57 participants (42 patients and 15 healthy subjects. Ambulatory DPA was measured using actigraphy, and oxygen saturation was measured with a pulse oximeter.Results: COPD patients had lower DPA, lower 6 min walking distance (6MWD, lower delta saturation pulse oxygenation (SpO2 during the 6MWT, and lower delta SpO2 during DPA than HSs. COPD patients had higher proteasome activity and protein carbonyl than HSs. Circulating proteasome activity was significantly negatively correlated with DPA (r=−0.568, P<0.05 in COPD patients, whereas delta SpO2 during the 6MWT was significantly positively correlated with proteasome activity (r=0.685, P<0.05 in HSs. Protein carbonyl was significantly negatively correlated with the body mass index (r=−0.318, P<0.05, mid-arm circumference (r=0.350, P<0.05, calf circumference (r=0.322, P<0.05, forced expiratory volume in the first second (r=−0.441, P<0

Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel

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Luz María Tejada-Tayabas

2015-04-01

Full Text Available OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.

Preliminary study of visual perspective in mental time travel in schizophrenia.

Science.gov (United States)

Wang, Ya; Wang, Yi; Zhao, Qing; Cui, Ji-Fang; Hong, Xiao-Hong; Chan, Raymond Ck

2017-10-01

This study explored specificity and visual perspective of mental time travel in schizophrenia. Fifteen patients with schizophrenia and 18 controls were recruited. Participants were asked to recall or imagine specific events according to cue words. Results showed that schizophrenia patients generated fewer specific events than controls, the recalled events were more specific than imagined events. Schizophrenia adopted less field perspective and more observer perspective than controls. These results suggested that patients with schizophrenia were impaired in mental time travel both in specificity and visual perspective. Further studies are needed to identify the underlying mechanisms. Copyright © 2017 Elsevier B.V. All rights reserved.

78 FR 53506 - Proposed Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

Science.gov (United States)

2013-08-29

... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481); Activity: Comment Request... required to obtain patient perspective on satisfaction with the CCHT program and messaging devices. DATES.... Titles: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. OMB...

78 FR 76193 - Agency Information Collection (Care Coordination Home Telehealth (CCHT) Patient Satisfaction...

Science.gov (United States)

2013-12-16

... Coordination Home Telehealth (CCHT) Patient Satisfaction Survey) Activities Under OMB Review AGENCY: Veterans... patient perspective on satisfaction with the CCHT program and messaging devices. DATES: Comments must be...: Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey, VA Form 10-0481. Type of Review...

Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis

DEFF Research Database (Denmark)

Egsmose, Emilie Lund; Madsen, Ole Rintek

2015-01-01

The interplay between patient-reported outcome measures in rheumatology is not well clarified. The objective of the study was to examine associations on the group level and concordance on the individual patient level between patient global assessment (PaGl), pain, and fatigue as scored on visual...... analog scales (VAS) in the daily clinic by patients with active rheumatoid arthritis (RA). Associations with other measures of disease activity were also examined. Traditional disease activity data on 221 RA patients with active disease planned to initiate biological treatment were extracted from...... clinical measures of disease activity and were nearly identical on the group level. On the individual patient level, however, differences between the scores varied considerably. The findings highlight the challenge of understanding and dealing with traditional patient-reported VAS measures when it comes...

Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine.

Science.gov (United States)

Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R

2014-08-01

Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies

What information do patients need following a whiplash injury? The perspectives of patients and physiotherapists.

Science.gov (United States)

Maujean, Annick; Sterling, Joanna; Sterling, Michele

2018-05-01

The aims of the present study were to identify information that individuals with whiplash associated disorders (WAD) need to know in the early stages of recovery and to establish whether there is a difference between what physiotherapists and whiplash-injured patients perceive as important information. Forty-one participants were recruited (20 whiplash-injured patients, 21 physiotherapists). Participants were asked to provide five statements to one open-ended question about what they believe is the most important information individuals with WAD need to know in the early stages of recovery. Participants provided 182 statements which were reviewed independently and organised into themes by two of the authors. Six key themes emerged from the statements. These included general information about whiplash injury, treatment and recovery, reassurance, provision of poor information and patients' interaction with general practitioners, maintaining daily activities, and compensation claims and litigation. Both patients and physiotherapists agreed on the type of general whiplash information that should be provided however, major differences were found with regard to information pertaining to compensation claims and litigation and maintaining daily activities. The findings of this study provide some insight into the type of information that WAD individuals require in the early stages of recovery. Implications for Rehabilitation The provision of reassurance can be an effective communication tool to decrease patients concerns about their injury and help strengthen the patient-health practitioner relationship. Although clinical guidelines for the management of whiplash injuries recommend that individuals must remain physically active post-injury, statements from the patient group indicate that this information is not always provided and clearly explained to patients. Keeping in line with the patient centred care approach of being responsive to patient needs and values, it is

Physician's practices and perspectives regarding tobacco cessation in a teaching hospital in Mysore City, Karnataka.

Science.gov (United States)

Saud, Mohammed; Madhu, B; Srinath, K M; Ashok, N C; Renuka, M

2014-01-01

Tobacco is a leading cause of disease and premature death. Most of the smokers visit a doctor for various health related ailments and thus such clinic visits provide many opportunities for interventions and professional tobacco cessation advice. The primary aim of the following study is to assess the physician practices, perspectives, resources, barriers and education relating to tobacco cessation and their perceived need for training for the same. The secondary aim is to compare the physician's cessation practices from patient's perspective. A descriptive study was conducted in a hospital attached to Medical College in Mysore city, Karnataka. Information about doctor's practices, perspectives and their perceived need for training in tobacco cessation were collected using pre-structured self-administered Questionnaire, which were distributed in person. Patient's practices and perspectives were assessed using a pre-structured Oral Questionnaire. Almost 95% of physicians said that they ask patients about their smoking status and 94% advise them to quit smoking, but only 50% assist the patient to quit smoking and only 28% arrange follow-up visits. Thus, they do not regularly provide assistance to help patients quit, even though 98% of the physicians believed that helping patients to quit was a part of their role. Only 18% and 35% of the physicians said that Undergraduate Medical Education and Post Graduate Medical Education respectively prepared them very well to participate in smoking cessation activities. Tobacco cessation requires repeated and regular assistance. Such assistance is not being provided to patients by attending doctors. Our medical education system is failing to impart the necessary skills to doctors, needed to help patients quit smoking. Reforms in education are needed so as to prepare the physician to effectively address this problem.

The integrated care of asthma in Switzerland (INCAS)-study: Patients' perspective of received asthma care and their interest in asthma education.

Science.gov (United States)

Dürr, Selina; Hersberger, Kurt E; Zeller, Andreas; Scheuzger, Jonas; Miedinger, David; Gregoriano, Claudia; Leuppi, Jörg D; Steurer-Stey, Claudia

2016-11-01

For successful long-term asthma care, self-management education is a cornerstone. Little is known about associations between patients' interest in education, asthma control and care delivery. We compared patients' characteristics, asthma control and patients' perspective about asthma care in subjects with and without interest in asthma education. Moreover, we assessed reasons, why patients denied participating in asthma education. Baseline data of 223 patients with asthma (age 43 ± 12 years, 38% male, 58% non-smokers, 13% current smokers), who participated in a multicentre longitudinal controlled study, are reported. At baseline, patients completed the Asthma Control Test (ACT), the Patient Assessment Chronic Illness Care questionnaire (PACIC 5A) and stated their interest in an asthma education programme. Overall, 34% of all participants showed uncontrolled asthma. One hundred and twenty-five (56%) patients were interested in education. Compared to patients without interest, they were characterised by male gender (p = 0.013), worse asthma control (p < 0.001), and perception of lower quality of chronic asthma care delivery, in particular lower self-management support (p < 0.001). Main reasons for rejecting asthma education were having sufficient asthma knowledge, having only mild asthma, receiving adequate medical support and lack of time. More than half of the patients were interested in asthma education. Interest was associated with worse asthma control and lower receipt of care according to the Chronic Care Model. Considering these aspects, this approach may help to improve care quality and allow targeting interventions to those patients who are interested in becoming active participants in their care and who might benefit most.

The role of the corporate nurse executive: providing balance and perspective for patient care and the corporate structure.

Science.gov (United States)

Ameigh, A Y

1996-01-01

The nurse executive at the corporate level is in a pivotal position to provide balance between the provision of integrated patient care and success of the corporate mission. In this role, the nurse executive shifts the spotlight from a solely nursing perspective to the systems approach in support of patient care. The response that follows is often a redoubling of the efforts of health care providers to render more efficient and cohesive care to patients. In the end, success is an outgrowth of strong teamwork combined with the ability of the executive to connect the corporate business strategy with the provision of patient care wherever it is delivered.

Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective.

Science.gov (United States)

Padela, Aasim I; Rodriguez del Pozo, Pablo

2011-01-01

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations.

Randomised controlled trial of a secondary prevention program for myocardial infarction patients ('ProActive Heart': study protocol. Secondary prevention program for myocardial infarction patients

Directory of Open Access Journals (Sweden)

Taylor C Barr

2009-05-01

Full Text Available Abstract Background Coronary heart disease (CHD is a significant cause of health and economic burden. Secondary prevention programs play a pivotal role in the treatment and management of those affected by CHD although participation rates are poor due to patient, provider, health system and societal-level barriers. As such, there is a need to develop innovative secondary prevention programs to address the treatment gap. Telephone-delivered care is convenient, flexible and has been shown to improve behavioural and clinical outcomes following myocardial infarction (MI. This paper presents the design of a randomised controlled trial to evaluate the efficacy of a six-month telephone-delivered secondary prevention program for MI patients (ProActive Heart. Methods 550 adult MI patients have been recruited over a 14 month period (December 2007 to January 2009 through two Brisbane metropolitan hospitals, and randomised to an intervention or control group (n = 225 per group. The intervention commences within two weeks of hospital discharge delivered by study-trained health professionals ('health coaches' during up to 10 × 30 minute scripted telephone health coaching sessions. Participants also receive a ProActive Heart handbook and an educational resource to use during the health coaching sessions. The intervention focuses on appropriate modification of CHD risk factors, compliance with pharmacological management, and management of psychosocial issues. Data collection occurs at baseline or prior to commencement of the intervention (Time 1, six months follow-up or the completion of the intervention (Time 2, and at 12 months follow-up for longer term outcomes (Time 3. Primary outcome measures include quality of life (Short Form-36 and physical activity (Active Australia Survey. A cost-effective analysis of the costs and outcomes for patients in the intervention and control groups is being conducted from the perspective of health care costs to the

HIV/TB co-infection:perspectives of TB patients and providers on the integrated HIV/TB pilot program in Tamilnadu, India

OpenAIRE

Lakshminarayanan, Mahalakshmi

2009-01-01

The WHO recommends routine HIV testing among TB patients as a key strategy to combat the dual HIV/TB epidemic. India has integrated its HIV and TB control programs and is offering provider initiated HIV testing for all TB patients since 2007. Using a mixed methods approach, this study aims to understand the perspectives of TB patients and providers on the integrated HIV/TB pilot program in Tamilnadu, India. A survey conducted by the Tuberculosis Research Center, India on 300 TB patients is th...

Patients' perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care.

Science.gov (United States)

Chapman, S C E; Horne, R; Chater, A; Hukins, D; Smithson, W H

2014-02-01

Nonadherence to antiepileptic drugs (AEDs) can result in suboptimal outcomes for patients. This study aimed to assess the utility of a theory-based approach to understanding patient perspectives on AEDs and adherence. Patients with epilepsy, identified by a GP case note review, were mailed validated questionnaires assessing their perceptions of AEDs and their adherence to them. Most (84.9%) of the 398 AED-treated respondents accepted the necessity of AEDs, but over half expressed doubts, with 55% disagreeing or uncertain about the statement 'I would prefer to take epilepsy medication than risk a seizure'. Over a third (36.4%) expressed strong concerns about the potential negative effects of AEDs. We used self-report and medication possession ratio to classify 36.4% of patients as nonadherent. Nonadherence was related to beliefs about medicines and implicit attitudes toward AEDs (pbeliefs about pharmaceuticals (BMQ General: General Harm, General Overuse, and General Benefit scales) and perceptions of personal sensitivity to medicines (PSM scale). We identified salient, adherence-related beliefs about AEDs. Patient-centered interventions to support medicine optimization for people with epilepsy should take account of these beliefs. © 2013.

Migrant and Refugee Patient Perspectives on Travel and Tuberculosis along the Thailand-Myanmar Border: A Qualitative Study.

Science.gov (United States)

Tschirhart, Naomi; Sein, Tabitha; Nosten, Francois; Foster, Angel M

2016-01-01

The Thailand-Myanmar border separates two very different health systems. The healthcare system in eastern Myanmar remains underdeveloped as a result of decades of instability. Comparatively, Tak province, Thailand has more healthcare resources. In this Thai border province government hospitals and non-governmental organizations provide tuberculosis (TB) treatment to migrants and refugees. Our overall study aimed to explore accessibility of TB treatment, TB surveillance and health system responsiveness specific to migrant and refugee populations in Tak province. In this paper, we focus on the perspectives of migrant and refugee TB patients with respect to travel and treatment in Tak province. In 2014 we conducted focus group discussions with 61 TB, Tuberculosis and Human Immunodeficiency Virus co-infection, and multidrug-resistant TB patients in Tak province. We analyzed the data for content and themes and documented individual travel trajectories. Migrants are travelling with active TB within the country and between Thailand and Myanmar. Migrants primarily travelled to obtain treatment but two participants reported travelling home to seek family care in Myanmar before returning to Thailand for treatment. Travel, while expensive and arduous, is an adaptive strategy that migrants use to access healthcare. Migrant's need for travel points to larger difficulties associated with healthcare access in the border region. Long distance travel with an infectious disease can be seen as an indicator that local healthcare is not available or affordable. These findings suggest that public health officials from both sides of the border should discuss the factors that contribute to travel with active TB and explore potential solutions to mitigate disease transmission in migrant populations.

Photonic Network R&D Activities in Japan-Current Activities and Future Perspectives

Science.gov (United States)

Kitayama, Ken-Ichi; Miki, Tetsuya; Morioka, Toshio; Tsushima, Hideaki; Koga, Masafumi; Mori, Kazuyuki; Araki, Soichiro; Sato, Ken-Ichi; Onaka, Hiroshi; Namiki, Shu; Aoyama, Tomonori

2005-10-01

R&D activities on photonic networks in Japan are presented. First, milestones in current ongoing R&D programs supported by Japanese government agencies are introduced, including long-distance and wavelength division multiplexing (WDM) fiber transmission, wavelength routing, optical burst switching (OBS), and control-plane technology for IP backbone networks. Their goal was set to evolve a legacy telecommunications network to IP-over-WDM networks by introducing technologies for WDM and wavelength routing. We then discuss the perspectives of so-called PHASE II R&D programs for photonic networks over the next 5 years until 2010, by focusing on the report that has been recently issued by the Photonic Internet Forum (PIF), a consortium that has major carriers, telecom vendors, and Japanese academics as members. The PHASE II R&D programs should serve to establish a photonic platform to provide abundant bandwidth on demand, at any time on a real-time basis, through the customer's initiative to promote bandwidth-rich applications, such as grid computing, real-time digital-cinema streaming, medical and educational applications, and network storage in e-commerce.

Experiences and perceptions of patients with 100% adherence to highly active antiretroviral therapy: a qualitative study.

Science.gov (United States)

Sidat, Mohsin; Fairley, Christopher; Grierson, Jeffrey

2007-07-01

A decade has passed since the introduction of highly active antiretroviral therapy (HAART) as standard of care for HIV/AIDS patients. The success of HAART is largely dependent on almost 100% adherence to it. In this study our primary aim was to understand from patients' own perspectives and experiences what resulted in them having 100% adherence to HAART. Thus, we purposefully recruited for in-depth interviews 10 participants (7 men and 3 women) with 100% adherence to HAART (>/=6 months previous to the interviews). All interviews were transcribed verbatim and analyzed by using Giorgi's phenomenological analysis approach. The following issues emerged from the analysis: readiness to go on HAART; HAART viewed as a life-line; maintenance of 100% adherence related with willingness to live longer and healthier; optimal ongoing patient-physician relationship, better coping and/or lack of perceived side effects; and improvements in clinical condition as well as in CD4 T-cells count and viral load reinforced the motivation to continue 100% adherence. The study findings should be helpful for health professionals caring for HIV-infected individuals on HAART.

Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment.

Science.gov (United States)

Lindgreen, Pil; Clausen, Loa; Lomborg, Kirsten

2018-04-01

The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from eating disorders. Oppositely to traditional pen-and-paper meal diaries, the app allows for in-app patient-clinician linkage enabling clinicians to access patient app data anytime. The aim of our study was to explore the interdisciplinary clinical perspective on Recovery Record and its impact on treatment. Thirty-one clinicians from a Danish eating disorder treatment facility participated in field studies and 23 of these in interviews. Data were generated and analyzed concurrently applying the inductive methodology of Interpretive Description. We found two overarching themes: "Access to app data between treatment sessions", and "The patient-clinician relationship". Sub-themes associated with the former were "Online obligations" in relation to the added workload of continuously monitoring patient app data, and "Prepared or prejudiced" relating to advantages and disadvantages of using patient app data as preparation for treatment sessions. Sub-themes pertaining to the latter were "Expectation discrepancy" in relation to patients' and clinicians' divergent expectations for app usage, and "Pacified patients" regarding the clinicians' experience that the app potentially compromised the patient initiative in treatment sessions. Recovery Record induced new and affected pre-existing treatment and work conditions for clinicians. Clinicians were preoccupied with challenges associated with the app, for example, an added work load and potential harm to the patient-clinician collaboration. Thus, prior to adopting the app, we encourage clinicians and managements to discuss the objectives, advantages and disadvantages of adopting the app, and outline specific guidelines for patient and clinician app usage. © 2018 Wiley Periodicals, Inc.

IAEA activities in nuclear safety: future perspectives. Spanish Nuclear Safety Council, Madrid, 28 May 1998

International Nuclear Information System (INIS)

ElBaradei, M.

1998-01-01

The document represents the conference given by the Director General of the IAEA at the Spanish Nuclear Safety Council in Madrid, on 28 May 1998, on Agency's activities in nuclear safety. The following aspects are emphasized: Agency's role in creating a legally binding nuclear safety regime, non-binding safety standards, services provided by the Agency to assist its Member States in the Application of safety standards, Agency's nuclear safety strategy, and future perspective concerning safety aspects related to radioactive wastes, residues of past nuclear activities, and security of radiological sources

Patient Activity Levels After Reverse Total Shoulder Arthroplasty: What Are Patients Doing?

Science.gov (United States)

Garcia, Grant H; Taylor, Samuel A; DePalma, Brian J; Mahony, Gregory T; Grawe, Brian M; Nguyen, Joseph; Dines, Joshua S; Dines, David M; Warren, Russell F; Craig, Edward V; Gulotta, Lawrence V

2015-11-01

The indications for reverse total shoulder arthroplasty (RTSA) continue to expand, which has resulted in younger patients who want to remain active after RTSA. Little information is available to manage expectations of both physicians and patients for return to sporting activities. To determine the rate of return to sporting activities and assess average time to return to sports after RTSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive RTSA patients collected from our institution's shoulder arthroplasty registry. All patients who played sports preoperatively and had a minimum of 1-year follow-up were included. Final follow-up consisted of an additional patient-reported questionnaire with questions regarding physical fitness and sporting activities. Each patient also completed an assessment with the American Shoulder and Elbow Society (ASES) Shoulder Score and a visual analog scale (VAS) for pain. Seventy-six patients played a sport preoperatively and met inclusion and exclusion criteria. The average follow-up was 31.6 months (range, 12-65 months), and average age was 74.8 years (range, 49.9-92.6 years). Average VAS pain scores improved from 6.57 to 0.63 (P sport. Average time to return to full sports was 5.3 months. Fitness sports had the highest direct rate of return (81.5%), followed by swimming (66.7%), running (57.1%), cycling (50.0%), and golf (50%). Postoperatively, 41.1% of patients reported improved physical fitness; 88.2% felt that their sports outcome was good to excellent, and 93.4% felt that their surgical outcome was good to excellent. Patients undergoing RTSA had an 85% rate of return to 1 or more sporting activities at an average of 5.3 months after surgery. Age greater than 70 years was a significant predictor of decreased return to activities. The present study offers valuable information to help manage patient and surgeon expectations. © 2015 The Author(s).

[Impact of social disadvantages and time perspective on smoking cessation].

Science.gov (United States)

Merson, Frédéric; Perriot, Jean

2012-02-01

Smoking addiction and tobacco dependence are related to social deprivation and time perspective. The objective of this study was to understand how these factors influenced the results of smoking cessation in order to optimize the care of this population. We included 200 patients from our outpatient clinic from March 1, 2009 to June 30, 2010. This study focused on the impact of social disadvantages and time perspective on smoking cessation. Time perspective was measured with the short version of the Zimbardo Time Perspective Inventory, social disadvantages with Epices scale. Information on each individual's characteristics, smoking addiction, and smoking cessation was collected. One hundred and ninety-two patients (of whom 45% were socially disadvantaged) participated. Socially disadvantaged people tend to lean towards dimensions "Past Negative" (Pdisadvantages and time perspective in helping these addicted patients to stop smoking. Copyright © 2011. Published by Elsevier Masson SAS.

Music and Music Intervention for Therapeutic Purposes in Patients with Ventilator Support; Gamelan Music Perspective

Directory of Open Access Journals (Sweden)

Suhartini Suhartini

2011-01-01

Full Text Available Background: Gamelan music is one of folk music for Javanese people. Several research studies testing the effects of music were conducted in Western countries. The music studies for therapeutic purposes used classical music commonly. Even in Indonesia, some researchers may use that music for therapeutic purposes. This concern article explains the perspective music and music intervention as therapeutic purposes, view with Javanese classical music.Objectives: To explore the evidence of music and music intervention for therapeutic purposes and to describe the perspective of gamelan music used in nursing interventionMethods: Using five bibliography databases (MEDLINE, CINAHL, Science Direct, Interscience, and Proquest were searched from 1999-2010 for original clinical reports or reviews that evaluated the use of complementary therapy for therapeutic intervention in patients with ventilator support. The term of complementary therapy, anxiety, and pain were used in a comprehensive search of electronic databases. Articles were screened and excluded based on the title and abstract information.Results: Music brings about helpful changes in the emotional and physical health of patients, and has the ability to provide an altered state of physical arousal and subsequent mood improvement by processing a progression of musical notes of varying tone, rhythm, and instrumentation for a pleasing effect.Conclusion: Music can be used for therapeutic purposes, for instance to reduce anxiety, to decrease pain sensation, and some effects of psychological impact. Include, the gamelan music can be offer for patients for Javanese people in Indonesia.Key words: Music, music intervention, therapeutic purposes

Reasons for discontinuation of subcutaneous biologic therapy in the treatment of rheumatoid arthritis: a patient perspective

Directory of Open Access Journals (Sweden)

Bolge SC

2015-01-01

Full Text Available Susan C Bolge,1 Amir Goren,2 Neeta Tandon1 1Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA; 2Health Outcomes Practice, Kantar Health, New York, NY, USA Objective: To examine reasons why rheumatoid arthritis patients discontinued subcutaneous (SQ anti-tumor necrosis factor (anti-TNF treatment in the past 12 months, so as to help inform successful, uninterrupted therapy.Methods: Data were collected in March and April 2011 using self-reported, internet-based questionnaires. Study inclusion criteria comprised: rheumatoid arthritis diagnosis; discontinuation of SQ anti-TNF medication (adalimumab, certolizumab, etanercept, or golimumab within the past 12 months; aged ≥18 years; United States residency; and consent to participate. Patients reported primary and other reasons for discontinuation of their most recently discontinued anti-TNF.Results: Questionnaires from 250 patients were analyzed; 72.8% were female, 80.8% were white, and median age was 51 years. Patients had discontinued etanercept (n=109, adalimumab (n=98, certolizumab (n=24, or golimumab (n=19 within the past 12 months. When prompted about their primary reason for discontinuation, lack of effectiveness (40.8% was cited most often, followed by injection experience (18.4%. Combining prompted primary and other reasons for discontinuation, 60.8% of patients reported lack of effectiveness, while 40.8% reported injection experience, which included: pain/burning/discomfort after injection (14.4%; pain/burning/discomfort during injection (13.2%; injection reactions such as redness/swelling after injection (12.4%; dislike of self-injection (11.6%; dislike of frequency of injection (10.4%; and fear of injection/needles (6.8%. Conclusion: From the patient perspective, there are unmet needs with regard to the effectiveness and injection experience associated with SQ anti-TNF medications, which may lead to discontinuation. Treatment options with a

A Survey on Proactive, Active and Passive Fault Diagnosis Protocols for WSNs: Network Operation Perspective

Directory of Open Access Journals (Sweden)

Amjad Mehmood

2018-06-01

Full Text Available Although wireless sensor networks (WSNs have been the object of research focus for the past two decades, fault diagnosis in these networks has received little attention. This is an essential requirement for wireless networks, especially in WSNs, because of their ad-hoc nature, deployment requirements and resource limitations. Therefore, in this paper we survey fault diagnosis from the perspective of network operations. To the best of our knowledge, this is the first survey from such a perspective. We survey the proactive, active and passive fault diagnosis schemes that have appeared in the literature to date, accenting their advantages and limitations of each scheme. In addition to illuminating the details of past efforts, this survey also reveals new research challenges and strengthens our understanding of the field of fault diagnosis.

The market of the activities bound to the wastes situation 2002-2003 and perspectives 2004; Le marche des activites liees aux dechets situation 2002-2003 et perspectives 2004

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-12-01

This study presents the different activities bound to the wastes, evaluates the economical stakes, the short-dated development perspectives, identifies the new markets and analyzes the regulations impact on the short-dated markets. It concerns the non hazardous and hazardous wastes. (A.L.B.)

"I have nine specialists. They need to swap notes!" Australian patients' perspectives of medication-related problems following discharge from hospital.

Science.gov (United States)

Eassey, Daniela; McLachlan, Andrew J; Brien, Jo-Anne; Krass, Ines; Smith, Lorraine

2017-10-01

Research has shown that patients are most susceptible to medication-related problems (MRPs) when transitioning from hospital to home. Currently, the literature in this area focuses on interventions, which are mainly orientated around the perspective of the health-care professional and do not take into account patient perspectives and experiences. To capture the experiences and perceptions of Australian patients regarding MRPs following discharge from hospital. A cross-sectional study was conducted using a questionnaire collecting quantitative and qualitative data. Thematic analysis was conducted of the qualitative data. Survey participants were recruited through The Digital Edge, an online market research company. Five hundred and six participants completed the survey. A total of 174 participants self-reported MRPs. Two concepts and seven subthemes emerged from the analysis. The first concept was types of MRPs and patient experiences. Three themes were identified: unwanted effects from medicines, confusion about medicines and unrecognized medicines. The second concept was patient engagement in medication management, of which four themes emerged: informing patients, patient engagement, communication amongst health-care professionals and conflicting advice. This study provides an important insight into patients' experiences and perceptions of MRPs following discharge from hospital. Future direction for practice and research should look into implementing patient-centred care at the time of hospital discharge to ensure the provision of clear and consistent information, and developing ways to support and empower patients to ensure a smooth transition post-discharge from hospital. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Assessing the patient's mammogram experience.

Science.gov (United States)

Dodendorf, Diane M; Deogun, Gurvinder K; Rodie, Amy Risch; Pol, Louis G

2004-01-01

This study overviews an operational blueprint that diagrams the activities and interactions of all participants in a typical screening mammography appointment in a large medical center. The blueprint is constructed from multiple sources of data collected from mammography patients, service providers in the radiology department, and medical records. The benefits from using patient perspectives, the insights gained from the blueprint development process, and the value of the resulting screening mammography appointment blueprint are included.

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

Science.gov (United States)

Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

2018-06-01

To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

New Perspectives on Spontaneous Brain Activity: Dynamic Networks and Energy Matter.

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Tozzi, Arturo; Zare, Marzieh; Benasich, April A

2016-01-01

Spontaneous brain activity has received increasing attention as demonstrated by the exponential rise in the number of published article on this topic over the last 30 years. Such "intrinsic" brain activity, generated in the absence of an explicit task, is frequently associated with resting-state or default-mode networks (DMN)s. The focus on characterizing spontaneous brain activity promises to shed new light on questions concerning the structural and functional architecture of the brain and how they are related to "mind". However, many critical questions have yet to be addressed. In this review, we focus on a scarcely explored area, specifically the energetic requirements and constraints of spontaneous activity, taking into account both thermodynamical and informational perspectives. We argue that the "classical" definitions of spontaneous activity do not take into account an important feature, that is, the critical thermodynamic energetic differences between spontaneous and evoked brain activity. Spontaneous brain activity is associated with slower oscillations compared with evoked, task-related activity, hence it exhibits lower levels of enthalpy and "free-energy" (i.e., the energy that can be converted to do work), thus supporting noteworthy thermodynamic energetic differences between spontaneous and evoked brain activity. Increased spike frequency during evoked activity has a significant metabolic cost, consequently, brain functions traditionally associated with spontaneous activity, such as mind wandering, require less energy that other nervous activities. We also review recent empirical observations in neuroscience, in order to capture how spontaneous brain dynamics and mental function can be embedded in a non-linear dynamical framework, which considers nervous activity in terms of phase spaces, particle trajectories, random walks, attractors and/or paths at the edge of the chaos. This takes us from the thermodynamic free-energy, to the realm of "variational

Trauma team activation: Not just for trauma patients

Directory of Open Access Journals (Sweden)

Phoenix Vuong

2017-01-01

Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.

Elderly patients' and GPs' perspectives of patient-GP communication concerning polypharmacy: a qualitative interview study.

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Schöpf, Andrea C; von Hirschhausen, Maike; Farin, Erik; Maun, Andy

2017-12-26

Aim The aim of this study was to explore elderly patients' and general practitioners' (GPs') perceptions of communication about polypharmacy, medication safety and approaches for empowerment. To manage polypharmacy, GPs need to know patients' real medication consumption. However, previous research has shown that patients do not always volunteer all information about their medication regimen, for example, such as the intake of over-the-counter medication or the alteration or discontinuation of prescribed medication. A qualitative interview study including patients of at least 65 years old with polypharmacy (⩾5 medications) and their GPs in a German Primary Healthcare Centre. The transcripts from the semi-structured interviews (n=6 with patients; n=3 with GPs) were analysed using a framework analytical approach. Findings We identified three themes: differing medication plans: causes?; dialogue concerning medication: whose responsibility?; supporting patients' engagement: how? While GPs stated that patients do not always report or might even conceal information, all patients reported that they could speak openly about everything with their GPs. In this context, trust might act as a double-edged sword, as it can promote open communication but also prevent patients from asking questions. Both GPs and patients could name very few ways in which patients could be supported to become more informed and active in communication concerning polypharmacy and medication safety. This study shows that patients' awareness of the significance of their active role in addressing polypharmacy needs to be increased. This includes understanding that trusting the doctor does not preclude asking questions or seeking more information. Thus, interventions which improve patients' communication skills and address specific issues of polypharmacy, particularly in elderly patients, should be designed. GPs might support patients by 'inviting' their contribution.

Patient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis.

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Vanstone, Meredith; Rewegan, Alex; Brundisini, Francesca; Dejean, Deirdre; Giacomini, Mita

2015-01-01

Patients with uncontrolled type 1 diabetes mellitus may be candidates for pancreatic islet cell transplantation. This report synthesizes qualitative research on how patients with uncontrolled type 1 diabetes perceive their quality of life. The objective of this analysis was to examine the perceptions of patients with uncontrolled type 1 diabetes on how it affects their lived experience and quality of life. This report synthesizes 31 primary qualitative studies to examine quality of life from the perspectives of adult patients with type 1 diabetes mellitus and their families or partners. We performed a qualitative meta-synthesis to integrate findings across primary research studies. Long- and short-term negative consequences of uncontrolled type 1 diabetes affect all aspects of patients' lives: physical, emotional, practical, and social. The effect on each domain is far-reaching, and effects interact across domains. Uncontrolled blood sugar levels lead to substantial psychological distress, negative moods, cognitive difficulties, irritable or aggressive behaviour, and closely associated problems with relationships, self-image, and confidence. Emotional distress is pervasive and under-addressed by health care providers. Patients live in fear of complications from diabetes over the long term. In the shorter term, they are anxious about the personal, social, and professional consequences of hypoglycemic episodes (e.g., injury, humiliation), and may curtail normal activities such as driving or socializing because they are worried about having an episode. The quality of life for patients' family members is also negatively impacted by uncontrolled type 1 diabetes. Uncontrolled type 1 diabetes has significant negative impacts on the quality of life of both people with the disease and their families.

Primary Care Perspectives on Hepatitis C Virus Screening, Diagnosis and Linking Patients to Appropriate Care.

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Lebovics, Edward; Torres, Richard; Porter, Lucinda K

2017-02-01

-up HCV RNA test, and every effort must be made to overcome the challenge of losing patients between these two steps. Good communication between the physician, the physician's office staff, and the patient is necessary. In addition, point-of-care tests and PCR reflex testing can alleviate the need for HCV antibody positive patients to arrange subsequent office visits to undergo confirmatory HCV RNA testing. Physician and patient perspectives are presented throughout this roundtable discussion to obtain a complete picture of the management barriers encountered prior to initiation of therapy. Physician perspectives are provided by Edward Lebovics, the Upham Professor of Gastroenterology and Director of the Sarah C. Upham Division of Gastroenterology and Hepatobiliary Diseases at New York Medical College and Westchester Medical Center in Valhalla, New York, and Richard Torres, Chief Medical Officer at Optimus Health Care and an Associate Professor of Medicine at Yale School of Medicine. Torres has been a primary care provider for 29 years, working at the largest federally qualified community health center in Southwestern CT, which provides over 240,000 patient visits annually primarily to populations that are underserved and suffering from healthcare disparities. Patient perspectives in this roundtable are provided by Lucinda K. Porter, RN, who is the author of two books for hepatitis C patients, and is a former hepatology nurse and hepatitis C patient. She has been advocating for others since 1997, and writes for the HCV Advocate. Lucinda is a contributing editor of HEP magazine, and she blogs at www.LucindaPorterRN.com. The overall goal of this video roundtable discussion is to demonstrate that when provided with appropriate clinical knowledge, and aided by supportive collaborations with appropriate specialists, primary care clinicians should be able to effectively screen, diagnose, and link patients with hepatitis C to appropriate care. While patients need to be educated

The PROactive innovative conceptual framework on physical activity

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Dobbels, Fabienne; de Jong, Corina; Drost, Ellen; Elberse, Janneke; Feridou, Chryssoula; Jacobs, Laura; Rabinovich, Roberto; Frei, Anja; Puhan, Milo A.; de Boer, Willem I.; van der Molen, Thys; Williams, Kate; Pinnock, Hillary; Troosters, Thierry; Karlsson, Niklas; Kulich, Karoly; Rüdell, Katja; Brindicci, Caterina; Higenbottam, Tim; Troosters, Thierry; Dobbels, Fabienne; Decramer, Marc; Tabberer, Margaret; Rabinovich, Roberto A; MacNee, William; Vogiatzis, Ioannis; Polkey, Michael; Hopkinson, Nick; Garcia-Aymerich, Judith; Puhan, Milo; Frei, Anja; van der Molen, Thys; de Jong, Corina; de Boer, Pim; Jarrod, Ian; McBride, Paul; Kamel, Nadia; Rudell, Katja; Wilson, Frederick J.; Ivanoff, Nathalie; Kulich, Karoly; Glendenning, Alistair; Karlsson, Niklas X.; Corriol-Rohou, Solange; Nikai, Enkeleida; Erzen, Damijan

2014-01-01

Although physical activity is considered an important therapeutic target in chronic obstructive pulmonary disease (COPD), what “physical activity” means to COPD patients and how their perspective is best measured is poorly understood. We designed a conceptual framework, guiding the development and content validation of two patient reported outcome (PRO) instruments on physical activity (PROactive PRO instruments). 116 patients from four European countries with diverse demographics and COPD phenotypes participated in three consecutive qualitative studies (63% male, age mean±sd 66±9 years, 35% Global Initiative for Chronic Obstructive Lung Disease stage III–IV). 23 interviews and eight focus groups (n = 54) identified the main themes and candidate items of the framework. 39 cognitive debriefings allowed the clarity of the items and instructions to be optimised. Three themes emerged, i.e. impact of COPD on amount of physical activity, symptoms experienced during physical activity, and adaptations made to facilitate physical activity. The themes were similar irrespective of country, demographic or disease characteristics. Iterative rounds of appraisal and refinement of candidate items resulted in 30 items with a daily recall period and 34 items with a 7-day recall period. For the first time, our approach provides comprehensive insight on physical activity from the COPD patients’ perspective. The PROactive PRO instruments’ content validity represents the pivotal basis for empirically based item reduction and validation. PMID:25034563

Prefrontal cortex activity during swallowing in dysphagia patients.

Science.gov (United States)

Lee, Jun; Yamate, Chisato; Taira, Masato; Shinoda, Masamichi; Urata, Kentaro; Maruno, Mitsuru; Ito, Reio; Saito, Hiroto; Gionhaku, Nobuhito; Iinuma, Toshimitsu; Iwata, Koichi

2018-05-24

Prefrontal cortex activity is modulated by flavor and taste stimuli and changes during swallowing. We hypothesized that changes in the modulation of prefrontal cortex activity by flavor and taste were associated with swallowing movement and evaluated brain activity during swallowing in patients with dysphagia. To evaluate prefrontal cortex activity in dysphagia patients during swallowing, change in oxidized hemoglobin (z-score) was measured with near-infrared spectroscopy while dysphagia patients and healthy controls swallowed sweetened/unsweetened and flavored/unflavored jelly. Total z-scores were positive during swallowing of flavored/unsweetened jelly and negative during swallowing of unflavored/sweetened jelly in controls but negative during swallowing of sweetened/unsweetened and flavored/unflavored jelly in dysphagia patients. These findings suggest that taste and flavor during food swallowing are associated with positive and negative z-scores, respectively. Change in negative and positive z-scores may be useful in evaluating brain activity of dysphagia patients during swallowing of sweetened and unsweetened food.

Psychosocial Perspectives on Girls and Women in Sport and Physical Activity: A Tribute to Dorothy V. Harris.

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Feltz, Deborah L.

1992-01-01

Introduces theme issue of this journal on the psychosocial influences on girls and women in sport and physical activity, focusing on the work of Dorothy V. Harris who battled for equal sporting opportunities and benefits for females. The papers are written from a feminist perspective. (SM)

Public and patient involvement in quantitative health research: A statistical perspective.

Science.gov (United States)

Hannigan, Ailish

2018-06-19

The majority of studies included in recent reviews of impact for public and patient involvement (PPI) in health research had a qualitative design. PPI in solely quantitative designs is underexplored, particularly its impact on statistical analysis. Statisticians in practice have a long history of working in both consultative (indirect) and collaborative (direct) roles in health research, yet their perspective on PPI in quantitative health research has never been explicitly examined. To explore the potential and challenges of PPI from a statistical perspective at distinct stages of quantitative research, that is sampling, measurement and statistical analysis, distinguishing between indirect and direct PPI. Statistical analysis is underpinned by having a representative sample, and a collaborative or direct approach to PPI may help achieve that by supporting access to and increasing participation of under-represented groups in the population. Acknowledging and valuing the role of lay knowledge of the context in statistical analysis and in deciding what variables to measure may support collective learning and advance scientific understanding, as evidenced by the use of participatory modelling in other disciplines. A recurring issue for quantitative researchers, which reflects quantitative sampling methods, is the selection and required number of PPI contributors, and this requires further methodological development. Direct approaches to PPI in quantitative health research may potentially increase its impact, but the facilitation and partnership skills required may require further training for all stakeholders, including statisticians. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

The quality of radiation care: the results of focus group interviews and concept mapping to explore the patient's perspective.

NARCIS (Netherlands)

Nijman, J.L.; Sixma, H.; Triest, B. van; Keus, R.B.; Hendriks, M.

2012-01-01

Background and purpose: In this study, we explore the quality aspects of radiation care from the patient’s perspective in order to develop a draft Consumer Quality Index (CQI) Radiation Care instrument. Materials and methods: Four focus group discussions with (former) cancer patients were held to

Primary health care teams and the patient perspective: a social network analysis.

Science.gov (United States)

Cheong, Lynn H M; Armour, Carol L; Bosnic-Anticevich, Sinthia Z

2013-01-01

Multidisciplinary care (MDC) has been proposed as a potential strategy to address the rising challenges of modern health issues. However, it remains unclear as to how patients' health connections may impact on multidisciplinary processes and outcomes. This research aims to gain a deeper understanding of patients' potential role in MDC: i) describe patients' health networks, ii) compare different care groups, iii) gain an understanding of the nature and extent of their interactions, and iv) identify the role of pharmacists within patient networks. In-depth, semi-structured interviews were conducted with asthma patients from Sydney, Australia. Participants were recruited from a range of standard asthma health care access points (community group) and a specialized multidisciplinary asthma clinic (clinic group). Quantitative social network analysis provided structural insight into asthma networks while qualitative social network analysis assisted in interpretation of network data. A total of 47 interviews were conducted (26 community group participants and 21 clinic group participants). Although participants' asthma networks consisted of a range of health care professionals (HCPs), these did not reflect or encourage MDC. Not only did participants favor minimal interaction with any HCP, they preferred sole-charge care and were found to strongly rely on lay individuals such as family and friends. While general practitioners and respiratory specialists were participants' principal choice of HCP, community pharmacists were less regarded. Limited opportunities were presented for HCPs to collaborate, particularly pharmacists. As patients' choices of HCPs may strongly influence collaborative processes and outcomes, this research highlights the need to consider patient perspectives in the development of MDC models in primary care. Copyright © 2013 Elsevier Inc. All rights reserved.

Universal tumor screening for Lynch syndrome: Assessment of the perspectives of patients with colorectal cancer regarding benefits and barriers.

Science.gov (United States)

Hunter, Jessica Ezzell; Zepp, Jamilyn M; Gilmore, Mari J; Davis, James V; Esterberg, Elizabeth J; Muessig, Kristin R; Peterson, Susan K; Syngal, Sapna; Acheson, Louise S; Wiesner, Georgia L; Reiss, Jacob A; Goddard, Katrina A B

2015-09-15

Universal tumor screening for Lynch syndrome, the most common form of hereditary colorectal cancer (CRC), has been recommended among all patients newly diagnosed with CRC. However, there is limited literature regarding patient perspectives of tumor screening for Lynch syndrome among patients with CRC who are not selected for screening based on family history criteria. A total of 145 patients aged 39 to 87 years were administered surveys assessing perceived risk, patient perspectives, and potential benefits of and barriers to tumor screening for Lynch syndrome. Associations between patient-specific and cancer-specific factors and survey responses were analyzed. The majority of participants perceived their risk of developing Lynch syndrome as being low, with 9 participants (6.2%) anticipating an abnormal screening result. However, most participants endorsed the potential benefits of screening for themselves and their families, with 84.8% endorsing ≥6 benefits and 50.3% endorsing all 8 benefits. Participants also endorsed few potential barriers to screening, with 89.4% endorsing ≤4 of 9 potential barriers. A common barrier was worry about the cost of additional testing and surveillance, which was endorsed by 54.5% of participants. The level of distress associated with tumor screening for Lynch syndrome, which was very low, was not associated with age or CRC stage. The results of the current study indicate that patients with CRC overall have a positive attitude toward tumor screening for Lynch syndrome, endorse the benefits of screening, and experience low levels of distress. These findings provide insight into patient attitudes toward tumor screening for Lynch syndrome among unselected patients with CRC to inform educational approaches that assist in patient decision-making and guide the successful implementation of screening programs. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

Changed nursing scheduling for improved safety culture and working conditions - patients' and nurses' perspectives.

Science.gov (United States)

Kullberg, Anna; Bergenmar, Mia; Sharp, Lena

2016-05-01

To evaluate fixed scheduling compared with self-scheduling for nursing staff in oncological inpatient care with regard to patient and staff outcomes. Various scheduling models have been tested to attract and retain nursing staff. Little is known about how these schedules affect staff and patients. Fixed scheduling and self-scheduling have been studied to a small extent, solely from a staff perspective. We implemented fixed scheduling on two of four oncological inpatient wards. Two wards kept self-scheduling. Through a quasi-experimental design, baseline and follow-up measurements were collected among staff and patients. The Safety Attitudes Questionnaire was used among staff, as well as study-specific questions for patients and staff. Fixed scheduling was associated with less overtime and fewer possibilities to change shifts. Self-scheduling was associated with more requests from management for short notice shift changes. The type of scheduling did not affect patient-reported outcomes. Fixed scheduling should be considered in order to lower overtime. Further research is necessary and should explore patient outcomes to a greater extent. Scheduling is a core task for nurse managers. Our study suggests fixed scheduling as a strategy for managers to improve the effective use of resources and safety. © 2016 John Wiley & Sons Ltd.

Bioethical dilemmas on medical grounds – psychological perspective

Directory of Open Access Journals (Sweden)

Justyna A. Kaczmarczyk

2017-03-01

Full Text Available The rapid development of medicine that has taken place in the last 10 years confronts personnel with new challenges that extend beyond life-saving treatments; they include moral, legal, and deontological dilemmas, which can be recognised as bioethical ones. The new discourse of patient’s participation in planning their treatment makes it impossible to remain indifferent to their expectations and will, the patient’s approval, and declaration of intent on the healing process, and at the same time not to respect their basic privileges guaranteed by law and those arising from the codes of ethics. Humans are a bio-psychophysical unity, and therefore should be perceived from a holistic perspective. This article presents the different dilemmas concerning the treatment of patients in the terminal stage of disease, including minors. It indicates the assessment and the prospect of death, from the child and adult perspective. It recognises patient’s rights, his/her autonomy, dignity, subjectivity, but also the responsibilities and duties of health care personnel, taking into account respect for the patient, his/her independence, the adequacy of activities, and reference to the principle of double effect.

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

Science.gov (United States)

O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

2016-02-25

Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

Care for patients with severe mental illness: the general practitioner's role perspective

Directory of Open Access Journals (Sweden)

Groenier Klaas H

2009-05-01

Full Text Available Abstract Background Patients with severe mental illness (SMI experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. Methods A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. Results 186 general practitioners distributed over urban areas (49%, urbanised rural areas (38% and rural areas (15% of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices. GPs also saw their role as giving support and information to the patient's family. However, they felt a need for recognition of their competencies when working with mental health care specialists. Conclusion GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.

Care for patients with severe mental illness: the general practitioner's role perspective.

Science.gov (United States)

Oud, Marian J T; Schuling, Jan; Slooff, Cees J; Groenier, Klaas H; Dekker, Janny H; Meyboom-de Jong, Betty

2009-05-06

Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.

Measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective.

Science.gov (United States)

Heggland, Liv-Helen; Mikkelsen, Aslaug; Øgaard, Torvald; Hausken, Kjell

2014-02-01

To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Survey. A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation. © 2013 Blackwell Publishing Ltd.

Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

Science.gov (United States)

Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

2015-01-01

Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management

What´s cheapest, intravenous iron sucrose- or intravenous iron carboxymaltose treatment in IBD patients?

DEFF Research Database (Denmark)

Bager, Palle; Dahlerup, Jens Frederik

a Budget Impact Analysis (BIA) from a hospital perspective, a Cost Effective Analysis (CEA) from a patient perspective and a Cost Benefit Analysis (CBA) consecutively including 20 IBD patients' willingness-to-pay' (WTP) assessment. BIA and CEA analysis were based on total infusion-doses from 500 mg Fe......-effective than iron sucrose, due to fewer outpatient setting visits. As IBD-patients could have less income as the average of the background population due to disease activity, sensitivity analysis using a 50% income level were done, showing the same tendency but less significant. The average patients WTP...

Patient Perspectives on Gene Transfer Therapy for Sickle Cell Disease.

Science.gov (United States)

Strong, Heather; Mitchell, Monica J; Goldstein-Leever, Alana; Shook, Lisa; Malik, Punam; Crosby, Lori E

2017-08-01

Sickle cell disease (SCD) is a chronic genetic disease with high morbidity and early mortality; it affects nearly 100,000 individuals in the USA. Bone marrow transplantation, the only curative treatment, is available to less than 20% of patients because of a number of access barriers. Gene transfer therapy (GTT) has been shown to be curative in animal models and is approved for use in humans for early-phase studies at a few centers. GTT would offer a more accessible treatment option available to all patients. It is important to understand patient perspectives on GTT to help ensure human clinical trial success. Two focus groups were conducted with younger (18-30 years) and older (31 years and older) adults with SCD to obtain data on patient knowledge and beliefs about GTT. Data from these two focus groups was used to develop a GTT educational brochure. A third focus group was conducted to obtain participant feedback on acceptability and feasibility of education and the brochure. Most adults, especially young adults, had little knowledge about GTT and expressed fear and uncertainty about the side effects of chemotherapy (e.g., hair loss, infertility), use of a human immunodeficiency virus (HIV)-derived viral vector, and potential for cancer risk. Participants wanted full transparency in educational materials, but advised researchers not to share the vector's relation to HIV because of cultural stigma and no HIV virus is used for the GTT vector. Older adults had more desire to participate in human clinical GTT trials than younger participants. When recruiting for trials, researchers should develop GTT educational materials that address participant lack of trust in the healthcare system, cultural beliefs, fears related to side effects, and include visual illustrations. Use of such materials will provide adults with SCD the information they need to fully evaluate GTT.

Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry

NARCIS (Netherlands)

Kakkar, A.K.; Mueller, I.; Bassand, J.P.; Fitzmaurice, D.A.; Goldhaber, S.Z.; Goto, S.; Haas, S.; Hacke, W.; Lip, G.Y.; Mantovani, L.G.; Turpie, A.G.G.; Eickels, M. van; Misselwitz, F.; Rushton-Smith, S.; Kayani, G.; Wilkinson, P.; Verheugt, F.W.A.; et al.,

2013-01-01

BACKGROUND: Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients

Physical activity maintenance in patients with rheumatoid arthritis

DEFF Research Database (Denmark)

Loeppenthin, K; Esbensen, Bente Appel; Østergaard, Mikkel

2014-01-01

OBJECTIVE: To describe the experience of physical activity maintenance in patients with rheumatoid arthritis. DESIGN: A qualitative salutogenic-oriented interview study. SETTING: A rheumatology outpatient clinic. SUBJECTS: A purposive sample of 16 physically active patients (mean age 50, range 37...... with non-arthritis populations. CONCLUSION: This study demonstrates that physical activity in patients with rheumatoid arthritis may be understood as a resource to resist disability and to feel and stay healthy while creating and sustaining meaningfulness in life.......-67) diagnosed with rheumatoid arthritis on average 21 years previously (range 4-46 years). METHODS: In-depth interviews were conducted using a semi-structured interview guide to illuminate how the phenomenon 'physical activity maintenance' was experienced by patients with rheumatoid arthritis. The interviews...

Perspectives on counseling patients about menopausal hormone therapy: strategies in a complex data environment.

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Parish, Sharon J; Nappi, Rossella E; Kingsberg, Sheryl

2018-03-05

This narrative review strives to give healthcare providers (HCPs) who care for menopausal women better tools and skills to initiate discussions with women about menopause and hormone therapy (HT), communicate complex concepts and data, and promote shared decision-making. We review relevant studies on HT, barriers to treatment of menopausal symptoms, and effective communication strategies. We also provide recommendations for communicating with patients about HT based on the medical literature and our own professional experience. Both patient and HCP-related barriers can prevent women from accessing treatment for bothersome symptoms of menopause. Many women and HCPs have a poor understanding of the complex, nuanced data regarding HT. The benefits and risks vary with patient age and time since menopause, duration of use, inclusion of a progestin, and patient medical history. Women may also have fears about potential side effects of HT and feel unable to make informed choices. Strategies for effective patient communication and shared decision-making include use of open-ended questions to elicit patient's concerns and preferences, reflecting back to the patient what the HCP heard, presenting evidence about benefits and risks in language the patient can understand, keeping risks in perspective (eg, provide absolute, and also relative risks) without minimizing them, and making conscious efforts to minimize potential bias. Necessary components for achieving high-quality, shared decisions about HT involve a combination of medical evidence, communication skills, and recognition of patient goals and concerns. Use of such strategies can enhance women's satisfaction with care.

Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care

Directory of Open Access Journals (Sweden)

Chien WT

2013-09-01

Full Text Available Wai Tong Chien, Sau Fong Leung, Frederick KK Yeung, Wai Kit Wong School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Abstract: Schizophrenia is a disabling psychiatric illness associated with disruptions in cognition, emotion, and psychosocial and occupational functioning. Increasing evidence shows that psychosocial interventions for people with schizophrenia, as an adjunct to medications or usual psychiatric care, can reduce psychotic symptoms and relapse and improve patients' long-term outcomes such as recovery, remission, and illness progression. This critical review of the literature was conducted to identify the common approaches to psychosocial interventions for people with schizophrenia. Treatment planning and outcomes were also explored and discussed to better understand the effects of these interventions in terms of person-focused perspectives such as their perceived quality of life and satisfaction and their acceptability and adherence to treatments or services received. We searched major healthcare databases such as EMBASE, MEDLINE, and PsycLIT and identified relevant literature in English from these databases. Their reference lists were screened, and studies were selected if they met the criteria of using a randomized controlled trial or systematic review design, giving a clear description of the interventions used, and having a study sample of people primarily diagnosed with schizophrenia. Five main approaches to psychosocial intervention had been used for the treatment of schizophrenia: cognitive therapy (cognitive behavioral and cognitive remediation therapy, psychoeducation, family intervention, social skills training, and assertive community treatment. Most of these five approaches applied to people with schizophrenia have demonstrated satisfactory levels of short- to medium-term clinical efficacy in terms of symptom control or reduction, level of

New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain.

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Hsu, Clarissa; Sherman, Karen J; Eaves, Emery R; Turner, Judith A; Cherkin, Daniel C; Cromp, DeAnn; Schafer, Lisa; Ritenbaugh, Cheryl

2014-07-30

Positive patient expectations are often believed to be associated with greater benefits from complementary and alternative medicine (CAM) treatments. However, clinical studies of CAM treatments for chronic pain have not consistently supported this assumption, possibly because of differences in definitions and measures of expectations. The goal of this qualitative paper is to provide new perspectives on the outcome expectations of patients prior to receiving CAM therapies for chronic low back pain. We conducted semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. Interviews were recorded and transcribed. Transcripts were analyzed by a team of experienced qualitative researchers using an immersion/crystallization approach to coding and analysis. Overall, participants' expectations of treatment outcomes tended to cluster in four key domains: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment. Furthermore, outcome expectations were complex on several levels. First, the concept of expectations overlapped with several related concepts; in particular, hopes. Participants sometimes used expectations and hopes interchangeably and at other times made clear distinctions between these two terms depending on context. A related finding was that participants were cautious about stating that they expected positive outcomes. Finally, participants articulated strong interrelationships among the four key domains and often discussed how changes in one domain might affect other domains. Overall, these findings contribute to a growing body of literature exploring the role of expectations in patient outcomes. This paper provides important guidance that may help refine the way treatment expectations are

Causes and consequences of coagulation activation in sepsis: an evolutionary medicine perspective.

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Fiusa, Maiara Marx Luz; Carvalho-Filho, Marco Antonio; Annichino-Bizzacchi, Joyce M; De Paula, Erich V

2015-05-06

Coagulation and innate immunity have been linked together for at least 450 million years of evolution. Sepsis, one of the world's leading causes of death, is probably the condition in which this evolutionary link is more evident. However, the biological and the clinical relevance of this association have only recently gained the attention of the scientific community. During sepsis, the host response to a pathogen is invariably associated with coagulation activation. For several years, coagulation activation has been solely regarded as a mechanism of tissue damage, a concept that led to several clinical trials of anticoagulant agents for sepsis. More recently, this paradigm has been challenged by the failure of these clinical trials, and by a growing bulk of evidence supporting the concept that coagulation activation is beneficial for pathogen clearance. In this article we discuss recent basic and clinical data that point to a more balanced view of the detrimental and beneficial consequences of coagulation activation in sepsis. Reappraisal of the association between coagulation and immune activation from an evolutionary medicine perspective offers a unique opportunity to gain new insights about the pathogenesis of sepsis, paving the way to more successful approaches in both basic and clinical research in this field.

[Temporal perspective and other psychological factors making it difficult to adapt to requirements of treatment in chronic dialysis patients].

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Zawadzka, Barbara; Byrczek, Magdalena; Zawadzka, Sara

2014-01-01

The study analyzed the relationship between temporal perspective, selected personal resources, and unhealthy behavior, manifesting in problems with adherence to fluid intake restrictions, in chronic.hemodialyzis patients. The authors tried to answer the question whether there is temporal perspective and other psychological factors increasing the risk of non-adaptive behaviors. Sixty-one patients, aged 23-81 years (m = 59; SD = 13,9) on chronic hemodialysis at the Department of Nephrology University Hospital were qualified to the study. The study group consisted of 30 patients with poorer fluid regimen adherence and 31 con- trols, who maintained fluid regimen. The patients were qualified on the bases of the average interdialysis weight gains measured nine times during three weeks. The following research tools were used: P. Zimbardo and J. Boyd ZTPI test; P.T. Costa and R.R. McCrae NEO-FFI Inventory; J. Strelau Temperament Inventory, R. Schwarzer GSES; M. F. Scheier; C. S. Carver and M. W. Bridges LOT-R; M. Watson and S. Greer CECS; BJ. Felton, TA. Revenson, GA. Hinrichsen AIS. Difficulties in adapting to the fluid intake restrictions are significantly associated with temporal orientation towards negative aspects of the present and the past. Non-adaptive health behaviors are typical for patients with temperamental lack of balance between agitation and inhibition processes and are characterized by high agreeableness and low conscientious- ness. The association between excessive anger control and the risk of non-adherence medical recommendations. Time perception and other personality factors form mechanisms regulating health behaviors in chronically treatment patients.

Somatisation: illness perspectives of asylum seeker and refugee patients from the former country of Yugoslavia

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Hudelson Patricia

2006-02-01

Full Text Available Abstract Background Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. Methods We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. Results Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. Conclusion Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.

Cortical activation in patients with functional hemispherectomy.

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Leonhardt, G; Bingel, U; Spiekermann, G; Kurthen, M; Müller, S; Hufnagel, A

2001-10-01

Functional hemispherectomy, a safe and effective therapeutical procedure in medically intractable epilepsy, offers the chance to investigate a strictly unilateral cortical activation in ipsilateral limb movement. We assessed the pattern of cortical activation in a group of patients following functional hemispherectomy. We measured regional cerebral blood flow (rCBF) in 6 patients postoperatively and 6 normal subjects with positron emission tomography using 15[O]H2O as a tracer. Brain activation was achieved by passive elbow movements of the affected arm. Analysis of group results and between-group comparisons were performed with statistical parametric mapping, (SPM96). In normal subjects brain activation was found contralaterally in the cranial sensorimotor cortex and the supplementary motor area and ipsilaterally in the inferior parietal cortex. In patients significant rCBF increases were found in the inferior parietal cortex, caudal sensorimotor cortex and the supplementary motor area ipsilaterally. The activation was weaker than in normal subjects. Compared with normal subjects patients showed additional activation in the premotor cortex, caudal sensorimotor cortex and the inferior parietal cortex of the remaining hemisphere. Less activation compared with normal subjects was found in the cranial sensorimotor cortex and the supplementary motor area. A functional network connecting the inferior parietal cortex, premotor cortex and the supplementary motor area as well as the existence of ipsilateral projections originating from these regions may explain why these areas are predominantly involved in reorganization confined to a single hemisphere.

Results from an online survey of patient and caregiver perspectives on unmet needs in the treatment of bipolar disorder.

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Masand, Prakash S; Tracy, Natasha

2014-01-01

To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder.

[Effectively communicate active listening : Comparison of two concepts].

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Martin, O; Rockenbauch, K; Kleinert, E; Stöbel-Richter, Y

2017-09-01

Communication between physicians and patients has a great influence on patient adherence, patient satisfaction and the success of treatment. In this context, patient centered care and emotional support have a high positive impact; however, it is unclear how physicians can be motivated to communicate with patients in an appreciative and empathetic way. The implementation of such behavior requires a multitude of communicative skills. One of them is active listening, which is very important in two respects. On the one hand active listening provides the basis for several conversational contexts as a special communication technique and on the other hand active listening is presented in current textbooks in different ways: as an attitude or as a technique. In light of this, the question arises how active listening should be taught in order to be not only applicable in concrete conversations but also to lead to the highest possible level of patient satisfaction. The aim of this pilot study was to examine some variations in simulated doctor-patient conversations, which are the result of the different approaches to active listening. For this purpose three groups of first semester medical students were recruited, two of which were schooled in active listening in different ways (two groups of six students), i.e. attitude versus technique oriented. The third group (seven students) acted as the control group. In a pre-post design interviews with standardized simulation patients were conducted and subsequently evaluated. The analysis of these interviews was considered from the perspectives of participants and observers as well as the quantitative aspects. This study revealed some interesting tendencies despite its status as a pilot study: in general, the two interventional groups performed significantly better than the control group in which no relevant changes occurred. In a direct comparison, the group in which active listening was taught from an attitude approach achieved

Valsartan combination therapy in the management of hypertension – patient perspectives and clinical utility

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Nash, David T; McNamara, Michael S

2009-01-01

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy should include a RAAS inhibitor. Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of antihypertensive therapy. In this article, we discuss two ARB combinations (valsartan/hydrochlorothiazide [HCTZ] and amlodipine/valsartan), both of which are indicated for the treatment of hypertension in patients not adequately controlled on monotherapy and as initial therapy in patients likely to need multiple drugs to achieve BP goals. Randomized, double-blind studies that have assessed the antihypertensive efficacy and safety of these combinations in the first-line treatment of hypertensive patients are reviewed. Both valsartan/HCTZ and amlodipine/valsartan effectively lower BP and are well tolerated in a broad range of patients with hypertension, including difficult-to-treat populations such as those with severe BP elevations, prediabetes and diabetes, patients with the cardiometabolic syndrome, and individuals who are obese, elderly, or black. Also discussed herein are patient-focused perspectives related to the use of valsartan/HCTZ and amlodipine/valsartan, and the rationale for use of single-pill combinations as one approach to enhance patient compliance with antihypertensive therapy. PMID:21949614

Successful After-School Physical Activity Clubs in Urban High Schools: Perspectives of Adult Leaders and Student Participants

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Garn, Alex C.; McCaughtry, Nate; Kulik, Noel L.; Kaseta, Michele; Maljak, Kim; Whalen, Laurel; Shen, Bo; Martin, Jeffrey J.; Fahlman, Mariane

2014-01-01

Grounded in social cognitive theory, the purpose of this study was to examine leaders' and students' perspectives of factors that contribute to effective voluntary after-school physical activity clubs. Data were collected over two-years via field observations (n= 115) and interviews with students (n= 278) and adult leaders (n= 126). Results…

Experience, Intersubjectivity, and Reflection: A Human Science Perspective on Preparation of Future Professionals in Adaptive Physical Activity

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Standal, Øyvind F.; Rugseth, Gro

2016-01-01

The aim of this article is to show that and how philosophy and philosophical thinking can be of relevance for the preparation of future professionals in adaptive physical activity. To this end we utilize philosophical insights from the human science perspective on two central issues, namely experience and intersubjectivity, which are weaved…

Measuring patient activation in Italy: Translation, adaptation and validation of the Italian version of the patient activation measure 13 (PAM13-I).

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Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Lozza, Edoardo; Hibbard, Judith

2015-12-23

The Patient Activation Measure (PAM13) is an instrument that assesses patient knowledge, skills, and confidence for disease self-management. This cross-sectional study was aimed to validate a culturally-adapted Italian Patient Activation Measure (PAM13-I) for patients with chronic conditions. 519 chronic patients were involved in the Italian validation study and responded to PAM13-I. The PAM 13 was translated into Italian by a standardized forward-backward translation. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average inter-item correlation), item-rest correlations. Rasch Model and differential item functioning assessed scale properties. Mean PAM13-I score was 66.2. Rasch analysis showed that the PAM13-I is a good measure of patient activation. The level of internal consistency was good (α = 0.88). For all items, the distribution of answers was left-skewed, with a small floor effect (range 1.7-4.5 %) and a moderate ceiling effect (range 27.6-55.0 %). The Italian version formed a unidimensional, probabilistic Guttman-like scale explaining 41 % of the variance. The PAM13-I has been demonstrated to be a valid and reliable measure of patient activation and the present study suggests its applicability to the Italian-speaking chronic patient population. The measure has good psychometric properties and appears to be consistent with the developmental nature of the patient activation phenomenon, although it presents a different ranking order of the items comparing to the American version. PAM13-I can be a useful assessment tool to evaluate interventions aimed at improving patient engagement in healthcare and to train doctors in attuning their communication to the level of patients' activation. Future research could be conducted to further confirm the validity of the PAM13-I.

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

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Collins, Sarah A; Rozenblum, Ronen; Leung, Wai Yin; Morrison, Constance Rc; Stade, Diana L; McNally, Kelly; Bourie, Patricia Q; Massaro, Anthony; Bokser, Seth; Dwyer, Cindy; Greysen, Ryan S; Agarwal, Priyanka; Thornton, Kevin; Dalal, Anuj K

2017-04-01

To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Transforming consumer health informatics through a patient work framework: connecting patients to context.

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Valdez, Rupa S; Holden, Richard J; Novak, Laurie L; Veinot, Tiffany C

2015-01-01

Designing patient-centered consumer health informatics (CHI) applications requires understanding and creating alignment with patients' and their family members' health-related activities, referred to here as 'patient work'. A patient work approach to CHI draws on medical social science and human factors engineering models and simultaneously attends to patients, their family members, activities, and context. A patient work approach extends existing approaches to CHI design that are responsive to patients' biomedical realities and personal skills and behaviors. It focuses on the embeddedness of patients' health management in larger processes and contexts and prioritizes patients' perspectives on illness management. Future research is required to advance (1) theories of patient work, (2) methods for assessing patient work, and (3) techniques for translating knowledge of patient work into CHI application design. Advancing a patient work approach within CHI is integral to developing and deploying consumer-facing technologies that are integrated with patients' everyday lives. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com. For numbered affiliations see end of article.

A "good death": perspectives of Muslim patients and health care providers.

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Tayeb, Mohamad A; Al-Zamel, Ersan; Fareed, Muhammed M; Abouellail, Hesham A

2010-01-01

Twelve "good death" principles have been identified that apply to Westerners. This study aimed to review the TFHCOP good death perception to determine its validity for Muslim patients and health care providers, and to identify and describe other components of the Muslim good death perspective. Participants included 284 Muslims of both genders with different nationalities and careers. We used a 12-question questionnaire based on the 12 principles of the TFHCOP good death definition, followed by face-to-face interviews. We used descriptive statistics to analyze questionnaire responses. However, for new themes, we used a grounded theory approach with a "constant comparisons" method. On average, each participant agreed on eight principles of the questionnaire. Dignity, privacy, spiritual and emotional support, access to hospice care, ability to issue advance directives, and to have time to say goodbye were the top priorities. Participants identified three main domains. The first domain was related to faith and belief. The second domain included some principles related to self-esteem and person's image to friends and family. The third domain was related to satisfaction about family security after the death of the patient. Professional role distinctions were more pronounced than were gender or nationality differences. Several aspects of "good death," as perceived by Western communities, are not recognized as being important by many Muslim patients and health care providers. Furthermore, our study introduced three novel components of good death in Muslim society.

Patient Perspective on Use of an Interactive Website for Sleep Apnea

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Carl Stepnowsky

2013-01-01

Full Text Available Incomplete patient adherence with nasal continuous positive airway pressure (CPAP limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control versus MyCPAP group (intervention. Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4  ±  2.4 and 4.1  ±  2.3 hrs/nt; P=0.02; mean  ±  SD. Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies.

Economic activity in agriculture in the perspective of embeddedness theory: The case of Poland

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Dudek Michał

2016-01-01

Full Text Available The paper presents the concept of embeddedness of economic activity in relation to agriculture. In this perspective, economic activity can be considered dependent on cognitive structures, structures of social relations, culture, and political institutions. It has been concluded that the idea of embeddedness can be an interesting and useful analytical tool for the analysis of economic activity undertaken by farmers. The article presents an analysis of the state of the art, as well uses selected information and data on the methodology of panel surveys carried out by the Institute of Agricultural and Food Economics - National Research Institute. Based on the analysis of the embeddedness theory, it is argued that embeddedness is not a coherent theoretical concept but rather a potential framework for investigating various economic issues. One of these issues is agricultural activity. Embeddedness framework constitutes a scheme which could organize an alternative approach to economic actions to mainstream agriculture economics.

What is competent communication behaviour of patients in physician consultations? - Chronically-ill patients answer in focus groups.

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Schmidt, Erika; Schöpf, Andrea C; Farin, Erik

2017-09-01

Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient's perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two ('documentation of patient and clinician views') in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.

Telemonitoring of Daily Activity and Symptom Behavior in Patients with COPD

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Monique Tabak

2012-01-01

Full Text Available Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness, and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9% and 21 healthy controls (57.0 years participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm. Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( cpm versus  cpm, . COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3% were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels.

Perspectives on Research Participation and Facilitation Among Dialysis Patients, Clinic Personnel, and Medical Providers: A Focus Group Study.

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Flythe, Jennifer E; Narendra, Julia H; Dorough, Adeline; Oberlander, Jonathan; Ordish, Antoinette; Wilkie, Caroline; Dember, Laura M

2017-12-19

Most prospective studies involving individuals receiving maintenance dialysis have been small, and many have had poor clinical translatability. Research relevance can be enhanced through stakeholder engagement. However, little is known about dialysis clinic stakeholders' perceptions of research participation and facilitation. The objective of this study was to characterize the perspectives of dialysis clinic stakeholders (patients, clinic personnel, and medical providers) on: (1) research participation by patients and (2) research facilitation by clinic personnel and medical providers. We also sought to elucidate stakeholder preferences for research communication. Qualitative study. 7 focus groups (59 participants: 8 clinic managers, 14 nurses/patient care technicians, 8 social workers/dietitians, 11 nephrologists/advanced practice providers, and 18 patients/care partners) from 7 North Carolina dialysis clinics. Clinics and participants were purposively sampled. Focus groups were recorded and transcribed. Thematic analysis. We identified 11 themes that captured barriers to and facilitators of research participation by patients and research facilitation by clinic personnel and medical providers. We collapsed these themes into 4 categories to create an organizational framework for considering stakeholder (narrow research understanding, competing personal priorities, and low patient literacy and education levels), relationship (trust, buy-in, and altruistic motivations), research design (convenience, follow-up, and patient incentives), and dialysis clinic (professional demands, teamwork, and communication) aspects that may affect stakeholder interest in participating in or facilitating research. These themes appear to shape the degree of research readiness of a dialysis clinic environment. Participants preferred short research communications delivered in multiple formats. Potential selection bias and inclusion of English-speaking participants only. Our findings

Serum levels of C-reactive protein in patients with stable coronary artery disease: JUPITER in perspective.

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Saely, Christoph H; Rein, Philipp; Vonbank, Alexander; Drexel, Heinz

2010-10-29

The JUPITER trial has recently demonstrated an outstanding reduction of cardiovascular events by 20 mg rosuvastatin/day in subjects with high CRP who were apparently healthy at baseline. However, absence of atherosclerosis in JUPITER was based on the subjects' history and not proven objectively. To put the results of JUPITER in perspective, we evaluated serum CRP in a consecutive series of 703 statin-naïve Caucasian patients with angiographically proven stable CAD. From these stable CAD patients, only 69.2% met the ≥2.0 mg/l serum CRP inclusion criterion of the JUPITER trial. Median CRP [interquartile range] in our CAD patients was 3.3 [1.6-6.6] mg/l, which was significantly (pJUPITER (4.2 mg/l). Our results point to considerable subclinical atherosclerosis in the patients studied in JUPITER. The impressive results of that trial may not be generalizable to healthy populations all over the world. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Patient Preferences for Receiving Remote Communication Support for Lifestyle Physical Activity Behaviour Change: The Perspective of Patients with Musculoskeletal Disorders from Three Hospital Services

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Steven M. McPhail

2015-01-01

Full Text Available This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods. People with musculoskeletal disorders (n=221 of 296 eligible accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”. Results. Most (n=155, 70% desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10, followed by email and telephone (both 5/10, text messaging (1/10, and private Internet-based social network messages (0/10. Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001, telephone calls (coefficient = 3.000, p<0.001, and email (coefficient = 2.059, p=0.02. Older age was associated with lower preference for email (coefficient = −0.100, p<0.001, texting (coefficient = −0.096, p<0.001, and social network messages (coefficient = −0.065, p<0.001. Conclusion. Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

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Sarah J. Iribarren

2014-01-01

Full Text Available Purpose. In Argentina, tuberculosis (TB control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n=16, multidisciplinary TB team members (n=26, and TB program directors (n=12 at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.

Clinical Practice Guidelines for the Medical Management of Nonhospitalized Ulcerative Colitis: The Patient Perspective

Directory of Open Access Journals (Sweden)

A Hillary Steinhart

2015-01-01

Full Text Available A series of clinical practice guidelines were recently developed by the Canadian Association of Gastroenterology (CAG to provide clinicians with recommendations for the medical management of nonhospitalized ulcerative colitis (UC patients. These guidelines were developed, reviewed and agreed on by expert clinicians and methodologists. Following the finalization of the guidelines, a group of patients with UC as well as several inflammatory bowel disease clinicians, were brought together for a half-day workshop to provide feedback from the patient perspective. At the workshop, the guideline development process was described and the guidelines were reviewed to ensure comprehension. Patients then had the opportunity to provide their insight to the relevance of the guideline development process and the content of the guidelines as it related to their personal experiences with UC. The patient group believed that, although the new guidelines will be a tremendous resource for the health care provider community, a more ‘lay-friendly’ version would better facilitate dialogue between patients and their health care practitioners. The importance of the patient/physician relationship is paramount when making decisions regarding treatment plans, in which patient preferences play a key role in determining the most appropriate therapy and dosing regimen, which, in turn, impact the likelihood of adherence to the treatment plan. It was also believed that quality of life issues were not fully addressed in the guidelines. Much could be learned from shared experiences and coping strategies that would empower patients to take charge of their health and become equal partners with their care providers.

A survey to evaluate patients' perspective concerning e-mail in an oncology practice

International Nuclear Information System (INIS)

Katzen, C.S.; Dicker, A.P.

2001-01-01

Purpose: Use of e-mail to improve physician-patient communication is becoming increasingly widespread, however, little research has been done to evaluate patients' interest and concerns regarding this technology. The goals of this study were to (1) evaluate the effectiveness of e-mail for communication between patients and their oncologist and (2) assess from the perspective of the patient the accessibility and usefulness of e-mail to facilitate medical treatment and advice as compared to conventional mail and telephone. E-mail as a clinical tool is a new trend in medicine that is growing quickly, however, there are few reports to date that evaluate the patients' perspective concerning e-mail usage. The use of e-mail in doctor-patient communication is potentially faster and more efficient than conventional mail and may reduce 'telephone tag'. E-mail initiated by the physician also allows for potential follow-up after treatment. Our study evaluated the types of transactions (personal medical questions, referrals, etc.) for which patients' preferred using e-mail in place of conventional communication methods. Materials and Methods: A self-administered survey (8 pages; 50 items) was mailed to 65 patients who were treated within the previous three years for prostate cancer in a radiation oncology practice. This survey explored the opinions and behaviors of patients with regard to online communication about general healthcare issues. The items included: patients' interest in e-mail, comfort in using e-mail, concerns about confidentiality, and access to e-mail. Patients' interest in using e-mail for specific situations were also evaluated, such as, making appointments, following up on treatment, or asking general health related questions. Patients' concerns about using email to communicate with healthcare organizations also were assessed. Results: The response rate to the survey was 63%, with a median age of 68 years (range 53-82), and the majority of respondents were

Staff and patient perspectives on the purpose of psychotropic prescribing in prisons: care or control?

Science.gov (United States)

Hassan, Lamiece; Edge, Dawn; Senior, Jane; Shaw, Jenny

2013-01-01

The objective was to explore perspectives on reasons for psychotropic medication use in prisons. We recruited a purposive sample of healthcare staff and patients prescribed psychotropic medicines from four East of England prisons. Participants took part in qualitative, semistructured interviews, which were recorded, transcribed and analyzed thematically. While patients and healthcare staff viewed psychotropic medicines primarily as a treatment for reducing symptoms of mental illness, they were also used as a coping strategy and to reduce insomnia. Appropriate psychotropic prescribing was also thought to contribute towards the rehabilitation agenda and helped to maintain order in prisons. Staff voiced concerns regarding possible overreliance on psychotropic medicines. However, patients perceived insufficient access to alternative, nonpharmacological forms of treatment and support in prison. Psychotropic medicines are used for multiple purposes in prisons and are generally considered a useful resource. Nonetheless, further work may be needed to find the right balance between psychotropic medicines and alternative, nonpharmacological therapies. Copyright © 2013 Elsevier Inc. All rights reserved.

End-of-life care communications and shared decision-making in Norwegian nursing homes--experiences and perspectives of patients and relatives.

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Gjerberg, Elisabeth; Lillemoen, Lillian; Førde, Reidun; Pedersen, Reidar

2015-08-19

Involving nursing home patients and their relatives in end-of-life care conversations and treatment decisions has recently gained increased importance in several Western countries. However, there is little knowledge about how the patients themselves and their next-of-kin look upon involvement in end-of-life care decisions. The purpose of this paper is to explore nursing home patients' and next-of-kin's experiences with- and perspectives on end-of-life care conversations, information and shared decision-making. The study has a qualitative and explorative design, based on a combination of individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 33 relatives. The data was analysed applying a "bricolage" approach". Participation was based on informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. Few patients and relatives had participated in conversations about end-of-life care. Most relatives wanted such conversations, while the patients' opinions varied. With some exceptions, patients and relatives wanted to be informed about the patient's health condition. The majority wanted to be involved in the decision-making process, but leave the final decisions to the health professionals. Among the patients, the opinion varied; some patients wanted to leave the decisions more or less completely to the nursing home staff. Conversations about end-of-life care issues are emotionally challenging, and very few patients had discussed these questions with their family. The relatives' opinions of the patient's preferences were mainly based on assumptions; they had seldom talked about this explicitly. Both patients and relatives wanted the staff to raise these questions. Nursing home staff should initiate conversations about preferences for end-of-life care, assisting patients and relatives in talking about these issues, while at the same time being sensitive to the diversity in

Assessing changes in a patient's condition - perspectives of intensive care nurses.

Science.gov (United States)

Kvande, Monica; Delmar, Charlotte; Lykkeslet, Else; Storli, Sissel Lisa

2017-03-01

To explore the phenomenon of assessing changes in patients' conditions in intensive care units from the perspectives of experienced intensive care nurses. Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes in a patient's condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient's condition and in improving patient outcomes. This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care nurses. The nurses' experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen. An overarching theme of 'sensitive situational attention' was identified, in which the nurses were sensitive in relation to a patient and understood the significance of a given situation. This theme was further unfolded in four subthemes: (1) being sensitive and emotionally present, (2) being systematic and concentrating, (3) being physically close to the bedside and (4) being trained and familiar with the routines. Nurses understand each patient's situation and foresee clinical eventualities through a sensitive and attentive way of thinking and working. This requires nurses to be present at the bedside with both their senses (sight, hearing, smell and touch) and emotions and to work in a concentrated and systematic manner. Knowledge about the unique patient exists in interplay with past experiences and medical knowledge, which are essential for nurses to understand the situation. Clinical practice should develop routines that enable nurses to be present at the bedside and to work in a concentrated and systematic manner. Furthermore, providing safe care requires nurses to be sensitive and attentive to each patient's unique situation. © 2016 British Association of

A case study from a nursing and occupational therapy perspective - Providing care for a patient with a traumatic brachial plexus injury.

Science.gov (United States)

Wellington, Beverley; McGeehan, Claire

2015-02-01

This paper presents a case study that demonstrates how collaborative working between professionals enhanced the holistic care for a patient following a traumatic brachial plexus injury. The paper will describe the patient's journey of care from initial presentation, diagnosis and assessment, acute care provision, discharge & rehabilitation to ongoing supportive counselling. The care encompasses input from both a nursing and occupational therapy perspective. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient seeking behaviors and online personas: social media's role in cosmetic dermatology.

Science.gov (United States)

Ross, Nicholas A; Todd, Quintin; Saedi, Nazanin

2015-02-01

Social media sites, composed of providers, patients, and their social circles, facilitate health and healthcare delivery. To examine patients' perspective on social media as an information source, communication tool, and referral service through an anonymous survey. In addition, influences on patient Internet personas, an actively constructed online identity, around the time of cosmetic procedures are examined. Patients completed an anonymous institutional review board-approved survey during their initial cosmetic visit. Patients are highly active on social media using it as a multipurpose tool for physician referral services, support groups, and disease education. Patients gathered dermatology information from multiple sources, including friends, family, social media pages, and other online sources, often sharing their own experiences through social media platforms. Patients indicated a desire for provider educational materials on interactive media pages. Most preferred material written by a physician, but some indicated a preference for both physician and lay material. Online images highlighting dissatisfying skin features were influential to select patients, prompting manipulation of online personas and evaluation for aesthetic procedures. Although the study examines cosmetic patient perspectives, data highlight valuable trends for all dermatologists. Social media can improve patient education, collaboration, recruitment, and online professional image, leading to healthier patient-centered care.

Sarcopenia and physical activity in older male cardiac patients.

Science.gov (United States)

Izawa, Kazuhiro P; Watanabe, Satoshi; Oka, Koichiro; Kasahara, Yusuke; Morio, Yuji; Hiraki, Koji; Hirano, Yasuyuki; Omori, Yutaka; Suzuki, Norio; Kida, Keisuke; Suzuki, Kengo; Akashi, Yoshihiro J

2016-11-01

There is little information on the association of sarcopenia with physical activity in elderly cardiac patients. This study determined differences in physical activity and cutoff values for physical activity according to the presence or absence of sarcopenia in elderly male cardiac patients. Sixty-seven consecutive men aged ≥65 years with cardiac disease were enrolled. We defined sarcopenia using the European Working Group on Sarcopenia in Older People algorithm. Patients were divided into the sarcopenia group (n=25) and the non-sarcopenia group (n=42). In the patients with and without sarcopenia of physical activities were evaluated to determine cutoff values of physical activity. After adjusting for patient characteristics, both the average daily number of steps (3361.43±793.23 vs. 5991.55±583.57 steps, P=0.021) and the average daily energy expenditure of physical activity (71.84±22.19 vs. 154.57±16.18kcal, P=0.009) were significantly lower in the sarcopenia versus non-sarcopenia group. Receiver-operating characteristic analysis identified a cutoff value for steps of physical activity of 3551.80steps/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.44 and a cutoff value for energy expenditure of physical activity of 85.17kcal/day for 1 week, with a sensitivity of 0.73 and 1-specificity of 0.27. Physical activity in the male cardiac patients with sarcopenia was significantly lower than that in those without sarcopenia. The cutoff values reported here may be useful values to aid in the identification of elderly male cardiac patients with sarcopenia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Exploring the patient journey to diagnosis of Gaucher disease from the perspective of 212 patients with Gaucher disease and 16 Gaucher expert physicians.

Science.gov (United States)

Mehta, Atul; Belmatoug, Nadia; Bembi, Bruno; Deegan, Patrick; Elstein, Deborah; Göker-Alpan, Özlem; Lukina, Elena; Mengel, Eugen; Nakamura, Kimitoshi; Pastores, Gregory M; Pérez-López, Jordi; Schwartz, Ida; Serratrice, Christine; Szer, Jeffrey; Zimran, Ari; Di Rocco, Maja; Panahloo, Zoya; Kuter, David J; Hughes, Derralynn

2017-11-01

Gaucher disease (GD) is a rare hereditary disorder caused by a deficiency of the lysosomal enzyme β-glucocerebrosidase. Diagnosis is challenging owing to a wide variability in clinical manifestations and severity of symptoms. Many patients may experience marked delays in obtaining a definitive diagnosis. The two surveys reported herein aimed to explore the patient journey to diagnosis of GD from the perspectives of Gaucher expert physicians and patients. Findings from the surveys revealed that many patients experienced diagnostic delays and misdiagnoses, with nearly 1 in 6 patients stating that they were not diagnosed with GD for 7years or more after first consulting a doctor. Physicians and patients both reported multiple referrals to different specialties before a diagnosis of GD was obtained, with primary care, haematology/haematology-oncology and paediatrics the main specialties to which patients first presented. Splenomegaly, thrombocytopenia, anaemia and bone pain were reported as the most common medical problems at first presentation in both surveys. These findings support a clear need for straightforward and easy-to-follow guidance designed to assist non-specialists to identify earlier patients who are at risk of GD. Copyright © 2017 The Authors and Shire HGT Inc. Published by Elsevier Inc. All rights reserved.

Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain

Directory of Open Access Journals (Sweden)

Wallace LS

2014-06-01

Full Text Available Lorraine S Wallace,1 Randell K Wexler,1 Leon McDougle,1 W Frederick Miser,1 J David Haddox2,3 1Department of Family Medicine, the Ohio State University, Columbus, OH, USA; 2Health Policy, Purdue Pharma L.P., Stamford, CT, USA; 3Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Background: Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups in examining the daily experiences of primary care patients living with chronic pain. Methods: A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain. Results: Patients submitted an average of 20.2±3.1 photographs (range =8–27 photographs. Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain. Conclusion: The qualitative methods employed in this study provide deep insight into perceptions

Reconciling White-Box and Black-Box Perspectives on Behavioral Self-adaptation

DEFF Research Database (Denmark)

Bruni, Roberto; Corradini, Andrea; Gadducci, Fabio

2015-01-01

This paper proposes to reconcile two perspectives on behavioral adaptation commonly taken at different stages of the engineering of autonomic computing systems. Requirements engineering activities often take a black-box perspective: A system is considered to be adaptive with respect to an environ......This paper proposes to reconcile two perspectives on behavioral adaptation commonly taken at different stages of the engineering of autonomic computing systems. Requirements engineering activities often take a black-box perspective: A system is considered to be adaptive with respect...... to an environment whenever the system is able to satisfy its goals irrespectively of the environment perturbations. Modeling and programming engineering activities often take a white-box perspective: A system is equipped with suitable adaptation mechanisms and its behavior is classified as adaptive depending...

[Quality in diabetes mellitus control in Primary Care Units in Mexico. A study of the perspectives of the patient's family].

Science.gov (United States)

Avalos García, María Isabel; López Ramón, Concepción; Morales García, Manuel Higinio; Priego Álvarez, Heberto Romeo; Garrido Pérez, Silvia María Guadalupe; Cargill Foster, Nelly Ruth

2017-01-01

To identify the perspectives of the patient's family in the quality of diabetes mellitus control. Qualitative methodology of exploratory design, oriented towards health services research, conducted in 2014 using non-probability sampling. Primary Care Units mainly situated in the state of Tabasco, Mexico. 42 family members were selected, who agreed to participate voluntarily in the study. Six focus groups were set up; interview guides and group dynamics were employed. The information was documented, saturated and categorised; the most representative discourses were used, and conclusions reached. The results show a highly critical position of the families as regards the patient, some of which appear justified, and others have a cultural, historical, and to some extent, an ignorance connotation. They have also commented on the health care and the role that patients and families can play, in both cases, also expressed critically. The family perspectives reveal what they think and feel about diabetes mellitus. It is important to note their lack of support and the content of their expressions due to lack of knowledge of the disease. Their discourses are critical, mythical, and with false beliefs of the fear of being future carriers of the disease. They feel sorry for the patient but they resist taking care of them, and do not want a life with diabetes. The family is the closest support for patients and an invaluable human resource for health services. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Patient-oriented health technologies: Patients' perspectives and use.

Science.gov (United States)

Bauer, Amy M; Rue, Tessa; Munson, Sean A; Ghomi, Reza Hosseini; Keppel, Gina A; Cole, Allison M; Baldwin, Laura-Mae; Katon, Wayne

2017-08-01

For patient-oriented mobile health tools to contribute meaningfully to improving healthcare delivery, widespread acceptance and use of such tools by patients are critical. However, little is known about patients' attitudes toward using health technology and their willingness to share health data with providers. To investigate primary care patients' comfort sharing health information through mobile devices, and patients' awareness and use of patient portals. Patients (n=918) who visited one of 6 primary care clinics in the Northwest US completed a survey about health technology use, medical conditions, and demographics. More patients were comfortable sharing mobile health information with providers than having third parties store their information (62% vs 30%, Somers D=.33, phigher among patients with a chronic condition (AOR= 3.18, p=0.004). Comfort, awareness, and use of health technologies were variable. Practices introducing patient-facing health technologies should promote awareness, address concerns about data security, and provide education and training, especially to older adults and those with health literacy limitations. Patient-facing health technologies provide an opportunity for delivering scalable health education and self-management support, particularly for patients with chronic conditions who are already using patient portals.

Identifying the determinants of perceived quality in outpatient child and adolescent mental health services from the perspectives of parents and patients.

Science.gov (United States)

Kapp, Carole; Perlini, Thomas; Jeanneret, Tiffanie; Stéphan, Philippe; Rojas-Urrego, Alejandro; Macias, Manuel; Halfon, Olivier; Holzer, Laurent; Urben, Sébastien

2017-10-01

This cross-sectional survey adopting a multiple-informant perspective explores the factors that influence perceived quality (i.e., therapeutic alliance and satisfaction) in an outpatient setting within child and adolescent mental health services (CAMHS). A total of 1433 participants (parents, n = 770, and patients, n = 663) attending or having attended (drop-out) outpatient units participated in the study. The outcome measures were satisfaction (Client Satisfaction Questionnaire) and the therapeutic alliance (Helping Alliance Questionnaire). The determinants of these quality indicators were socio-demographic variables (e.g., age, gender, and mother's socio-economic status), factors related to the extent of difficulties (number of reasons for the consultation, number of people who referred the child to the CAMHS), the approach to treatment at outset (agreeing to the consultation, feeling reassured at the first appointment), the organizational friendliness (secretary, waiting room, waiting time for the first appointment) and the organization of the therapy (frequency of sessions, time for questions, change of therapist). The approach to treatment at outset, accessibility by phone, satisfaction with the frequency of the sessions and having enough time for questions were the factors that consistently explain the quality indicators from both perspectives (patients and parents). In contrast, the socio-demographic variables as well as the extent of difficulties and factors related to the organizational friendliness and the organization of the therapy (frequency of sessions, change of therapist) were not related to the quality indicators. This study identifies key determinants of the quality indicators from the perspective of patients and parents that should be considered to improve CAMHS care quality. First appointments should be carefully prepared, and clinicians should centre care on the needs and expectations of patients and parents.

Nutrition and Physical Activity in CKD patients

Directory of Open Access Journals (Sweden)

Adamasco Cupisti

2014-07-01

Full Text Available Chronic kidney disease (CKD patients are at risk for protein-energy wasting, abnormal body composition and impaired physical capacity. These complications lead to increased risk of hospitalization, morbidity and mortality.In CKD patient as well as in healthy people, there is a close association between nutrition and physical activity. Namely, inadequate nutrient (energy intake impairs physical performance thus favoring a sedentary lifestyle: this further contributes to loss of muscle strength and mass, which limit the quality of life and rehabilitation of CKD patients. In CKD as well as in end-stage-renal-disease patients, regular physical activity coupled with adequate energy and protein intake counteracts protein-energy wasting and related comorbidity and mortality. In summary, exercise training can positively influence nutritional status and the perception of well-being of CKD patients and may facilitate the anabolic effects of nutritional interventions.

Dysarthria following stroke: the patient's perspective on management and rehabilitation.

Science.gov (United States)

Brady, Marian C; Clark, Alexander M; Dickson, Sylvia; Paton, Gillian; Barbour, Rosaline S

2011-10-01

To explore the perceptions of people with stroke-related dysarthria in relation to the management and rehabilitation of dysarthria. Qualitative semi-structured interviews. Community setting Subjects: Twenty-four people with an acquired dysarthria as a result of a stroke in the previous three years. All were living at home at the time of the interview. None exhibited a co-existing impairment (for example, aphasia, apraxia or cognitive impairment) that might have contributed to their communicative experiences. Participants described the considerable efforts they made to maximize their communicative effectiveness prior to, and during, communicative interactions. Activities described included careful articulation and vocal projection as well as more inconspicuous strategies including pre-planning interactions, focused, effortful speech and word substitution. Communication was facilitated by a range of strategies including drafting, rehearsal, manoeuvring and ongoing monitoring and repair. Self-led speech rehabilitation activities were functionally based and often undertaken regularly. Some novel reading-aloud and speaking-aloud activities were described. The quantity and nature of inconspicuous, internalized, cognitive activities people with dysarthria engage in to maximize their communicative effectiveness should be considered in evaluating the impact of dysarthria following stroke. Focusing upon externally observable characteristics alone is insufficient. Challenging, functionally relevant, patient-focused activities, materials and targets are more likely to be perceived by the patient as relevant and worthwhile and are thus more likely to ensure adherence to recommended rehabilitation activities.

Physical activity of elderly patients after total hip arthroplasty.

Science.gov (United States)

Cukras, Zbigniew; Praczko, Katarzyna; Kostka, Tomasz; Jegier, Anna

2007-01-01

Total hip arthroplasty (THA) is the most common method of treatment of severe hip osteoarthritis. There is little data concerning the physical activity of total hip arthroplasty patients in Poland and investigations to explore this area are useful. The aim of the study was to describe the post-operative physical activity of total hip arthroplasty patients. A total of 146 adult people were examined, among which 28 men and 41 women had undergone total hip arthroplasty due to primary osteoarthritis of the hip, while another 32 men and 41 women matched for age who had not undergone hip surgery for osteoarthritis served as controls. The physical activity of study participants was assessed with the 7-Day Physical Activity Recall Questionnaire. All participants were also asked about the type and amount of physical activity they engaged in to maintain good health. Physical activity measured as the total amount of calories expended through physical activity per week was similar in the post-THA patients compared to the controls. The only differences were a smaller amount of calories expended during low-intensity physical activity by men after total hip arthroplasty compared to men who had not undergone surgery for osteoarthritis and a smaller amount of calories expended through high-intensity physical activity by women after total hip arthroplasty compared to female controls. The kinds of recreational physical activity most commonly practised by patients a mean of two years after total hip arthroplasty were marching, bicycling and general body conditioning exercises (usually the continuation of exercises recommended during post-operative rehabilitation). The percentage of post-THA patients undertaking physical activity for the prevention of non-communicable diseases was low. Physical activity should be more effectively encouraged in patients after total hip arthroplasty.

Perspectives of Patients, Families, and Health Care Professionals on Decision-Making About Dialysis Modality—The Good, the Bad, and the Misunderstandings!

OpenAIRE

Griva, Konstadina; Li, Zhi Hui; Lai, Alden Yuanhong; Choong, Meng Chan; Foo, Marjorie Wai Yin

2013-01-01

♦ Objectives: This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore.

Need for information, honesty and respect: patient perspectives on health care professionals communication about cancer and fertility

OpenAIRE

Ussher, Jane M.; Parton, Chloe; Perz, Janette

2018-01-01

Background Individuals affected by cancer report a need for information about fertility from health care professionals (HCPs), in order to inform decision making and alleviate anxiety. However, there is evidence that many health professionals do not engage in such discussions. Method A mixed method design was used to examine the construction and subjective experience of communication with health professionals about fertility in the context of cancer, from the perspective of patients. A survey...

How Residents Learn From Patient Feedback: A Multi-Institutional Qualitative Study of Pediatrics Residents' Perspectives.

Science.gov (United States)

Bogetz, Alyssa L; Orlov, Nicola; Blankenburg, Rebecca; Bhavaraju, Vasudha; McQueen, Alisa; Rassbach, Caroline

2018-04-01

Residents may view feedback from patients and their families with greater skepticism than feedback from supervisors and peers. While discussing patient and family feedback with faculty may improve residents' acceptance of feedback and learning, specific strategies have not been identified. We explored pediatrics residents' perspectives of patient feedback and identified strategies that promote residents' reflection on and learning from feedback. In this multi-institutional, qualitative study conducted in June and July 2016, we conducted focus groups with a purposive sample of pediatrics residents after their participation in a randomized controlled trial in which they received written patient feedback and either discussed it with faculty or reviewed it independently. Focus group transcripts were audiorecorded, transcribed, and analyzed for themes using the constant comparative approach associated with grounded theory. Thirty-six of 92 (39%) residents participated in 7 focus groups. Four themes emerged: (1) residents valued patient feedback but felt it may lack the specificity they desire; (2) discussing feedback with a trusted faculty member was helpful for self-reflection; (3) residents identified 5 strategies faculty used to facilitate their openness to and acceptance of patient feedback (eg, help resident overcome emotional responses to feedback and situate feedback in the context of lifelong learning); and (4) residents' perceptions of feedback credibility improved when faculty observed patient encounters and solicited feedback on the resident's behalf prior to discussions. Discussing patient feedback with faculty provided important scaffolding to enhance residents' openness to and reflection on patient feedback.

A Dyadic Perspective on Engagement in Advance Care Planning.

Science.gov (United States)

Fried, Terri; Zenoni, Maria; Iannone, Lynne

2017-01-01

To understand the perspectives of both patients and the person who would make medical decisions for them if they were unable (surrogates) on their participation in advance care planning (ACP). Qualitative cross-sectional study. Community. Thirty-one veterans age 55 years and older and their surrogates. In interviews conducted with both the veteran and surrogate, they were asked to discuss their participation in four ACP activities: communication about life-sustaining treatment, communication about views on quality of life, completion of a living will, and appointment of a healthcare proxy. They were asked about barriers to and facilitators of ACP engagement. When they did not agree about engagement, they each provided their perspective on what they believed had or had not occurred. Many of the same barriers to and facilitators of engagement were discussed by both patients and surrogates. These included difficulty thinking about dying, differences in values, and experiences with others that demonstrated the ability of ACP to decrease burden or avoid conflict. Reasons for disagreements in perceptions about whether communication had occurred included surrogates' need for more detailed information, surrogates' lack of readiness to hear what the patient was saying, and surrogates' reliance on what they know about the patient. For some dyads, participation in the study prompted additional communication, resulting in a better shared understanding of ACP engagement. Surrogates can both impede and facilitate engagement in ACP, and they can hold different perceptions from patients regarding this engagement. Efforts to promote ACP may be most successful if they assess and address both patients' and surrogates' attitudes and help to facilitate clear communication between them. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Worksite physical activity breaks: Perspectives on feasibility of implementation.

Science.gov (United States)

Bramante, Carolyn T; King, Maggie M; Story, Mary; Whitt-Glover, Melicia C; Barr-Anderson, Daheia J

2018-01-01

Worksites offer a unique opportunity to increase physical activity in persons with both active and sedentary lifestyles. The objective of this study was to examine employee and supervisor perspectives on feasibility and acceptability of 10-minute Instant Recess ® physical activity videos in the worksite. Convenience sample of public and private worksites in Minneapolis/St. Paul, MN. Employees (n = 187) at 13 worksites were recruited by a one-time email invitation to participate in a group Instant Recess break and complete a 15-question survey. One supervisor per site participated in a one-on-one interview to assess suggestions for feasibility of implementation. Likert-type survey responses were averaged per worksite and overall. Interview results were recorded, transcribed, and coded by two authors. Employees were extremely positive about enjoyment, increased productivity, comfort, and feasibility of doing Instant Recess at the same time and place every day (score = 4.29, 4.17, 4.25, and 4.37 out of 5, respectively). However, they did not feel comfortable leading an Instant Recess break (score = 2.68 out of 5). Supervisors voiced during the one-on-one interviews that they enjoyed Instant Recess (13 out of 13 supervisors), were enthusiastic about Instant Recess as a simple and cost-effective entry into worksite wellness (11 out of 13 supervisors), and felt that Instant Recess could be institutionalized by offering it daily at a set time and place (13 out of 13 supervisors). Employees and supervisors at various worksites believed that it is feasible and desirable to offer 10-minute physical activity breaks using videos during the workday.

Main communication barriers in the process of delivering bad news to oncological patients - medical perspective.

Science.gov (United States)

Zielińska, Paulina; Jarosz, Magdalena; Kwiecińska, Agnieszka; Bętkowska-Korpała, Barbara

2017-01-01

Delivering bad news is a major aspect of a doctor's work. The literature most often refers to patient's expectations or needs, and methods of delivering bad news, while medical perspective is often skipped. The purpose of this paper is to examine competencies (knowledge, skills and experience) in delivering bad news by medical specialists in the areas related to the causal and symptomatic treatment of oncological patients; identification of major communication problems and obstacles in this specific situation and evaluation of teaching needs for delivering bad news. The study was performed on a group of 61 medical specialists in the areas related to the causal and symptomatic treatment of oncological patients, using a self-generated questionnaire based on other studies in the literature. Topics that are considered most demanding are: delivering news on the termination of causal treatment and preparing the patient/ close ones for death. The most difficult aspect of such discussions for the respondents was associated with the emotions manifested by the patient. On the other hand, doctors were mostly distressed by the feeling of taking the patient's hope away. The study points to the need for education of doctors in the eld of techniques for delivering bad news, particularly in the area of dealing with the emotions manifested by the patient and giving them real hope. The results encourage to conduct studies on a larger group of doctors.

Exploration and development of practice with Non Invasive Ventilation (NIV) to patients with Chronic Obstructive Pulmonary Disease (COPD) in exacerbation based on the patients, their relatives and healthcare professionals perspectives on treatment

DEFF Research Database (Denmark)

Christensen, Helle Marie

Body: Background: Assessment of life expectancy and end stage COPD is difficult and often discussed in the clinical setting with regards to the ordination “Not-to-intubate” and “Continuation of respiratory assistance/NIV” as life sustaining treatment. There is little knowledge of how the patients...... experience NIV, and health care professionals express a need for developing new clinical strategies which draws on patient's perspectives. Aim: To provide insight into how patients with COPD experience treatment with NIV. To develop new clinical strategies for treatment with NIV based on patients, relatives...

Clinician Perspectives on an Electronic Portal to Improve Communication with Patients and Families in the Intensive Care Unit.

Science.gov (United States)

Bell, Sigall K; Roche, Stephanie D; Johansson, Anna C; O'Reilly, Kristin P; Lee, Barbara S; Sands, Kenneth E; Talmor, Daniel S; Brown, Samuel M

2016-12-01

Communication in the intensive care unit (ICU) often falls short of patient and family needs, putting them at risk for significant physical and emotional harm. As electronic patient portals rapidly evolve, one designed specifically for the ICU might potentially enhance communication among patients, family members, and clinicians; however, the views of frontline ICU staff on such technology are unknown. To identify clinician perspectives on the current state of communication among patients, families, and clinicians in the ICU, and assess their views on whether and how an electronic portal may address existing communication deficits and improve care. Three focus groups comprised altogether of 26 clinicians from 6 ICUs, representing several disciplines in an academic medical center in Boston, Massachusetts. Transcripts were analyzed inductively for major themes using grounded theory. We identified seven themes reflecting clinician perspectives on communication challenges and desired portal functionality: (1) comprehension and literacy; (2) results and updates; (3) patient and family preferences; (4) interclinician communication; (5) family informational needs; (6) the ICU as an unfamiliar environment; and (7) enhancing humanism through technology. Each theme included current gaps in practice, potential benefits and concerns related to an ICU communication portal, and participant recommendations. Benefits included enhanced education, patient/family engagement, and clinician workflow. Challenges included the stress and uncertainty of ICU care, fear of technology replacing human connection, existing interclinician communication failures, and the tension between informing families without overwhelming them. Overall, clinicians were cautiously supportive of an electronic portal to enhance communication in the ICU and made several specific recommendations for design and implementation. As new technologies expand opportunities for greater transparency and participation in