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1.
Br J Radiol ; 93(1105): 20190240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31651188

RESUMO

OBJECTIVE: To compare the participation rate between CT colonography (CTC) and colonoscopy in screening population in randomized controlled trials (RCTs). METHODS: A search was performed using the PubMed, Web of Science, and Cochrane databases. RCTs that included screening populations and reported participation number were assessed. Cochrane risk of bias tool was used to assess the bias and quality. Risk ratio (RR) was used to present the results. The non-participation rate was analyzed to verify the results of participation rate. RESULTS: Five of 760 studies, with a total of 15,974 invitees, were included. The participation rate was higher at CTC (28.8%) than colonoscopy (20.8%), although the difference did not reach statistical significance (RR = 1.26; p = 0.070; I2 = 90.3%). The non-participation rate at CTC was significantly lower than colonoscopy (RR = 0.92; p = 0.012; I2 = 86.7%). Subgroup analysis suggested both the participation and non-participation rate were with significant difference between reduced/no cathartic preparation CTC and colonoscopy. Cumulative meta-analysis showed both the participation rate and non-participation rate exhibited a trend over time and sample size. CONCLUSION: The participation rate was higher at CTC than colonoscopy, although the difference did not reach statistical significance. But the non-participation rate was with statistical difference. Screening population seemed more likely to participate the reduced/no cathartic preparation CTC. Statistical evidence was provided for more large RCTs are needed in the future. ADVANCES IN KNOWLEDGE: The screening populations seem more likely to participate in the CTC, especially the reduced/no cathartic preparation CTC. The statistical evidence was provided for more large RCTs are needed in the future.


Assuntos
Colonografia Tomográfica Computadorizada/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico por imagem , Programas de Rastreamento/métodos , Participação do Paciente/estatística & dados numéricos , Detecção Precoce de Câncer , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Nursing ; 50(1): 1-3, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855997

RESUMO

This article discusses the potential drivers and barriers to clinical nurse research participation. Here, the author describes a research exemplar that highlights how understanding the link between research and practice can influence participation.


Assuntos
Pesquisa em Enfermagem Clínica/organização & administração , Participação do Paciente/estatística & dados numéricos , Humanos , Seleção de Pacientes
3.
J Clin Ethics ; 30(4): 331-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851624

RESUMO

Situations in which patients lack medical decision-making (MDM) capacity raise ethical challenges, especially when the patients decline care that their surrogate decision makers and/or clinicians agree is indicated. These patients are a vulnerable population and should receive treatment that is the standard of care, in line with their the values of their authentic self, just as any other patient would. But forcing treatment on patients who refuse it, even though they lack capacity, carries medical and psychological risks to the patients and the hospital staff. It is also often impractical to force some treatments, especially in the long term. For example, independent of the ethical "should" question, how would one force hemodialysis for the rest of a patient's life, or force a surgery that requires weeks of post-operative physical therapy? In this article we present a novel algorithm that can help clinicians with ethical and practical decision making, with the goals of achieving the best outcomes for patients and reducing moral distress for their caretakers and clinicians.


Assuntos
Tomada de Decisão Clínica/ética , Tomada de Decisões , Ética Clínica , Recusa do Paciente ao Tratamento , Humanos , Competência Mental , Participação do Paciente , Diálise Renal , Recusa do Paciente ao Tratamento/ética
4.
Psychiatr Prax ; 46(8): 439-444, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31683334

RESUMO

OBJECTIVE: The investigation of mediating effects of empowerment and stigmatization on the association between depressive symptoms and subjective quality of life in patients with affective disorders. METHOD: Depressive Symptoms (BDI-II), internalized and perceived stigmatization (ISMI; PDDQ), empowerment (EPAS) and subjective quality of life (WHOQOL-BREF) were assessed in 37 patients with affective disorders (F31 - F33; ICD-10), age 18+ in inpatient, day hospital or outpatient psychiatric treatment. Data analyses were conducted by means of path-analysis. RESULTS: Empowerment and in low proportion internalized and perceived stigma turned out to be mediating variables between the severity of depression and subjective quality of life. 57 % of the variance of the subjective quality of life could be explained by the path model. CONCLUSION: Empowerment has meaningful influence mediating between depression and subjective quality of life. In order to improve the quality of life of patients with an affective disorder, strategies for increasing empowerment are to be integrated into treatment.


Assuntos
Transtornos do Humor/psicologia , Qualidade de Vida , Estigma Social , Alemanha , Humanos , Participação do Paciente , Índice de Gravidade de Doença
5.
Artigo em Chinês | MEDLINE | ID: mdl-31623050

RESUMO

Objective:To explore the applicability of the Chinese version of voice activity and participation profile in patients with voice disorder. Method:This study enrolled patients with voice disorder and their healthy family members in the outpatient, from 2017 July to 2019 April. They were divided into voice disorder group and without voice disorder group, and the questionnaire was filled out. Result:These scores of 28 items and five dimensions in the voice disorder group were higher than those in the group without voice disorder, and the differences were statistically significant(P<0.05). In the voice disorder group, the score of items affecting work was the highest(4.26), and the score of low self-esteem caused by voice disorder was the lowest(1.98). Conclusion:Voice disorder could negatively affect the voice related quality of life. The Chinese version of voice activity and participation profile is suitable for evaluating voice related quality of life.


Assuntos
Participação do Paciente , Distúrbios da Voz , Voz , Grupo com Ancestrais do Continente Asiático , China , Humanos , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31613375

RESUMO

This article highlights a special subtype of this dilemma, in which the patient requests a treatment that the physician judges to be substandard. Reasons for and against providing substandard treatment in the name of patient autonomy are presented and discussed. It is suggested that physicians carefully consider the risk of crowding out of other patients if substandard treatment is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde/ética , Preferência do Paciente , Qualidade da Assistência à Saúde/ética , Beneficência , Ética Médica , Prioridades em Saúde , Humanos , Participação do Paciente , Direitos do Paciente , Autonomia Pessoal , Papel do Médico
10.
Rev Med Suisse ; 15(669): 1995-1996, 2019 Oct 30.
Artigo em Francês | MEDLINE | ID: mdl-31663701
14.
17.
Z Gastroenterol ; 57(9): 1051-1058, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31525797

RESUMO

BACKGROUND AND AIM: Colorectal cancer (CRC) screening can effectively reduce cancer-associated mortality. In Germany, individuals over the age of 50 or 55 have access to CRC screening services. However, utilization rates are persistently low, particular in the male population. This observational study investigates the effect of standard versus gender-specific invitation letters on utilization of CRC screening services. METHODS: We analyzed utilization rates of individuals who were insured by a large health insurance fund in Bavaria, Germany. Persons who became eligible for CRC screening received a standard (2013-2014) or a gender-specific invitation letter (2015-2016). We compared utilization rates within 6 months after receipt of the invitation letter using billing codes of the health insurance fund. RESULTS: Invitation letters were sent to 49 535 individuals, of which 48.8 % were gender-specific. The overall utilization rate did not differ between recipients of the standard versus gender-specific invitation letter (11.6 % vs 11.1 %; RR: 0.97 [0.92-1.02], p = 0.19). However, uptake of screening colonoscopy was significantly higher among recipients of gender-specific invitations (2.9 % vs 3.5 %; RR: 1.21 [1.04-1.39], p = 0.01), whereas utilization of fecal occult blood tests declined (10.4 % vs 9.7 %; RR: 0.93 [0.88-0.99], p = 0.016). CONCLUSIONS: Gender-specific design of invitation letters can modify the patients' preference for specific CRC screening services and increase the acceptance of screening colonoscopy.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Colonoscopia , Neoplasias Colorretais/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Sangue Oculto
18.
BMC Surg ; 19(1): 125, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477107

RESUMO

BACKGROUND: Perioperative care in colorectal surgery is systematically defined in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improves perioperative care in a multimodal way to enhance early and safe release from the hospital. Adequate compliance to the elements of the ERAS protocol is multifactorial. There are still opportunities to improve compliance of the protocol by actively involving the patient. The main objective of this study is to investigate whether compliance of selected items in the ERAS protocol can be improved through actively involving patients in the ERAS care pathway through the use of a patient-centred mobile application. METHODS: A multicentre randomized controlled trial will be conducted. Patients undergoing elective colorectal surgery, who are 18 years or older and in possession of an eligible smartphone, will be included. Patients assigned to the intervention group will install a patient-centred mobile application to be guided through the ERAS care pathway. Patients in the control group will receive care as usual. Both groups will wear an activity tracker. The primary outcome is overall compliance to selected active elements of the ERAS protocol, as registered by the patient. Secondary outcomes include Patient Reported Outcome Measures (PROMs) such as health-related quality of life, physical activity, and patient satisfaction of received care. Care-related outcomes, such as length of hospital stay, number of complications, re-intervention, and readmission rates, will also be assessed. RESULTS: The enrolment of patients will start in the second quarter of 2019. Data collection had not begun by the time this protocol was submitted. CONCLUSION: We hypothesize that by providing patients with a patient-centred mobile application, compliance to the active elements of ERAS protocol can be improved, resulting in an increased health-related quality of life, physical activity, and patient satisfaction. TRIAL REGISTRATION: Netherlands Trial Register, NTR7314 , prospectively registered on the 9th of November 2017 ( http://www.trialregister.nl ).


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Aplicativos Móveis , Participação do Paciente , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Humanos , Tempo de Internação , Cooperação do Paciente , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Recuperação de Função Fisiológica
19.
Stud Health Technol Inform ; 267: 20-27, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483250

RESUMO

In the context of the German Medical Informatics Initiative (MII), where data reuse and data sharing are major goals, cross-site, long-term research on patient care data can only be conducted lawfully with informed patient consent. Thus, the MII consent working group developed a template form for patient information and broad consent based on work that has been done for a former biobank project. The broad consent enables the patient to consent to the use of a wide range of the documented data including research purposes. Therefore, a user-friendly tool is needed which not only supports the storage and maintenance of the patient's consents but also allows him to easily review or withdraw his consents. Furthermore, the tool should allow the patient to review the use of his data in research projects and possible publications. This is why we developed a concept of how such a tool could be integrated into the clinical and research system landscape and implemented a prototype as a proof of concept.


Assuntos
Consentimento Livre e Esclarecido , Participação do Paciente , Humanos , Disseminação de Informação , Masculino
20.
J Cancer Res Clin Oncol ; 145(11): 2845-2854, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506739

RESUMO

PURPOSE: We examined whether multi-disciplinary stepped psychosocial care for cancer patients improves quality of care from the patient perspective. METHODS: In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for distress, consultation between doctor and patient, and the provision of psychosocial services. Quality of care was measured with the Quality of Care from the Patient Perspective questionnaire. The analysis employed mixed-effects multivariate regression, adjusting for age and gender. RESULTS: Thirteen wards were randomized, and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Patients who were highly distressed at baseline had 2.3 times the odds of saying they had had the possibility to converse in private with doctors and/or psychologists/social workers when they were in stepped care compared to standard care, 1.3 times the odds of reporting having experienced shared decision-making, 1.1 times the odds of experiencing their doctors as empathic and personal, and 0.6 times the odds of experiencing the care at the ward to be patient oriented. There was no evidence for an effect of stepped care on perceived quality of care in patients with moderate or low distress. CONCLUSIONS: Stepped care can improve some aspects of perceived quality of care in highly distressed patients. TRIAL REGISTRATION: http://www.clinicaltrials.gov . NCT01859429.


Assuntos
Saúde Mental/normas , Neoplasias/psicologia , Neoplasias/terapia , Participação do Paciente/psicologia , Psicoterapia , Qualidade da Assistência à Saúde/normas , Serviço Social em Psiquiatria/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Prognóstico , Psicometria , Melhoria de Qualidade , Encaminhamento e Consulta , Adulto Jovem
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