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Montejano RD, Chattopadhyay A, Woodruff CM, Botto N. Patient-Centered Communication Tools for the Patch Test Clinic. Dermatitis 2023; 34:392-398. [PMID: 36917543 DOI: 10.1089/derm.2022.0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patient-centered communication positively impacts the clinical encounter. Multiple strategies exist to improve communication between providers and their patients; the application and impact of these strategies have been studied in multiple specialties, though little exists regarding communication best practices in the patch test clinic. Because the procedural components of patch testing often span the course of an entire week, effective communication with patients during the patch testing visit is important for not only technical success, but also patient understanding and experience. In this study, we highlight the value of beginning the patch testing visit with clear introductions and agenda setting, improving patient understanding and engagement through methods such as teach backs and cycles of questions and answers that create patient-provider dialogue, and using communication techniques to make expressions of empathy. We provide detailed examples regarding the application of these techniques to the patch testing process, aimed at enhancing the patch testing experience and improving clinical outcomes. Our review exemplifies how dermatologists can leverage communication tools to improve patient satisfaction and outcomes during patch testing.
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Affiliation(s)
- Rubi Danielle Montejano
- From the *Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aheli Chattopadhyay
- Department of Dermatology, University of San Francisco, San Francisco, California, USA
| | | | - Nina Botto
- Department of Dermatology, University of San Francisco, San Francisco, California, USA
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2
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Martin ED, Eginli A, Munavalli GS. Developing relationships with patients, staff, and industry in dermatology. Clin Dermatol 2023; 41:262-267. [PMID: 37423266 DOI: 10.1016/j.clindermatol.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient-physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important.
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Affiliation(s)
- Elise D Martin
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ariana Eginli
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Girish S Munavalli
- Dermatology, Laser & Vein Specialists of the Carolinas, Charlotte, North Carolina, USA.
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Toy J, Gregory A, Rehmus W. Barriers to healthcare access in pediatric dermatology: A systematic review. Pediatr Dermatol 2021; 38 Suppl 2:13-19. [PMID: 34338358 DOI: 10.1111/pde.14748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Barriers to healthcare access are healthcare inequities that have been widely studied across different medical specialties. No studies have previously evaluated the state of barriers to healthcare access research in pediatric dermatology. A systematic review was conducted to examine the types of barriers identified within pediatric dermatology literature. Relevant information was extracted and categorized into the themes of systemic, sociocultural, or individual barriers. The systemic barriers we found include finances, wait times, and geography. The sociocultural barriers included culture beliefs and communication. Patient beliefs and health knowledge were found as individual barriers. The small number and limited scope of studies we identified suggest that barriers to healthcare access in pediatric dermatology remain an understudied topic. Additional research is needed to further characterize these barriers to dermatologic care, as well as the impact of any interventions designed to overcome them.
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Affiliation(s)
- Jeffrey Toy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allison Gregory
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Wingfield Rehmus
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Balanescu AR, Bojinca VC, Schweitzer AM, Joca B, Mardale DA, Badea D, Bojinca M. Translation and cultural adaptation of a romanian version of the communication assessment tool (CAT_Ro). BMC Health Serv Res 2021; 21:184. [PMID: 33639947 PMCID: PMC7913309 DOI: 10.1186/s12913-021-06186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The communication between health providers and patients influences the quality of medical care. The Communication Skills Assessment (CAT) is a reliable, validated tool, which was developed to assess interpersonal communication skills between physicians and patients. The purpose of this study was to obtain a Romanian version of the CAT (CAT_Ro), using a controlled and systematic process to translate and cross-culturally adapt the original questionnaire, since there are no validated instruments to assess healthcare professionals' communication capability in Romania. METHODS The study was conducted in two Departments of Internal Medicine and Rheumatology from Bucharest, Romania, using a rigorous scientific methodology for the translation process, according to literature recommendations, implicating conceptual evaluation, semantics, and cultural adaptation, which involved several steps. The updated version was pre-tested in a pilot study, which included 89 outpatients. RESULTS The results showed a narrow range of variability in item interpretation, without differences in patients' responses according to variables such as age, gender, education, disease type, number of previous visits with the same doctor. CONCLUSION CAT-Ro is the result of a comprehensive process study. It represents the first translation and cultural adaptation in Romanian of an instrument able to assess the health providers' communication skills, which was validated in a pilot study and is to be used in more extensive studies with patients from several specialties.
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Affiliation(s)
- Andra Rodica Balanescu
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu street, sector 2, 020021, Bucharest, Romania
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, 37-39 Ion Mihalache Bl. Sector 1, 011172, Bucharest, Romania
| | - Violeta Claudia Bojinca
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu street, sector 2, 020021, Bucharest, Romania.
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, 37-39 Ion Mihalache Bl. Sector 1, 011172, Bucharest, Romania.
| | | | | | - Denise Ani Mardale
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, 37-39 Ion Mihalache Bl. Sector 1, 011172, Bucharest, Romania
| | - Denisa Badea
- Department of Internal Medicine and Rheumatology, "Dr. Ion Cantacuzino" Clinical Hospital, 5-7 Ion Movila Street, Bucharest, 030167, Romania
| | - Mihai Bojinca
- University of Medicine and Pharmacy "Carol Davila", 37 Dionisie Lupu street, sector 2, 020021, Bucharest, Romania
- Department of Internal Medicine and Rheumatology, "Dr. Ion Cantacuzino" Clinical Hospital, 5-7 Ion Movila Street, Bucharest, 030167, Romania
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5
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Foissac R, Benatar MJ. Influence of botulinum toxin type A esthetic injections on facial expressions. J Cosmet Dermatol 2021; 20:1405-1410. [PMID: 33539679 DOI: 10.1111/jocd.13980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) injection remains the leading medical cosmetic procedure worldwide, with a high rate of patient satisfaction. However, it still suffers from patients' fear of being unable to transmit their emotions and of looking frozen from unnatural results. AIM This study aimed to determine whether BoNT-A can decrease the intensity of emotions in facial expressions. PATIENTS/METHODS In this single-center prospective study, 42 patient investigators assessed four patients' facial expressions for six emotions and neutral faces, before and after injection of 36 IU or 48 IU of onabotulinumtoxinA, using photographs. Photographs were presented on a tablet to the investigators. RESULTS There were no statistical differences between the before and after photographs for the intensity of emotions for all expressions (P > .05) except for the expression of surprise in the group of patients that received 48 IU of the injection (protocol with injection of the frontalis muscle). All patient investigators answered negatively to the question "Do you think that this patient has a 'frozen face'?". CONCLUSION This study shows that esthetic injection of BoNT-A in the upper face has no negative effects on facial expressions and does not lead to the feared "frozen face" when it is injected with respect for best practice guidelines. This study can be used as an example for patients who have some reticences against BoNT-A injection.
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Affiliation(s)
- Rémi Foissac
- Plastic and reconstructive Surgery, Clinique Saint George, Nice, France
| | - Marc J Benatar
- Plastic and reconstructive Surgery, Clinique Santa Maria, Nice, France
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Mauskar MM, Marathe K, Venkatesan A, Schlosser BJ, Edwards L. Vulvar diseases: Approach to the patient. J Am Acad Dermatol 2019; 82:1277-1284. [PMID: 31712174 DOI: 10.1016/j.jaad.2019.07.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/25/2022]
Abstract
Patients with vulvar dermatoses often delay seeking medical treatment because of anxiety and embarrassment. Moreover, women frequently self-treat with various home remedies and see multiple clinicians before presenting to a dermatologist. Despite serving as the primary providers for patients with vulvovaginal symptoms, gynecologists typically receive limited training in the causes and management of these conditions. Dermatologists are experts in the evaluation and management of cutaneous disease and should be the caretakers of all skin, including the genitalia. Vulvar disorders are underrecognized by dermatologists for numerous reasons: inadequate training, lack of comfort with both interview and examination techniques, and unfamiliarity with normal anatomic variations. The first article in this continuing medical education series on vulvar dermatoses reviews the fundamentals, approach, and techniques that can be used to ensure a successful visit for both patient and provider.
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Affiliation(s)
- Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Kalyani Marathe
- Department of Dermatology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio; Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Aruna Venkatesan
- Department of Dermatology, Stanford University, Stanford, California; Division of Dermatology, Santa Clara Valley Medical Center, San Jose, California
| | - Bethanee J Schlosser
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Libby Edwards
- Department of Dermatology, University of North Carolina, Charlotte, North Carolina; Division of Dermatology, Carolinas Medical Center and Southeast Vulvar Clinic, Charlotte, North Carolina
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7
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Shohani M, Mozafari M, Khorshidi A, Lotfi S. Comparing the effects of face-to-face and telenursing education on the quality of family caregivers caring in patients with cancer. J Family Med Prim Care 2018; 7:1209-1215. [PMID: 30613499 PMCID: PMC6293933 DOI: 10.4103/jfmpc.jfmpc_317_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Taking care of patients with cancer is often done at home and by family caregivers. However, these groups do not receive the necessary education regarding care at home. OBJECTIVES The present study aimed to compare the effects of face-to-face and telenursing training methods on the quality of services provided by the family caregiver for patients with cancer. MATERIALS AND METHODS A total of 103 family caregivers of patients with cancer were randomly divided into 3 groups: control (N = 35), face to face (N = 34), and telenursing (N = 34). The control group only received the routine training, and the face-to-face and telenursing groups were trained for 12 weeks. Quality of care was measured using a questionnaire before and after intervention. Chi-square, Fisher's exact, and analysis of variance tests were used for data analysis. RESULTS After intervention, the average total quality score for the care of patients in face-to-face (166.13 ± 13.91) and telenursing (157.76 ± 17.24) groups was significantly higher than the control group (82.51 ± 16.84) (P < 0.001). In addition, the average psychosocial care score for face-to-face group (49.06 ± 6.05) was significantly higher than telenursing group (43.83 ± 6.15) (P < 0.001). CONCLUSION The results of the study showed that the two methods of training were effective on the quality of care among family caregivers of patients with cancer to a similar extent.
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Affiliation(s)
- Masoumeh Shohani
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Mosayeb Mozafari
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- Department of Epidemiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Shohreh Lotfi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
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8
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Adib-Hajbaghery M, Karimi Z. Comparing the Effects of Face-to-face and Video-based Education on Inhaler Use: A Randomized, Two-group Pretest/posttest Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:352-357. [PMID: 30186339 PMCID: PMC6111659 DOI: 10.4103/ijnmr.ijnmr_17_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: The quality of inhaler use can significantly affect the effectiveness of inhalation medications. This study was done to compare the effects of face-to-face and video-based education methods on inhaler use. Materials and Methods: A quasi-experimental, pretest/posttest clinical trial study was conducted on 120 patients with respiratory diseases who were under treatment with metered-dose inhalers. Patients were randomly allocated into two groups to receive either face-to-face (n = 60) or video-based education (n = 60) about correct inhaler use. Inhaler use was assessed using a 15-item checklist before, 2 weeks, and 1 month after the education. Chi-square and independent sample t-test as well as repeated-measures analysis of variance were used for data analysis. Results: At baseline, the groups did not differ significantly in inhaler use as shown by the mean score (t = 0.81, p = 0.33). Repeated-measures analysis showed that the mean score of inhaler use significantly increased in both groups 2 weeks and 1 month after the intervention (F = 585.07, p < 0.001). The t-test showed that at 2 weeks and 1 month after intervention the amount of increase in the face-to-face group was significantly greater than the video-based group (t = 3.31 and 5.93, p < 0.001). Conclusions: Both face-to-face and video-based education methods significantly improve inhaler use, even though the effects of the face-to-face method are significantly greater. Nurses can use either of these two methods or both for education of patients about inhaler use.
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Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | - Zeynab Karimi
- Trauma Nursing Research Centre, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
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9
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Baumann L. How to Use Oral and Topical Cosmeceuticals to Prevent and Treat Skin Aging. Facial Plast Surg Clin North Am 2018; 26:407-413. [PMID: 30213422 DOI: 10.1016/j.fsc.2018.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Skin aging is caused by DNA damage in nuclei and mitochondria, inflammation, glycation, decreased function of keratinocytes and fibroblasts and breakdown of heparan sulfate, hyaluronic acid, collagen, and elastin. Identifying patients at an increased risk of skin aging using a standardized methodology to diagnose the Baumann Skin Type will allow doctors to prescribe an efficacious antiaging skin care regimen. Cosmeceuticals can activate LGR6+ stem cells, improve cell response to signals such as growth factors, stimulate collagen genes, neutralize free radicals, and decrease breakdown of collagen and elastin. Giving written instructions will increase patient compliance and improve outcomes.
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Affiliation(s)
- Leslie Baumann
- Division of Cosmetic Dermatology, University of Miami, 4500 Biscayne Boulevard Suite 101, Miami, FL 33137, USA.
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10
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Trüeb RM, Vañó-Galván S, Kopera D, Jolliffe VML, Ioannides D, Gavazzoni Dias MFR, Macpherson M, Ruíz Ávila J, Gadzhigoroeva A, Ovcharenko J, Lee WS, Murugusundram S, Kurata S, Chang M, Tanglertsampan C. Trichologist, Dermatotrichologist, or Trichiatrist? A Global Perspective on a Strictly Medical Discipline. Skin Appendage Disord 2018; 4:202-207. [PMID: 30410886 DOI: 10.1159/000488544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/16/2018] [Indexed: 11/19/2022] Open
Abstract
Few dermatologic problems carry as much emotional overtones as the complaint of hair loss. The best way to alleviate the distress related to hair loss is to effectively treat it. In fact, one of the oldest medical professions is the Egyptian physician who specialized on diseases of the head. And yet, from ancient Egypt down to modern times, human hair has been the object of superstition and mystery. Remarkably and despite the genuine advances in effective medical treatments, hair cosmetics, and surgical procedures, phony hair loss solutions continue to be marketed with an amazing success. In 1860, a quasi-scientific interest in hair loss and hair care originated in a London barbershop and became known as trichology, with the Institute of Trichologists being founded. Other corporations successively followed internationally, but it was only in 2010 that the term dermatotrichologist was proposed for board-certified dermatologists dealing with the scientific study of the hair and scalp, in contrast to the trichologist who is rather associated with laity and cosmetics than with medical professionalism, or - worse - offers opportunities to possible imposters with a primary commercial interest. The new term "trichiatrist" is proposed, literally meaning the "medical treatment of the hair," to designate the strictly medical professional dealing with the hair and scalp in health and disease. Trichiatrists differ from trichologists by virtue of being physicians. The quality and stringency of their graduate medical training is identical to that of other physicians.
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Affiliation(s)
- Ralph Michel Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb and University of Zurich, Zurich, Switzerland
| | | | - Daisy Kopera
- Center of Aesthetic Medicine, Department of Dermatology, Medical University Graz, Graz, Austria
| | | | - Demetrios Ioannides
- 1st Department of Dermatology-Venereology, Hospital of Skin and Venereal Diseases, Aristotle University Medical School, Thessaloniki, Greece
| | - Maria Fernanda Reis Gavazzoni Dias
- Department of Dermatology, Centro de Ciências Médicas, Hospital Universitário Antonia Pedro, Universidade Federal Fluminense, Niterói, Brazil
| | - Melanie Macpherson
- Department of Dermatology and Venereology, San Gabriel Clinic, Lima, Peru
| | | | - Aida Gadzhigoroeva
- Moscow Scientific and Practical Center of Dermatology and Cosmetology, Moscow City Health Department, Moscow, Russian Federation
| | - Julya Ovcharenko
- General and Clinical Immunology and Allergology Department, School of Medicine, V.N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Won-Soo Lee
- Department of Dermatology, Wonju College of Medicine, Yonsei University, Gangwon-do, Republic of Korea
| | | | - Sotaro Kurata
- Beppu Garden Hill Clinic and Kurata Clinic, Beppu, Japan
| | - Mimi Chang
- Prince of Wales Hospital and the Chinese University of Hong Kong, Hong Kong, China
| | - Chuchai Tanglertsampan
- Department of Dermatology, Bumrungrad International Hospital, Mae Fah Luang University Hospital, Bangkok, Thailand
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Use of Electronic Tablets for Patient Education on Flushing Peripherally Inserted Central Catheters. JOURNAL OF INFUSION NURSING 2017; 40:298-304. [PMID: 28885478 DOI: 10.1097/nan.0000000000000239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the efficacy of using an electronic tablet to provide patient education for flushing peripherally inserted central catheters (PICCs) as a way to reduce the incidence of occlusion. Eleven patients, newly diagnosed with cancer, participated in a pilot study that used a video on PICC flushing and remote coaching using FaceTime (Apple, Cupertino, CA) to teach patients how to maintain their PICCs in their homes. At the end of the 6-week intervention, no adverse outcomes (occlusions or infections) were noted among the patients who participated in the study.
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12
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Santer M, Chandler D, Lown M, Francis NA, Muller I. Views of oral antibiotics and advice seeking about acne: a qualitative study of online discussion forums. Br J Dermatol 2017; 177:751-757. [PMID: 28218972 DOI: 10.1111/bjd.15398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acne vulgaris is common and can significantly impair quality of life, yet little is known about patients' understanding of acne and its treatments. Oral antibiotics are widely used for acne despite concerns about antibiotic resistance. People are increasingly turning to online discussion forums for advice, and information on these sites may influence health beliefs and treatment adherence. OBJECTIVES To explore understandings about the use of oral antibiotics for acne and advice shared among messages posted on online forums. METHODS We systematically searched for online forums and identified four where acne was frequently discussed. Discussion threads relating to oral antibiotics were analysed thematically. RESULTS We extracted 136 pages of data comprising 65 discussions among 294 participants. We found a wide range of perceptions around effectiveness of antibiotics for acne and concerns about adverse effects. The delayed onset of action of antibiotics was a source of frustration and compounded dissatisfaction with healthcare providers, who were perceived by people as 'fobbing them off' with prolonged courses of ineffective treatment. Advice ranged from when to ask for or insist on referral to use of costly cleansers. Forum posts related to a wide range of severities, from 'spots' to severe acne, which may make it confusing for users to assess appropriateness of information. CONCLUSIONS Online forums offer opinions that could confuse patients, or lead to early abandonment of treatments, challenging consultations and patient dissatisfaction. Users expressed frustration about the delayed onset of action of antibiotics for acne, perceptions of only temporary effectiveness and adverse effects.
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Affiliation(s)
- M Santer
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - D Chandler
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - M Lown
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
| | - N A Francis
- Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, U.K
| | - I Muller
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, U.K
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13
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Comparing the Effect of Electronic Software and Training Booklet on Maternal Self-Confidence and Awareness About Newborn Care: A Randomized Controlled Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2017. [DOI: 10.5812/ircmj.44152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Pickett K, Loveman E, Kalita N, Frampton GK, Jones J. Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness. Health Technol Assess 2016; 19:1-176, v-vi. [PMID: 26502807 DOI: 10.3310/hta19860] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases. DATA SOURCES Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted. REVIEW METHODS Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses. RESULTS Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area. LIMITATIONS The application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported. CONCLUSIONS There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective. STUDY REGISTRATION This study is registered as PROSPERO CRD42014007426. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Emma Loveman
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Pickett K, Frampton G, Loveman E. Education to improve quality of life of people with chronic inflammatory skin conditions: a systematic review of the evidence. Br J Dermatol 2016; 174:1228-41. [PMID: 26833102 DOI: 10.1111/bjd.14435] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 01/10/2023]
Abstract
Patient and carer education has been proposed as a way of improving health-related quality of life (HRQoL) among people with chronic inflammatory skin conditions. This systematic review aimed to assess the effects of education that specifically addresses HRQoL among people with chronic inflammatory skin conditions. We searched 12 literature databases and other sources (up to July 2014). Seven randomized controlled trials (RCTs) met the review inclusion criteria. Data from these RCTs were extracted and critically appraised. Two RCTs showed that for psoriasis in adults, group-based and text message education (as adjuncts to usual care) resulted in better HRQoL and disease severity outcomes than comparators, respectively. One RCT found that group-based education for children with eczema (atopic dermatitis) and their parents resulted in greater improvements in parents' HRQoL and in the children's disease severity than no education at 12 months. The remaining RCTs evaluated an educational session for psoriasis, a website for carers of children with eczema, information on skincare and make-up use given to women with acne, and an itch-coping programme for a range of conditions, all as adjuncts to usual care. None of these RCTs found statistically significant effects on HRQoL or disease severity compared with usual care. Common features of the effective interventions were long delivery (over 6 weeks to 3 months) and delivery by a multidisciplinary team. Overall, the evidence base is currently limited and generally has an unclear risk of bias. There is a need for more large RCTs evaluating piloted and theory-based interventions.
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Affiliation(s)
- K Pickett
- Southampton Health Technology Assessments Centre, Faculty of Medicine, University of Southampton, Southampton, SO16 7NS, U.K
| | - G Frampton
- Southampton Health Technology Assessments Centre, Faculty of Medicine, University of Southampton, Southampton, SO16 7NS, U.K
| | - E Loveman
- Southampton Health Technology Assessments Centre, Faculty of Medicine, University of Southampton, Southampton, SO16 7NS, U.K.,Effective Evidence LLP, Chandlers Ford, Hampshire, U.K
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16
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Sundaram H, Signorini M, Liew S, Trindade de Almeida AR, Wu Y, Vieira Braz A, Fagien S, Goodman GJ, Monheit G, Raspaldo H. Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications. Plast Reconstr Surg 2016; 137:518e-529e. [PMID: 26910696 PMCID: PMC5242214 DOI: 10.1097/01.prs.0000475758.63709.23] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide, with a high rate of efficacy and patient satisfaction. METHODS A multinational, multidisciplinary group of plastic surgeons and dermatologists convened the Global Aesthetics Consensus Group to develop updated consensus recommendations with a worldwide perspective for botulinum toxin and hyaluronic acid fillers. This publication on botulinum toxin type A considers advances in facial analysis, injection techniques, and avoidance and management of complications. RESULTS Use of botulinum toxin has evolved from the upper face to also encompass the lower face, neck, and midface. The Global Aesthetics Consensus Group emphasizes an integrative, diagnostic approach. Injection dosage and placement are based on analysis of target muscles in the context of adjacent ones and associated soft and hard tissues. The indication for selection of botulinum toxin as a primary intervention is that excessive muscular contraction is the primary etiology of the facial disharmony to be addressed. Global Aesthetics Consensus Group recommendations demonstrate a paradigm shift toward neuromodulation rather than paralysis, including lower dosing of the upper face, more frequent combination treatment with hyaluronic acid fillers, and intracutaneous injection where indicated to limit depth and degree of action. CONCLUSIONS The accumulation of clinical evidence and experience with botulinum toxin has led to refinements in treatment planning and implementation. The Global Aesthetics Consensus Group advocates an etiology-driven, patient-tailored approach, to enable achievement of optimal efficacy and safety in patient populations that are rapidly diversifying with respect to ethnicity, gender, and age. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Hema Sundaram
- Rockville, Md.; Milan, Italy; Sydney, New South Wales, and Carlton, Victoria, Australia; São Paolo and Rio de Janeiro, Brazil; Beijing, China; Boca Raton, Fla.; Seoul, Korea; and Cannes, France
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17
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Sugamoto Y, Hamamoto Y, Kimura M, Fukunaga T, Tasaki K, Asai Y, Takeshita N, Maruyama T, Hosokawa T, Tamachi T, Aoyama H, Matsubara H. A Novel Method for Real-Time Audio Recording With Intraoperative Video. JOURNAL OF SURGICAL EDUCATION 2015; 72:795-802. [PMID: 26002537 DOI: 10.1016/j.jsurg.2015.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Although laparoscopic surgery has become widespread, effective and efficient education in laparoscopic surgery is difficult. Instructive laparoscopy videos with appropriate annotations are ideal for initial training in laparoscopic surgery; however, the method we use at our institution for creating laparoscopy videos with audio is not generalized, and there have been no detailed explanations of any such method. Our objectives were to demonstrate the feasibility of low-cost simple methods for recording surgical videos with audio and to perform a preliminary safety evaluation when obtaining these recordings during operations. DESIGN We devised a method for the synchronous recording of surgical video with real-time audio in which we connected an amplifier and a wireless microphone to an existing endoscopy system and its equipped video-recording device. We tested this system in 209 cases of laparoscopic surgery in operating rooms between August 2010 and July 2011 and prospectively investigated the results of the audiovisual recording method and examined intraoperative problems. SETTING Numazu City Hospital in Numazu city, Japan. PARTICIPANTS Surgeons, instrument nurses, and medical engineers. RESULTS In all cases, the synchronous input of audio and video was possible. The recording system did not cause any inconvenience to the surgeon, assistants, instrument nurse, sterilized equipment, or electrical medical equipment. Statistically significant differences were not observed between the audiovisual group and control group regarding the operating time, which had been divided into 2 slots-performed by the instructors or by trainees (p > 0.05). CONCLUSIONS This recording method is feasible and considerably safe while posing minimal difficulty in terms of technology, time, and expense. We recommend this method for both surgical trainees who wish to acquire surgical skills effectively and medical instructors who wish to teach surgical skills effectively.
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Affiliation(s)
- Yuji Sugamoto
- Department of Surgery, Numazu City Hospital, Shizuoka, Japan.
| | | | - Masayuki Kimura
- Department of Surgery, Numazu City Hospital, Shizuoka, Japan
| | - Toru Fukunaga
- Department of Surgery, Numazu City Hospital, Shizuoka, Japan
| | - Kentaro Tasaki
- Department of Surgery, Numazu City Hospital, Shizuoka, Japan
| | - Yo Asai
- Department of Surgery, Numazu City Hospital, Shizuoka, Japan
| | | | | | | | | | - Hiromichi Aoyama
- Department of Surgery, National Hospital Organization Chiba-East-Hospital, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Abstract
Patient satisfaction is an important component of dermatological care that reflects patients' perspectives on the care they receive. While physicians' expertise and judgment should always remain the foundation of providing appropriate and effective care, the patient experience can also be influenced by interpersonal relationships, expectations, and a sense of agency in the treatment patients receive. Dermatology providers can use practical techniques such as sitting rather than standing, reframing the concept of cure, and engaging patients in treatment decisions to improve the patient-provider experience and thereby optimize patient satisfaction.
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Affiliation(s)
- Eric Sorenson
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA,
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Schiller C, Franke T, Belle J, Sims-Gould J, Sale J, Ashe MC. Words of wisdom - patient perspectives to guide recovery for older adults after hip fracture: a qualitative study. Patient Prefer Adherence 2015; 9:57-64. [PMID: 25609927 PMCID: PMC4298293 DOI: 10.2147/ppa.s75657] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recovery after hip fracture is complex involving many transitions along the care continuum. The recovery process, and these transitions, often present significant challenges for older adults and their families and caregivers. There is an identified need for more targeted information to support older adults and their families throughout the recovery process.Therefore, our goal was to understand the recovery phase after hip fracture from the patient perspective, and identify specific messages that could be integrated into future educational material for clinical practice to support patients during recovery. Using a qualitative description design guided by a strengths-based focus, we invited men and women 60+ years with previous hip fracture and their family members/caregivers to participate in interviews. We used purposive criterion sampling within the community setting to recruit participants. We followed a semi-structured guide to conduct the interviews, either in person or over the telephone, and focused questions on experiences with hip fracture and factors that enabled recovery. Two investigators coded and analyzed interview transcripts to identify key messages. We interviewed a total of 19 participants: eleven older adults who sustained a hip fracture and eight family member/caregivers. Participants described three main messages that enabled recovery: 1) seek support; 2) move more; and 3) preserve perspective. Participants provided vital information about their recovery experience from hip fracture. In future, this knowledge can be incorporated into patient-centered education and shared with older adults, their families, and health care professionals across the continuum of care.
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Affiliation(s)
- Claire Schiller
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Thea Franke
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
| | - Jessica Belle
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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Abstract
Patient satisfaction has been and is of growing importance in healthcare. Recent healthcare initiatives aim to provide physicians with performance feedback reports based partially on patient completed surveys; thus, patient satisfaction will be an even more important determinant of high quality care. In the field of dermatology, patient satisfaction is particularly relevant and at times difficult to achieve, since many patients are plagued with chronic skin diseases often requiring intensive topical regimens or undesirable systemic immunosuppressants. The discussion of patient satisfaction is usually restricted to encounters with the general clinic population leaving encounters with difficult patients largely underreported; therefore, we provide examples of more common difficult patient encounters a dermatologist may face with specific recommendations on how to best optimize patient satisfaction.
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Zhang L, Yang H, Wang Y, Chen Y, Zhou H, Shen Z. Self-medication of psoriasis in southwestern China. Dermatology 2014; 228:368-74. [PMID: 24751982 DOI: 10.1159/000360284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 02/03/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medication adherence is essential for psoriasis management. Although studies have determined the prevalence and correlative factors of non-adherence, as far as we know, there has been no study specifically addressing them in China. METHODS Anonymous 23-item questionnaires were distributed to 324 psoriatic patients from June 2012 to June 2013. χ(2) test, normality test, Student's t test or Mann-Whitney U test, Bonferroni correction and the binary logistic regression model were applied. RESULTS Self-medication of psoriasis was high in China (82.4%). Joint involvement, absence of communication with families and short communication duration with doctors were the three top factors affecting adherence. Besides low efficacy (16.0%) and recurrence frustration (27.0%), we found that patients' deception by sham advertisings (24.1%) is an non-negligible issue. CONCLUSION Psoriasis self-medication in China was high. Improvement of patients' communication with families and/or doctors were suggested to be crucial to enhance adherence. Meanwhile, extermination of sham advertisings by administrative agencies is of great concern.
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Affiliation(s)
- Ling Zhang
- Outpatient Department, Southwest Hospital, Third Military Medical University, Chongqing, China
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Niesten D, van Mourik K, van der Sanden W. The impact of frailty on oral care behavior of older people: a qualitative study. BMC Oral Health 2013; 13:61. [PMID: 24175989 PMCID: PMC3819177 DOI: 10.1186/1472-6831-13-61] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people. METHODS We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers. RESULTS Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports. CONCLUSION The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.
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Affiliation(s)
- Dominique Niesten
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, PO Box 9101HB, Nijmegen, The Netherlands.
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