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1.
Int J Public Health ; 66: 1604298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795555

RESUMO

Objectives: To identify the proportion of the population that had experienced that alcohol was addressed in health care the previous year, to explore experiences and perceived effects of addressing alcohol, and to investigate the proportion of risky drinkers in the population. Methods: Cross-sectional national web-based survey with 1,208 participants. Socio-demographic data, alcohol consumption (AUDIT-C), and experiences with alcohol conversations were investigated. Results: Approximately four in five respondents had visited health care the past 12 months, and one in six reported having experienced addressing alcohol. Women and older respondents were less likely to report having experienced alcohol conversations compared to other groups. Risky drinkers were not more likely to have experienced an alcohol conversation, but reported longer duration of alcohol conversations and more frequently perceived addressing alcohol as awkward or judgmental. Almost a third of respondents were classified as risky drinkers. Conclusion: The proportion experiencing addressing alcohol in routine health care is low, also among risky drinkers, and risky drinkers more frequently experienced the conversations as judgmental. More sensitive and relevant ways of addressing alcohol in health care is needed.


Assuntos
Consumo de Bebidas Alcoólicas , Pacientes , Consumo de Bebidas Alcoólicas/prevenção & controle , Comunicação , Estudos Transversais , Humanos , Pacientes/psicologia , Relações Profissional-Paciente
2.
Br J Community Nurs ; 26(11): 526-531, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34731040

RESUMO

Although dignity has been widely explored in the context of healthcare, it has rarely been the subject of empirical exploration when care is delivered by community district nursing teams. This paper demonstrates how a commonplace community nursing task (changing dressings) can constitute a clinical lens through which to explore the ways in which community nurses can influence patients' dignity. This ethnographic study involved two research methods: interviews with patients and nurses (n=22) and observations of clinical interactions (n=62). Dignity can manifest during routine interactions between community nurses and patients. Patient-participants identified malodour from their ill-bodies as a particular threat to dignity. Nurses can reinforce the dignity of their patients through relational aspects of care and the successful concealment of 'leaky' bodies.


Assuntos
Comunicação , Enfermagem em Saúde Comunitária/métodos , Relações Enfermeiro-Paciente , Enfermeiros de Saúde Comunitária/psicologia , Pacientes/psicologia , Pessoalidade , Respeito , Antropologia Cultural , Atitude do Pessoal de Saúde , Bandagens , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , População Urbana
3.
Res Nurs Health ; 44(5): 796-810, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34515341

RESUMO

Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.


Assuntos
Cuidadores/psicologia , Fadiga/terapia , Meditação/métodos , Manipulações Musculoesqueléticas/métodos , Neoplasias/psicologia , Neoplasias/terapia , Pacientes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fadiga/etiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Meditação/psicologia , Pessoa de Meia-Idade , Manipulações Musculoesqueléticas/psicologia , Neoplasias/complicações , Resultado do Tratamento
4.
PLoS One ; 16(9): e0257453, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529708

RESUMO

OBJECTIVE: To determine whether patients attending the ophthalmology department underestimate their glaucoma risks. METHOD: We conducted a cross-sectional survey with a final study population of 1203 individuals from two medical centers in Taiwan during January 1-June 30, 2019. The "High concern" group was defined as the set of patients who rated themselves as having low risk but who had been rated by physicians as having medium or high risk of developing glaucoma over the next year. RESULTS: Approximately 12% of the respondents belonged to the "High concern" group. For those with education at the college level or higher, the interaction term was estimated to be 0.294 (95% CI = 0.136-0.634). Marginal effect calculations revealed significant sex-based differences in the effect of knowledge at specific age intervals. CONCLUSIONS: A considerable proportion of patients attending the ophthalmology department underestimate their glaucoma risks. Misjudgment of glaucoma risks can lead to delays in seeking of medical attention. Glaucoma education should be designed according to each patient's education level and sex, as its effect is not consistent across different education and sex clusters.


Assuntos
Glaucoma/patologia , Conhecimento , Pacientes/psicologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Risco , Autorrelato , Inquéritos e Questionários
7.
PLoS One ; 16(9): e0257802, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34559846

RESUMO

BACKGROUND: In 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot. METHODS: Qualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically. RESULTS: Interviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs. CONCLUSION: The SEM Consultants' ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.


Assuntos
Exercício Físico/fisiologia , Pessoal de Saúde/psicologia , Pacientes/psicologia , Inglaterra , Estudos de Viabilidade , Hospitais , Humanos , Entrevistas como Assunto , Masculino , Saúde do Trabalhador , Pesquisa Qualitativa , Medicina Estatal
9.
Health Psychol ; 40(7): 472-479, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34435799

RESUMO

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome that disproportionally affects younger women. The underlying etiology is incompletely understood, postmorbid psychological distress is high, and treatment plans are predominantly based on clinician experience. There remains uncertainty on how to adequately address the needs of patients with SCAD as part of secondary prevention. METHOD: As a Define and Refine phase of the ORBIT model (Phase 1), this study investigated SCAD patients' challenges and rehabilitative intervention needs using a qualitative research design. Patients with SCAD were purposively recruited to participate in structured interviews that were analyzed using inductive thematic coding techniques. RESULTS: Patients with SCAD (n = 15; 86.7% female; mean age = 47.5 years; data saturation reached with patient sample) expressed challenges in (a) navigating uncertainty associated with the disease; (b) living with anxiety; (c) reconciling pre and post-SCAD identities; (d) accurately identifying symptoms and experiencing a sense of isolation in recovery due to gender and young age; and (e) managing changing family dynamics and family members' stress. Intervention needs included (a) addressing unique demographic and cardiovascular profiles when designing programs for cardiac rehabilitation; (b) providing more psychological and peer support resources to address anxiety and sense of isolation; (c) disseminating information on rapidly evolving SCAD research; and (d) acknowledging and providing support to the family system. CONCLUSIONS: The results signal curricula to be included in tailored SCAD programming and underscore the need for further study and dissemination of optimal secondary preventative care for this patient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Anomalias dos Vasos Coronários/reabilitação , Pacientes/psicologia , Doenças Vasculares/reabilitação , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade
10.
PLoS One ; 16(8): e0256544, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34437610

RESUMO

BACKGROUND: Patients with hepatocellular carcinoma (HCC) represent a vulnerable population potentially negatively affected by COVID-19-associated reallocation of healthcare resources. Here, we report the impact of COVID-19 on the management of HCC patients in a large tertiary care hospital. METHODS: We retrospectively analyzed clinical data of HCC patients who presented at the Vienna General Hospital, between 01/DEC/2019 and 30/JUN/2020. We compared patient care before (period 1) and after (period 2) implementation of COVID-19-associated healthcare restrictions on 16/MAR/2020. RESULTS: Of 126 patients, majority was male (n = 104, 83%) with a mean age of 66±11 years. Half of patients (n = 57, 45%) had impaired liver function (Child-Pugh stage B/C) and 91 (72%) had intermediate-advanced stage HCC (BCLC B-D). New treatment, was initiated in 68 (54%) patients. Number of new HCC diagnoses did not differ between the two periods (n = 14 vs. 14). While personal visits were reduced, an increase in teleconsultation was observed (period 2). Number of patients with visit delays (n = 31 (30%) vs. n = 10 (10%); p = 0.001) and imaging delays (n = 25 (25%) vs. n = 7 (7%); p = 0.001) was higher in period 2. Accordingly, a reduced number of patients was discussed in interdisciplinary tumor boards (lowest number in April (n = 24), compared to a median number of 57 patients during period 1). Median number of elective/non-elective admissions was not different between the periods. One patient contracted COVID-19 with lethal outcome. CONCLUSIONS: Changes in patient care included reduced personal contacts but increased telephone visits, and delays in diagnostic procedures. The effects on long-term outcome need to be determined.


Assuntos
COVID-19/epidemiologia , Carcinoma Hepatocelular/diagnóstico , Neoplasias Hepáticas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , COVID-19/virologia , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Diagnóstico Tardio , Feminino , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pandemias , Pacientes/psicologia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Taxa de Sobrevida , Telemedicina , Centros de Atenção Terciária
11.
PLoS One ; 16(8): e0256578, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34460854

RESUMO

BACKGROUND: Concern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems. METHODS: We searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement. RESULTS: The electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty. CONCLUSIONS: Explicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/virologia , Bases de Dados Factuais , Humanos , Pandemias , Pacientes/psicologia , SARS-CoV-2/isolamento & purificação , Listas de Espera
12.
Lancet Digit Health ; 3(9): e599-e611, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34446266

RESUMO

Artificial intelligence (AI) promises to change health care, with some studies showing proof of concept of a provider-level performance in various medical specialties. However, there are many barriers to implementing AI, including patient acceptance and understanding of AI. Patients' attitudes toward AI are not well understood. We systematically reviewed the literature on patient and general public attitudes toward clinical AI (either hypothetical or realised), including quantitative, qualitative, and mixed methods original research articles. We searched biomedical and computational databases from Jan 1, 2000, to Sept 28, 2020, and screened 2590 articles, 23 of which met our inclusion criteria. Studies were heterogeneous regarding the study population, study design, and the field and type of AI under study. Six (26%) studies assessed currently available or soon-to-be available AI tools, whereas 17 (74%) assessed hypothetical or broadly defined AI. The quality of the methods of these studies was mixed, with a frequent issue of selection bias. Overall, patients and the general public conveyed positive attitudes toward AI but had many reservations and preferred human supervision. We summarise our findings in six themes: AI concept, AI acceptability, AI relationship with humans, AI development and implementation, AI strengths and benefits, and AI weaknesses and risks. We suggest guidance for future studies, with the goal of supporting the safe, equitable, and patient-centred implementation of clinical AI.


Assuntos
Inteligência Artificial , Atitude Frente aos Computadores , Atitude Frente a Saúde , Pacientes/psicologia , Opinião Pública , Humanos
13.
Psychiatr Q ; 92(4): 1785-1796, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34463904

RESUMO

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.


Assuntos
COVID-19 , Transtornos Mentais , Serviços de Saúde Mental , Pacientes , Encaminhamento e Consulta , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pacientes/psicologia , Pacientes/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
14.
PLoS One ; 16(7): e0253448, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34270564

RESUMO

BACKGROUND: Patients diagnosed with cancer who are due to commence radiotherapy, often, despite the provision of a considerable amount of information, report a range of unmet information needs about the treatment process. Factors such as inadequate provision of information, or the stressful situation of having to deal with information about unfamiliar things, may influence the patient's ability to comprehend the information. There is a need to further advance the format in which such information is presented. The composition of information should be tailored according to the patient's individual needs and style of learning. METHOD AND FINDINGS: The PD methodology is frequently used when a technology designed artefact is the desired result of the process. This research is descriptive of its kind and provides a transparent description of the co-design process used to develop an innovative digital information tool employing PD methodology where several stakeholders participated as co-designers. Involving different stakeholders in the process in line with recommended PD activities enabled us to develop a digital information tool that has the potential to be relevant and user-friendly for the ultimate consumer. CONCLUSIONS: Facilitating collaboration, structured PD activities can help researchers, healthcare professionals and patients to co-design patient information that meets the end users' needs. Furthermore, it can enhance the rigor of the process, ensure the relevance of the information, and finally have a potential to employ a positive effect on the reach of the related digital information tool.


Assuntos
Pessoal de Saúde/psicologia , Educação de Pacientes como Assunto , Pacientes/psicologia , Design de Software , Idoso , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Neoplasias/radioterapia , Educação de Pacientes como Assunto/métodos , Assistência Centrada no Paciente , Participação dos Interessados
15.
Radiol Med ; 126(10): 1366-1373, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34268681

RESUMO

AIM: To explore breast cancer patient's perspective on future genetic testing for prediction of toxicity after breast radiotherapy (RT). MATERIALS AND METHODS: The study involved patient enrolled in the Italian branch of the REQUITE project conducted at the National Cancer Institute in Milan. Semi-structured interviews were conducted within one month from the end of radiotherapy treatment by two radiation oncologists and a radiotherapy technician previously trained by a clinical psychologist with experience in the oncology field. Semi-structured interviews are characterized by a set of pre-defined questions and developed ad hoc by researchers in Leicester within the REQUITE project. The interview questions investigated interest in undergoing the genetic test and expectations on its usefulness and disadvantages. RESULTS: Eighteen interviews were conducted and analysed. Forty-five initial codes were combined into nine themes which were then clustered in two main macro-areas (i) Opportunities and (ii) Challenges. Overall, all patients understand the aim of the genetic test and considered its intrinsic opportunity to make the physician more confident with the treatment. Regarding side effects, most of patients felt prepared to RT but not without fear. Many women considered important to have the largest and reliable information, also about negative experiences. Prevailing emotions were anxiety and fear but not connected to genetic test's result. CONCLUSIONS: A genetic test could be an opportunity because generate knowledge and give patients a dynamic role in the decision-making approach. Prediction of single patient radiosensitivity before RT could prompt suggestion to entail a more and more tailored radiation treatment in the era of personalized approach.


Assuntos
Neoplasias da Mama/radioterapia , Testes Genéticos/métodos , Pacientes/psicologia , Tolerância a Radiação/genética , Adulto , Idoso , Feminino , Humanos , Entrevistas como Assunto , Itália , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Valor Preditivo dos Testes , Inquéritos e Questionários
16.
Anaesthesia ; 76(11): 1511-1517, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34289084

RESUMO

Supraglottic airway devices are commonly used to manage the airway during general anaesthesia. There are sporadic case reports of temporomandibular joint dysfunction and dislocation following supraglottic airway device use. We conducted a prospective observational study of adult patients undergoing elective surgery where a supraglottic airway device was used as the primary airway device. Pre-operatively, all participants were asked to complete a questionnaire involving 12 points adapted from the Temporomandibular Joint Scale and the Liverpool Oral Rehabilitation Questionnaire. Objective measurements included inter-incisor distance as well as forward and lateral jaw movements. The primary outcome was the inter-incisor distance, an accepted measure of temporomandibular joint mobility. Both the questionnaire and measurements were repeated in the postoperative period and we analysed data from 130 participants. Mean (SD) inter-incisor distance in the pre- and postoperative period was 46.5 (7.2) mm and 46.3 (7.5) mm, respectively (p = 0.521) with a difference (95%CI) of 0.2 (-0.5 to 0.9) mm. Mean (SD) forward jaw movement in the pre- and postoperative period was 3.6 (2.4) mm and 3.9 (2.4) mm, respectively (p = 0.018). Mean (SD) lateral jaw movement to the right in the pre- and postoperative period was 8.9 (4.1) mm and 9.1 (4.0) mm, respectively (p = 0.314). Mean (SD) lateral jaw movement to the left in the pre- and postoperative period was 8.8 (4.0) mm and 9.3 (3.6) mm, respectively (p = 0.008). The number of patients who reported jaw clicks or pops before opening their mouth as wide as possible was 28 (21.5%) vs. 12 (9.2%) in the pre- and postoperative period, respectively (p < 0.001) with a difference (95%CI) of 12.3% (6.7-17.9%). There was no significant difference in the responses to the other 11 questions or in the number of patients who reported pain in the temporomandibular joint area postoperatively. No clinically significant dysfunction of the temporomandibular joint following the use of supraglottic airway devices in the postoperative period was identified by either patient questionnaires or objective measurements.


Assuntos
Anestesia Geral , Intubação Intratraqueal/instrumentação , Articulação Temporomandibular/fisiologia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Intubação Intratraqueal/métodos , Arcada Osseodentária/fisiologia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/patologia , Pacientes/psicologia , Período Pós-Operatório , Estudos Prospectivos , Inquéritos e Questionários
17.
J Rehabil Med ; 53(7): jrm00218, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34240223

RESUMO

OBJECTIVE: To examine the validity of the Comprehensive and Brief International Classification of Functioning, Disability and Health (ICF) Core Sets for Traumatic Brain Injury for patients with traumatic brain injury living in the community in Australia. DESIGN: Qualitative methodology using focus groups and individual interviews. PATIENTS: Community-dwelling adult persons with traumatic brain injury. METHODS: Patients sustaining traumatic brain injury with post-traumatic amnesia between September 2009 and August 2013, selected from the Royal Melbourne Hospital Trauma Registry, were invited to participate in the study. Participants were asked structured questions based on the ICF framework. Digital recordings of the discussions were transcribed in full for linking to the ICF categories. RESULTS: Saturation of data was reached after 5 groups involving 21 participants. Participants identified as relevant 77.7% (n = 108/139) and 100% (n = 23/23) of the Comprehensive and Brief ICF Core Sets for traumatic brain injury, respectively. Additional ICF categories identified in 2 or more groups were: b180 "experience of self and time functions"; b250 "taste function"; b265 "touch function"; b530 "weight maintenance function"; b780 "sensation related to muscles and movement"; and d650 "caring for household objects". CONCLUSION: The study found additional ICF categories to consider and supports the use of the ICF Core Sets for traumatic brain injury in Australian adults in the community.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas/classificação , Lesões Encefálicas/diagnóstico , Pessoas com Deficiência , Pacientes/psicologia , Atividades Cotidianas , Adulto , Austrália , Lesões Encefálicas/reabilitação , Avaliação da Deficiência , Grupos Focais , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Entrevistas como Assunto , Pesquisa Qualitativa , Reabilitação , Autorrelato
18.
PLoS One ; 16(7): e0253664, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34264973

RESUMO

BACKGROUND: The COVID-19 pandemic has had a profound worldwide impact. Vietnam, a lower middle-income country with limited resources, has successfully slowed this pandemic. The objectives of this report are to explore the impact of the COVID-19 pandemic on the research activities of an ongoing hypertension trial using a storytelling intervention in Vietnam. METHODS: Data were collected in a mixed-methods study among 86 patients and 10 health care workers participating in a clinical trial designed to improve hypertension control. Several questions related to the impact of COVID-19 on patient's daily activities and adherence to the study interventions were included in the follow-up visits. A focus group discussion was conducted among health care workers to discuss the impact of COVID-19 on research related activities. RESULTS: Fewer patients in the intervention group reported that they faced difficulties in adhering to prescribed study interventions, wanted to receive a call from a dedicated hotline, or have a visit from a community health worker as compared with those in the comparison group. Most study patients are willing to participate in future health research studies. When asked about the potential use of mobile phones in health research studies, fewer patients in the intervention group felt comfortable using a mobile phone for the delivery of intervention and interviews compared with those in the comparison condition. Community health workers shared that they visited patient's homes more often than previously due to the pandemic and health care workers had to perform more virus containment activities without a corresponding increase in ancillary staff. CONCLUSIONS: Both patients and health care workers in Vietnam faced difficulties in adhering to recommended trial interventions and procedures. Multiple approaches for intervention delivery and data collection are needed to overcome these difficulties during future health crises and enhance the implementation of future research studies. TRIAL REGISTRATION: ClinicalTrials.gov. Registration number: https://clinicaltrials.gov/ct2/show/NCT03590691 (registration date July 17, 2018).


Assuntos
COVID-19/epidemiologia , Serviços de Laboratório Clínico/normas , Ensaios Clínicos como Assunto , Pessoal de Laboratório Médico/psicologia , Pacientes/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços de Laboratório Clínico/estatística & dados numéricos , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Vietnã
20.
Ann Intern Med ; 174(9): 1282-1292, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34181449

RESUMO

BACKGROUND: Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort. OBJECTIVE: To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care. DESIGN: Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987). SETTING: 3 Swiss teaching hospitals. PATIENTS: Adult medical patients who were hospitalized. INTERVENTION: Patients were randomly assigned to bedside or outside the room case presentation. MEASUREMENTS: The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care. RESULTS: Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P < 0.001). LIMITATION: Only Swiss hospitals and medical patients were included. CONCLUSION: Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings. PRIMARY FUNDING SOURCE: Swiss National Foundation (10531C_ 182422).


Assuntos
Letramento em Saúde , Assistência Centrada no Paciente , Pacientes/psicologia , Visitas com Preceptor , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Relações Médico-Paciente , Suíça , Terminologia como Assunto
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