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1.
Med Teach ; 43(9): 1031-1038, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33840349

RESUMO

INTRODUCTION: To train health professionals for patient-centered care, patient engagement in medical curriculum development and assessment is widely recommended. But there are few published methods on how to consult with patients effectively, particularly when creating entrustable professional activities (EPAs). In this mixed-method study, we developed a questionnaire for facilitating patient input when developing EPA assessment criteria. METHODS: We developed a questionnaire for documenting patient expectations of their doctors which included: patient interviews to identify questionnaire items, expert validation, cognitive interviews with respondents, and finally, pilot testing. For the pilot testing, 87 participants with a variety of health problems from medical/surgical wards and outpatient clinics at a tertiary hospital were recruited. The final questionnaire included open-ended and ranking-style questions. RESULTS: Using the questionnaire, patients could identify their key expectations of their doctors when managing their current medical problem. Most patients wrote clear, brief free-text responses directly applicable to EPA descriptors that were time-efficient to analyze. CONCLUSIONS: The questionnaire is a feasible method of recording patient expectations, enabling educators to consult with and include patient perspectives when developing criteria for entrustment decisions in a diverse range of clinical contexts.


Assuntos
Internato e Residência , Médicos , Competência Clínica , Educação Baseada em Competências , Humanos , Motivação , Inquéritos e Questionários
2.
BMC Musculoskelet Disord ; 21(1): 133, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111200

RESUMO

BACKGROUND: One in three women and one in five men are expected to experience a minimal-trauma-fracture after the age of 50-years, which increases the risk of subsequent fracture. Importantly, timely diagnosis and optimal treatment in the form of a fracture liaison service (FLS), has been shown to reduce this risk of a subsequent fracture. However, baseline risk of subsequent fracture among this group of FLS patients has not been well described. Therefore, this study aims to estimate absolute risk of subsequent fracture, among women and men aged 50-years or more, presenting to hospital with a minimal-trauma-fracture. METHODS: Women and men aged 50-years or more with a minimal-trauma-fracture, presenting to hospitals across the South Western Sydney Local Health District between January 2003 and December 2017 were followed to identify subsequent fracture presentations to hospital. Absolute risk of subsequent fracture was estimated, by taking into account the competing risk of death. RESULTS: Between January 2003 and December 2017-15,088 patients presented to the emergency departments of the five hospitals in the SWSLHD (11,149, women [74%]), with minimal-trauma-fractures. Subsequent fractures identified during the follow-up period (median = 4.5 years [IQR, 1.6-8.2]), occurred in 2024 (13%) patients. Death during the initial hospital stay, or during a subsequent hospital visit was recorded among 1646 patients (11%). Women were observed to have 7.1% risk of subsequent fracture after 1-year, following an initial fracture; and, the risk of subsequent fracture after 1-year was 6.2% for men. After 5-years the rate among women was 13.7, and 11.3% for men, respectively. Cumulative risk of subsequent fracture when initial fractures were classified as being at proximal or distal sites are also presented. CONCLUSION: This study has estimated the baseline risk of subsequent fracture among women and men presenting to hospital with minimal trauma fractures. Importantly, this information can be used to communicate risk to patients deciding to attend an osteoporosis refracture prevention clinic, and highlight the need for screening, and initial of treatment when indicated, once a minimal-trauma-fracture has occurred.


Assuntos
Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/prevenção & controle , Prevenção Secundária/métodos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/cirurgia , Recidiva , Medição de Risco , Fatores de Risco , Fatores Sexuais
4.
Patient Educ Couns ; 118: 107996, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37832345

RESUMO

OBJECTIVE: People with autoimmune and inflammatory rheumatic disease (AIIRD) are at an increased risk of morbidity from COVID-19. While COVID-19 vaccination is effective at reducing disease complications, there have been significant levels of vaccine hesitancy in people with AIIRD. We aimed to understand vaccine hesitancy and promote shared decision-making by describing the experiences and perspectives of people with AIIRD who had concerns with COVID-19 vaccinations. METHODS: Adults with AIIRD on immunosuppressive medications who expressed concerns regarding the COVID-19 vaccination were purposively sampled until thematic saturation. Individual semi-structured interviews were conducted and analysed using reflexive thematic analysis. RESULTS: Sixteen adults with an AIIRD were interviewed. Thematic analysis yielded four themes: heightened sense of vulnerability; determining individual suitability; desperate for freedom and relief; deterred by scepticism. CONCLUSIONS: The perspectives of people with AIIRD towards the COVID-19 vaccination were shaped by a sense of vulnerability. The decision-making experience was challenging, resulting from struggles with handling information, dealing with external pressures, and facing negativity. PRACTICE IMPLICATIONS: A collaborative approach, involving close family and friends and avoiding negativity and pressure can improve engagement and support decision-making around COVID-19 vaccination. Clearly addressing potential risks of vaccination may prevent subsequent regret and hesitancy if they arise.


Assuntos
Doenças Autoimunes , COVID-19 , Doenças Reumáticas , Adulto , Humanos , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Tomada de Decisão Compartilhada , Vacinação
5.
Radiol Case Rep ; 16(3): 678-683, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33488898

RESUMO

Magnetic resonance imaging (MRI) is regarded as the most specific and sensitive of imaging modalities for the detection and progression of osteonecrosis (ON). We present MRI progression of ON in the knee in a 40-year-old female patient with Sjogren disease-related interstitial nephritis recently initiated on corticosteroids for deteriorating renal function. This case report correlates the degree of surrounding marrow edema with the patient's symptoms.

6.
Int J Rheum Dis ; 24(9): 1112-1120, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34076348

RESUMO

BACKGROUND: Psoriatic arthritis (PsA), rheumatoid arthritis (RA) and psoriasis (PsO) are associated with systemic inflammation and increased cardiovascular mortality and morbidity. Metabolic syndrome (MetS) is associated with systemic inflammation, and conditions associated with MetS, such as obesity, are associated with difficulty in attaining minimal disease activity (MDA) in individuals with inflammatory arthritis. This systematic review aims to determine whether there is an increased prevalence of MetS in PsA populations compared with PsO and RA populations. METHODS: A systematic review was conducted to assess the prevalence of MetS in PsA, PsO, and RA populations following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of the studies reviewed was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. RESULTS: The pooled prevalence of MetS in PsA populations was 0.46 ± 0.06 (95% CI 0.40-0.51). In comparison, the prevalence of MetS in PsO and RA populations was 0.34 ± 0.03 (95% CI 0.32-0.37) and 0.31 ± 0.04 (95% CI 0.27-0.35), respectively. Patients with PsA were 1.62 ± 0.036 (95% CI 1.50-1.74) and 1.66 ± 0.038 (95% CI 1.54-1.79) times more likely to have MetS compared with PsO and RA populations. CONCLUSION: The prevalence of MetS is significantly increased in PsA populations compared with PsO and RA populations. Further studies should be performed using a standardized definition of MetS in PsA, RA, and PsO populations to determine whether addressing the metabolic components in MetS offers any therapeutic benefits and in terms of attaining MDA and improving cardiovascular health.


Assuntos
Artrite Psoriásica/epidemiologia , Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Psoríase/epidemiologia , Artrite Psoriásica/diagnóstico , Artrite Reumatoide/diagnóstico , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Prevalência , Psoríase/diagnóstico , Medição de Risco , Fatores de Risco
7.
Artigo em Inglês | MEDLINE | ID: mdl-34930756

RESUMO

Ménétrier's disease (MD) is a rare gastropathy characterised by giant rugal folds which can present with nausea, vomiting, abdominal pain and protein losing gastropathy. We report a 21-year-old woman with comorbid MD and ulcerative colitis (UC). Management was complicated by limited treatment options for MD, significant symptom burden, worsening nutrition and difficulty determining which disease was the predominant cause of symptoms. Since age 18 the patient experienced recurrent UC flares characterised by diarrhoea, persistent vomiting and corticosteroid dependence. Endoscopic assessment demonstrated concurrent MD and active UC. Octreotide and cetuximab were trialled given persistent hypoalbuminaemia and suspicion for MD associated protein-losing gastropathy. UC management comprised dose-optimised infliximab and methotrexate. Repeat endoscopic assessment demonstrated improvement in UC without corresponding improvement in symptoms or hypoalbuminaemia. Nasojejunal feeding and parenteral nutrition failed to significantly improve nutritional status and accordingly the patient proceeded to radical total gastrectomy. Postoperatively, MD-associated symptoms and hypoalbuminemia resolved completely.


Assuntos
Colite Ulcerativa , Gastrite Hipertrófica , Hipoalbuminemia , Gastropatias , Adolescente , Adulto , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Feminino , Gastrectomia/efeitos adversos , Gastrite Hipertrófica/complicações , Gastrite Hipertrófica/diagnóstico , Gastrite Hipertrófica/cirurgia , Humanos , Hipoalbuminemia/complicações , Hipoalbuminemia/cirurgia , Gastropatias/complicações , Gastropatias/cirurgia , Vômito , Adulto Jovem
8.
J Patient Exp ; 7(6): 1724-1731, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33457636

RESUMO

Understanding and measuring patient expectations of health care is central to improving patient satisfaction and delivering patient-centered care. However, most empiric research in this field has focused on measuring patient expectations for specific diseases only. Patient expectations common to a variety of settings and clinical contexts need to be better understood to design measures with wider utility. We aimed to understand how patients express and conceptualize their expectations of health care across a range of clinical contexts and conditions. Semi-structured interviews were conducted with patients presenting to a major metropolitan hospital, informed by interpretive phenomenological analysis. Sampling continued until thematic saturation. Interview topics explored the illness experience, interactions with clinicians, how patients communicated and conceptualized their expectations of health care, and the nature of these expectations. The 26 participants conceptualized and described their expectations in 3 distinct domains: (1) health outcomes, (2) individual clinicians, and (3) the health-care system. Importantly, these domains were consistent across a variety of clinical contexts, participant demographics, and medical conditions. Despite variation in expectations due to individual patient circumstances, we identified 3 conceptual domains within which expectations consistently lie. When designing measurement tools for patient expectations, we suggest incorporating questions specifically addressing the 3 domains we have identified. With such measures, clinicians and health-care providers can be empowered to provide and monitor patient-centered care with outcomes tailored to what patients desire.

9.
Int J Rheum Dis ; 22(6): 967-973, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31025820

RESUMO

AIM: To investigate the point prevalence of depression and anxiety in psoriatic arthritis and putative reductions in these comorbidities with the treatment of psoriatic arthritis. METHOD: We performed a systematic review in accordance with PRISMA guidelines examining point prevalence of depression and anxiety in psoriatic arthritis as well as effects of treatment for psoriatic arthritis on these psychiatric comorbidities. MEDLINE, EMBASE, EBM Reviews and Cochrane, and PsycINFO were searched from inception to October 2017. Quality of studies was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. Study and population characteristics were extracted and entered into an electronic database for subsequent descriptive and meta-analysis of point prevalence. RESULT: Three studies matched inclusion criteria with significant statistical heterogeneity. The prevalence of depression ranged between 9%-22% and anxiety between 15%-30% in patients with psoriatic arthritis. One study matched inclusion criteria for treatment effect analysis, albeit with a high risk of bias and illustrated a benefit of etanercept on the prevalence of depression (9% vs 16%) and anxiety (14% vs 30%) after 24 weeks of treatment. CONCLUSION: This is the first systematic review of point prevalence of depression and anxiety in patients with psoriatic arthritis. There is a moderate point prevalence of both depression and anxiety in patients with psoriatic arthritis, which is similar or slightly higher than the general population and comparable to that seen in other rheumatic diseases. The effects of treatment for psoriatic arthritis on comorbid depression and anxiety remain unclear.


Assuntos
Afeto , Ansiedade/epidemiologia , Artrite Psoriásica/epidemiologia , Depressão/epidemiologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/psicologia , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/psicologia , Comorbidade , Depressão/diagnóstico , Depressão/psicologia , Etanercepte/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Resultado do Tratamento , Inibidores do Fator de Necrose Tumoral/uso terapêutico
10.
Int J Rheum Dis ; 21(4): 796-803, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27125577

RESUMO

AIM: To understand the patient experience of being admitted to hospital with acute low back pain (LBP), with a view to developing suggestions for care and LBP management guidelines. METHOD: Interpretive phenomenological analysis (IPA) was adopted to examine semi-structured interviews from patients admitted to hospital with acute LBP. Sampling continued until thematic saturation was reached (n = 14). Data were analyzed using the Framework Method, so that data from multiple participants could be systematically summarized, compared, and analyzed. RESULTS: Four themes were identified: pain and helplessness, desire for validation, interactions with healthcare teams, and a return to pre-morbid identity and roles. Patients' initial presentation to hospital was characterized by severe pain, disability and difficulty in communicating their illness experience. Patients expected doctors to investigate for an underlying cause of the back pain. To recover, they were required to navigate a system they did not understand, interacting with healthcare workers who seemed to operate independently rather than as a team. Patients viewed medical treatment as a means of returning to pre-morbid activities of daily living, roles and relationships. Using these themes, a model of the inpatient journey was developed. CONCLUSION: We have described new patient insights which highlight how the hospital environment adds unique challenges to managing acute LBP. Several suggestions for acute LBP management guidelines are made: developing lay summaries for patients, including methods for communicating the team structure and roles to patients, and ensuring all members of treating teams are educated to ensure guidelines are consistently implemented.


Assuntos
Dor Aguda/psicologia , Prestação Integrada de Cuidados de Saúde , Dor Lombar/psicologia , Admissão do Paciente , Satisfação do Paciente , Dor Aguda/diagnóstico , Dor Aguda/fisiopatologia , Dor Aguda/terapia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Comunicação , Efeitos Psicossociais da Doença , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Percepção da Dor , Limiar da Dor , Equipe de Assistência ao Paciente , Relações Profissional-Paciente , Pesquisa Qualitativa , Recuperação de Função Fisiológica , Índice de Gravidade de Doença
11.
Acad Med ; 92(6): 800-808, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28557946

RESUMO

PURPOSE: The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA. METHOD: The authors chose "management of acute low back pain (LBP)" as a common, important clinical task on which to base the patient-centered EPA. In 2015, 14 patients who presented to a teaching hospital with acute LBP participated in semistructured interviews exploring their illness experience and expectations of doctors. Clinicians representing multiple disciplines participated in a focus group. The authors used the Framework Method to analyze data, identifying and developing themes, similarities, and differences between patient and clinician input. They used the findings to develop the EPA. Through an iterative procedure of data review and tracking data sources, they determined how patient and clinician input informed each EPA descriptor. RESULTS: Drawing from their firsthand experience of LBP, patients described unique expectations of trainees which directly informed EPA descriptors. For example, the authors primarily used patients' detailed descriptions of desirable and observable trainee behaviors to inform the required attitudes descriptor. CONCLUSIONS: Patients can provide unique contributions, complementary to those of clinicians, to EPAs. Consultations with patients led to the development of a patient-centered EPA, which aligned best clinical practice with patient expectations. Educators seeking to apply patient-centered care to EPA development could adopt a similar approach.


Assuntos
Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Internato e Residência/normas , Dor Lombar/terapia , Participação do Paciente , Assistência Centrada no Paciente/normas , Competência Profissional/normas , Adulto , Avaliação Educacional/métodos , Feminino , Grupos Focais , Humanos , Masculino , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina , Estados Unidos , Adulto Jovem
12.
RMD Open ; 3(1): e000391, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29225915

RESUMO

OBJECTIVE: To compare patients with a primary diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (RA) for scores on a patient self-report MDHAQ/RAPID3 (Multidimensional Health Assessment Questionnaire/Routine Assessment of Patient Index Data 3), and for physician global assessment (DOCGL). METHODS: All patients with all diagnoses complete an MDHAQ/RAPID3 at all routine rheumatology visits in the waiting area before seeing a rheumatologist at four sites, one in Australia and three in the USA. The two-page MDHAQ includes 0-10 scores for physical function (in 10 activities), pain and patient global assessment [on 0-10 visual analogue scales (VAS)], compiled into a 0-30 RAPID3, as well as fatigue and self-report painful joint count scales. Rheumatologists estimate a 0-10 DOCGL VAS. Demographic, MDHAQ/RAPID3 and DOCGL data from a random visit were compared in patients with RA versus patients with OA using multivariate analysis of variance, adjusted for age, disease duration and formal education level. RESULTS: Median RAPID3 was higher in OA versus RA at all four sites (11.7-16.8 vs 6.2-11.8) (p<0.001 at three sites). Median DOCGL in OA versus RA was 5 vs 4, 4 vs 3.7, 2.2 vs 2.5 and 2 vs 1. Patterns were similar for individual RAPID3 items, fatigue and painful joint scales, and in stratified analyses of patients aged 55-70. CONCLUSION: Patient MDHAQ/RAPID3 and physician DOCGL indicate similar or higher disease burden in OA versus RA. Routine MDHAQ/RAPID3 allows direct comparisons of the two diseases. The findings suggest possible revision of current clinical and public policy views concerning OA.

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