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Stefana A, Vieta E, Fusar-Poli P, Youngstrom EA. Enhancing Psychotherapy Outcomes by Encouraging Patients to Regularly Self-Monitor, Reflect on, and Share Their Affective Responses Toward Their Therapist: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55369. [PMID: 38587881 PMCID: PMC11036184 DOI: 10.2196/55369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The quality of the therapeutic relationship is pivotal in determining psychotherapy outcomes. However, facilitating patients' self-awareness, reflection on, and sharing of their affective responses toward their therapist remains underexplored as a potential tool for enhancing this relationship and subsequent treatment outcomes. OBJECTIVE The primary objective of this study is to examine whether and how the patients' regular self-monitoring and self-reflection (fostered by the systematic compilation of a brief postsession battery) on their affective reactions toward the psychotherapist impact the quality of the therapeutic relationship and treatment outcomes in individual psychotherapy. Secondary objectives are to (1) explore whether and how the characteristics of the patient, the therapist, and the process moderate the effect of regular self-monitoring on the therapeutic relationship and outcomes; (2) examine the relationships between the affective response of the patient, the alliance, and the result of the therapy session outcome; and (3) explore how the affective responses of the patient unfold or change throughout the course of the therapy. METHODS We conducted a 1:1 randomized controlled trial of adults in individual psychotherapy versus individual psychotherapy plus self-monitoring. Participants will be enrolled through the web-based recruitment platforms "ResearchMatch" and "Research for Me," and data will be collected through web-based surveys. Participants in the control group will receive only their regular individual psychotherapy (treatment as usual) and will not complete postsession questionnaires. Participants in the intervention group will continue their regular individual psychotherapy sessions and complete the "in-Session Patient Affective Reactions Questionnaire" and the "Rift In-Session Questionnaire" following each therapy session in the 10 weeks of the trial. Additionally, after completion of the postsession battery, they will receive general written feedback encouraging them to discuss their feelings and reflections with their therapist. Participants in both groups will complete a comprehensive psychological assessment at baseline, midtrial (week 5), and end-of-trial (week 10). The primary outcome measure of the trial is the "Clinical Outcomes in Routine Evaluation-Outcome Measure," while the secondary outcomes are the "Real Relationship Inventory-Client-Short Form," the "Working Alliance Inventory-Short Revised," and the number of scheduled therapy sessions that the patient has missed or canceled. RESULTS The trial was approved by the institutional review board of the University of North Carolina at Chapel Hill. Recruitment started in September 2023. A total of 475 individuals completed the baseline assessment. Data collection was completed in February 2024. The results are expected to be published in the autumn of 2024. CONCLUSIONS This study could reveal key information on how regular self-monitoring and introspection can influence both the therapeutic relationship and treatment outcomes. Findings have the potential to shape interventions, enhance the efficacy of psychotherapeutic sessions, and possibly offer a cost-effective strategy for improving patients' well-being. TRIAL REGISTRATION ClinicalTrials.gov NCT06038747; https://classic.clinicaltrials.gov/ct2/show/NCT06038747. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55369.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona,, Barcelona, Spain
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital, Division of Child and Family Psychiatry, The Ohio State University, Columbus, OH, United States
- Helping Give Away Psychological Science, Chapel Hill, NC, United States
- Department of Psychiatry, The Ohio State University, Columbus, OH, United States
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Marty M, Chiaverini C, Milon C, Costa-Mendes L, Kémoun P, Mazereeuw-Hautier J, Joseph C. Perception of Oral Health-Related Quality of Life in Children with Epidermolysis Bullosa: A Quantitative and Qualitative Study. JDR Clin Trans Res 2023; 8:349-355. [PMID: 35993264 DOI: 10.1177/23800844221118362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT The results of this study confirm the difficulties experienced by patients in the oral sphere. They also show that patients are able to adapt and that their demands go beyond functional rehabilitation. This work should encourage dental practitioners to be part of the overall management of the disease, involving regular checkups, preventive dental measures, and oral hygiene education. Therefore, more effective communication is required, not only between the dental and dermatological teams but also with the parents and caregivers.
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Affiliation(s)
- M Marty
- Universite Toulouse III Paul Sabatier, Toulouse, France
| | - C Chiaverini
- University Hospital Centre Nice, Nice, Provence-Alpes-Côte d'Azu, France
| | - C Milon
- University Paul Sabatier Toulouse III Faculty of Dental Surgery, Toulouse, Midi-Pyrénées, France
| | - L Costa-Mendes
- University Paul Sabatier Toulouse III Faculty of Dental Surgery, Toulouse, Midi-Pyrénées, France
| | - P Kémoun
- University Paul Sabatier Toulouse III Faculty of Dental Surgery, Toulouse, Midi-Pyrénées, France
| | | | - C Joseph
- University of Cote d'Azur, Nice, France
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Giordano C, Ambrosiano I, Graffeo MT, Di Caro A, Gullo S. The transition to online psychotherapy during the pandemic: a qualitative study on patients' perspectives. Res Psychother 2022; 25:638. [PMID: 36373388 PMCID: PMC9893047 DOI: 10.4081/ripppo.2022.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has substantially increased online psychotherapies due to the impossibility of participating in vis-a-vis settings. In the last years, research about online therapy has been quickly growing. However, until now, few studies investigated patients' perspective about the transition to online psychotherapy and, specifically, no qualitative research in group therapy has been done on this topic. This study aimed to explore the experience of 51 patients (39 group patients and 12 from individual psychotherapies) who continued psychotherapy in the online setting during the COVID-19 outbreak. A structured online questionnaire with open answers investigated the following topics: setting online, effectiveness, psychotherapy relationship, specific dynamics of online psychotherapy. Patients' answers were analysed by means of Consensual Qualitative Research, modified version (CQRM), an inductive method that allows analysing a large sample and relatively brief written answers. The results show the impact of shift to online platforms on patients and explore how easy or difficult it is for them to adapt to therapeutic processes are in online therapy (vs in-person therapy), by highlighting potential barriers and resources to practice implementation. Participants' responses have been arranged into three main domains: setting online, content/effectiveness of online therapy and therapeutic relationship. A fourth domain, specific for online group therapy, collected responses referred to the changes perceived regarding the group dynamics. From the patient's perspective, online therapy is effective and satisfying. Patients perceived a positive quality of therapeutic relationship in online setting, whereas produced more controversial judgments concerned the changes due to the online setting. Finally, patients in group therapy gave more attention and importance in showing and seeing private personal spaces than the ones in individual therapy.
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Affiliation(s)
- Cecilia Giordano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy,Department of Psychology, Educational Sciences and Human Movement, University of Palermo, viale delle Scienze, Edificio 15, 90128 Palermo, Italy. +39.091.23897718.
| | | | - Maria Teresa Graffeo
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Alessandro Di Caro
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Salvatore Gullo
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
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Caminati M, Camiciottoli G, Baiardini I, Antonicelli L, Beghè B, Crimi N, Favero E, Stanziola AA, Valenti G, Visca D, Del Giacco S. Patients and doctors group meetings: an innovative way to explore severe asthma backstage. Multidiscip Respir Med 2022; 17:854. [PMID: 36158780 PMCID: PMC9491102 DOI: 10.4081/mrm.2022.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
Severe asthma patients' life is heavily influenced by the disease, which has impact on personal and professional choices or general lifestyle. Despite the available tools to help physicians investigating the patient-reported outcomes there is a need for a more standardised and structured approach to include the evaluation of quality of life together with the emotions of patients into the routine clinical interaction. We hereby report the use of an active listening and insight approach to understand the emotions of patients with severe asthma through dedicated in-person meetings involving a group of patients with their doctors, caregivers and an external moderator. The initiative "Patients insight meeting" was organized within 17 specialist referral centres for severe asthma in Italy in 2019 and involved 149 patients. Insights related to 4 different items were collected and a task force composed by the external moderators produced a general report including the suggestions from the participating centres. This experience of group-meetings involving both patients and doctors together represents an innovative way to investigate real life experience and the emotions of asthmatic patients, highlighting unmet needs related to patient's experience of his/her disease that need to be included in severe asthmatics' management strategy.
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Affiliation(s)
- Marco Caminati
- Department of Medicine, Allergy and Clinical Immunology Section, University of Verona
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Cardio-Thoraco-Vascular Department, AOUC Azienda Ospedaliero-Universitaria Careggi, Florence
| | - Ilaria Baiardini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | | | - Bianca Beghè
- Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena
| | - Nunzio Crimi
- Respiratory Medicine Unit, AOU "Policlinico-Vittorio Emanuele" and Department of Clinical and Experimental Medicine, University of Catania
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergy Clinic Ca' Foncello Hospital, Treviso
| | | | - Giuseppe Valenti
- Allergology and Pulmonology Unit, Provincial Outpatient Center of Palermo
| | - Dina Visca
- Department of Medicine and Surgery, University of Insubria, Varese and Department of Medicine and Cardiopulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate (VA)
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato-Cagliari, Italy
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Valdés-Stauber J, Kendel U. The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital. Int J Psychiatry Med 2021; 56:389-407. [PMID: 33327843 DOI: 10.1177/0091217420982102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. METHODS This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. RESULTS The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. DISCUSSION Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.
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Affiliation(s)
- Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Südwürttemberg's Center of Psychiatry, University of Ulm, Ulm, Germany
| | - Ulrich Kendel
- Department of Psychosomatics, Südwürttemberg's Center of Psychiatry, Friedrichshafen, Germany
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Lazris D, Perkins MM, Bay AA, Hackney ME. Qualitative Evaluation Informs Understanding of Motor Cognition and Therapies in Older Adults with Mild Cognitive Impairment. J Alzheimers Dis 2021; 84:691-703. [PMID: 34569954 PMCID: PMC10105980 DOI: 10.3233/jad-210617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND 10%to 20%of Americans aged 65 and older have mild cognitive impairment (MCI) with 10%progressing to Alzheimer's disease (AD) each year. Underserved groups, including African Americans (AAs), are among the most vulnerable to MCI and AD. Although evidence continues to amass, the benefits of exercise and movement for AD is still understudied in AD. OBJECTIVE Understanding the attitudes, perceptions, and beliefs about motor-cognitive integration and examining the physical activity of a sample of predominantly Black women community members with self-reported memory problems will allow improved recruitment and refinement of multimodal interventions designed to improve motor-cognitive and cognitive function. METHODS We conducted focus groups with older adults who reported subjective memory complaints (n = 15; Black: n = 12, White: n = 3, mean age 71.7±5.8). RESULTS Findings from thematic analysis showed most participants knew of benefits of exercise. However, most participants reported not getting adequate exercise due to factors such as pain, increased responsibilities, and fear of injury. Despite barriers, participants expressed enthusiasm for multimodal interventions designed to target body and brain health and provided several suggestions to improve or enhance the proposed interventions. CONCLUSION Results provide useful insights regarding improving participation among historically under-represented groups in clinical movement-based research. Participants' discussion focused primarily on the way motor-cognitive integration prevents falls, maintains memory, and provides a social benefit. The reported perceived benefits and limitations of exercise, as this population understands it, can help researchers and physicians better engage the community for lifestyle changes that will support greater motor-cognitive health.
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Affiliation(s)
- David Lazris
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Molly M Perkins
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center (GRECC), Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Emory University, Department of Sociology, Atlanta, GA, USA
| | - Allison A Bay
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madeleine E Hackney
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Birmingham/Atlanta VA Geriatric Research, Education and Clinical Center (GRECC), Atlanta, GA, USA.,Emory University School of Nursing, Atlanta, GA, USA.,Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
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Ceccarelli F, Covelli V, Olivieri G, Natalucci F, Conti F. Systemic Lupus Erythematosus before and after COVID-19 Lockdown: How the Perception of Disease Changes through the Lenses of Narrative Medicine. Healthcare (Basel) 2021; 9:healthcare9060726. [PMID: 34204733 PMCID: PMC8231514 DOI: 10.3390/healthcare9060726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic contributes to the burden of living with different diseases, including Systemic Lupus Erythematosus (SLE). We described, from a narrative point of view, the experiences and perspectives of Italian SLE adults during the COVID-19 emergency, by distinguishing the illness experience before and after the lockdown. METHODS Fifteen patients were invited to participate. Illness narratives were collected between 22 and 29 March 2020 using a written modality to capture patients' perspectives before and after the COVID-19 lockdown. We performed a two-fold analysis of collected data by distinguishing three narrative types and a qualitative analysis of content to identify the relevant themes and sub-themes reported. RESULTS Eight narratives included in the final analysis (mean length 436.9 words) have been written by eight females (mean age 43.3 ± 9.9 years, mean disease duration 13.1 ± 7.4 years). Six patients provided a quest narrative, one a chaos and the remaining one a restitution narrative. By text content analysis, we identified specific themes, temporally distinct before and after the lockdown. Before COVID-19, all the patients referred to a good control of disease, however the unexpected arrival of the COVID-19 emergency broke a balance, and patients perceived the loss of health status control, with anxiety and stress. CONCLUSIONS We provided unique insight into the experiences of people with SLE at the time of COVID-19, underlining the perspective of patients in relation to the pandemic.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
- Correspondence: ; Tel.: +39-06-4997-4631
| | - Venusia Covelli
- Faculty of Psychology, eCampus University, Novedrate, 22060 Como, Italy;
| | - Giulio Olivieri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
| | - Francesco Natalucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
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Abu-Rustum RS, Bright M, Moawad N, Weber LeBrun E, Roussos-Ross K, Christman G, Rhoton-Vlasak A, Smulian JC. COVID-19: changing the care process for women's health-the patient's perspective. J Matern Fetal Neonatal Med 2021; 35:6180-6184. [PMID: 34044744 DOI: 10.1080/14767058.2021.1909560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Assess women's perceptions of the impact of COVID-19 on their health care and well-being, access to and satisfaction with medical care due to the changes in delivery of care triggered by the pandemic. METHODS An online survey of women having health care appointments in the outpatient facilities across all divisions of a Department of Obstetrics and Gynecology at a tertiary care referral center in North Central Florida. Patients had outpatient appointments that were scheduled, canceled or rescheduled, in person or by telemedicine, between 11 March 2020 and 11 May 2020, a time during which a COVID-19 stay-at-home order was enacted across our state. A total of 6,697 visits were planned. Patients with multiple visits were unified, leaving 6,044 unique patients to whom the survey was emailed between 20 July 2020 and 31 July 2020. The survey was closed on 21 August 2020. Analyses were focused on simple descriptive statistics to assess frequency of responses. Analyses of variance and chi-square analyses were conducted to compare outcomes when all cells were ≥ 10, based on sub-specialty and insurance status; otherwise, frequencies were examined for the entire sample only. Missing data were excluded listwise. RESULTS A total of 6044 patients were contacted. Completed surveys numbered 1,083 yielding a response rate of 17.9%. The most common sub-specialty visit was gynecology (56.7%) followed by obstetrics (31.5%,), pelvic floor disorders (4.8%), gynecological oncology (2.9%,), and reproductive endocrinology (0.5%). A substantial percentage of women had visits canceled (19.2%), rescheduled (32.8%) or changed (42.1%) to telemedicine. In our patient population, 32.6% were worried about visiting the clinic and 48.1% were worried about visiting the hospital. COVID-19 triggered changes were perceived to have a negative impact by 26.1% of respondents. Refusal of future telemedicine visits was by 17.2%, however, 75.2% would prefer to use both in-person and telemedicine visits. CONCLUSION During the initial COVID-19 surge with lockdown, the majority of survey respondents were following public health precautions. However, there were significant concerns amongst women related to obstetric and gynecologic medical appointments scheduled during that period. During pandemics, natural disasters and similar extreme circumstances, digital communication and telemedicine have the potential to play a critical role in providing reassurance and care. Nevertheless, given the concerns expressed by survey respondents, communication and messaging tools are needed to increase comfort and ensure equity with the rapidly changing methods of care delivery.
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Affiliation(s)
- Reem S Abu-Rustum
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Melissa Bright
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Nash Moawad
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Emily Weber LeBrun
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Kay Roussos-Ross
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Gregory Christman
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Alice Rhoton-Vlasak
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - John C Smulian
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
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Claessen KMJA, Andela CD, Biermasz NR, Pereira AM. Clinical Unmet Needs in the Treatment of Adrenal Crisis: Importance of the Patient's Perspective. Front Endocrinol (Lausanne) 2021; 12:701365. [PMID: 34354671 PMCID: PMC8329717 DOI: 10.3389/fendo.2021.701365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022] Open
Abstract
Adrenal crisis is the most severe manifestation of adrenal insufficiency (AI), but AI can present with variable signs and symptoms of gradual severity. Despite current hormone replacement strategies, adrenal crisis is still one of the leading causes of mortality in AI patients. Although underlying factors explaining differences in interindividual susceptibility are not completely understood, several subgroups are particularly vulnerable to adrenal crises, such as patients with primary AI, and patients treated for Cushing's syndrome. Currently, the health care professional faces several challenges in the care for AI patients, including the lack of reliable biomarkers measuring tissue cortisol concentrations, absence of a universally used definition for adrenal crisis, and lack of clinical tools to identify individual patients at increased risk. Also from the patient's perspective, there are a number of steps to be taken in order to increase and evaluate self-management skills and, finally, improve health-related quality of life (HR-QoL). In this respect, the fact that inadequate handling of AI patients during stressful situations is a direct consequence of not remembering how to act due to severe weakness and cognitive dysfunction in the context of the adrenal crisis is quite underexposed. In this narrative review, we give an overview of different clinical aspects of adrenal crisis, and discuss challenges and unmet needs in the management of AI and the adrenal crisis from both the doctor's and patient's perspective. For the latter, we use original focus group data. Integration of doctor's and patient's perspectives is key for successful improvement of HR-QoL in patients with AI.
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Abstract
Access to mental health care has significant disparities due to treatment gap, more so particularly for the remotely residing, physically vulnerable, aging populations. Adoption of technology will enable more people to receive specialty care addressing distance, transportation and cost-related barriers to treatment engagement from the comfort of home. Telemedicine has been regarded as "electronic personal protective equipment" by reducing the number of physical contacts and risk contamination for patients during COVID-19 crisis. This review aimed to give a broad view of patients' perception of the use of telepsychiatry in terms of clinical outcome, cost-effectiveness, and solutions to address patients' challenges with the adoption of technology. Over the years, telepsychiatry, both in synchronous and asynchronous modalities, had shown to improve patients' adherence to treatment, follow-up rates, and clinical symptoms, overcome stigma and discrimination, and save cost expenses accessing health care with better satisfaction and usability outcomes. Its utility is widespread such as in delivering care emergency evaluation, crisis intervention, conducting neuropsychological assessments, psychotherapy, promoting lifestyle modification, enhancing self-efficacy, and overcoming patients' linguistic and cultural barriers to care. However, patients' privacy and confidentiality and psychiatrists' legal liability remain as matter of major concern in digital platform. To keep up with the pace of technology and patients' expectations, a more agile approach is essential to develop, improve, and evaluate telepsychiatric interventions.
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Affiliation(s)
- Shalini S Naik
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Tele Medicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Crutzen S, Baas G, Abou J, van den Born-Bondt T, Hugtenburg JG, Bouvy ML, Heringa M, Taxis K, Denig P. Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study. Front Pharmacol 2020; 11:1268. [PMID: 32973509 PMCID: PMC7468428 DOI: 10.3389/fphar.2020.01268] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/31/2020] [Indexed: 01/01/2023] Open
Abstract
Background Deprescribing has been recommended for managing polypharmacy but deprescribing preventive medication in older patients is still uncommon. We aimed to investigate older patients’ barriers to and enablers of deprescribing cardiometabolic medication. Methods Two focus groups were conducted among patients ≥70 years with polypharmacy, including cardiometabolic medication. Purposive sampling through four community pharmacies was used in two regions in the Netherlands. A topic list was developed using literature and the theoretical domains framework (TDF). The meetings were audio recorded, transcribed verbatim and coded using thematic coding, attribute coding and the TDF. In addition, patients were categorized on attitudes towards medication and willingness to stop. Results The meetings were attended by 17 patients and 1 caregiver (71 to 84 years). In total 15 barriers and 13 enablers were identified within four themes, partly related to beliefs, fears and experiences regarding using or stopping medication, and partly related to the relationship with the health care professional and the conditions to stop. Some patients attributed their wellbeing to their medication and were therefore unwilling to stop. Reducing cardiometabolic medication because of less strict treatment targets confused some patients and was a barrier to deprescribing. Having options to monitor clinical measurements and restart medication were enablers. Patients were only willing to stop cardiometabolic medication when this was proposed by a HCP they trusted. Patients with a positive attitude towards medication varied in their willingness to stop cardiometabolic medication. Patients with a negative attitude towards medication were generally willing to stop medication but still perceived several barriers and may consider some medication as being essential. Conclusion Fears, beliefs, and experiences regarding using and stopping medication as well as trust in the HCP influence willingness to have medication deprescribed. Attitudes towards medication in general do not necessarily translate into willingness or unwillingness to stop specific medication. For deprescribing cardiometabolic medication, patient involvement when setting new treatment targets and monitoring the effects on short-term outcomes are important.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands
| | - Jamila Abou
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, Netherlands
| | - Tessa van den Born-Bondt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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12
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Scichilone N, Barnes PJ, Battaglia S, Benfante A, Brown R, Canonica GW, Caramori G, Cazzola M, Centanni S, Cianferoni A, Corsico A, De Carlo G, Di Marco F, Gaga M, Hawrylowicz C, Heffler E, Matera MG, Matucci A, Paggiaro P, Papi A, Popov T, Rogliani P, Santus P, Solidoro P, Togias A, Boulet LP. The Hidden Burden of Severe Asthma: From Patient Perspective to New Opportunities for Clinicians. J Clin Med 2020; 9:jcm9082397. [PMID: 32727032 PMCID: PMC7463666 DOI: 10.3390/jcm9082397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Severe asthma is an important topic in respiratory diseases, due to its high impact on morbidity and mortality as well as on health-care resources. The many challenges that still exist in the management of the most difficult-to-treat forms of the disease, and the acknowledgement of the existence of unexplored areas in the pathophysiological mechanisms and the therapeutic targets represent an opportunity to gather experts in the field with the immediate goals to summarize current understanding about the natural history of severe asthma and to identify gaps in knowledge and research opportunities, with the aim to contribute to improved medical care and health outcomes. This article is a consensus document from the “International Course on Severe Asthma” that took place in Palermo, Italy, on May 10–11, 2019. Emerging topics in severe asthma were addressed and discussed among experts, with special focus on patient’s needs and research opportunities, with the aim to highlight the unanswered questions in the diagnostic process and therapeutic approach.
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Affiliation(s)
- Nicola Scichilone
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
- Correspondence: ; Tel.: +39-091-655-2146
| | - Peter John Barnes
- Airway Disease Section, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK;
| | - Salvatore Battaglia
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Alida Benfante
- Division of Respiratory Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90143 Palermo, Italy; (S.B.); (A.B.)
| | - Robert Brown
- Department of Anesthesiology and Critical Care Medicine, Medicine, Department of Medicine, Division of Pulmonary Medicine, Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Giorgio Walter Canonica
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Gaetano Caramori
- Respiratory Medicine Unit, Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging (BIOMORF), University of Messina, 98122 Messina, Italy;
| | - Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Antonella Cianferoni
- Pediatrics Department, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and Department of Internal Medicine and Therapeutics – University of Pavia, 27100 Pavia, Italy;
| | - Giuseppe De Carlo
- The European Federation of Allergy and Airways Diseases Patients Associations (EFA), 1000 Brussels, Belgium;
| | - Fabiano Di Marco
- Respiratory Unit, ASST - Papa Giovanni XXIII Hospital, Bergamo, University of Milan, 24127 Milan, Italy;
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Asthma Cen, Athens Chest Hospital, 11527 Athens, Greece;
| | - Catherine Hawrylowicz
- Division of Asthma, Allergy and Lung Biology, King’s College London, Guy’s Hospital, London SE1 9RT, UK;
| | - Enrico Heffler
- Personalised Medicine Clinic Asthma & Allergy, Humanitas University, Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (G.W.C.); (E.H.)
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Matucci
- Immunoallergology Unit, Careggi University Hospital, 50139 Florence, Italy;
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, 56126 Pisa, Italy;
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Todor Popov
- Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilski, 1431 Sofia, Bulgaria;
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.C.); (P.R.)
| | - Pierachille Santus
- Division of Respiratory Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Paolo Solidoro
- Pneumology Unit U, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Turin, Italy;
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, MD 20814, USA;
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13
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Salmi LR, Côté P, Cedraschi C. Covering patient's perspective in case-based critical review articles to improve shared decision making in complex cases. Health Expect 2020; 23:1037-1044. [PMID: 32700821 PMCID: PMC7696115 DOI: 10.1111/hex.13108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 12/19/2022] Open
Abstract
Background The patient has always been at the centre of the evidence‐based medicine model. Case‐based critical reviews, such as best‐evidence topics, however, are incomplete reflections of the evidence‐based medicine philosophy, because they fail to consider the patient's perspective. We propose a new framework, called the ‘Shared Decision Evidence Summary’ (ShaDES), where the patient's perspective on available treatment options is explicitly included. Methods Our framework is grounded in the critical appraisal of a clinical scenario, and the development of a clinical question, including patient characteristics, compared options and outcomes to be improved. Answers to the clinical question are informed by the literature, the evaluation of its quality and its potential usefulness to the clinical scenario. Finally, the evidence synthesis is presented to the patient to facilitate the formulation of an evidence‐informed decision about the treatment options. Key results Using three similar but contrasted clinical scenarios of patients with low back pain, we illustrate how considering the patient's preferences on the proposed treatment options impact the bottom line, a synthetic formulation of the answer to the focused question. ShaDES includes clinical and psychosocial components, transformed in a searchable question, with a full search strategy. Conclusions ShaDES is a practical framework that may facilitate clinical decisions adapted to psychological, social and other relevant non‐clinical characteristics of patients.
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Affiliation(s)
- Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U1219 Bordeaux Population Health, Bordeaux, France.,INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health, Bordeaux, France.,CHU de Bordeaux, Pole de Sante Publique, Service d'information Medicale, Bordeaux, France
| | - Pierre Côté
- Center for Disability Prevention and Rehabilitation, Canadian Memorial Chiropractic College, Univ. of Ontario Institute of Technology, Oshawa, ON, Canada.,Ontario Technical University, Oshawa, ON, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva Faculty of Medicine, Geneva, Switzerland.,Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Univ. Hospitals, Geneva University, Geneva, Switzerland
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14
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Toubøl A, Moestrup L, Ryg J, Thomsen K, Nielsen DS. "Even Though I Have Dementia, I Prefer That They Are Personable": A Qualitative Focused Ethnography Study in a Danish General Hospital Setting. Glob Qual Nurs Res 2020; 7:2333393619899388. [PMID: 31976359 PMCID: PMC6958651 DOI: 10.1177/2333393619899388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 01/01/2023] Open
Abstract
Patients with dementia often face challenges in hospital settings due to cognitive impairment. The aim of this study is to explore the encounter between patients with dementia and hospital staff, from the patient perspective. Focused ethnography guided the method for data collection and the analytical approach was abductive. The findings, based on 10 observations of patients with dementia and their encounter with hospital staff in a variety of hospital settings, reveal that staff often seem to not see the person beyond the dementia diagnosis. The findings also show, however, that significant moments are constantly negotiated during encounters between patients with dementia and hospital staff, moments which occasionally allow staff to see the patients to be seen as the person they are. A rethinking of the current dementia discourse is discussed, recommending attention to the two-way interaction between patients with dementia and hospital staff, and within this an awareness of a personable approach.
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Affiliation(s)
- Annemarie Toubøl
- University College Lillebaelt, Vejle, Denmark.,University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
| | | | - Jesper Ryg
- University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
| | | | - Dorthe Susanne Nielsen
- University College Lillebaelt, Vejle, Denmark.,University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Odense, Denmark
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15
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Sampaio R, Azevedo LF, Dias CC, Castro Lopes JM. Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients. Patient Prefer Adherence 2020; 14:321-332. [PMID: 32109998 PMCID: PMC7037084 DOI: 10.2147/ppa.s232577] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Pharmacological interventions remain the cornerstone of chronic pain treatment; however, nearly 40% of the prescription medicines are not taken as prescribed. The present study aims at understanding and describing non-adherence from the perspective of chronic pain patients during a 1-year follow-up study. METHODS A cohort of 950 consecutive patients referred to a first consultation in Multidisciplinary Chronic Pain Clinics was followed with a standardized protocol for 1 year. This included assessment of pain characteristics; prescribed medication; therapeutic adherence; effectiveness of treatment, non-adherence and its perceived reasons; clinical outcomes and quality of life. We used a mixed methods approach, including qualitative and quantitative analyses. RESULTS Forty-nine percent of the 562 patients who responded to all assessments during follow-up were adherent after 1 year of chronic pain treatment. The core associations between each "non-adherence reason" and Anatomical Therapeutic Chemical Code (ATC) group were perceived side effects (p=0.019) and delayed start (p=0.022) for narcotic analgesics (opioids); perceived non-efficacy (p=0.017) and delayed start (p=0.004) for antiepileptics and anticonvulsants; perceived low necessity (p=0.041) and delayed start (p=0.036) for analgesics antipyretics; change in prescriptions because of a new clinical condition for antidepressants (p=0.024); high concerns (p=0.045) and change in prescriptions because of a new clinical condition (p<0.001) for non-steroidal anti-inflammatory drugs; delayed start (p=0.016) and financial constraints (p=0.018) for other medications. DISCUSSION This study emphasizes the patient's perspective regarding non-adherence to pharmacological treatment of chronic pain, providing valuable and novel information to be used in future interventions to help patients make an informed choice about their adherence behavior.
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Affiliation(s)
- Rute Sampaio
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- Correspondence: Rute Sampaio Faculty of Medicine of Porto University, Department of Biomedicine – 5 Floor, Alameda Hernani Monteiro, Porto4200-319, Portugal Email
| | - Luís Filipe Azevedo
- Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal
- Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - Cláudia Camila Dias
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde, Faculdade de Medicina da Universidade do Porto (MEDCIDS), Porto, Portugal
- Centro de Investigação Em Tecnologias e em Serviços de Saúde (CINTESIS), Porto, Portugal
| | - José M Castro Lopes
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Biologia Molecular e Celular (IBMC), Universidade do Porto, Porto, Portugal
- Centro Nacional de Observação em Dor - OBSERVDOR, Porto, Portugal
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16
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Obadeyi O, Baffoe N, Paxton J. A patient's decision aid for vascular access placement in the emergency department. J Vasc Access 2019; 21:419-425. [PMID: 31595808 DOI: 10.1177/1129729819879828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Vascular access device placement is one of the most routinely performed procedures in the emergency department. Despite its high usage, most patients have limited knowledge about vascular access device placement. Patient decision aids have been utilized heavily in non-emergency department settings to provide basic clinical information regarding a patient's medical care options. In this study, we investigated whether exposure to a patient decision aid on vascular access devices and patients' experiences with vascular access devices would influence their vascular access device preference during an acute care episode. METHODS Patients in this institutional review board-approved study were enrolled prospectively in the emergency department at a busy level 1 trauma institution. A patient decision aid on vascular access device was constructed using criteria developed by the International Patient Decision Aid Standards. All participants were exposed to the patient decision aid and were asked to complete two questionnaires, and two tests. RESULTS Fifty subjects (50) were enrolled prospectively in the emergency department. The mean pretest score was 17.2% (95% confidence interval, 0.54-1.18), while the mean post-test score was 72.4% (95% confidence interval, 3.15-4.09). We found that patients who were exposed to the patient decision aid preferred landmark-based peripheral intravenous lines over ultrasound-guided peripheral intravenous lines in this data set. CONCLUSION The result from this analysis indicated that most patients visiting the emergency department are not knowledgeable about their options related to vascular access device placement. The observed increase in the average correct responses on the post-test indicates that a patient decision aid can be an effective educational tool in the emergency department.
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Affiliation(s)
- Oluseyi Obadeyi
- School of Medicine, Wayne state University, Detroit, MI, USA
| | - Nana Baffoe
- School of Medicine, Wayne state University, Detroit, MI, USA
| | - James Paxton
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
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17
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Mengshoel AM, Bjorbækmo WS, Sallinen M, Wahl AK. 'It takes time, but recovering makes it worthwhile'- A qualitative study of long-term users' experiences of physiotherapy in primary health care. Physiother Theory Pract 2019; 37:6-16. [PMID: 31081435 DOI: 10.1080/09593985.2019.1616343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In several European countries, patients with chronic pain conditions are high consumers of physicians' and physiotherapists' health services in primary health care. This study aimed to explore how patients in a Norwegian context make sense of their long-term use of physiotherapy. Narrative interviews were conducted with six long-term users. The data material was subjected to a narrative analysis with a focus on the stories' content and how health professionals and informants were inscribed in the stories. The stories provide rich and varied information about the informants' experiences with prior and present health services inscribed in their experiences of illness and recovery. The narrative's introduction portrays a shared illness narrative, centered around negative experiences as illustrated by the theme 'A long time searching for explanations and solutions to recover'. The narrative's plot describes a gradually ascending story of recovery where abilities overshadowed disabilities, as the informants are 'Learning their own meaningful ways to proceed'. The narrative has no definite ending, but instead depicts an 'Uncertainty about future and own ability to reverse relapse'. The shared narrative's storyline is that 'It takes time, but recovering makes it worthwhile'.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway
| | - Wenche Schrøder Bjorbækmo
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway.,Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University , Oslo, Norway
| | - Merja Sallinen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway.,Faculty of Health and Wellbeing, Satakunta University of Applied Sciences , Pori, Finland
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo , Oslo, Norway
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18
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Rusconi S, Marcotullio S, Cingolani A. Long-acting agents for HIV infection: biological aspects, role in treatment and prevention, and patient's perspective. New Microbiol 2017; 40:75-79. [PMID: 28368071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
Current cART regimens are highly potent and well tolerated, but long-term toxicities, drug-drug interactions, lifetime costs and scarce option for multiclass failed patients could limit the efficacy of treatment itself. Long-acting formulations of antiretrovirals, which could potentially replace daily tablets, have been developed and are under investigation for prevention and treatment of HIV infection. Cabotegravir and rilpivirine represent the first drugs studied in this context. The aim of this review is to summarize the biological bases, the available information on completed and ongoing clinical trials and the potential development of long-acting regimens for the treatment and prevention of HIV infection.
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Affiliation(s)
- Stefano Rusconi
- Divisione Clinicizzata di Malattie Infettive, DIBIC Luigi Sacco, Università degli Studi di Milano, Italia
| | | | - Antonella Cingolani
- Istituto Clinica Malattie Infettive, Università Cattolica S. Cuore, Policlinico "A. Gemelli", Roma, Italia
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19
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Tai BWB, Bae YH, Le QA. A Systematic Review of Health Economic Evaluation Studies Using the Patient's Perspective. Value Health 2016; 19:903-908. [PMID: 27712720 DOI: 10.1016/j.jval.2016.05.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 05/01/2016] [Accepted: 05/18/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Patient-centered care has become increasingly important and relevant for informed health care decision making. OBJECTIVE Our study aimed to perform a systematic review of health economic evaluation studies from the patient's perspective. METHODS PubMed, EMBASE, and Cochrane Central databases were searched through May 2014 for cost-effectiveness, cost-utility, and cost-benefit studies using the patient's perspective in their analysis. The reporting quality of the studies was evaluated on the basis of Consolidated Health Economic Evaluation Reporting Standards. RESULTS We identified 30 health economic evaluations using the patient's perspective, of which 7 were conducted in the United States, 9 in Europe, and 14 in Asian or other countries. Seventeen of 23 health conditions evaluated were chronic in nature. Among 12 studies that justified the use of the patient's perspective, patient's financial burden associated with medical treatment was the most commonly cited rationale. A total of 29, 17, and 15 studies examined direct medical, direct nonmedical, and indirect costs, respectively. Seventeen studies also included societal, governmental or payer's, and/or provider's perspective(s) in their analyses. Based on Consolidated Health Economic Evaluation Reporting Standards, more than 20% of the reporting items in these studies were either partially satisfied or not satisfied. CONCLUSIONS There is a paucity of health economic evaluations conducted from the patient's perspective in the literature. For those studies using the patient's perspective, the true patient costs were not fully explored and study reporting quality was not optimal. With the increasing focus on patient-centered outcomes in health policy research, more frequent use of the patient's perspective in economic studies should be advocated.
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Affiliation(s)
| | - Yuna H Bae
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Quang A Le
- Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
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20
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Zanini CA, Rubinelli S. Using Argumentation Theory to Identify the Challenges of Shared Decision-Making when the Doctor and the Patient have a Difference of Opinion. J Public Health Res 2012; 1:165-9. [PMID: 25170461 PMCID: PMC4140355 DOI: 10.4081/jphr.2012.e26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/02/2012] [Indexed: 11/23/2022] Open
Abstract
This paper aims to identify the challenges in the implementation of shared decision-making (SDM) when the doctor and the patient have a difference of opinion. It analyses the preconditions of the resolution of this difference of opinion by using an analytical and normative framework known in the field of argumentation theory as the ideal model of critical discussion. This analysis highlights the communication skills and attitudes that both doctors and patients must apply in a dispute resolution-oriented communication. Questions arise over the methods of empowerment of doctors and patients in these skills and attitudes as the preconditions of SDM. Overall, the paper highlights aspects in which research is needed to design appropriate programmes of training, education and support in order to equip doctors and patients with the means to successfully engage in shared decision-making.
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Affiliation(s)
- Claudia A Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research (SPF) , Nottwil, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research (SPF) , Nottwil, Switzerland
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21
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Abstract
The goal of this article is to augment the ethical discussion among nurses with the findings from empirical research on autonomy of older adults with type 2 diabetes mellitus. There are many factors influencing autonomy. These include: health conditions, treatment, knowledge, experience and skills, personal approach as well as familial patterns, type of relationship, life history and social context. Fifteen older adults with type 2 diabetes mellitus were interviewed in a nurse-led diabetes clinic. These participants perceive three processes which support autonomy in responsive relationships: preserving patterns of concern and interaction, nurturing collaborative responsibilities and being closely engaged in trustful and helpful family relations. People with diabetes realize autonomy in various responsive relationships in their unique life context. Next, we performed a literature review of care ethics and caring in nursing with regard to relational autonomy. We classified the literature in five strands of care: attitude-oriented, dialogue-oriented, activity-oriented, relationship-oriented and life-oriented. According to our respondents, autonomy in responsive relationships is fostered when patient, nurses, professionals of the health team and family members carry out care activities supported by a relational attitude of care. They can best realize autonomy in relationships with others when several essential aspects of care and caring are present in their lives. Therefore, we advocate a comprehensive approach to care and caring.
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Affiliation(s)
- Albine Moser
- Department of General Practice, Faculty of Health, Medicine and Life Science, Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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