Optimizing Communication About Topical Corticosteroids: A Quality Improvement Study [Formula: see text].

BACKGROUND: Patients are often non-adherent to topical corticosteroids (TCS). This may be in part due to poor communication between patients and dermatologists. OBJECTIVES: This quality improvement (QI) study aims to describe dermatologist-patient communication about TCS treatments and to compare communication before and after the implementation of an educational intervention. METHODS: This QI study assesses the communication between dermatologists and new dermatology outpatients receiving a TCS prescription in a tertiary care center. The QI intervention is 2-pronged, consisting of an educational pamphlet for patients and a communication workshop for the dermatology team. Encounters were audiotaped, and communication was analyzed using a coding system (MEDICODE). Phase 1 recordings happened preintervention and reflect the usual dermatologist-patient communication in this practice setting and phase 2 recordings were postintervention. RESULTS: Phase 1 reveals that dermatologists frequently address informational medication themes, such as naming the medications and informing patients about their proper use. They less frequently discuss patient experience themes, such as goals of treatment, adverse effects of treatments, and exploring patients' emotions about medications (such as anxiety, fears, etc.). After the intervention, there was more frequent discussion of patient experience themes without increasing consultation length. But, in both phases, physicians address most themes as a monolog with little verbal input from patients. CONCLUSIONS: Our study raises awareness regarding dermatologists' communication patterns about TCS, identifying specific areas for improvement, such as discussions of adverse effects, and explicitly addressing patients' attitudes and emotions. This is an essential step to foster a sense-making of TCS for patients.

The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial.

OBJECTIVE: Examine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care. METHODS: Three arm single-blind RCT in community primary care (PC) practices. PC practitioners (n=18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia. INTERVENTIONS: (1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care. OUTCOME: Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for. RESULTS: Patients (n=322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00-2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up. CONCLUSIONS: Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients. PRACTICE IMPLICATIONS: Web communication interventions are an effective tool that can be used in primary care.

Communication and patient participation influencing patient recall of treatment discussions.

CONTEXT: Patient recall of treatment information is a key variable towards chronic disease (CD) management. It is unclear what communication and patient participation characteristics predict recall. OBJECTIVES: To assess what aspects of doctor-patient communication predict patient recall of medication information. To describe lifestyle treatment recall, in CD primary care patients. DESIGN: Observational study within a RCT. SETTING & PARTICIPANTS: Community-based primary care (PC) practices. Family physicians (n=18): practicing >5 years, with a CD patient caseload. Patients (n=159): >40 years old, English speaking, computer literate, off-target hypertension, type II diabetes and/or dyslipidaemia. MAIN VARIABLES: Patient characteristics: age, education, number of CDs. Information characteristics: length of encounter, medication status, medication class. Communication variables: socio-emotional utterances, physician dominance and communication control scores and PACE (ask, check and express) utterances, measured by RIAS. Number of medication themes, dialogue and initiative measured by MEDICODE. MAIN OUTCOME MEASURES: Recall of CD, lifestyle treatment and medication information. RESULTS: Frequency of lifestyle discussions varied by topic. Patients recalled 43% (alcohol), 52% (diet) to 70% (exercise) of discussions. Two and a half of six possible medication themes were broached per medication discussion. Less than one was recalled. Discussing more themes, greater dialogue and patient initiative were significant predictors of improved medication information recall. DISCUSSION: Critical treatment information is infrequently exchanged. Active patient engagement and explicit conversations about medications are associated with improved treatment information recall in off-target CD patients followed in PC. CONCLUSION: Providers cannot take for granted that long-term off-target CD patients recall information. They need to encourage patient participation to improve recall of treatment information.

[Emotional Memory and Electrocortical Activity in Schizophrenia]. / Mémoire émotionnelle et activités électrocorticales en schizophrénie.

Context Abnormal emotion processing is frequent in schizophrenia and affects social and functional outcome. Past event-related potential (ERP) research investigating processing of affective stimuli in schizophrenia was done mainly with facial expressions and revealed impaired facial emotion recognition in patients relative to control subjects. Experimentations involving fMRI with this group of patients, showed alteration of limbic and frontal regions in response to emotional unpleasant images, compared to neutral stimuli during a memory task. Other studies have also noted an increase in brain activity when the activation of the stimuli was high compared to low arousal stimuli. This may indicate a different sensitivity threshold to emotional arousal and emotional valence involving frontal pathways in these patients. But very few studies attempted to separate the contributions of emotional valence and arousal within an episodic memory protocol with ERP, in that population.Goal The aim of the current research is to investigate brain electro-cortical activity in schizophrenia in response to emotional images during an episodic memory task.Method ERP components were analyzed in 16 schizophrenic and 17 control participants matched for age, sex and intelligence. ERPs were obtained from 56 EEG electrodes. The tasks consisted in a classical episodic memory task that presented 100 repeated old and 100 new photographic images divided into four categories (unpleasant-high arousal, unpleasant-low arousal, pleasant-high arousal and pleasant-low arousal) selected from the International Affective Picture System. The N200, P300 and late positive component (LPC) mean amplitude, were analyzed using repeated-measure analyses of variance (MANOVA).Results Patients with schizophrenia and control subjects gave comparable subjective evaluations of arousal and valence. However, the frontal N200 and the P300 both showed an interaction of the group x memory x valence x hemisphere (F [1.32]=8.36; p <.01). Thus, this complex interaction denotes an increase of the episodic memory effect in the right hemisphere in response to unpleasant stimuli, with schizophrenic patients. With respect to the control group, there is also an increase of this memory effect in the right hemisphere, but in response to pleasant stimuli. The schizophrenic patients presented a smaller LPC memory effect, especially at the frontal region. More specifically, the frontal LPC was reduced, and the clinical group was less reactive to the emotional arousal content, compared to the control group.Discussion Altogether, our results revealed that while the subjective evaluation of emotional pictures is equivalent across groups, cerebral differences are present in schizophrenic patients during emotional recognition. N200 and P300 results in the frontal region suggest impaired selective attention and episodic memory to unpleasant stimuli in patients, while later processes related to conscious recollection (parietal LPC) are not affected with patients affected with schizophrenia.Conclusion This finding provides further support for the notion of a possible discrepancy between the subjective experience and the physiological expression of emotions in schizophrenia patients. Those results could open the door to new clinical research investigations in psychiatry, particularly in the comprehension of a relationship between frontal cortex vulnerability and episodic memory often present in psychosis.

The impact of a primary care e-communication intervention on the participation of chronic disease patients who had not reached guideline suggested treatment goals.

OBJECTIVE: To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs. METHODS: 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires. RESULTS: Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change. CONCLUSION: Following interventions, CD patients were more activated even in well-established doctor-patient relationships. PRACTICE IMPLICATIONS: PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it.

The effects of three mindfulness skills on chocolate cravings.

There is accumulating evidence that mindfulness-based interventions are useful in reducing food cravings. However, existing studies have applied many mindfulness skills together, rendering it unclear which skills are essential and which are unnecessary. Based on recent investigations into the efficacy of individual mindfulness skills at managing cravings, the goal of the present study was to compare the efficacy of two-week mindfulness-based interventions, targeting different combinations of specific mindfulness skills (awareness, acceptance, disidentification), at reducing trait and state chocolate cravings. We compared the efficacy of the mindfulness interventions to an active control intervention (distraction). Overall, disidentification emerged as the most efficacious mindfulness skill. After two weeks of practice, those trained in disidentification reported less intense state cravings after a craving induction task compared with those trained in distraction. Mediation analyses revealed that this effect was mediated first by a greater increase in the disidentification skill, and subsequently by a greater decrease in trait chocolate cravings. Manipulation checks revealed that training the disidentification skill was more successful than training the other skills. Disidentification is shown to be a crucial mindfulness skill that can be taught to help better cope with food cravings.

Sex differences in memory of emotional images: a behavioral and electrophysiological investigation.

Current research suggests that emotional responses differ between men and women. Sex differences regarding emotional effects on memory have been recently studied through brain imaging techniques. However, the majority of investigations have often neglected to balance the variable of emotional intensity (arousal) across pleasant and unpleasant pictures. Additionally, men and women were often mixed or studied separately. The current study aims at comparing men and women's electrophysiological responses related to emotional memory of photographic material. These responses were measured using Event Related brain Potentials (ERP) in response to a task of episodic memory of emotional images. The frontal N200, the parietal P300 and the central LPC were compared in 17 men and 17 women matched for age, social economic status, education and intelligence. Behavioral results showed that, in men, reaction times were modulated by valence, whereas for women, reaction times were mainly modulated by arousal. Accuracy was affected by both emotional valence and arousal, but only in women. ERP analyses revealed that emotional valence influenced earlier time components (frontal N200 and parietal P300), whereas arousal influenced memory in the later time component (central LPC). Moreover, sex differences, mediated by valence and arousal, were found in ERP responses at different times in the processing stream.