A Standardized Treatment Pathway for Telehealth-Based Care of Chronic Wounds in Austria

Chronic wounds present a significant healthcare challenge in Austria as well as in other countries. The interdisciplinary approach to wound treatment involving various caregivers, doctors, and relatives, poses challenges in documentation and information exchange. To overcome these barriers and promote patient-centered care, a new telehealth-supported treatment pathway for chronic wounds has been developed. The primary focus was to regularly update the status of the chronic wound by responding to predefined questions and transmitted images of the chronic wound. This was achieved by an interdisciplinary team of experts in chronic wound care, providing a new perspective for digital implementation in the healthcare system.

A Patient-Centered Decision-Support Tool Informed by History of Interpersonal Violence: "Will This Treatment Work for Me?"

The Probability of Treatment Benefit (PTB) chart is a decision-support tool that quantifies, in absolute terms, the probability that an individual patient will benefit from a psychological treatment based on the individual's pre-treatment characteristics. The demand for such a tool has increased with the growing emphasis on personalized medicine and the need for selecting a treatment from an expanding list of evidence-based models. This method has the potential to provide clinicians and mental health consumers with a practical and interpretable means of comparing treatment options for individuals whose benefit from a particular treatment may differ substantially. We provide a practice update and demonstrate how to develop a PTB chart using data from a randomized controlled trial examining the efficacy of two approaches for treating posttraumatic stress disorder based on patients' pre-treatment exposure to multiple types of interpersonal violence. Step-by-step instructions for applying the PTB method are provided.

Medication treatment perceptions, concerns and expectations among depressed individuals with Type I Bipolar Disorder

BACKGROUND

Subjective experience of illness affects outcomes among populations with bipolar disorder (BD). This cross-sectional study combined qualitative and quantitative approaches to evaluate perceived treatment effects, concerns and expectations among 90 individuals with BD.

METHODS

Adults with Type I BD, mean age 36.6 years, 51% women, completed a semi-structured interview that was audio taped, transcribed, coded and analyzed along emergent themes. Quantitative scales measured depressive symptoms (Hamilton Depression Scale/HAM-D), psychopathology (Clinical Global Impression/CGI), and insight and treatment attitudes (Insight and Treatment Attitudes Questionnaire/ITAQ).

RESULTS

Individuals had moderate depression and psychopathology with good insight into need for treatment. Drug treatment was perceived as beneficial, by "stabilizing" or "balancing" mood (42%, N=38), decreasing anxiety/depressive symptoms (19%, N=17) and improving sleep (10%, N=9). While 39%, (N=35) of individuals denied medication concerns, nearly 29%, (N=26) feared possible long-term effects, particularly diabetes or liver/kidney damage. Media stories and advertisements contributed to medication fears. Hopes and expectations for treatment ranged from those that were symptom or functional status-based, such as desiring mood stabilization and elimination of specific symptoms (23%, N=21), to more global hopes such as "being normal" (20%, N=18) or "cured" (18%, N=16).

LIMITATIONS

Limitations include relatively small sample, lack of a comparator, inclusion of only depressed individuals and those willing to discuss their illness experience.

CONCLUSIONS

While individuals with BD appreciate the effects of medications, concerns regarding adverse effects and discrepancy between actual and hoped-for outcomes can be substantial. Subjective experience with medications using qualitative and quantitative methods should be explored in order to optimize treatment collaboration and outcomes.