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Baillie J, Gill P, Courtenay M. Perceptions of peritonitis risk, prevention, diagnosis and stigma: Findings from a mixed methods study with patients and relatives using peritoneal dialysis. J Ren Care 2024; 50:138-150. [PMID: 36946307 DOI: 10.1111/jorc.12464] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/27/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Peritonitis is the main treatment-related complication of peritoneal dialysis and a primary concern for patients and their relatives. Therefore, understanding their perceptions of peritonitis is important. OBJECTIVES To explore patients' and relatives' perceptions of peritoneal dialysis-associated peritonitis risk, prevention measures and experiences of diagnosis, and experience of perceived stigma. DESIGN A sequential mixed methods study design was used, including a questionnaire and semi-structured interviews. PARTICIPANTS Patients using peritoneal dialysis and relatives (n = 75) from six National Health Service organisations from the United Kingdom. MEASUREMENTS A structured questionnaire was administered with patients and relatives (n = 75) using peritoneal dialysis; data were analysed using descriptive statistics. Thirty questionnaire respondents were then purposively sampled and interviewed in-depth; data were analysed thematically. Data were collected 2017-2018. Ethical and governance approvals were gained. RESULTS Qualitative and quantitative analyses were integrated and three themes presented: • Perceptions of risk: participants assessed their risk of developing peritonitis and possible implications on their health and relatives. Participants felt greatly responsible for preventing infection. • Preventing peritonitis: participants reported similar and some differing measures to minimise their risk of developing peritonitis. Participants wanted to be seen as "clean". • Diagnosis of peritonitis: peritonitis diagnosis was embarrassing and stigmatising for many individuals. This was influenced by the response of healthcare professionals and the cause of peritonitis. CONCLUSIONS It is important that healthcare professionals are aware of how responsible patients and relatives feel about preventing peritonitis, the emotional effect of this responsibility and crucially the impact this may have on seeking help.
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Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Paul Gill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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2
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Cirkovic S, Wilkinson J, Lensen S, Jackson E, Harper J, Lindemann K, Costa-Font J. Is the use of IVF add-on treatments driven by patients or clinics? Findings from a UK patient survey. HUM FERTIL 2023; 26:365-372. [PMID: 37063051 DOI: 10.1080/14647273.2023.2197628] [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] [Received: 09/06/2022] [Accepted: 03/15/2023] [Indexed: 04/18/2023]
Abstract
There are conflicting narratives over what drives demand for add-ons. We undertook an online survey of IVF patients to determine whether patients perceive that use of IVF add-ons is driven by patients or practitioners. People who underwent IVF in the UK in the previous five years were recruited via social media Survey questions focussed on the roles of clinician offer and patient request, including who first suggested use of add-ons in IVF consultations, where patients first heard about them, and which information sources they trusted. From a total of 261 responses, 224 met the inclusion criteria. Overall, 67% of respondents had used one or more IVF add-ons, most commonly: time-lapse imaging (27%), EmbryoGlue (27%), and endometrial scratching (26%). Overall, 81% of the add-ons used were offered to participants by clinicians (compared to 19% requested by themselves). Half (54%) reported being offered add-ons during consultations, compared to 24% who initiated discussion about add-ons. Higher proportions of private patients reported being offered (90%), requesting (47%) and using (74%) add-ons than those with NHS funding (74%, 29%, 52%, respectively). The main limitations of this study are the small sample size, recruitment via a convenience sample, and the self-reported data capture which is subject to recall bias.
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Affiliation(s)
- Stevan Cirkovic
- Law School, London School for Economics and Political Science (LSE), London, UK
- Human Fertilisation and Embryology Authority (HFEA), London, UK
| | - Jack Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Australia
| | - Emily Jackson
- Law School, London School for Economics and Political Science (LSE), London, UK
| | - Joyce Harper
- Institute of Women's Health, University College London (UCL), London, UK
| | | | - Joan Costa-Font
- Department of Health Policy and Ageing and Health Incentives Lab (AHIL), London School for Economics and Political Science (LSE), London, UK
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Sun S, Chen J, Li H, Lou Y, Chen L, Lv B. Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China. Qual Life Res 2023; 32:2561-2571. [PMID: 37093542 PMCID: PMC10123591 DOI: 10.1007/s11136-023-03417-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
AIM To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China. METHODS We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory. RESULTS We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life. CONCLUSION Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.
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Affiliation(s)
- Shaopeng Sun
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiajia Chen
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Heng Li
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yijie Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lixia Chen
- Nursing College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
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Todowede O, Afaq S, Adhikary A, Kanan S, Shree V, Jennings HM, Faisal MR, Nisar Z, Khan I, Desai G, Huque R, Siddiqi N. Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi-country qualitative study. BMC Health Serv Res 2023; 23:818. [PMID: 37525209 PMCID: PMC10391993 DOI: 10.1186/s12913-023-09783-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 07/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Depression is common among people with tuberculosis (TB). The condition is typically unrecognised or untreated despite available and effective treatments in most low- and middle-income countries. TB services in these countries are relatively well established, offering a potential opportunity to deliver integrated depression screening and care. However, there is limited evidence on how such integration could be achieved. This study aimed to understand the barriers and facilitators to integrate depression care in TB services. METHODS We conducted nine workshops with 76 study participants, including people with TB, their carers, and health service providers in Bangladesh, India, and Pakistan, seeking views on integrating depression care into TB clinics. We used a deductive thematic approach to analyse the translated transcripts of audio recordings, contemporaneous notes made during workshops for Bangladesh and India and workshop reports for Pakistan. Using the SURE (Supporting the Use of Research Evidence) thematic framework, we extracted and categorised barriers and facilitators into various domains. RESULTS Reported barriers to integrating depression care in TB services included lack of knowledge about depression amongst patients and the staff, financial burden, and associated stigma for people with TB and their carers. Government buy-in and understanding of how to identify and screen for depression screening were potential facilitators reported. Additionally, breaking through mental health stigma and providing the additional resources required to deliver this service (human resources and consultation time) were essential for integrating depression and TB care. CONCLUSIONS Depression is a common condition found among people with TB, requiring early identification among people with TB. Integrating depression care into Tb services by health workers requires the availability of political support and the provision of resources.
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Affiliation(s)
- Olamide Todowede
- University of York, York, England, UK
- University of Nottingham, Nottingham, England, UK
| | - Saima Afaq
- University of York, York, England, UK.
- School of Public Health, Faculty of Medicine, Imperial College London, London, England, UK.
- Khyber Medical University, Peshawar, Pakistan.
| | - Anoshmita Adhikary
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Vidhya Shree
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | | | - Zara Nisar
- Khyber Medical University, Peshawar, Pakistan
| | - Ikram Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Geetha Desai
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Najma Siddiqi
- University of York, York, England, UK
- Hull York Medical School, York, England, UK
- Bradford District Care NHS Foundation Trust, Bradford, England, UK
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5
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Mboweni SH, Risenga PR. Experiences of patients with chronic diseases during the COVID-19 pandemic in the North West province, South Africa. S Afr Fam Pract (2004) 2023; 65:e1-e10. [PMID: 37427778 PMCID: PMC10318609 DOI: 10.4102/safp.v65i1.5643] [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] [Received: 09/28/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. METHODS A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. RESULTS Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. CONCLUSION Policymakers should consider PWCDs when responding to a public health concern in the future.Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs.
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Affiliation(s)
- Sheillah H Mboweni
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria.
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Chaiyachati KH, Shea JA, Ward M, Nelson MN, Ghosh M, Reilly J, Kelly S, Chisholm DL, Barbati Z, Hemmons JE, Abdel-Rahman D, Ebert JP, Xiong RA, Snider CK, Lee KC, Friedman AB, Meisel ZF, Kilaru AS, Asch DA, Delgado MK, Morgan AU. Patient and clinician perspectives of a remote monitoring program for COVID-19 and lessons for future programs. BMC Health Serv Res 2023; 23:698. [PMID: 37370059 PMCID: PMC10304230 DOI: 10.1186/s12913-023-09684-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
COVID Watch is a remote patient monitoring program implemented during the pandemic to support home dwelling patients with COVID-19. The program conferred a large survival advantage. We conducted semi-structured interviews of 85 patients and clinicians using COVID Watch to understand how to design such programs even better. Patients and clinicians found COVID Watch to be comforting and beneficial, but both groups desired more clarity about the purpose and timing of enrollment and alternatives to text-messages to adapt to patients' preferences as these may have limited engagement and enrollment among marginalized patient populations. Because inclusiveness and equity are important elements of programmatic success, future programs will need flexible and multi-channel human-to-human communication pathways for complex clinical interactions or for patients who do not desire tech-first approaches.
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Affiliation(s)
- Krisda H Chaiyachati
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Judy A Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Michaela Ward
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria N Nelson
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Medha Ghosh
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julianne Reilly
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sheila Kelly
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Deena L Chisholm
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Zoe Barbati
- Mixed Methods Research Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica E Hemmons
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dina Abdel-Rahman
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey P Ebert
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ruiying A Xiong
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher K Snider
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Kathleen C Lee
- Comcast NBCUniversal in Philadelphia, PA, Philadelphia, USA
| | - Ari B Friedman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Zachary F Meisel
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Austin S Kilaru
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - M Kit Delgado
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- The Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna U Morgan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia, PA, USA
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Abstract
BACKGROUND Despite widespread adoption of surveillance testing for coronavirus disease 2019 (Covid-19) among staff members in skilled nursing facilities, evidence is limited regarding its relationship with outcomes among facility residents. METHODS Using data obtained from 2020 to 2022, we performed a retrospective cohort study of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among staff members in 13,424 skilled nursing facilities during three pandemic periods: before vaccine approval, before the B.1.1.529 (omicron) variant wave, and during the omicron wave. We assessed staff testing volumes during weeks without Covid-19 cases relative to other skilled nursing facilities in the same county, along with Covid-19 cases and deaths among residents during potential outbreaks (defined as the occurrence of a case after 2 weeks with no cases). We reported adjusted differences in outcomes between high-testing facilities (90th percentile of test volume) and low-testing facilities (10th percentile). The two primary outcomes were the weekly cumulative number of Covid-19 cases and related deaths among residents during potential outbreaks. RESULTS During the overall study period, 519.7 cases of Covid-19 per 100 potential outbreaks were reported among residents of high-testing facilities as compared with 591.2 cases among residents of low-testing facilities (adjusted difference, -71.5; 95% confidence interval [CI], -91.3 to -51.6). During the same period, 42.7 deaths per 100 potential outbreaks occurred in high-testing facilities as compared with 49.8 deaths in low-testing facilities (adjusted difference, -7.1; 95% CI, -11.0 to -3.2). Before vaccine availability, high- and low-testing facilities had 759.9 cases and 1060.2 cases, respectively, per 100 potential outbreaks (adjusted difference, -300.3; 95% CI, -377.1 to -223.5), along with 125.2 and 166.8 deaths (adjusted difference, -41.6; 95% CI, -57.8 to -25.5). Before the omicron wave, the numbers of cases and deaths were similar in high- and low-testing facilities; during the omicron wave, high-testing facilities had fewer cases among residents, but deaths were similar in the two groups. CONCLUSIONS Greater surveillance testing of staff members at skilled nursing facilities was associated with clinically meaningful reductions in Covid-19 cases and deaths among residents, particularly before vaccine availability.
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Affiliation(s)
- Brian E McGarry
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
| | - Ashvin D Gandhi
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
| | - Michael L Barnett
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
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Yong C, Suvarna A, Harrington R, Gummidipundi S, Krumholz HM, Mehran R, Heidenreich P. Temporal Trends in Gender of Principal Investigators and Patients in Cardiovascular Clinical Trials. J Am Coll Cardiol 2023; 81:428-430. [PMID: 36697143 DOI: 10.1016/j.jacc.2022.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023]
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Abbott A, Montgomery SP, Chancey RJ. Characteristics and Adverse Events of Patients for Whom Nifurtimox Was Released Through CDC-Sponsored Investigational New Drug Program for Treatment of Chagas Disease - United States, 2001-2021. MMWR Morb Mortal Wkly Rep 2022; 71:371-374. [PMID: 35271563 PMCID: PMC8911997 DOI: 10.15585/mmwr.mm7110a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dvir Y, Ryan C, Straus JH, Sarvet B, Ahmed I, Gilstad-Hayden K. Comparison of Use of the Massachusetts Child Psychiatry Access Program and Patient Characteristics Before vs During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e2146618. [PMID: 35107575 PMCID: PMC8811623 DOI: 10.1001/jamanetworkopen.2021.46618] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This cross-sectional study compares the number of encounters at the Massachusetts Child Psychiatry Access Program, patient characteristics, and mental health diagnoses before vs during the COVID-19 pandemic.
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Affiliation(s)
- Yael Dvir
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Massachusetts Chan Medical School, UMass Memorial Medical Center, Worcester
| | - Clare Ryan
- University of Massachusetts Medical School, Worcester
| | - John H. Straus
- Massachusetts Child Psychiatry Access Program/Beacon Health Options, Boston
| | - Barry Sarvet
- Department of Psychiatry, University of Massachusetts-Baystate, Springfield
| | - Ireen Ahmed
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
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11
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Olié E, Dubois J, Benramdane M, Guillaume S, Courtet P. Psychological state of a sample of patients with mood disorders during the first French COVID-19 lockdown. Sci Rep 2021; 11:23711. [PMID: 34887481 PMCID: PMC8660817 DOI: 10.1038/s41598-021-03037-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022] Open
Abstract
Since the beginning of the COVID-19 pandemic, evidence shows the negative psychological impact of lockdown measures in the general population. It is also important to identify predictors of psychological distress in vulnerable people, particularly patients with history of depressive episodes (the most prevalent psychiatric disorder), in order to adapt mental health strategies for future lockdown measures. This study aim was to (1) compare in 69 healthy controls (HC) and 346 patients with a major depressive episode in the two previous years (PP) self-reported psychological symptoms (depression, anxiety, insomnia, suicidal ideation, traumatic stress, anger) and living conditions during the first national French lockdown, and (2) identify predictors of significant psychological distress in PP. The levels of psychological symptoms were very low in HC compared with PP, independently of the living conditions. Half of PP had no psychiatric contact during the lockdown. Loneliness and boredom were independent predictors of depression, anxiety and insomnia, whereas daily physical activity was a protective factor. Virtual contacts protected against suicidal ideation. Our results highlight the need of specific strategies to target loneliness and boredom and to improve care access, including telepsychiatry. Longitudinal studies must investigate the COVID-19 pandemic psychological impact in clinical samples.
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Affiliation(s)
- Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, University of Montpellier, Montpellier, France.
- IGF, CNRS, INSERM, Montpellier, France.
| | | | | | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, University of Montpellier, Montpellier, France
- IGF, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, University of Montpellier, Montpellier, France
- IGF, CNRS, INSERM, Montpellier, France
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12
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El Hayek S, Kassir G, Zalzale H, Gonzalez-Diaz JM, Bizri M. Emerging Psychiatric Themes in Post-COVID-19 Patients on a Psychiatry Consultation-liaison Service. Psychiatr Q 2021; 92:1785-1796. [PMID: 34463904 PMCID: PMC8405712 DOI: 10.1007/s11126-021-09944-5] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 01/19/2023]
Abstract
The need for consultation-liaison psychiatry on COVID-19 wards has substantially increased since the start of the pandemic. In this cross-sectional study, we aimed to summarize the characteristics of patients admitted to the post-COVID-19 ward of the American University of Beirut Medical Center who received a psychiatric consultation. We collected relevant sociodemographic and medical data, information about past psychiatric history, psychiatry consultation details, hospital course, and disposition outcome. We also conducted chi-square and binary logistic regression analyses to assess the association between the different variables and disposition outcome. A total of 52 patients (mean age 57.33 years; equal gender distribution) were seen by the psychiatry consult-liaison team. Most had medical comorbidities and 21.2% required intubation. The most prevalent psychiatric diagnoses were delirium (30.8%), major depressive episode (15.4%), and other anxiety disorder (15.4%). Pharmacological management was implemented in 90.4% of cases and mainly included second-generation antipsychotics (36.5%). Non-pharmacological interventions consisted of those related to delirium and therapy for anxiety. Only intubation was significantly associated with disposition outcome (p = 0.004). This study highlights the various psychiatric themes emerging during the acute and post-acute periods of hospitalization for COVID-19. Hospitalized individuals recovering from the infection should be diligently screened and referred to the psychiatry consultation-liaison team to ensure the implementation of appropriate interventions.
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Affiliation(s)
- Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ghida Kassir
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Hussein Zalzale
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jairo M Gonzalez-Diaz
- UR Center for Mental Health - CERSAME, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
- Clínica Nuestra Señora de La Paz, Bogota, Colombia
- Barcelona Clínic Schizophrenia Unit, Neurosciences Institute, Barcelona University, Barcelona, Spain
| | - Maya Bizri
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon.
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13
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Abstract
The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients' psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients' psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.
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Affiliation(s)
- Magdalena Seethaler
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Stötzner
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Janina Brandl
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (Psychiatric University Clinic at St. Hedwig Hospital), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Reed G, Ahmad SR, Khoong EC, Olazo K, Jagsi R, Mangurian C, Sarkar U. Evaluation of Sexual Harassment Policies at Medical Institutions to Understand Attention to Harassment of Physicians by Patients. JAMA Netw Open 2021; 4:e2135131. [PMID: 34787660 PMCID: PMC8600387 DOI: 10.1001/jamanetworkopen.2021.35131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This quality improvement study assesses the policies of top US medical centers for addressing sexual harassment of physicians by patients.
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Affiliation(s)
- Gabriela Reed
- Department of Internal Medicine, University of California, San Francisco
| | - Sarah R. Ahmad
- Division of Headache Medicine, Department of Neurology, University of California, San Francisco
| | - Elaine C. Khoong
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
| | - Kristan Olazo
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Christina Mangurian
- Center for Vulnerable Populations, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Urmimala Sarkar
- Department of Internal Medicine, University of California, San Francisco
- Division of General Internal Medicine, University of California, San Francisco
- Center for Vulnerable Populations, University of California, San Francisco
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15
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Abstract
OBJECTIVES To study memories of ICU following discharge, their associations, and impact on mental health and quality of life in a low- and middle-income country. DESIGN Prospective observational cohort; data on memories (pain, fear, nightmare, factual), clinical and demographic variables, anxiety-depression, posttraumatic stress symptoms, and quality of life were collected 0, 7, 14, 30, 90, and 180 days post discharge. Home visits for assessment minimized loss to follow-up. Linear mixed-models and regression analyses were used to estimate adjusted effects of memories controlling for age, sex, time, and severity of illness. SETTING Twenty-five bedded ICU of a tertiary care center in East India. PATIENTS Adult ICU survivors between January 2017 and July 2018 able to communicate their memories. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Final sample consisted of 322 patients who completed 180 days follow-up. Pain, fear, factual, and nightmare memories dropped from 85%, 56%, 55%, and 45% at discharge to less than or equal to 5% at 180 days. Patients with gaps in ICU memory had worse anxiety-depression, posttraumatic stress symptoms, and quality of life at all follow-up points. Sedation (odds ratio, 0.54; CI, 0.4-0.7), steroids (odds ratio, 0.47; CI, 0.3-0.8), benzodiazepines (odds ratio, 1.74; CI, 1-3.04), and mechanical ventilation (odds ratio, 0.43; CI, 0.2-0.8) were independently associated with gaps in memory. Non-ICU factor such as substance addiction (odds ratio, 5.38; CI, 2-14) was associated with memories affecting mental health and quality of life. CONCLUSIONS Gaps in memory and various memory types were common after ICU admission, whose prevalence waned over time. Compared with nightmares and fearful memories, gaps in memories were most strongly associated with poor mental health and quality of life. Identifying patients with gaps in memories might be an objective way of planning interventions to improve their long-term outcomes.
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Affiliation(s)
- Swagata Tripathy
- Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Odisha, India
- Department of Psychiatry, Black County Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
- Department of Psychiatry, AIIMS Bhubaneswar, Odisha, India
| | - Nilamadhab Kar
- Department of Psychiatry, Black County Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
| | | | - Santosh Kumar Singh
- Department of Psychiatry, Black County Healthcare NHS Foundation Trust, Wolverhampton, United Kingdom
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16
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Bastiani L, Paolicchi F, Faggioni L, Martinelli M, Gerasia R, Martini C, Cornacchione P, Ceccarelli M, Chiappino D, Della Latta D, Negri J, Pertoldi D, Negro D, Nuzzi G, Rizzo V, Tamburrino P, Pozzessere C, Aringhieri G, Caramella D. Patient Perceptions and Knowledge of Ionizing Radiation From Medical Imaging. JAMA Netw Open 2021; 4:e2128561. [PMID: 34643721 PMCID: PMC8515210 DOI: 10.1001/jamanetworkopen.2021.28561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures. OBJECTIVE To assess patients' knowledge about medical radiation and related risks. DESIGN, SETTING, AND PARTICIPANTS A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020. MAIN OUTCOMES AND MEASURES Survey respondents' basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues. RESULTS Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P = .03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P = .004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P < .001) and having a higher educational level (intermediate vs low: OR, 1.48; 95% CI, 1.17-1.88; P < .001; high vs low: OR, 2.68; 95% CI, 2.09-3.43; P < .001). CONCLUSIONS AND RELEVANCE The results of this survey suggest that patients undergoing medical imaging procedures have overall limited knowledge about medical radiation. Intervention to achieve better patient awareness of radiation risks related to medical exposures may be beneficial.
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Affiliation(s)
- Luca Bastiani
- Institute of Clinical Physiology of the Italian National Research Council, Pisa, Italy
| | - Fabio Paolicchi
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Massimo Martinelli
- Italian National Research Council Institute of Information Science and Technologies, Signals & Images Laboratory, Pisa, Italy
| | - Roberta Gerasia
- Radiology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Patrizia Cornacchione
- UOC Oncological Radiotherapy, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, A. Gemelli University Hospital Foundation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Rome, Italy
| | - Matteo Ceccarelli
- Department of Physics, University of Cagliari, Calgiari, Italy
- Clinical Physiology of the Italian National Research Council/Institute of Materials, Cittadella Universitaria di Monserrato, Monserrato, Italy
| | - Dante Chiappino
- Department of Radiology, Institute of Clinical Physiology of the Italian National Research Council /Tuscany Region “Gabriele Monasterio Foundation,” Massa, Italy
| | - Daniele Della Latta
- Monasterio Foundation, Tuscany Region “Gabriele Monasterio Foundation, Massa, Italy
- Now with TeraRecon Inc, Durham, North Carolina
| | - Jacopo Negri
- Department of Radiology, Macerata Hospital, Macerata, Italy
| | - Donatella Pertoldi
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Donato Negro
- Department of Medicine-DIMED University Hospital of Padua, Padua, Italy
| | | | - Vincenzo Rizzo
- Nuclear Medicine Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Paola Tamburrino
- Foggia United Hospitals, University Hospital of Foggia, Foggia, Italy
| | - Chiara Pozzessere
- Radiology Unit, AUSL Toscana Centro San Giuseppe Hospital, Empoli, Italy
| | - Giacomo Aringhieri
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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Anderson EC, DiPalazzo J, Edelman E, Helbig P, Reed K, Miesfeldt S, Thomas C, Lucas FL, Fenton ATHR, Antov A, Hall MJ, Roberts JS, Rueter J, Han PKJ. Patients' Expectations of Benefits From Large-Panel Genomic Tumor Testing in Rural Community Oncology Practices. JCO Precis Oncol 2021; 5:PO.21.00235. [PMID: 34632254 PMCID: PMC8492376 DOI: 10.1200/po.21.00235] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 08/20/2021] [Indexed: 02/01/2023] Open
Abstract
Large-panel genomic tumor testing (GTT) is an emerging technology that promises to make cancer treatment more precise. Because GTT is novel and complex, patients may have unrealistic expectations and limited knowledge of its benefits. These problems may limit the clinical value of GTT, but their prevalence and associated factors have not been explored. METHODS Patients with cancer enrolled in a large initiative to disseminate GTT in community oncology practices completed surveys assessing their expectations, knowledge, and attitudes about GTT. The study sample (N = 1,139) consisted of patients with a range of cancer types (22% gynecologic, 14% lung, 10% colon, 10% breast, and 46% other malignancies) and cancer stages (4% stage I, 3% stage II, 15% stage III, and 74% stage IV). Mean age was 64 years (standard deviation = 11); 668 (59%) were women; 71% had no college degree; 57% came from households with less than $50,000 US dollars household income; and 73% lived in a rural area. RESULTS Generally, patients had high expectations that they would benefit from GTT (M = 2.81 on 0-4 scale) and positive attitudes toward it (M = 2.98 on 0-4 scale). Patients also had relatively poor knowledge about GTT (48% correct answers on an objective test of GTT knowledge). Greater expectations for GTT were associated with lower knowledge (b = -0.46; P < .001), more positive attitudes (b = 0.40; P < .001), and lower education (b = -0.53; P < .001). CONCLUSION This research suggests patients have high expectations that they will benefit from GTT, which is associated with low knowledge, positive attitudes, and low education. More research is needed to understand the concordance between expectations and actual clinical outcomes.
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Affiliation(s)
- Eric C. Anderson
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
- Tufts University School of Medicine, Boston, MA
| | - John DiPalazzo
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | | | | | | | | | | | - F. Lee Lucas
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | - Anny T. H. R. Fenton
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
| | | | | | | | | | - Paul K. J. Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME
- Tufts University School of Medicine, Boston, MA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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18
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Mercier MR, Galivanche AR, David WB, Malpani R, Pathak N, Hilibrand AS, Rubin LE, Grauer JN. Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty. PLoS One 2021; 16:e0257555. [PMID: 34582475 PMCID: PMC8478166 DOI: 10.1371/journal.pone.0257555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' satisfaction of their hospital experience. A minority of discharged patients return the survey. Underlying bias among who ultimately returns the survey (non-response bias) after total knee arthroplasty (TKA) may affect results of the survey. Thus, the objective of the current study is to assess the relationship between patient characteristics and postoperative outcomes on HCAHPS survey nonresponse. METHODS All adult patients at a single institution undergoing inpatient, elective, primary TKA between February 2013 and May 2020 were selected for analysis. Following discharge, all patients had been mailed the HCAHPS survey. The primary outcome analyzed in the current study is survey return. Patient characteristics, surgical variables, and 30-day postoperative outcomes were analyzed. Univariate and multivariate analyses were performed to identify factors independently associated with return of the HCAHPS survey. RESULTS Of 4,804 TKA patients identified, 1,498 (31.22%) returned HCAHPS surveys. On multivariate regression analyses controlling for patient factors, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (ASA score of 4 or higher, OR = 2.37; P<0.001), and be partially or totally dependent (OR = 2.37; P = 0.037). Similarly, patients who did not return the survey were more likely to have had a readmission (OR = 1.94; P<0.001), be discharged to a place other than home (OR = 1.52; P<0.001), or stay in the hospital for longer than 3 days (OR = 1.43; P = 0.004). DISCUSSION Following TKA, HCAHPS survey response rate was only 31.22% and completion of the survey was associated with several demographic and postoperative variables. These findings suggest that HCAHPS survey results capture a non-representative fraction of the true TKA patient population. This bias is necessary to consider when using HCAHPS survey results as a metric for quality of healthcare and federal reimbursement rates.
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Affiliation(s)
- Michael R. Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Anoop R. Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Wyatt B. David
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Neil Pathak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Ari S. Hilibrand
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
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Singh K, Bawa VS, Venkateshmurthy NS, Gandral M, Sharma S, Lodhi S, Wafford QE, Patel SA, Tandon N, Narayan KMV, Prabhakaran D, Huffman MD. Assessment of Studies of Quality Improvement Strategies to Enhance Outcomes in Patients With Cardiovascular Disease. JAMA Netw Open 2021; 4:e2113375. [PMID: 34125220 PMCID: PMC8204210 DOI: 10.1001/jamanetworkopen.2021.13375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Clinical care quality improvement (QI) strategies are critical to prevent and control cardiovascular disease (CVD). However, there is limited evidence regarding which components of the health system-, clinician-, and patient-based QI strategies contribute to their impact on CVD. OBJECTIVES To identify, map, and organize evidence on the effectiveness and implementation of cardiovascular QI strategies that seek to improve outcomes in patients with CVD. EVIDENCE REVIEW Eight electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, ProQuest, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform) were searched for studies published between January 1, 2009, and October 25, 2019. Eligible study designs included randomized trials and preintervention and postintervention evaluations. Descriptive findings of included studies were reported using several frameworks to map the intervention components stratified by target population, setting, outcomes, and overall results. FINDINGS From 8066 screened titles and abstracts, 456 unique studies with 150 148 unique patients (38.1% women and 61.9% men; mean [SD] age, 64.6 [7.1] years) were identified, including 427 randomized trials, 21 quasi-randomized studies, and 8 preintervention and postintervention studies. Of 336 studies from 45 countries that were classified, 255 (75.9%) were from high-income countries; 68 (20.2%), upper-middle-income countries; 13 (3.9%), lower-middle-income countries; and 0, low-income countries, with diverse clinical settings and target patient populations (post-myocardial infarction, stroke, heart failure). Patient support (311 studies), information communication technology (ICT) for health (78 studies), community support (18 studies), supervision (15 studies), and high-intensity training (14 studies) were the most commonly evaluated QI strategies. Other strategies were group problem-solving (7 studies), printed information (5 studies), strengthening infrastructure (4 studies), and financial incentives (3 studies). Patient support, ICT for health, training, and community support were strategies that had been evaluated the most for clinical end points and showed modest associations with several clinical outcomes. The other strategies did not have outcome-driven evaluations reported. Group problem-solving was associated with improved patient self-care and quality of life. Strengthening infrastructure was associated with improved treatment satisfaction. Printed information and financial incentives showed no meaningful effect. CONCLUSIONS AND RELEVANCE This systematic review found that substantial variations exist in the types, effectiveness, and implementation of QI strategies for patients with CVD. A comprehensive map of QI strategies created by this study would be useful for researchers to identify where new knowledge is needed to improve cardiovascular outcomes. Outcome-driven evaluations and long-term studies are needed, particularly in low-income settings, to better understand the effects of QI strategies on prevention and control of CVD.
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Affiliation(s)
- Kavita Singh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Vidit Singh Bawa
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Nikhil Srinivasapura Venkateshmurthy
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Mareesha Gandral
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
| | - Shuchita Sharma
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Sugandha Lodhi
- Indian Institute of Public Health, Delhi, Public Health Foundation of India, Gurugram, India
| | - Q. Eileen Wafford
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shivani A. Patel
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, University of New South Wales, Kensington, Sydney, Australia
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20
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Knutzen KE, Sacks OA, Brody-Bizar OC, Murray GF, Jain RH, Holdcroft LA, Alam SS, Liu MA, Pollak KI, Tulsky JA, Barnato AE. Actual and Missed Opportunities for End-of-Life Care Discussions With Oncology Patients: A Qualitative Study. JAMA Netw Open 2021; 4:e2113193. [PMID: 34110395 PMCID: PMC8193430 DOI: 10.1001/jamanetworkopen.2021.13193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier. Objective To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer. Design, Setting, and Participants This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020. Exposures The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions. Main Outcomes and Measures Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities. Results The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity. Conclusions and Relevance Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
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Affiliation(s)
- Kristin E. Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Olivia A. Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Genevra F. Murray
- Department of General Medicine, Boston Medical Center, Boston, Massachusetts
| | - Raina H. Jain
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Shama S. Alam
- Pharmaceutical Product Development, Evidera, Bethesda, Maryland
| | - Matthew A. Liu
- School of Medicine, University of California, San Diego, La Jolla
| | | | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amber E. Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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21
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Zhang Y, Shi L, Chen H, Wang X, Sun G. Hubei's Core Response Policies in the Early Stage of COVID-19. Biomed Res Int 2021; 2021:6610045. [PMID: 34159196 PMCID: PMC8168471 DOI: 10.1155/2021/6610045] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study is aimed at confirming the effectiveness of nonpharmaceutical interventions during the COVID-19 outbreak in Hubei, China. METHODS The data are all from the epidemic information released by the National Health Commission of the People's Republic of China and the Health Commission of Hubei Province. We used the multivariable linear regression by the SPSS 19.0 software: the cumulative number of confirmed cases, the cumulative number of cured cases, and the number of daily severe cases were taken as dependent variables, and the six policies, including the Joint Prevention and Control Mechanism of the State Council, lockdown Wuhan city, the first-level response to public health emergencies, the expansion of medical insurance coverage to suspected patients, mobile cabin hospitals, and counterpart assistance in Hubei province, were gradually entered into multiple linear regression models as independent variables. RESULTS The factors influencing the cumulative number of diagnosed cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. The factors influencing the cumulative number of cured cases ranged from large to small: counterpart support medical teams in Hubei province and mobile cabin hospitals. The factors influencing the number of daily severe cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. CONCLUSION The mobile cabin hospital is a major reason for the successfully defeating COVID-19 in China. As COVID-19 pandemic spreads globally, the mobile cabin hospital is a successful experience in formulating policies to defeat COVID-19 for other countries in the outbreak phase.
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Affiliation(s)
- Yuyao Zhang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Haiqian Chen
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Xiaohan Wang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Gang Sun
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong 510515, China
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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22
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de Havenon A, Ney JP, Callaghan B, Hohmann S, Shippey E, Yaghi S, Anadani M, Majersik JJ. Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2110314. [PMID: 33999162 PMCID: PMC8129817 DOI: 10.1001/jamanetworkopen.2021.10314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.
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Affiliation(s)
| | - John P. Ney
- Department of Neurology, Boston University, Boston, Massachusetts
| | | | | | | | - Shadi Yaghi
- Department of Neurology, New York University, New York
| | - Mohammad Anadani
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
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23
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Ohanyan A, Noack J, Hümmelgen M, Löwe B, Kohlmann S. Investigating patients´ views on screening for depression in cardiac practice: A qualitative interview study. J Psychosom Res 2021; 144:110419. [PMID: 33765518 DOI: 10.1016/j.jpsychores.2021.110419] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice. METHODS This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. RESULTS We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. CONCLUSION We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.
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Affiliation(s)
- Ani Ohanyan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Jan Noack
- Cardiologicum Hamburg, Hamburg, Germany
| | | | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
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Murphy B, McShane CM, Santin O, Treanor C, Byrne B, Donnelly M, Anderson LA. Patient's perspectives of living with a precancerous condition: Monoclonal gammopathy of undetermined significance (MGUS). Eur J Oncol Nurs 2021; 51:101901. [PMID: 33503552 DOI: 10.1016/j.ejon.2021.101901] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/08/2020] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to investigate patient experiences of living with monoclonal gammopathy of undetermined significance (MGUS). Living with a premalignant condition such as MGUS may elicit negative psychosocial effects including increased anxiety and fear of progression to cancer. To date, no study utilising qualitative methodology has explored the lived experiences of MGUS patients. METHODS Data was collected via two focus groups and six telephone interviews. MGUS patients (n=14) were recruited via nurse-led haematology telephone-clinics in Northern Ireland. Interviews were transcribed verbatim and the data subjected to thematic analysis. OUTCOME Thematic analysis identified 3 overarching themes; (1) The psychosocial impact of an MGUS diagnosis, (2) Knowledge of MGUS and (3) Experiences of MGUS health services. Patients with MGUS reported experiencing poor psychological adjustment to their condition particularly at the point of diagnosis and approaching follow-up appointments. Feelings of isolation, poor information-provision, increased uncertainty and limited psychosocial support for MGUS patients were also reported. Patients did however reflect positively on their experience of being followed up via nurse-led telephone clinics. CONCLUSIONS Provision of patient friendly information guides at diagnosis, and additional psychosocial support services such as nurse-led telephone clinics and coordinated patient groups may help MGUS patients adjust better to their diagnosis and in doing so improve quality of life in this patient population.
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Affiliation(s)
- Blain Murphy
- Institute for Global Food Security (IGFS), School of Biological Sciences, Queen's University Belfast, UK
| | | | - Olinda Santin
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | | | - Bronagh Byrne
- Centre for Public Health, Queen's University Belfast, UK
| | | | - Lesley A Anderson
- Centre for Public Health, Queen's University Belfast, UK; Aberdeen Centre for Health Data Science, University of Aberdeen, UK.
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25
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Abstract
ABSTRACT Patients who learn they carry breast cancer genes 1 and 2 (BRCA1/2) must decide if, when, and how they want to disclose this information to family members who may be affected. This article discusses the psychosocial factors that may influence patient decisions to disclose positive BRCA1/2 results to family members, as well as the role of nurses in educating and advocating for patients and their families.
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Abstract
ABSTRACT Violence is a serious concern in the psychiatric inpatient and emergency setting. Much of the research on victims of inpatient violence has focused on identifying and supporting staff who are at risk of being victimized when working in psychiatric settings. This article presents an analysis of 72 patients who were targeted during incidents of patient-on-patient physical aggression in hospital-based psychiatric settings (both inpatient and emergency) from 2014 to 2018. Results suggest that patients who are at risk of being targeted by another patient while in the hospital tend to be younger, are more likely to be male, and present with manic symptoms and recent cannabis use. These variables have all been identified as risk factors for perpetration of violence by patients with mental illness. This study adds to a literature demonstrating a consistent overlap between individuals with mental illness who are victimized and those who initiate violence.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, New York
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27
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Aggarwal R, Hammond JG, Joynt Maddox KE, Yeh RW, Wadhera RK. Association Between the Proportion of Black Patients Cared for at Hospitals and Financial Penalties Under Value-Based Payment Programs. JAMA 2021; 325:1219-1221. [PMID: 33755063 PMCID: PMC7988363 DOI: 10.1001/jama.2021.0026] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study evaluates whether US hospitals with mostly Black patients are more likely than other hospitals to have penalties associated with Centers for Medicare & Medicaid Services (CMS) value-based payment programs.
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Affiliation(s)
- Rahul Aggarwal
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - J. Gmerice Hammond
- Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Karen E. Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
- Associate Editor, JAMA
| | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rishi K. Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Easterlin MC, Berdahl CT, Rabizadeh S, Spiegel B, Agoratus L, Hoover C, Dudovitz R. Child and Parent Perspectives on the Acceptability of Virtual Reality to Mitigate Medical Trauma in an Infusion Center. Matern Child Health J 2021; 24:986-997. [PMID: 32451966 DOI: 10.1007/s10995-020-02955-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Children may experience medical trauma when undergoing medical procedures even when procedures are minor. While virtual reality (VR) is effective for managing procedural pain and anxiety, few studies address how families feel about using VR. We explore pediatric patient and guardian views regarding the acceptability of using VR during procedures to mitigate medical trauma. METHODS Semi-structured qualitative interviews with 18 patient-guardian dyads at a tertiary outpatient infusion center for inflammatory bowel disease (IBD) treatment. Interviews explored how VR may change the infusion experience, including benefits, risks, and recommendations for clinical integration. Interviews were recorded, transcribed, and analyzed in ATLAS.ti. Two coders used a 3-step coding approach to: (1) identify themes; (2) develop a codebook and code transcripts using the constant comparative method; and (3) describe themes/patterns. RESULTS Potential benefits of VR were distraction from infusion-related anxiety and pain and generating excitement for the appointment. Potential challenges were VR-side effects (dizziness, nausea), limited mobility during the procedure, disorientation/immersion leading to shock upon IV-placement, and a lost opportunity to build coping skills. Families queried when VR should first be introduced and when during the appointment use would be optimal. Parents expressed concerns about pushing VR when their child was already under stress. A limited number of families doubted the utility of VR. CONCLUSIONS Patients and parents found VR to be an acceptable option for helping to manage medical trauma during infusions but highlighted that the VR experience must be carefully crafted to avoid unintended consequences, including lost opportunities to build resilience.
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Affiliation(s)
- Molly C Easterlin
- UCLA National Clinician Scholars Program, 1100 Glendon Ave. Suite 900, Space #19, Los Angeles, CA, 90024, USA.
- Department of Pediatrics, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Carl T Berdahl
- Departments of Medicine and Emergency Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Shervin Rabizadeh
- Department of Pediatrics, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Brennan Spiegel
- Health Services Research, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Lauren Agoratus
- Family Voices New Jersey At SPAN Parent Advocacy Network, Newark, USA
| | | | - Rebecca Dudovitz
- Department of Pediatrics & Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, UCLA, Los Angeles, USA
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Patel M, Jain R, Tohen M, Maletic V, Earley WR, Yatham LN. Efficacy of cariprazine in bipolar I depression across patient characteristics: a post hoc analysis of pooled randomized, placebo-controlled studies. Int Clin Psychopharmacol 2021; 36:76-83. [PMID: 33230026 PMCID: PMC7846289 DOI: 10.1097/yic.0000000000000344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/22/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Patients who experience bipolar depression have diverse demographic and clinical characteristics that have the potential to impact treatment. The efficacy of cariprazine in bipolar I depression was evaluated in patient subgroups defined by baseline demographic and clinical characteristics. Post hoc analyses of data from three randomized, double-blind, placebo-controlled trials in bipolar I depression (NCT01396447, NCT02670538 and NCT02670551) evaluated mean change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total scores for pooled cariprazine 1.5-3 mg/d versus placebo in subgroups defined by demographic and clinical characteristics. The least-squares mean difference in MADRS total score change from baseline was statistically significant for cariprazine 1.5-3 mg/d versus placebo in all patient subgroups analyzed (P < 0.05 all subgroups): demographic characteristics (age, sex, white or black race and obese/nonobese BMI); episode characteristics (defined by current episode duration, number of previous manic/mixed and depressive episodes, and prior bipolar disorder medication use) and disease severity (groups above and below Clinical Global Impressions-Severity and MADRS cutoff scores). Cariprazine 1.5-3 mg/d consistently improved depressive symptoms in all patient subgroups without regard to differences in baseline demographic and clinical characteristics, suggesting broad efficacy across a spectrum of patients with bipolar I depression.
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Affiliation(s)
- Mehul Patel
- Medical Afffairs, AbbVie, Madison, New Jersey
| | - Rakesh Jain
- Department of Psychiatry, Texas Tech University School of Medicine – Permian Basin, Midland, Texas
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Vladimir Maletic
- Psychiatry/Behavioral Science, University of South Carolina, Columbia, South Carolina, School of Medicine, Greenville, USA
| | | | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Represas-Carrera FJ, Méndez-López F, Couso-Viana S, Masluk B, Magallón-Botaya R, Clavería A. [Baseline characteristics and quality of life in patients with Diabetes Mellitus included in the EIRA randomized clinical trial.]. Rev Esp Salud Publica 2021; 95:e202103034. [PMID: 33642566] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/06/2020] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE The EIRA study is a randomized clinical multicenter trial that aims to evaluate the effectiveness of a complex multi-risk intervention aimed at people aged 45-75 in Primary Care. The objectives of this work were to describe the baseline characteristics of patients with Diabetes Mellitus included in phase III of the EIRA study and analyze the relationship that different independent variables may have with the quality of life. METHODS The data of all patients with Diabetes Mellitus that were included in phase III of EIRA study collected at baseline were analyzed. Patients with at least two or more of unhealthy lifestyles were selected: smoking, low adherence to the Mediterranean diet and/or low level of physical activity. The quality of life was measured with the EQ-5D-5L questionnaire. A descriptive and bivariate study was performed. The variables did not follow a normal distribution. Non-parametric statistical tests were used. For the multivariate analysis of the quality of life, automated linear regression was used with SPSS v19. RESULTS 694 were patients included with Diabetes Mellitus (356 controls, 338 in intervention, without significant differences between both groups). Control: 37.64% women, age (median) 60 years. Intervention: 37.87% women, age (median) 60 years. Most prevalent risk behaviors in descending order: low adherence to the Mediterranean diet, low level of physical activity and smoking. The variables that significantly influenced quality of life were: GAD-7, work activity, HbA1c and CIDI. CONCLUSIONS There are no significant differences motivated by the study design. The influence of mental health on the EQ-5D-5L is remarkable.
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Affiliation(s)
- Francisco Jesús Represas-Carrera
- Atención Primaria. Área Sanitaria de Vigo. Servicio Gallego de Salud (SERGAS). Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur). Galicia. España
| | - Fátima Méndez-López
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP). Instituto de Investigación Sanitaria Aragón. Zaragoza. España
| | - Sabela Couso-Viana
- Atención Primaria. Área Sanitaria de Vigo. Servicio Gallego de Salud (SERGAS). Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur). Galicia. España
| | - Bárbara Masluk
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP). Instituto de Investigación Sanitaria Aragón. Zaragoza. España
| | - Rosa Magallón-Botaya
- Grupo Aragonés de Investigación en Atención Primaria (GAIAP). Instituto de Investigación Sanitaria Aragón. Zaragoza. España
| | - Ana Clavería
- Técnica de Salud. Atención Primaria. Área Sanitaria de Vigo. Servicio Gallego de Salud (SERGAS). Grupo I-Saúde (Instituto de Investigación Sanitaria Galicia Sur), Vigo. Galicia. RedIAPP. España
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Chandra A, Kumar R, Kant S, Krishnan A. Diagnostic Pathways and Delays in Initiation of Treatment among Newly Diagnosed Tuberculosis Patients in Ballabgarh, India. Am J Trop Med Hyg 2021; 104:1321-1325. [PMID: 33617478 DOI: 10.4269/ajtmh.20-1297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022] Open
Abstract
A delay in diagnosis and initiation of treatment in patients with tuberculosis (TB) can affect the period of communicability and cost of treatment. We aimed to describe the diagnostic pathways and delays in initiation of treatment among drug-sensitive newly diagnosed TB patients in Ballabgarh, India. In May 2019, we interviewed 110 TB patients who were put on treatment in the past 2 months. It was a cross-sectional study where data collection was conducted by a physician. We used a structured questionnaire to collect the information on care-seeking practices, delays, and patient's cost. Descriptive analysis was carried out for the pathways, delays, and patient cost. The mean number of health facility contacted before the diagnosis of TB was 2.8 (SD: 1.3); 76% of patients first sought care at a private health facility. The median total delay was 34.5 (IQR: 21-60) days; median patient delay seven (IQR: 2-21) days, median health system delay 16 (IQR: 8-45) days, median diagnostic delay 32.5 (IQR: 18-57) days, and median treatment delay two (IQR: 1-3) days. Health system delay was 2.2 times longer than patient delay; the health system delay was primarily due to delay in diagnosis. Patients contacting private health facility first had 1.7 times total delay, 2.4 times longer health system delay, and 3.4 times of direct cost compared with patients contacting a public health facility first. Accelerated efforts are needed to achieve India's target to eliminate TB by 2025.
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Belsky JA, Stanek J, Skeens MA, Gerhardt CA, Rose MJ. Supportive care and osteopathic medicine in pediatric oncology: perspectives of current oncology clinicians, caregivers, and patients. Support Care Cancer 2021; 29:1121-1128. [PMID: 32647995 PMCID: PMC7767897 DOI: 10.1007/s00520-020-05612-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Many children receiving chemotherapy struggle with therapy-induced side effects. To date, there has been no literature investigating the needs, knowledge, or implementation of osteopathic manipulative treatments (OMT) as a supportive care option in pediatric oncology. We hypothesized that pediatric oncology clinicians, caregivers, and patients have (a) limited knowledge of OMT and (b) dissatisfaction with current supportive care options and (c) would be interested in having OMT available during chemotherapy, once educated. METHODS Participants included three cohorts: (1) children aged ≥ 9 years, diagnosed with cancer and actively receiving chemotherapy; (2) their caregivers; and (3) oncology clinicians at Nationwide Children's Hospital. Participants completed 1:1 semi-structured interviews, which were audio-recorded, transcribed, and analyzed for thematic content regarding their perception of supportive care measures and views on OMT. Quantitative data was summarized descriptively. RESULTS A total of 60 participants completed the interview. Participants demonstrated limited awareness of osteopathic medicine; no participant had more than "some" knowledge of OMT. After education about OMT using a brief video, all clinicians, caregivers, and 95% of patients were receptive to OMT as a supportive care option. Major themes included the following: (a) patients have uncontrolled chemotherapy side effects, (b) improved supportive care options are desired, and (c) osteopathic medicine is a favorable supportive care adjunct. CONCLUSIONS Pediatric oncology clinicians, caregivers, and patients reported a need for better management of chemotherapy-associated side effects and an interest in utilizing OMT. These findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology clinical setting.
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Affiliation(s)
- Jennifer A Belsky
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Joseph Stanek
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Micah A Skeens
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Cynthia A Gerhardt
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa J Rose
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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Abstract
Nurses conduct physical and psychosocial assessments during admissions to healthcare facilities. Patients rely upon nurses to provide support and education during their journey, from periods of health decline to states of optimal wellness. Therefore, nurses are an ideal population to assess spiritual health. The value and necessity of spiritual assessment were explored on an inpatient unit providing medical and palliative care to patients. Two spiritual assessment tools, comprised each of five items, were evaluated by nursing staff and patients. Spiritual Assessment Tool 1 used language that was unaffiliated with religion, nor a belief in God, and Spiritual Assessment Tool 2 used language affiliated with faith and belief in God.
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Affiliation(s)
- Cheryl Green
- Southern Connecticut State University, 501 Crescent Street, Jennings Hall Nursing Department, New Haven, CT, 06515, USA.
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Zhong Y, Liu W, Lee TY, Zhao H, Ji J. Risk perception, knowledge, information sources and emotional states among COVID-19 patients in Wuhan, China. Nurs Outlook 2021; 69:13-21. [PMID: 32980153 PMCID: PMC7442898 DOI: 10.1016/j.outlook.2020.08.005] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/24/2020] [Accepted: 08/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The rapidly evolving COVID-19 pandemic has become a global health crisis. Several factors influencing risk perception have been identified, including knowledge of the disease, information sources, and emotional states. Prior studies on COVID-19-related risk perception primarily focused on the general public, with little data available on COVID-19 patients. PURPOSE To investigate COVID-19 patients' risk perception, knowledge of the disease, information sources, and emotional states in the epicenter, Wuhan, during the COVID-19 outbreak in China. METHODS Data were collected online using self-administered electronic questionnaire developed with reference to previous relevant studies and publications by the World Health Organization. FINDINGS A higher level of perceived risk was found in relation to COVID-19 as compared to other potential health threats. Knowledge gaps existed regarding transmission and prevention of COVID-19. Additionally, risk perception was negatively related to knowledge and positively related to depressive states. Moreover, social media was a primary source for COVID-19 information, whereas the most trusted sources were health professionals. DISCUSSION Realistic perception of risk should be encouraged considering both physical and mental health while developing relevant strategies. Furthermore, risk communication needs to be specifically tailored for various target groups, such as the elderly and mentally vulnerable individuals, with the adoption of popular media platforms.
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Affiliation(s)
- Yaping Zhong
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; Department of Nursing, Sir Run Run Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Weihua Liu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China
| | | | - Huan Zhao
- School of Health & Life Sciences, Federation University, Berwick, Victoria, Australia
| | - Ji Ji
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong, PR China; Department of Nursing, Sir Run Run Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.
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Morgenstern-Kaplan D, Buitano-Tang B, Martínez-Gil M, Zaldívar-Pérez Pavón A, Talavera JO. U-shaped-aggressiveness of SARS-CoV-2: Period between initial symptoms and clinical progression to COVID-19 suspicion. A population-based cohort study. PLoS One 2020; 15:e0243268. [PMID: 33270769 PMCID: PMC7714139 DOI: 10.1371/journal.pone.0243268] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
Background Early identification of different COVID-19 clinical presentations may depict distinct pathophysiological mechanisms and guide management strategies. Objective To determine the aggressiveness of SARS-CoV-2 using symptom progression in COVID-19 patients. Design Historic cohort study of Mexican patients. Data from January-April 2020 were provided by the Health Ministry. Setting Population-based. Patients registered in the Epidemiologic Surveillance System in Mexico. Participants Subjects who sought medical attention for clinical suspicion of COVID-19. All patients were subjected to RT-PCR testing for SARS-CoV-2. Measurements We measured the Period between initial symptoms and clinical progression to COVID-19 suspicion (PISYCS) and compared it to the primary outcomes (mortality and pneumonia). Results 65,500 patients were included. Reported fatalities and pneumonia were 2176 (3.32%), and 11568 (17.66%), respectively. According to the PISYCS, patients were distributed as follows: 14.89% in <24 hours, 43.25% between 1–3 days, 31.87% between 4–7 days and 9.97% >7 days. The distribution for mortality and pneumonia was 5.2% and 22.5% in <24 hours, 2.5% and 14% between 1–3 days, 3.6% and 19.5% between 4–7 days, 4.1% and 20.6% >7 days, respectively (p<0.001). Adjusted-risk of mortality was (OR [95% CI], p-value): <24 hours = 1.75 [1.55–1.98], p<0.001; 1–3 days = 1 (reference value); 4–7 days = 1.53 [1.37–1.70], p<0.001; >7 days = 1.67 [1.44–1.94], p<0.001. For pneumonia: <24 hours = 1.49 [1.39–1.58], p<0.001; 1–3 days = 1; 4–7 days = 1.48 [1.41–1.56], p<0.001; >7 days = 1.57 [1.46–1.69], p<0.001. Limitations Using a database fed by large numbers of people carries the risk of data inaccuracy. However, this imprecision is expected to be random and data are consistent with previous studies. Conclusion The PISYCS shows a U-shaped SARS-CoV-2 aggressiveness pattern. Further studies are needed to corroborate the time-related pathophysiology behind these findings.
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Affiliation(s)
- Dan Morgenstern-Kaplan
- Centro de Investigación en Ciencias de la Salud Anáhuac (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México
| | - Bruno Buitano-Tang
- Centro de Investigación en Ciencias de la Salud Anáhuac (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México
| | - Mercedes Martínez-Gil
- Centro de Investigación en Ciencias de la Salud Anáhuac (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México
| | - Andrea Zaldívar-Pérez Pavón
- Centro de Investigación en Ciencias de la Salud Anáhuac (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México
| | - Juan O. Talavera
- Centro de Investigación en Ciencias de la Salud Anáhuac (CICSA), Facultad de Ciencias de la Salud, Universidad Anáhuac México, Huixquilucan, Estado de México, México
- Department of Medical Education and Research, ABC Medical Center, Mexico City, CDMX, Mexico
- * E-mail:
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Maschke A, Paasche-Orlow MK, Kressin NR, Schonberg MA, Battaglia TA, Gunn CM. Discussions of Potential Mammography Benefits and Harms among Patients with Limited Health Literacy and Providers: "Oh, There are Harms?". J Health Commun 2020; 25:951-961. [PMID: 33455518 PMCID: PMC8062298 DOI: 10.1080/10810730.2020.1845256] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Starting breast cancer screening at age 40 versus 50 may increase potential harms frequency with a small mortality benefit. Younger women's screening decisions, therefore, may be complex. Shared decision-making (SDM) is recommended for women under 50 and may support women under 55 for whom guidelines vary. How women with limited health literacy (LHL) approach breast cancer screening decision-making is less understood, and most SDM tools are not designed with their input. This phenomenological study sought to characterize mammography counseling experiences among women with LHL and primary care providers (PCPs). Women ages 40-54 with LHL who had no history of breast cancer or mammogram within 9 months were approached before a primary care visit at a safety-net hospital. PCPs at this site were invited to participate. Qualitative interviews explored mammography counseling experiences. Patients also reviewed sample information materials. A constant comparison technique generated four themes salient to 25 patients and 20 PCPs: addressing family history versus comprehensive risk assessment; potential mammography harms discussions; information delivery preferences; and integrating pre-visit information tools. Findings suggest that current counseling techniques may not be responsive to patient-identified needs. Opportunities exist to improve how mammography information is shared and increase accessibility across the health literacy spectrum.
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Affiliation(s)
- Ariel Maschke
- Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nancy R Kressin
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mara A Schonberg
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Gunn
- Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, MA, USA
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Kushemererwa D, Davis J, Moyo N, Gilbert S, Gray R. The Association between Nursing Skill Mix and Mortality for Adult Medical and Surgical Patients: Protocol for a Systematic Review. Int J Environ Res Public Health 2020; 17:ijerph17228604. [PMID: 33228155 PMCID: PMC7699481 DOI: 10.3390/ijerph17228604] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
Skill mix refers to the number and educational experience of nurses working in clinical settings. Authors have used several measures to determine the skill mix, which includes nurse-to-patient ratio and the proportion of baccalaureate-prepared nurses. Observational studies have tested the association between nursing skill mix and patient outcomes (mortality). To date, this body of research has not been subject to systematic review or meta-analysis. The aim of this study is to systematically review and meta-analyse observational and experimental research that tests the association between nursing skill mix and patient mortality in medical and surgical settings. We will search four key electronic databases—MEDLINE [OVID], EMBASE [OVID], CINAHL [EBSCOhost], and ProQuest Central (five databases)—from inception. Title, abstract, and full-text screening will be undertaken independently by at least two researchers using COVIDENCE review management software. We will include studies where the authors report an association between nursing skill mix and outcomes in adult medical and surgical inpatients. Extracted data from included studies will consist measures of nursing skill mix and inpatient mortality outcomes. A meta-analysis will be undertaken if there are at least two studies with similar designs, exposures, and outcomes. The findings will inform future research and workforce planning in health systems internationally.
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Bianciardi E, Imperatori C, Niolu C, Campanelli M, Franceschilli M, Petagna L, Zerbin F, Siracusano A, Gentileschi P. Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates. Front Public Health 2020; 8:582699. [PMID: 33313038 PMCID: PMC7706656 DOI: 10.3389/fpubh.2020.582699] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery. Surgical emergencies and oncological procedures were the only operations allowed in public hospitals. Consequently, patients with morbid obesity were put in a standby situation. With the aim at exploring the viewpoint of our future bariatric surgery patients, we built a questionnaire concerning obesity and COVID-19. Method: A total of 116 bariatric surgery candidates were approached using a telephonic interview during the Italian lockdown. Results: Of the total sample, 73.8% were favorable to regular bariatric surgery execution. Forty percent were concerned about their own health status due to the COVID-19 emergency, and 61.1% were troubled by the temporary closure of the bariatric unit. The majority of the sample were eating more. Forty-five percent and the 27.5% of patients reported a worsening of the emotional state and physical health, respectively. Most of the patients (52.2%) considered themselves more vulnerable to COVID-19, especially individuals with class III obesity. Patients who reported an increased consumption of food were younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender difference emerged. Conclusion: The lockdown had a negative result on Italian patients' psychological well-being and eating habits. The majority of patients would have proceeded with the surgery even during the COVID-19 emergency. Effective management and bariatric surgery should be restarted as soon as possible.
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Affiliation(s)
- Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Marzia Franceschilli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Lorenzo Petagna
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Zerbin
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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York T, Jenney H, Jones G. Clinician and computer: a study on patient perceptions of artificial intelligence in skeletal radiography. BMJ Health Care Inform 2020; 27:e100233. [PMID: 33187956 PMCID: PMC7668302 DOI: 10.1136/bmjhci-2020-100233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Up to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being explored. OBJECTIVES To determine patient confidence in clinician-led radiograph interpretation, the perception of AI-assisted interpretation and management, and to identify factors which might influence these views. METHODS A novel questionnaire was distributed to patients attending fracture clinic in a large inner-city teaching hospital. Categorical and Likert scale questions were used to assess participant demographics, daily electronics use, pain score and perceptions towards AI used to assist in interpretation of their radiographs, and guide management. RESULTS 216 questionnaires were included (M=126, F=90). Significantly higher confidence in clinician rather than AI-assisted interpretation was observed (clinician=9.20, SD=1.27 vs AI=7.06, SD=2.13), 95.4% reported favouring clinician over AI-performed interpretation in the event of disagreement.Small positive correlations were observed between younger age/educational achievement and confidence in AI-assistance. Students demonstrated similarly increased confidence (8.43, SD 1.80), and were over-represented in the minority who indicated a preference for AI-assessment over their clinicians (50%). CONCLUSIONS Participant's held the clinician's assessment in the highest regard and expressed a clear preference for it over the hypothetical AI assessment. However, robust confidence scores for the role of AI-assistance in interpreting skeletal imaging suggest patients view the technology favourably.Findings indicate that younger, more educated patients are potentially more comfortable with a role for AI-assistance however further research is needed to overcome the small number of responses on which these observations are based.
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Affiliation(s)
- Thomas York
- Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Heloise Jenney
- Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Gareth Jones
- Clinical Senior Lecturer, Trauma and Orthopaedics, Imperial College London, London, UK
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Hernandez R, Petronio S. "Starting that Conversation Is Even Harder than Having It": Female Patients' Perceptions of Physicians' Communication Competence in Communication about Sexual Behavior. J Health Commun 2020; 25:917-924. [PMID: 33372850 DOI: 10.1080/10810730.2020.1864518] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Female college students demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behavior that puts them at risk for sexually transmitted infections and unplanned pregnancy. Physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particular young women, are reticent to talk to their physicians about sexual behavior because they typically consider the information to be private. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients. In this study, Communication Privacy Management (CPM) theory is used to investigate the criteria that female college students employ to negotiate the disclosure and concealment of information about sexual behavior in communication with physicians. Qualitative analysis of semi-structured interviews with female college students was used to explain their perceptions of disclosure of sexual behaviors to their physician. Specifically, the participants' perceptions of physicians' communication competence informed privacy management rules. These findings have the potential to improve communication interventions for both female college students and healthcare professionals.
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Affiliation(s)
- Rachael Hernandez
- Department of Communication, University of Missouri, Columbia, MO, USA
| | - Sandra Petronio
- Department of Communication Studies, Communication Privacy Management Center, Senior Affiliate Faculty, Charles Warren Fairbanks Center for Medical Ethics, Indiana University - Purdue University Indianapolis, Indianapolis, IN, USA
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Murphy M, McCaughan E, Carson MA, Donovan M, Wilson RH, Fitzsimons D. Nothing to lose: a grounded theory study of patients' and healthcare professionals' perspectives of being involved in the consent process for oncology trials with non-curative intent. BMC Palliat Care 2020; 19:166. [PMID: 33126874 PMCID: PMC7602307 DOI: 10.1186/s12904-020-00661-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Clinical cancer research trials may offer little or no direct clinical benefit to participants where a cure is no longer possible. As such, the decision-making and consent process for patient participation is often challenging. AIM To gain understanding of how patients make decisions regarding clinical trial participation, from the perspective of both the patient and healthcare professionals involved. METHODS In-depth, face to face interviews using a grounded theory approach. This study was conducted in a regional Cancer Centre in the United Kingdom. Of the 36 interviews, 16 were conducted with patients with cancer that had non-curative intent and 18 with healthcare professionals involved in the consent process. RESULTS 'Nothing to lose' was identified as the core category that underpinned all other data within the study. This highlighted the desperation articulated by participants, who asserted trial participation was the 'only hope in the room'. The decision regarding participation was taken within a 'trusting relationship' that was important to both patients and professionals. Both were united in their 'fight against cancer'. These two categories are critical in understanding the decision-making/consent process and are supported by other themes presented in the theoretical model. CONCLUSION This study presents an important insight into the complex and ethically contentious situation of consent in clinical trials that have non-curative intent. It confirms that patients with limited options trust their doctor and frequently hold unrealistic hopes for personal benefit. It highlights a need for further research to develop a more robust and context appropriate consent process.
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Affiliation(s)
- Mary Murphy
- Resuscitation Services, Elliott Dynes Building, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Eilís McCaughan
- School of Nursing and Midwifery, Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Matthew A Carson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Monica Donovan
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Richard H Wilson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
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De Marchis EH, Hessler D, Fichtenberg C, Fleegler EW, Huebschmann AG, Clark CR, Cohen AJ, Byhoff E, Ommerborn MJ, Adler N, Gottlieb LM. Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients. JAMA Netw Open 2020; 3:e2021201. [PMID: 33064137 PMCID: PMC7568201 DOI: 10.1001/jamanetworkopen.2020.21201] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Health care organizations are increasingly incorporating social risk screening into patient care. Studies have reported wide variations in patients' interest in receiving health care-based assistance for identified social risks. However, no study to date has examined the factors associated with patients' interest in receiving assistance, including whether interest in receiving assistance varies based on specific patient demographic characteristics. Targeted research on this topic could improve the success of health care-based programs that offer social care services. OBJECTIVE To identify participant characteristics associated with interest in receiving health care-based social risk assistance. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in 7 primary care clinics and 4 emergency departments in 9 US states between July 2, 2018, and February 13, 2019. A convenience sample of adult patients and adult caregivers of pediatric patients completed a screening survey that measured social risk factors and participants' interest in receiving assistance for identified social risks. Participants were randomly selected to receive 1 of 2 versions of the survey, which differed based on the order in which questions about social risks and interest in receiving assistance were presented. Multivariable logistic regression analyses were used to evaluate the associations between covariates and participants' interest in receiving assistance, stratified by social risk screening results. Data were analyzed from September 8, 2019, to July 30, 2020. EXPOSURES Social risk screening questions assessed risk factors comprising housing, food, transportation, utilities, and exposure to interpersonal violence. Additional questions assessed participants' interest in receiving assistance and their perspectives on health care-based social risk screening. MAIN OUTCOMES AND MEASURES Participant interest in receiving health care-based social risk assistance. RESULTS A total of 1021 adult participants with complete survey responses were included in the analysis. Of those, 709 of 1004 participants (70.6%) were female, and 544 of 1007 participants (54.0%) were aged 18 to 44 years. Overall, 353 of 662 participants (53.3%) with positive screening results for 1 or more social risk factors were interested in receiving assistance, whereas 31 of 359 participants (8.6%) with negative screening results for all social risks were interested in receiving assistance. Participants with positive screening results for 1 or more social risk factors had a higher likelihood of being interested in receiving assistance if they answered the question about interest in receiving assistance before they answered the questions about social risk factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.05-2.07), had positive screening results for a higher number of social risk factors (aOR, 2.40; 95% CI, 1.68-3.42), reported lower household income levels (aOR, 7.78; 95% CI, 2.96-20.44), or self-identified as having non-Hispanic Black ancestry (aOR, 2.22; 95% CI, 1.37-3.60). Among those with negative screening results for all social risk factors, the interest in receiving assistance was higher if the participants reported lower household income levels (aOR, 12.38; 95% CI, 2.94-52.15), previous exposure to health care-based social risk screening (aOR, 2.35; 95% CI, 1.47-3.74), higher perceived appropriateness of social risk screening (aOR, 3.69; 95% CI, 1.08-12.55), or worse health status (aOR, 4.22; 95% CI, 1.09-16.31). CONCLUSIONS AND RELEVANCE In this study, multiple factors were associated with participants' interest in receiving social risk assistance. These findings may have implications for how and when social risk assistance is offered to patients. As the health care system's role in addressing social risk factors evolves, an understanding of patients' perspectives regarding screening and their interest in receiving assistance may be important to implementing patient-centered interventions.
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Affiliation(s)
- Emilia H. De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Caroline Fichtenberg
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
| | - Eric W. Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy G. Huebschmann
- Division of General Internal Medicine and Center for Women’s Health Research, University of Colorado School of Medicine, Aurora
| | - Cheryl R. Clark
- Division of General Internal Medicine and Primary Care, Center for Community Health and Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alicia J. Cohen
- Providence VA Medical Center, Departments of Family Medicine and Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Elena Byhoff
- Department of Medicine and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Mark J. Ommerborn
- Center for Community Health and Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nancy Adler
- Department of Psychiatry, University of California, San Francisco, San Francisco
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco
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Cheong AT, Tong SF, Chinna K, Khoo EM, Liew SM. Gender differences in factors influencing intention to undergo cardiovascular disease health checks: A cross-sectional survey. PLoS One 2020; 15:e0239679. [PMID: 32970741 PMCID: PMC7514016 DOI: 10.1371/journal.pone.0239679] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022] Open
Abstract
Background Undergo a health check for cardiovascular disease (CVD) is an important strategy to improve cardiovascular (CV) health. Men are reported to be less likely to undergo cardiovascular disease (CVD) health check than women. Gender difference could be one of the factors influencing health seeking behaviour of men and women. We aimed to identify gender differences in factors influencing the intention to undergo CVD health checks. Methods This was a cross-sectional survey using mall intercept interviews. Malaysians aged ≥30 years without known CVD were recruited. They were asked for their intention to undergo CVD health checks and associated factors. The factors included seven internal factors that were related to individuals’ attitude, perception and preparedness for CVD health checks and two external factors that were related to external resources. Hierarchical ordinal regression analysis was used to evaluate the importance of the factors on intention to undergo CVD health checks, for men and women separately. Results 397 participants were recruited, 60% were women. For men, internal factors explained 31.6% of the variances in likeliness and 9.6% of the timeline to undergo CVD health checks, with 1.2% and 1.8% added respectively when external factors were sequentially included. For women, internal factors explained 18.9% and 22.1% of the variances, with 3.1% and 4.2% added with inclusion of the external factors. In men, perceived drawbacks of health checks was a significant negative factor associated with likeliness to undergo CVD health checks (coefficient = -1.093; 95%CI:-1.592 to -0.594), and timeline for checks (coefficient = -0.533; 95%CI:-0.975 to -0.091). In women, readiness to handle outcomes following health checks was significantly associated with likeliness to undergo the checks (coefficient = 0.575; 95%CI: 0.063 to 1.087), and timeline for checks (coefficient = 0.645; 95%CI: 0.162 to 1.128). Both external factors 1) influence by significant others (coefficient = 0.406; 95%CI: 0.013 to 0.800) and 2) external barriers (coefficient = -0.440; 95%CI:-0.869 to -0.011) were also significantly associated with likeliness to undergo CVD health checks in women. Conclusions Both men and women were influenced by internal factors in their intention to undergo CVD health checks, and women were also influenced by external factors. Interventions to encourage CVD health checks need to focus on internal factors and be gender sensitive.
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Affiliation(s)
- Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- * E-mail: ,
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University Malaysia, Subang Jaya, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Min D, Park JS, Choi EY, Ahn JA. Comparison of learning needs priorities between healthcare providers and patients with heart failure. PLoS One 2020; 15:e0239656. [PMID: 32970770 PMCID: PMC7514042 DOI: 10.1371/journal.pone.0239656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022] Open
Abstract
It is necessary to understand the learning needs of heart failure (HF) patients to provide adequate patient education. It is necessary to identify what HF patients want to know and how this differs from the educational needs of healthcare providers. The aim of this descriptive and exploratory study was to evaluate and compare the learning needs priorities between HF patients and their healthcare providers. One hundred patients with HF and 20 healthcare providers were recruited from cardiovascular outpatient clinics at 2 large tertiary medical centers in South Korea. Learning needs were measured using a self-administered questionnaire with the Heart Failure Patients’ Learning Needs Inventory. Data were analyzed using SPSS 23.0 program. Overall rank orders for 48 items were similar in both groups (Spearman rank order correlation 0.605, p < .001). The educational topics of medications and worsening signs and symptoms ranked highest in both groups. However, healthcare providers were more concerned with diet management than were the patients (mean score 4.18 vs. 3.62; p = .001). The study showed both similarities and differences between the assessments of the patients and healthcare providers of detailed educational learning needs. It is important to develop patient-centered educational materials considering HF patients’ actual learning needs, and also to provide comprehensive and practical patient education based on a supportive understanding of healthcare provider needs.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Eui-Young Choi
- Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ah Ahn
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Korea
- * E-mail:
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45
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Abstract
BACKGROUND Patients with an intestinal stoma experience psychological difficulties, including disturbances in self-efficacy and self-esteem. There is evidence that they are interdependent. AIM This study aimed to determine the correlation between self-efficacy and self-esteem in patients with an intestinal stoma. METHODS A descriptive-correlational study was conducted with 155 patients with an intestinal stoma. Participants were selected using convenience sampling. Data were collected using demographic questions, the stoma self-efficacy scale and the Rosenberg self-esteem scale, and analysed using descriptive and analytical statistics. FINDINGS Seventy-nine men and 76 women took part; the 50-70 years age group had the highest proportion of participants. Regarding diagnosis, 52.26% had cancer and 45.81% had inflammatory bowel disease or related conditions. Pearson's correlation coefficient indicated a positive, significant correlation between total self-efficacy and its dimensions with self-esteem (P<0.001; r=0.54). CONCLUSION Self-efficacy is positively correlated with self-esteem in patients with an intestinal stoma. It is recommended that educational interventions are planned and implemented to boost self-esteem and self-efficacy in these patients.
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Affiliation(s)
- Fariba Nasiriziba
- Lecturer, Enterostomal Therapist/Wound, Ostomy and Continence Nurse, Medical Surgical Department, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Saati
- Medical Surgical Nursing Student, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Haghani
- Assistant Professor, Biostatistics Department, School of Health, Iran University of Medical Sciences, Tehran, Iran
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Abstract
This cross-sectional study examines the degree to which patient bills of rights and responsibilities from 50 academic hospitals in the US communicate a zero-tolerance policy against patient-perpetrated sexual harassment toward health care professionals.
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Affiliation(s)
- Elizabeth M. Viglianti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Lisa M. Meeks
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Andrea L. Oliverio
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor
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Rathlev NK, Visintainer P, Schmidt J, Hettler J, Albert V, Li H. Patient Characteristics and Clinical Process Predictors of Patients Leaving Without Being Seen from the Emergency Department. West J Emerg Med 2020; 21:1218-1226. [PMID: 32970578 PMCID: PMC7514399 DOI: 10.5811/westjem.2020.6.47084] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Delays in patient flow in the emergency department (ED) result in patients leaving without being seen (LWBS). This compromises patient experience and quality of care. Our primary goal was to develop a predictive model by evaluating associations between patients LWBS and ED process measures and patient characteristics. METHODS This was a cross-sectional study in a 95,000 annual visit adult ED comparing patients LWBS, with controls. Data were drawn from four seasonally adjusted four-week periods (30,679 total visits). Process measures included 1) arrivals per hour; 2) "door-to-provider" time; and the numbers of 3) patients in the waiting room; 4) boarding ED patients waiting for an inpatient bed; 5) providers and nurses (RN); and 6) patients per RN. Patient characteristics collected included 1) age; 2) gender; 3) race/ethnicity; 4) arrival mode (walk-in or via emergency medical services [EMS]); and 5) acuity based on Emergency Severity Index (ESI). Univariable analyses included t-tests and Pearson's chi-square tests. We split the data randomly into derivation and validation cohorts. We used backward selection to develop the final derivation model, and factors with a p-value ≤ 0.05 were retained. Estimates were applied to the validation cohort and measures of discrimination (receiver operating characteristic) and model fit were assessed. RESULTS In the final model, the odds of LWBS increased with the number of patients in the waiting room (odds ratio [OR] 1.05; 95% confidence interval [CI], 1.03 to 1.06); number of boarding patients (OR 1.02; 95% CI, 1.01 to 1.03); arrival rate (OR 1.04; 95% CI, 1.02 to 1.05) and longer "door-to-provider" times (test of linear trend in the adjusted OR was p = 0.002). Patient characteristics associated with LWBS included younger age (OR 0.98; 95% CI, 0.98 to 0.99), and lower acuity (higher ESI category) (OR 2.01; 95% CI, 1.84 to 2.20). Arrival by EMS was inversely associated with LWBS (OR 0.29; 0.23 to 0.36). The area under the curve for the final model in the validation cohort was 0.85 (95% CI, 0.84 to 0.86). There was good agreement between the observed and predicted risk. CONCLUSION Arrival rate, "door-to-provider time," and the numbers of patients in the waiting room and ED boarders are all associated with patients LWBS.
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Affiliation(s)
- Niels K Rathlev
- University of Massachusetts Medical School - Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Paul Visintainer
- University of Massachusetts Medical School - Baystate, Department of Epidemiology and Biostatistics Core, Springfield, Massachusetts
| | - Joseph Schmidt
- University of Massachusetts Medical School - Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Joeli Hettler
- University of Massachusetts Medical School - Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Vanna Albert
- University of Massachusetts Medical School - Baystate, Department of Emergency Medicine, Springfield, Massachusetts
| | - Haiping Li
- University of Massachusetts Medical School - Baystate, Department of Emergency Medicine, Springfield, Massachusetts
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48
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Abstract
IMPORTANCE Medical practices increasingly allow patients to schedule their own visits through online patient portals, yet little is known about who adopts direct scheduling or how this service is used. OBJECTIVE To determine patient and visit characteristics associated with direct scheduling, visit patterns, and potential implications for access and continuity in the primary care setting. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used electronic health record (EHR) data from 17 adult primary care practices in a large academic medical center in the Boston, Massachusetts, area. Participants included patients 18 years or older who were attributed in the EHR to an active primary care physician at 1 of the included primary care practices, were enrolled in the patient portal, and had at least 1 visit to 1 of these practices between March 1, 2018, and March 1, 2019, the period of analysis. Data were analyzed from October 25, 2019, to April 14, 2020. MAIN OUTCOMES AND MEASURES Adoption of direct scheduling, defined as at least 1 use during the study period. Usual scheduling was defined as scheduling with clinic staff by telephone or in person. RESULTS We examined 134 225 completed visits by 62 080 patients (mean [SD] age, 51.1 [16.4] years, 37 793 [60.9%] women) attributed to 140 primary care physicians at 17 primary care practices. A total of 5020 patients (8.1% [95% CI, 7.9%-8.3%]) adopted direct scheduling, with an age range of 18 to 95 years. Compared with nonadopters in the same practices, adopters were younger (adjusted odds ratio [AOR] per additional year, 0.98 [95% CI, 0.98-0.99]) and were more likely to be White (AOR, 1.09 [95% CI, 1.01-1.17]) and commercially insured (AOR vs uninsured, 1.40 [95% CI, 1.11-1.76]) and to have more comorbidities (AOR per additional comorbidity, 1.07 [95% CI, 1.04-1.11]). Compared with usually scheduled visits, directly scheduled visits were more likely to be for general medical examinations (1979 visits [36.7%] vs 26 519 visits [21.9%]; P < .001) and with one's own primary care physician (5267 visits [95.2%] vs 94 634 visits [73.5%]; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that direct scheduling was associated with greater primary care continuity. Early adopters were more likely to be young, White, and commercially insured, and to the extent these differences persist as direct scheduling is used more widely, this service may widen socioeconomic disparities in primary care access.
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Affiliation(s)
- Ishani Ganguli
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - E. John Orav
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claire Lupo
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Joshua P. Metlay
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Thomas D. Sequist
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Mass General Brigham, Boston, Massachusetts
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Chattopadhyay D, Ma T, Sharifi H, Martyn-Nemeth P. Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18839. [PMID: 32729837 PMCID: PMC7426801 DOI: 10.2196/18839] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications. OBJECTIVE The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined. METHODS Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed. RESULTS Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1). CONCLUSIONS We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.
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Affiliation(s)
- Debaleena Chattopadhyay
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Tengteng Ma
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Hasti Sharifi
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL, United States
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Health Science, University of Illinois at Chicago, Chicago, IL, United States
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50
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Jagsi R, Griffith KA, Carrese JA, Collins M, Kao AC, Konrath S, Tovino SA, Wheeler JL, Wright SM. Public Attitudes Regarding Hospitals and Physicians Encouraging Donations From Grateful Patients. JAMA 2020; 324:270-278. [PMID: 32692387 DOI: 10.1001/jama.2020.9442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines. OBJECTIVE To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients. DESIGN, SETTING, AND PARTICIPANTS Using the Ipsos KnowledgePanel, a probability-based sample representative of the US population, a survey solicited opinions from a primary cohort representing the general population and 3 supplemental cohorts (with high income, cancer, and with heart disease, respectively). EXPOSURES Web-based questionnaire. MAIN OUTCOMES AND MEASURES Descriptive analyses (with percentages weighted to make the sample demographically representative of the US population) evaluated respondents' attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship. RESULTS Of 831 individuals targeted for the general population sample, 513 (62%) completed surveys, of whom 246 (48.0%) were women and 345 (67.3%) non-Hispanic white. In the weighted sample, 47.0% (95% CI, 42.3%-51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients' permission was definitely or probably acceptable; 8.5% (95% CI, 5.7%-11.2%) endorsed referring without asking permission. Of the participants, 79.5% (95% CI, 75.6%-83.4%) reported it acceptable for physicians to talk to patients about donating if patients have brought it up; 14.2% (95% CI, 10.9%-17.6%) reported it acceptable when patients have not brought it up; 9.9% (95% CI, 7.1%-12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5%-86.9%) agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4%-54.7%) indicated it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9%-30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1%-23.5%) by providing physicians' cell phone numbers. CONCLUSIONS AND RELEVANCE In this survey study of participants drawn from the general US population, a substantial proportion did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.
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Affiliation(s)
| | | | | | | | | | - Sara Konrath
- Indiana University-Purdue University Indianapolis
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