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Millar KA, Crump L, LaChapelle DL. Lived Experiences of Cognitive Dysfunction in Fibromyalgia: How Patients Discuss Their Experiences and Suggestions for Patient Education. J Patient Exp 2024; 11:23743735241229385. [PMID: 38333024 PMCID: PMC10851761 DOI: 10.1177/23743735241229385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Cognitive dysfunction (CD) is a common, impairing symptom experienced by persons with fibromyalgia (FM). This study explored how individuals with FM describe their experience of CD in an online peer support environment. Posts referencing cognitive symptoms were extracted from two Facebook FM peer support groups at two timepoints. Using inductive Thematic Analysis, key discussion themes were identified and compared across groups and time. Four themes represented the way members described their cognitive experiences in FM: understanding and describing CD experiences, distrust of cognitive abilities, choosing between pain and medication side effects, and misunderstanding and judgement from others. Two themes represented the impact of CD on members' lives: impaired social interaction and loss of identity. Group members described broad impairments in daily functioning that significantly and negatively impacted their quality of life, indicating CD symptoms may play a more prominent role in the FM experience than previously understood. An infographic is included to aid patient education and help facilitate patient-provider discussions of CD symptoms.
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Affiliation(s)
- Kayla A Millar
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Lyndsay Crump
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
| | - Diane L LaChapelle
- Department of Psychology, University of New Brunswick, Fredericton, NB, Canada
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Crump L, LaChapelle D. "My Fibro Family!" A qualitative analysis of facebook fibromyalgia support groups' discussion content. Can J Pain 2022; 6:95-111. [PMID: 36505010 PMCID: PMC9733682 DOI: 10.1080/24740527.2022.2078183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Fibromyalgia (FM) is a diagnostically controversial syndrome characterized by chronic widespread pain, fatigue, sleep difficulties, cognitive dysfunction, and mental health symptoms. Though online peer support groups (OPSGs) may help persons with FM access support and information, there are concerns that such groups can be harmful. Aims and Methods Using a nonparticipatory observational stance, the authors analyzed discussions in three Facebook FM OPSGs (approximately 15,000 members, mostly women) to determine what themes best characterize their discussion content and whether being in a particular group was related to the type of thematic content to which they were exposed. Results Two themes were identified that represented explicit reasons group members participated in the OPSG (trying to understand FM and seeking/offering emotional support). Six themes represented underlying reasons members sought informational and emotional support in FM OPSGs (fighting FM, learning to live with FM, struggling with identity, distressing thoughts and feelings, judgment, empowerment-seeking). No salient differences were identified between the thematic content of each group. Conclusions The findings suggest that FM OPSGs may provide much needed psychosocial and emotional support regarding important aspects of psychological adjustment to living with FM while also inadvertently encouraging approaches to living with FM that do not align with evidence-based FM management recommendations (e.g., investment in fighting rather than accepting FM). These findings may be useful to patients considering joining an FM OPSG and to health providers helping patients navigate to resources that can address their emotional or psychological support needs.
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Affiliation(s)
- Lyndsay Crump
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada,CONTACT Lyndsay Crump Department of Psychology, University of New Brunswick, P.O. Box 4400, Fredericton, NBE3B 5A3, Canada
| | - Diane LaChapelle
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
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Hennemann S, Kuhn S, Witthöft M, Jungmann SM. Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients. JMIR Ment Health 2022; 9:e32832. [PMID: 35099395 PMCID: PMC8844983 DOI: 10.2196/32832] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. OBJECTIVE This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists' diagnoses based on structured clinical interviews. METHODS Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada-check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. RESULTS A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA's first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA's first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. CONCLUSIONS Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Stefanie M Jungmann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Mainz, Germany
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Theys S, Malfait S, Eeckloo K, Verhaeghe S, Beeckman D, Van Hecke A. Patient empowerment in Flemish hospital wards: a cross-sectional study. Acta Clin Belg 2021; 76:453-461. [PMID: 32397919 DOI: 10.1080/17843286.2020.1762350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective: Measuring empowerment of patients on Flemish hospital wards by the short form of the Patient Activation Measure (PAM-13) and exploring the association between patient empowerment and patient-centred care, health literacy, patient- and context-related characteristics.Methods: Secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders between February and June 2016. Patients needed to be admitted for a least 1 day, aged 18 years or over, and mentally competent with adequate ability to speak and read the Dutch language. Independent t-tests, one-way ANOVA and multivariable regression analysis were performed.Results: Mean empowerment was 58. Of the 670 patients, 22.7% tended to be unprepared to play an active role in their health care, 22.2% were struggling to manage own health, 39.4% reported to take action to maintain and improve own health, and 15.7% reported having confidence to perform adequate behaviours in most circumstances. Multivariable analysis showed that patients living together with family, a partner or a friend (p = 0.018), with higher health literacy (p < 0.001), and with higher perceptions of individuality in patients' care (p < 0.001) had higher empowerment scores.Conclusion: The multivariable analysis found three variables associated with patient empowerment and provided empirical evidence for the interrelatedness between patient-centred care and patient empowerment. Future research should use a clear framework to make sure that all relevant determinants of patient empowerment are included. Interventions to improve patient empowerment should incorporate patient characteristics and elements of both health literacy and patient-centred care.
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Affiliation(s)
- Sofie Theys
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | | | - Kristof Eeckloo
- Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Department Health Care, VIVES University College, Roeselare, Belgium
| | - Dimitri Beeckman
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Skin Integrity Research Group (SKINT), Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, Southern Denmark
| | - Ann Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
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Lilje S, Eklund A, Wykman A, Sundberg T, Skillgate E. Naprapathy versus orthopaedic standard care for common musculoskeletal disorders: an 8-year follow-up of a pragmatic randomized controlled trial in Sweden. Chiropr Man Therap 2021; 29:43. [PMID: 34727936 PMCID: PMC8561905 DOI: 10.1186/s12998-021-00400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is among the most common reasons for seeking care, specialist competence for its treatment in primary care limited and waiting lists for orthopaedics often amongst the longest. Many referrals to orthopaedics do not concern disorders that benefit from surgery. Manual therapy is effective, yet not integrated in national health care systems, and there is a lack of research on other than neck and low back pain, and a lack of long-term follow-ups. The present study evaluates the long-term effects of a manual therapy (naprapathy) for common orthopaedic disorders. METHODS An 8-year follow-up (96 months) of a pragmatic randomized controlled trial of naprapathy (experimental group) versus standard orthopaedic care (control group) for non-surgical patients of working age with the most common musculoskeletal disorders on the waiting lists (n = 78). Bodily pain, physical function (SF36), Quality of life (QoL; SF6D), and data on health care utilization were collected. The treatments lasted from January 2007 to November 2007. RESULTS N = 75 participants in the original study sample completed the 8-year follow-up. The differences in bodily pain (21.7 (95% CI: 9.1-34.3)), physical function (17.6 (6.7-28.4)), and QoLs (0.823 (95% CI: 0.785-0.862) compared with 0.713 (95% CI: 0.668-0.758)) were statistically significantly in favor of the experimental group (p-values < 0.01). After sensitivity analysis the experimental group had altogether 260 health care visits compared with 1161 in the control group. CONCLUSIONS Naprapathy is a continuously effective treatment. Together with earlier research our study suggests that specialized manual therapy should be considered when triaging patients with common non-surgical musculoskeletal disorders in national health care systems. TRIAL REGISTRATION Not applicable, as per information given by ClinicalTrials.gov.
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Affiliation(s)
- Stina Lilje
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden.
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden.
| | - Andreas Eklund
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden
| | - Anders Wykman
- Helsingborg Hospital, Lund University, Charlotte Yléns g. 10, 252 23, Lund, Sweden
| | - Tobias Sundberg
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden
| | - Eva Skillgate
- Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Valhallav. 91, 114 28, Stockholm, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine (IMM), Karolinska Institutet, Nobels v. 13, 171 77, Stockholm, Sweden
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Luo Z, Chen C, Xu W, Wang P, Wang Y. A qualitative study on the experience of empowerment from the perspectives of breast cancer survivors. Nurs Open 2021; 8:2429-2438. [PMID: 34313022 PMCID: PMC8363359 DOI: 10.1002/nop2.1000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/19/2021] [Accepted: 07/10/2021] [Indexed: 02/05/2023] Open
Abstract
AIM To describe the experience of empowerment for breast cancer survivors in order to increase quality of life after treatment. DESIGN We adopted a qualitative design in this study. METHODS A qualitative descriptive approach guided by interpretive description methodology as the theoretical framework was used in this study. Semi-structured group and individual interviews were conducted with eleven female Chinese breast cancer survivors (mean age 54.18 years, 100% female). RESULTS Many survivors reported that they continued to experience disease-related discomfort from the physiological aspect, but they use multiple ways to improve quality of life. Breast cancer survivors experienced empowerment after treatment. Empowerment mainly required three components: a belief in good health, capability of self-management and acquisition of a good social support system.
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Affiliation(s)
- Zebing Luo
- Shantou University Medical CollegeShantouChina
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
| | - Chujun Chen
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
| | - Wanzhu Xu
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
| | - Peiru Wang
- Shantou University Medical CollegeShantouChina
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
| | - Yiru Wang
- Guangdong Provincial Key Laboratory of Breast Cancer Diagnosis and TreatmentShantouChina
- Cancer Hospital of Shantou University Medical CollegeShantouChina
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Rattanasuk D, Khuwatsamrit K. Causal Model of Psychological Empowerment Among People With Spinal Cord Injury in Thailand. Orthop Nurs 2021; 40:136-143. [PMID: 34004612 PMCID: PMC8140667 DOI: 10.1097/nor.0000000000000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study was to develop and evaluate a causal model illustrating the relationships of age, education, physical impairment duration, social support, functional ability, and self-esteem with psychological empowerment in persons with spinal cord injury. Participants were 260 individuals admitted to a hospital in Thailand. Data were analyzed using path analysis (with the maximum likelihood estimation technique) in Linear Structural Relationship (LISREL). The study results revealed that age and education did not significantly influence psychological empowerment. However, self-esteem had a direct effect on psychological empowerment, whereas physical impairment duration, functional ability, and social support had indirect effects through self-esteem. These four predictors explained 64% of the total variance in this model of psychological empowerment for people with spinal cord injury. These findings can be used as a guideline for developing appropriate interventions to promote psychological empowerment among Thais with spinal cord injury.
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Affiliation(s)
- Dalin Rattanasuk
- Correspondence: Dalin Rattanasuk, PhD, RN, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama 6 Rd, Phayathai, Rachathewi, Bangkok, Thailand, 10400 ()
| | - Kusuma Khuwatsamrit
- Dalin Rattanasuk, PhD, RN, Lecturer, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Kusuma Khuwatsamrit, PhD, RN, Assistant Professor, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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New Insights into Immunological Involvement in Congenital Disorders of Glycosylation (CDG) from a People-Centric Approach. J Clin Med 2020; 9:jcm9072092. [PMID: 32635232 PMCID: PMC7408855 DOI: 10.3390/jcm9072092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023] Open
Abstract
Congenital disorders of glycosylation (CDG) are rare diseases with variable phenotypes and severity. Immunological involvement remains a largely uncharted topic in CDG, mainly due to lack of robust data. To better characterize immune-related manifestations’ prevalence, relevance, and quality-of-life (QoL) impact, we developed electronic questionnaires targeting (1) CDG patients and (2) the general “healthy” population. Two-hundred and nine CDG patients/caregivers and 349 healthy participants were included in this study. PMM2-CDG was the most represented CDG (n = 122/209). About half of these participants (n = 65/122) described relevant infections with a noteworthy prevalence of those affecting the gastrointestinal tract (GI) (63.1%, n = 41/65). Infection burden and QoL impact were shown as infections correlated with more severe clinical phenotypes and with a set of relevant non-immune PMM2-CDG signs. Autoimmune diseases had only a marginal presence in PMM2-CDG (2.5%, n = 3/122), all being GI-related. Allergy prevalence was also low in PMM2-CDG (33%, n = 41/122) except for food allergies (26.8%, n = 11/41, of PMM2-CDG and 10.8%, n = 17/158, of controls). High vaccination compliance with greater perceived ineffectiveness (28.3%, n = 17/60) and more severe adverse reactions were described in PMM2-CDG. This people-centric approach not only confirmed literature findings, but created new insights into immunological involvement in CDG, namely by highlighting the possible link between the immune and GI systems in PMM2-CDG. Finally, our results emphasized the importance of patient/caregiver knowledge and raised several red flags about immunological management.
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Morley J, Floridi L. The Limits of Empowerment: How to Reframe the Role of mHealth Tools in the Healthcare Ecosystem. SCIENCE AND ENGINEERING ETHICS 2020; 26:1159-1183. [PMID: 31172424 PMCID: PMC7286867 DOI: 10.1007/s11948-019-00115-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/28/2019] [Indexed: 05/03/2023]
Abstract
This article highlights the limitations of the tendency to frame health- and wellbeing-related digital tools (mHealth technologies) as empowering devices, especially as they play an increasingly important role in the National Health Service (NHS) in the UK. It argues that mHealth technologies should instead be framed as digital companions. This shift from empowerment to companionship is advocated by showing the conceptual, ethical, and methodological issues challenging the narrative of empowerment, and by arguing that such challenges, as well as the risk of medical paternalism, can be overcome by focusing on the potential for mHealth tools to mediate the relationship between recipients of clinical advice and givers of clinical advice, in ways that allow for contextual flexibility in the balance between patiency and agency. The article concludes by stressing that reframing the narrative cannot be the only means for avoiding harm caused to the NHS as a healthcare system by the introduction of mHealth tools. Future discussion will be needed on the overarching role of responsible design.
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Affiliation(s)
- Jessica Morley
- Oxford Internet Institute, University of Oxford, 1 St Giles, Oxford, OX1 3JS, UK.
| | - Luciano Floridi
- Oxford Internet Institute, University of Oxford, 1 St Giles, Oxford, OX1 3JS, UK
- The Alan Turing Institute, 96 Euston Road, London, NW1 2DB, UK
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Jongen PJ, Ter Veen G, Lemmens W, Donders R, van Noort E, Zeinstra E. The Interactive Web-Based Program MSmonitor for Self-Management and Multidisciplinary Care in Persons With Multiple Sclerosis: Quasi-Experimental Study of Short-Term Effects on Patient Empowerment. J Med Internet Res 2020; 22:e14297. [PMID: 32149713 PMCID: PMC7091023 DOI: 10.2196/14297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 08/12/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Empowerment helps persons with a chronic disease to self-manage their condition and increase their autonomy and participation. MSmonitor (Curavista bv) is an interactive Web-based program for self-management and multidisciplinary care in multiple sclerosis (MS). It includes, among others, short questionnaires on fatigue (Modified Fatigue Impact Scale-5 [MFIS-5]) and health-related quality of life (HRQoL, Leeds Multiple Sclerosis Quality of Life [LMSQoL]); long questionnaires on disabilities, perception of disabilities (Multiple Sclerosis Impact Profile), and HRQoL (Multiple Sclerosis Quality of Life-54); a Medication and Adherence Inventory and an Activity Diary. The combination MFIS-5, LMSQoL, and Medication and Adherence Inventory constitutes the Quick Scan. OBJECTIVE This study aimed to investigate the short-term effects of MSmonitor on empowerment in patients with MS. METHODS We conducted a quasi-experimental study in a general hospital. Of the 180 patients with MS, 125 were eligible, 30 used MSmonitor, and 21 participated in the study (mean age 45.4 years, SD 10.2 years). A total of 24 eligible patients who did not use MSmonitor constituted the control group (mean age 49.3 years, SD 11.4 years). At baseline and at 4 months, we assessed self-efficacy (Multiple Sclerosis Self-Efficacy Scale [MSSES]), participation and autonomy (Impact on Participation and Autonomy [IPA] questionnaire), and self-management (Partners In Health [PIH] questionnaire). Differences between time points and groups were tested with paired t tests and χ² tests. RESULTS In the MSmonitor group, follow-up values remained unchanged for MSSES control (P=.19), MSSES function (P=.62), IPA limitations (P=.26), IPA problems (P=.40), PIH recognition and management of symptoms (P=.52), PIH adherence to treatment (P=.80), and PIH coping (P=.73), whereas the PIH knowledge score had improved (mean 27.8, SD 1.7 vs mean 28.7, SD 2.0; P=.02). The overall utilization rate of the program components was 83% and that of the Quick Scan was 95%. In the control group, all outcomes had remained unchanged. CONCLUSIONS The results suggest that for first-time users of the MSmonitor program and their health care providers, it may not be justified to expect a short-term improvement in empowerment in terms of self-efficacy, self-management, autonomy, or participation. Furthermore, a lack of effect on empowerment is not because of nonusage of the program components.
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Affiliation(s)
- Peter Joseph Jongen
- Department of Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,MS4 Research Institute, Nijmegen, Netherlands
| | - Gezien Ter Veen
- Zorggroep Noorderboog, Meppel, Netherlands.,Isala Hospital, Meppel, Netherlands
| | - Wim Lemmens
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, Netherlands
| | - Rogier Donders
- Radboud University Medical Center, Department for Health Evidence, Nijmegen, Netherlands
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Empowerment or Engagement? Digital Health Technologies for Mental Healthcare. THE 2019 YEARBOOK OF THE DIGITAL ETHICS LAB 2020. [DOI: 10.1007/978-3-030-29145-7_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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12
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Altuve M, Suárez L, Ardila J. Fundamental heart sounds analysis using improved complete ensemble EMD with adaptive noise. Biocybern Biomed Eng 2020. [DOI: 10.1016/j.bbe.2019.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Descriptive analysis of free-text comments on healthcare priorities and experiences in a national sample of people with multiple sclerosis. Mult Scler Relat Disord 2019; 34:141-149. [DOI: 10.1016/j.msard.2019.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/25/2019] [Accepted: 06/17/2019] [Indexed: 01/20/2023]
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14
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Altuve M, Severeyn E. Joint analysis of fasting and postprandial plasma glucose and insulin concentrations in Venezuelan women. Diabetes Metab Syndr 2019; 13:2242-2248. [PMID: 31235164 DOI: 10.1016/j.dsx.2019.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/24/2019] [Indexed: 01/21/2023]
Abstract
AIMS Plasma glucose and insulin concentrations in fasting and postprandial reflect the metabolism of glucose by the human body and are useful in the diagnosis of metabolic diseases, such as diabetes and insulin resistance. In this work, these concentrations are jointly analyzed in Venezuelan women and 28 classes that better specify each metabolic condition are generated. MATERIALS AND METHODS Each class comprises a combination of fasting and postprandial ranges of glucose and insulin concentrations defined in the literature as normal, impaired and diabetic. A hypothesis test was used to find statistically significant differences between the classes, and confidence intervals for age and glucose and insulin concentrations were defined for each class. RESULTS AND CONCLUSION The process of deterioration of glucose metabolism advances with the age of the subject, more than half of the prediabetics have impaired glucose levels in fasting but normal in postprandial and normal insulin levels in fasting and postprandial, and one third of diabetics have diabetic glucose levels in fasting and postprandial and normal insulin levels in fasting and postprandial. This categorization of subjects would allow the application of a more specific treatment and the possibility of predicting the progress of the metabolic disorder.
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Affiliation(s)
- Miguel Altuve
- Faculty of Electrical and Electronic Engineering, Pontifical Bolivarian University, Bucaramanga, Colombia.
| | - Erika Severeyn
- Department of Thermodynamics and Transfer Phenomena, Simon Bolivar University, Caracas, Venezuela.
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Ven Fong Z, Chang DC, Lillemoe KD, Nipp RD, Tanabe KK, Qadan M. Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery. Clin Colon Rectal Surg 2019; 32:95-101. [PMID: 30833857 DOI: 10.1055/s-0038-1676473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The implementation of upfront, preoperative habilitation ("prehabilitation"), as opposed to postoperative habilitation (rehabilitation), provides a unique opportunity to optimize surgical outcomes, while ensuring that patients receive necessary conditioning that may otherwise be significantly delayed by postoperative complications. In this review, opportunities to design, implement, monitor, and evaluate a surgical prehabilitation program in colorectal surgery are discussed, and broken down to include emotional, physical, and nutritional aspects of care in the preoperative setting.
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Affiliation(s)
- Zhi Ven Fong
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - David C Chang
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Berner JE, Ewertz E. The importance of non-technical skills in modern surgical practice. Cir Esp 2019; 97:190-195. [PMID: 30771999 DOI: 10.1016/j.ciresp.2018.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 01/11/2023]
Abstract
The significance of technical skills and manual dexterity for surgeons is an indisputable fact. However, the systematic study of medical errors has revealed that a significant percentage of these errors are caused by factors related to non-technical skills. The review presented in this article intends to describe and explore the relevance of these non-technical skills, including: situational awareness, decision-making, leadership and communication. In conclusion, the authors propose that adequate importance needs to be given to these aptitudes to provide safe clinical care.
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Affiliation(s)
- Juan Enrique Berner
- Kellogg College, Universidad de Oxford, Oxford, Reino Unido; Departamento de Cirugía Plástica, Queen Victoria Hospital, East Grinstead, Reino Unido.
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Talebizadeh Z, Shah A. Building a Bridge Between Genetics and Outcomes Research: Application in Autism (The AutGO Study). PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 11:451-462. [PMID: 29508356 PMCID: PMC6019410 DOI: 10.1007/s40271-018-0302-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Concerns over the need to improve translational aspects of genetics research studies and engaging community members in the research process have been noted in the literature and raised by patient advocates. In addition to the work done by patient advocacy groups, organizations such as the Patient-Centered Outcomes Research Institute advocate for a change in the culture of research from being researcher-driven to becoming more patient-driven. OBJECTIVE Our project, Autism Genetics and Outcomes (AutGO), consists of two phases. The goal for phase I was to initiate a general discussion around the main topic (i.e., linking genetics and outcomes research). We used the Patient-Centered Outcomes Research Institute engagement approach to: (aim 1) develop a partnership with a wide range of stakeholders to assess their perspective on developing projects that use both genetics and outcomes research data/principles; (aim 2) identify barriers, facilitators, and needs to promote engagement in patient-centered genetics research; and (aim 3) distill and describe actions that may facilitate utilization of patient/parent perspectives in designing genetics research studies. METHODS In phase I, we formed a community advisory board composed of 33 participants, including outcomes and genetics researchers, clinicians, healthcare providers, patients/family members, and community/industry representatives, and convened six sessions over the 12-month period. We structured the sessions as a combination of online PowerPoint presentations, surveys, and in-person group discussions. During the sessions, we discussed topics pertaining to linking genetics and outcomes research and reviewed relevant materials, including patient stories, research projects, and existing resources. RESULTS Two sets of surveys, project evaluations (k = 2) and session evaluations (k = 6), were distributed among participants. Feedback was analyzed using content analysis strategies to identify the themes and subthemes. Herein, we describe: the established partnership (aim 1), the identified barriers, facilitators, and needs (aim 2), as well as the lessons learned and suggested recommendations for the research community (aim 3). Following phase I participants' recommendation, in phase II, we will focus on a specific disease (i.e., autism); this projected plan is briefly outlined to highlight the overarching goal of the project and its potential significance. We also discuss the study limitations, challenges for conducting this type of multidisciplinary work, as well as potential ways to address them. CONCLUSIONS The AutGO project has created a unique collaborative forum to facilitate the much needed dialogue between genetics and outcomes researchers, which may contribute to finding ways to improve the translational aspects of genetics research studies.
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Affiliation(s)
- Zohreh Talebizadeh
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Ayten Shah
- Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Krüger R, Klucken J, Weiss D, Tönges L, Kolber P, Unterecker S, Lorrain M, Baas H, Müller T, Riederer P. Classification of advanced stages of Parkinson's disease: translation into stratified treatments. J Neural Transm (Vienna) 2017; 124:1015-1027. [PMID: 28342083 PMCID: PMC5514193 DOI: 10.1007/s00702-017-1707-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/11/2017] [Indexed: 01/07/2023]
Abstract
Advanced stages of Parkinson's disease (advPD) still impose a challenge in terms of classification and related stage-adapted treatment recommendations. Previous concepts that define advPD by certain milestones of motor disability apparently fall short in addressing the increasingly recognized complexity of motor and non-motor symptoms and do not allow to account for the clinical heterogeneity that require more personalized approaches. Therefore, deep phenotyping approaches are required to characterize the broad-scaled, continuous and multidimensional spectrum of disease-related motor and non-motor symptoms and their progression under real-life conditions. This will also facilitate the reasoning for clinical care and therapeutic decisions, as neurologists currently have to refer to clinical trials that provide guidance on a group level; however, this does not always account for the individual needs of patients. Here, we provide an overview on different classifications for advPD that translate into critical phenotypic patterns requiring the differential therapeutic adjustments. New concepts refer to precision medicine approaches also in PD and first studies on genetic stratification for therapeutic outcomes provide a potential for more objective treatment recommendations. We define novel treatment targets that align with this concept and make use of emerging device-based assessments of real-life information on PD symptoms. As these approaches require empowerment of patients and integration into treatment decisions, we present communication strategies and decision support based on new technologies to adjust treatment of advPD according to patient demands and safety.
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Affiliation(s)
- Rejko Krüger
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg.
- Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.
| | - Jochen Klucken
- Molecular Neurology, University of Erlangen, Erlangen, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, Center for Neurology, University of Tübingen, Tübingen, Germany
| | - Lars Tönges
- Department of Neurology of the Ruhr-University Bochum at St Josef-Hospital, Gudrunstrasse 56, 44791 , Bochum, Germany
| | - Pierre Kolber
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-Sur-Alzette, Luxembourg
- Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
| | - Stefan Unterecker
- Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Würzburg, Germany
| | | | - Horst Baas
- Department of Neurology, Klinikum Hanau GmbH, Hanau, Germany
| | - Thomas Müller
- Department of Neurology, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - Peter Riederer
- Center of Mental Health, Clinic and Policlinic of Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Würzburg, Germany
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Palumbo R, Annarumma C, Adinolfi P, Musella M. The missing link to patient engagement in Italy. J Health Organ Manag 2017; 30:1183-1203. [PMID: 27834606 DOI: 10.1108/jhom-01-2016-0011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to discuss the changing patterns of users' behavior in the health care service system. Although patient engagement and health services' co-production are understood as essential ingredients in the recipe for sustainable health systems, some determinants to patient involvement are still widely neglected by both policy makers and health care professionals. Among others, inadequate health literacy performs as a significant barrier to patient empowerment. Design/methodology/approach A survey aimed at objectively measuring health literacy-related skills was administered to a random sample of 600 Italian patients. The Italian version of the Newest Vital Sign (NVS) was used to assess the ability of the respondents to deal with written health information. Moreover, the respondents were asked to self-report their ability to navigate the health system. It was presumed that inadequate health literacy as measured by the NVS is related with impaired self-reported functional, interactive, and critical health-related competencies, paving the way for the inability and the unwillingness of patients to be involved in the health care provision. Findings About half of the sample showed inadequate health literacy. However, poor NVS scores were only slightly associated with limited self-reported functional, interactive, and critical health-related competencies. In general, patients with inadequate health-related skills were not likely to be engaged in the provision of health services. Elderly, people suffering from financial deprivation and less educated individuals were found to be at special risk of living with limited health literacy. Practical implications Limited health literacy is a common and relevant issue among people dealing with the health care service system. The impaired ability to collect, process, and use health information produces barriers to patient engagement and prevents the evolution of patients' behavior toward health care co-production. Originality/value Health literacy is a widely overlooked issue in the Italian national health system. This paper contributes in shedding light on the determinants and effects of health literacy of Italian hospital patients. Besides, some insights on the validity of the methodological tools typically used to assess health-related skills are provided.
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Affiliation(s)
- Rocco Palumbo
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
| | - Carmela Annarumma
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
| | - Paola Adinolfi
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
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Kotsilieris T, Pavlaki A, Christopoulou S, Anagnostopoulos I. The impact of social networks on health care. SOCIAL NETWORK ANALYSIS AND MINING 2017. [DOI: 10.1007/s13278-017-0438-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ravoire S, Lang M, Perrin E, Audry A, Bilbault P, Chekroun M, Demerville L, Escudier T, Guéroult-Accolas L, Guillot C, Malbezin M, Maugendre P, Micallef J, Molimard M, Montastruc F, Pierron E, Reichardt L, Thiessard F. Intérêts et limites des communautés virtuelles de patients pour la recherche sur les produits de santé. Therapie 2017; 72:125-134. [DOI: 10.1016/j.therap.2016.11.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
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Ravoire S, Lang M, Perrin E. Advantages and limitations of online communities of patients for research on health products. Therapie 2017; 72:135-143. [PMID: 28139283 DOI: 10.1016/j.therap.2016.11.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
The way patients and their caregivers share information on various online platforms about health topics and their own experiential knowledge presents new potential environments for research, particularly as concerns health products. The information provided individually and voluntarily by patients who are members of these online communities is a new resource for identifying and understanding precisely how health products are used, assessing their effectiveness, quantifying potential adverse effects in real-life situations, detecting subtle signs that are significant for experts in pharmacovigilance and addiction studies, and developing new assessment tools to help form new working hypotheses. How patients freely express their experiences and feelings and the reality of what they share also opens the way for societal research into health products, a field that is still under-explored. Well-established regulations govern research into health products, which uses resources and methodologies that have changed little over the years. However, the development of online communities of patients presents new possibilities in this field. The challenge we face today is defining their place among traditional research techniques. This place cannot be accepted by all stakeholders unless we first establish a firm understanding of the advantages, limitations, and constraints of these communities. The round table on this topic endeavoured to: explore these issues and develop a better understanding of the phenomenon and the different varieties of online communities and networks for patients; identify possible advantages, special features, and methodological, regulatory, and ethical limitations that researchers currently face; and finally, to put forward the first recommendations in this growing field of research.
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Affiliation(s)
- Sophie Ravoire
- SR Consulting, 54, rue Sébastien-Mercier, 75015 Paris, France.
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