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Qualitative Investigation of Experience and Quality of Life in Patients Treated with Calcium Electroporation for Cutaneous Metastases. Cancers (Basel) 2023; 15:cancers15030599. [PMID: 36765556 PMCID: PMC9913084 DOI: 10.3390/cancers15030599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: Calcium electroporation is a novel cancer treatment. It includes injecting calcium-solution and applying electric pulses to tumour tissue. Data on quality of life for patients with cutaneous metastases treated with calcium electroporation is limited. We evaluated quality of life in patients with skin metastases treated with calcium electroporation using qualitative interviews. (2) Methods: This investigation featured a subgroup from a non-randomised phase II study (CaEP-R) at Zealand University Hospital, Denmark, studying response to calcium electroporation in cutaneous metastasis (ClinicalTrials no. NCT04225767). Participants were interviewed at baseline before calcium electroporation treatment and after two months. Data was analysed phenomenologically; (3) Results: Interviews were conducted February 2020-November 2021. Nine patients were included, of which seven participated in both interviews. All seven patients expected treated tumours to disappear, symptom relief and minimal side effects. Most patients requested peer accounts. All patients found the treatment uncomfortable but acceptable; all thought their fears of electric pulses exceeded their experience. All would repeat the treatment if effective. Successful treatment had a positive effect on pain, symptomatic wounds, sleep, vigour and social inclination; (4) Conclusions: Calcium electroporation enhanced health-related quality of life by reducing symptoms and increasing social inclination. Peer accounts provide patients with a shortcut to confidence in treatment on top of doctors' recommendations.
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Fajnkuchen F, Delyfer MN, Conrath J, Baillif S, Mrejen S, Srour M, Bellamy JP, Dupas B, Lecleire-Collet A, Meillon C, Bonicel P, Hobeika M, Giocanti-Aurégan A. Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections. Acta Diabetol 2020; 57:1081-1091. [PMID: 32274583 DOI: 10.1007/s00592-020-01513-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/06/2020] [Indexed: 01/19/2023]
Abstract
AIMS Clinical outcomes of diabetic macular edema (DME) have been widely described, but data on diabetic retinopathy perceptions by diabetes patients are limited. The aim of this survey was to explore the lived experience, knowledge, fears and expectations about disease, and treatment in patients with diabetes and macular edema treated with intravitreal injections (IVTI) and to characterize patient profiles. METHODS Cross-sectional survey including a preliminary qualitative phase (20 patients with DME, treated or treatment-naive, 5 female and 15 male, age 36-74 years) followed by a quantitative survey (116 patients treated with IVTI for DME). Data ASKIA Analyze (version 5.3.3.5) was used for descriptive statistics, and R software (version 3.4.1) for multiple correspondence analysis. RESULTS The qualitative phase identified the wording used by patients and information helpful to propose modalities of response in the quantitative phase. In the quantitative survey (116 patients, mean age 66.6 years), most patients were treated with anti-vascular endothelial growth factor. Overall, 71.9% reported that the disease negatively affected their daily activities and 33.1% considered that regular visits to the ophthalmologist were disrupting their life. Treatment expectations differed significantly between patients in terms of disease experience (visit and injection schedules), fears and feelings, and relationship with physicians, allowing three patient profiles to be identified: "Worried" patients (n = 45) felt isolated and were worried about the need for repeated treatment and possible side effects. They were mainly active men aged < 60 with type I diabetes (T1D) and DME diagnosed for > 2 years; "Curious" patients (n = 21) experienced insufficient support and requested more information on their disease and existing treatments. They were mainly single women aged 60-69 years; "Passive" patients (n = 50) felt sufficiently informed by their ophthalmologist and were not concerned by DME. They were older (mean age: 70 years) and mainly type 2 diabetic men. CONCLUSIONS Patients with diabetes and macular edema treated with IVTI form a heterogeneous group regarding fears and expectations. Different patient profiles were identified and need to be confirmed in larger studies. A better understanding of psychological profiles may optimize compliance of diabetic patients.
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Affiliation(s)
- Franck Fajnkuchen
- Ophthalmology Department, Hôpital Avicenne and University Paris 13, Bobigny, Paris, France
- Centre d'Imagerie et de Laser, 11 rue Antoine Bourdelle, 75015, Paris, France
| | - Marie-Noëlle Delyfer
- Department of Ophthalmology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - John Conrath
- Centre Monticelli Paradis d'Ophtalmologie, Marseille, France
| | | | - Sarah Mrejen
- Centre d'Imagerie et de Laser, 11 rue Antoine Bourdelle, 75015, Paris, France
- Department of Ophthalmology, XV-XX Ophthalmology National Hospital Center, Paris, France
| | - Mayer Srour
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Université de Paris Est Créteil, Créteil, France
| | | | - Benedicte Dupas
- Ophthalmology Department, Hôpital Lariboisière, Université Paris 7, Paris, France
| | | | - Cyril Meillon
- Department of Ophthalmology, University Hospital, Dijon, France
| | - Pierre Bonicel
- Department of Ophthalmology, Orléans Hospital, Orléans, France
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Trento M, Charrier L, Cavallo F, Bertello S, Oleandri S, Donati MC, Rizzo S, Virgili G, Picca G, Bandello F, Lattanzio R, Aragona E, Perilli R, Casati S, Beltramo E, Mazzeo A, Fornengo P, Durando O, Merlo S, Porta M. Vision-related quality of life and locus of control in type 1 diabetes: a multicenter observational study. Acta Diabetol 2019; 56:1209-1216. [PMID: 31313005 DOI: 10.1007/s00592-019-01384-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS Diabetic retinopathy remains asymptomatic until its late stages but remains a leading cause of vision impairment and blindness. We studied quality of life and the ability to deal with the discomfort deriving from the presence of a chronic disease in patients with type 1 diabetes and different stages of retinopathy. METHODS Multicenter collaborative observational study involving nine centers screening for retinopathy in different areas of Italy. The National Eye Institute 25-item visual functioning questionnaire and the locus of control tool were administered to 449 people with type 1 diabetes between February 2016 and March 2018. Socio-demographic and clinical data were collected. RESULTS On multivariable analysis, severe retinopathy is associated with worse scores for general vision, ocular pain, near vision activities, distance vision activities, driving, color vision, peripheral vision and lower values of internal control, independently of visual acuity. Women had a perception of worse general health, distance vision activities and driving, and lower internal control and trust in others. Worse scores for visual-specific social functioning, visual-specific mental health, visual-specific role difficulties, visual-specific dependency and peripheral vision were associated with higher HbA1c levels. Fatalism increased with rising HbA1c levels. CONCLUSIONS These results confirm that a gap exists between patients' knowledge and expectations on retinopathy and providers' expertise and assumptions. To bridge this gap, patient-centered education and engaging approaches may be more effective than simple information given during consultations.
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Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy.
| | - Lorena Charrier
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Stefania Bertello
- Endocrinology and Diabetology Unit, Health Unit 1, Savigliano, Italy
| | | | - Maria Carla Donati
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Salvatore Rizzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Gianni Virgili
- Eye Clinic, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giuseppe Picca
- Endocrinology and Metabolic Diseases Unit, Hospital of Foggia, Foggia, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Elena Aragona
- Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy
| | - Roberto Perilli
- Department of Ophthalmology, Territorial Ophthalmology, Pescara, Italy
| | - Stefano Casati
- Eye Clinic, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elena Beltramo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Aurora Mazzeo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fornengo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
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Guerrier G, Rondet S, Hallal D, Levy J, Bourdon H, Brezin AP, Samama CM. Risk factors for intraoperative hypertension in patients undergoing cataract surgery under topical anaesthesia. Anaesth Crit Care Pain Med 2016; 35:343-346. [PMID: 27320050 DOI: 10.1016/j.accpm.2016.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 12/10/2015] [Accepted: 01/20/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Hypertension is the most common operative medical complication in patients undergoing cataract surgery under topical anaesthesia. Our objective was to identify risk factors for high blood pressure requiring anaesthetic interventions. METHODS All patients undergoing elective cataract operations were included in an observational prospective study preceded by a medical history description and physical examination. Intraoperative adverse medical events and type of management were recorded. RESULTS We studied 514 elective cataract operations. The overall rate of hypertension during surgery was 10.4% (n=54). Independent risk factors for developing intraoperative hypertension were female sex (OR=3.8 [1.4-10.3]; P=0.01), age>80years (OR=4.5 [1.5-13.8]; P=0.01) and anxiety (OR=10.5 [4.1-27.0]; P<0.001). The incidence of hypertension was not significantly reduced by premedication (OR=0.5 [0.04-6.0]; P=0.6). There was no significant difference between patients with or without hypertension history in the rates of hypertensive events (OR=3.2 [0.6-15.5]; P=0.15). Management of hypertension or anxiety was similar in patients regardless of their past medical history or ASA risk class. CONCLUSIONS A specific at-risk population may benefit from targeted preoperative interventions for reducing intraoperative anxiety and hypertension.
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Affiliation(s)
- Gilles Guerrier
- Département d'anesthésie-réanimation, hôpital Cochin, université Paris-Descartes, 75014 Paris, France.
| | - Sylvie Rondet
- Département d'anesthésie-réanimation, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
| | - Dalila Hallal
- Département d'anesthésie-réanimation, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
| | - Jacques Levy
- Département d'anesthésie-réanimation, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
| | - Hugo Bourdon
- Service d'ophtalmologie, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
| | - Antoine P Brezin
- Service d'ophtalmologie, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
| | - Charles Marc Samama
- Département d'anesthésie-réanimation, hôpital Cochin, université Paris-Descartes, 75014 Paris, France
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Chen X, Lu L. Depression in Diabetic Retinopathy: A Review and Recommendation for Psychiatric Management. PSYCHOSOMATICS 2016; 57:465-71. [PMID: 27380941 DOI: 10.1016/j.psym.2016.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/17/2016] [Accepted: 04/19/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and one of the main causes of irreversible vision impairment in the working-age population. Multiple studies have demonstrated the significantly high prevalence of depression in patients with DR in recent years. The progression of DR could lead to depression, whereas depressive symptoms often worsen the condition of DR. Therefore, DR is one of the causes of psychosomatic diseases, the treatment for which should combine traditional DR therapy with depression interventions. METHODS We reviewed existing articles that investigated the association between DR and depression in the context of prevalence, risk factors, biological mechanisms, and treatment indications. RESULTS The literature review in this article includes a brief introduction to current studies of depression and DR, followed by a focus on the epidemiology of depression in DR that help doctors better identify potential or existing depression patients upon first diagnosis. The underlying biologic mechanisms between the 2 diseases are briefly reviewed, and potential treatments are addressed. CONCLUSIONS Depression in patients with DR is not uncommon and has a negative effect on the condition of DR. To achieve optimal prognosis in patients with DR and depression, more attention to combined psychiatric therapies for depression is recommended.
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Affiliation(s)
- Xiaohong Chen
- Department of Fundus Diseases Center, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Lin Lu
- Department of Fundus Diseases Center, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.
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Royle P, Mistry H, Auguste P, Shyangdan D, Freeman K, Lois N, Waugh N. Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation. Health Technol Assess 2016; 19:v-xxviii, 1-247. [PMID: 26173799 DOI: 10.3310/hta19510] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR). OBJECTIVES The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP? ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) for efficacy but other designs also used. DATA SOURCES MEDLINE and EMBASE to February 2014, Web of Science. REVIEW METHODS Systematic review and economic modelling. RESULTS The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO. LIMITATION The current evidence is insufficient to recommend PRP for severe NPDR. CONCLUSIONS There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs. STUDY REGISTRATION This study is registered as PROSPERO CRD42013005408. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Pamela Royle
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Auguste
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Deepson Shyangdan
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Karoline Freeman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Norman Waugh
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016; 44:260-77. [DOI: 10.1111/ceo.12696] [Citation(s) in RCA: 444] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel Shu Wei Ting
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
| | - Gemmy Chui Ming Cheung
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
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Korsch M, Robra BP, Walther W. Implant counseling and information: questions, predictors, and decision-making of patients before implant therapy. Clin Oral Implants Res 2014; 26:e47-e50. [PMID: 24438331 DOI: 10.1111/clr.12329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implant counseling and information must enable the patient to make his/her own independent decision (informed consent). However, there are indications that patient counseling and information often provides incomplete information. METHODS In 40 implant counseling and information sessions, all questions raised by the patients were documented during the session. The patient's decision for or against implant therapy was recorded 3 months later. The influence of the patient's age and gender, the type of insurance, the number of questions asked by the patient, the number of required implants, and the need for augmentation on the patient's decision were determined. RESULTS Sixty-five percentage of the patients decided in favor of implant-prosthetic therapy. One significant factor influencing the patient's decision was the need for augmentation. Fifty-four percentage of the patients who decided in favor of the implant intervention needed augmentation. Eighty-six percentage of the patients who refused the intervention could have been treated only in conjunction with pre-implantological augmentation. The need for augmentation was associated with a higher mean number of questions per counseling and information session (3.7 vs. 2.3) (n.s.). Patients who had opted for implant treatment asked significantly fewer questions (2.5) than patients who refused the treatment (4.4). The patient's age and gender, the type of insurance, or the number of implants required had no influence on decision-making. CONCLUSION Patients who ask many questions rather tend to refuse the implant treatment. The need for augmentation was also associated with a significantly higher percentage of implant refusal. These results suggest that patients with an indication of augmentation require particularly detailed and comprehensive counseling and information.
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Affiliation(s)
- Michael Korsch
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Bernt P Robra
- Institute of Social Medicine and Health Economics, Otto-von-Guericke-University of Magdeburg, Magdeburg, Germany
| | - Winfried Walther
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
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Thetford C, Hodge S, Harding S, Taylor S, Knox PC. Living with age-related macular degeneration treatment: Patient experiences of being treated with ranibizumab (Lucentis)(R) intravitreal injections. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2013. [DOI: 10.1177/0264619613481778] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reports the results of a qualitative study of patient experiences of receiving treatment for wet age-related macular degeneration with ranibizumab (Lucentis)(R). Treatment involved monthly hospital visits for assessment and, where required, an intravitreal Lucentis injection. Qualitative narrative interviews were conducted with 22 patients, 18 of whom received treatment and were interviewed at two points during their treatment journey. Interviews allowed participants to reflect on their experiences of being assessed for and receiving this treatment. Overall, treated participants reported that while they had been apprehensive about treatment, the actual experience of it was far less unpleasant than they had expected. However, the data also revealed a number of issues surrounding the provision of information about treatment, as well as service delivery issues, which had considerable impact upon their experience.
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Fenwick E, Rees G, Pesudovs K, Dirani M, Kawasaki R, Wong TY, Lamoureux E. Social and emotional impact of diabetic retinopathy: a review. Clin Exp Ophthalmol 2012; 40:27-38. [PMID: 21575125 DOI: 10.1111/j.1442-9071.2011.02599.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
People with vision-threatening diabetic retinopathy are likely to experience enhanced social and emotional strain. Critically, those with both vision-threatening diabetic retinopathy and psychosocial problems may have significantly reduced levels of functioning compared with psychologically healthy counterparts. This can cause inadequate compliance, increased strain on family functioning, worse diabetes control, increased progression of diabetic retinopathy and, consequently, further psychosocial stress resulting in a number of concerning implications for disease management, clinical outcomes and healthcare costs. However, the emotional and social health consequences of diabetic retinopathy have not yet been systematically explored. This information is crucial as it allows for a targeted approach to treatment and prevention and avoidance of the potentially detrimental implications described above. Therefore, this paper reviews the current qualitative and quantitative evidence regarding the social and emotional impact of diabetic retinopathy and identifies directions for future research. Key search terms were applied to the electronic databases Pubmed, ISI Web of Science and Embase and the bibliographies of relevant papers were systematically reviewed for additional references. Overall, the evidence suggests that diabetic retinopathy and associated vision loss have several debilitating effects, including disruption of family functioning, relationships and roles; increased social isolation and dependence; and deterioration of work prospects resulting in increased financial strain. Adverse emotional responses include fear, anxiety, vulnerability, guilt, loss of confidence, anger, stress and self-perception issues. However, the research to date is largely qualitative in nature, with most quantitative studies being small, cross-sectional and somewhat outdated. Similarly, the outcome measures used in many studies to date are suboptimal in terms of content and validity. Therefore, this review identifies the need for improved outcome measures to provide valid, meaningful measurement of the social and emotional impact of diabetic retinopathy and discusses potential directions for future research such as item banking and computer adaptive testing.
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Affiliation(s)
- Eva Fenwick
- Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Caddick J, Jawad S, Southern S, Majumder S. The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery. Ann R Coll Surg Engl 2012; 94:94-8. [PMID: 22391371 PMCID: PMC3954151 DOI: 10.1308/003588412x13171221501267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during 'awake surgery', in particular of which aspects of the process may be distressing. METHODS Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients. RESULTS Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as 'knife' and 'scalpel' provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving. CONCLUSIONS Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.
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Affiliation(s)
- J Caddick
- Mid Yorkshire Hospitals NHS Trust, UK.
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Abstract
BACKGROUND The use of lasers is very common in dermatology; however, many patients fear it and have various misconceptions about it. A literature search failed to show any studies on this topic. OBJECTIVE To explore the various misconceptions of patients about lasers in dermatology. METHODS A self-administered questionnaire containing 21 questions about laser use in dermatology was distributed randomly to patients attending the dermatology clinic at King Khalid University Hospital in Riyadh, Saudi Arabia, from February to April 2009. RESULTS The response rate was 79.3%, with 714 of the 900 distributed questionnaires being returned; the individuals sampled included 348 men (48.73%). When asked about the nature of laser, 40% (279 of 698) reported that they did not know. About 36% (251 of 698) knew it was radiation of stimulated light amplification, while 10.2% (71 of 698) reported it to be nuclear radiation. Among study participants, 51.5% (364 of 707) believed that laser was harmful to children, while 51.1% (357 of 699) believed it was unsafe during pregnancy, and 21.4% (146 of 683) thought it could cause skin cancer. Laser was believed to treat most skin diseases by 47.7% (330 of 692) of those interviewed, among whom 24.1% said that they would not accept laser treatment if it was suggested to them by a dermatologist. A stance against laser (16.3%) was most common among men (P<0.001), the illiterate (P=0.006), and those with lower education (P=0.001). CONCLUSION Various misconceptions about laser treatment among patients are prevalent, especially among less educated individuals. Educating the community about laser could solve this problem.
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Affiliation(s)
- Khalid M AlGhamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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