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Kalra S, Bhattacharya S, Kapoor N. Counseling for Insulin Icodec: A Proposed Practitioner's Guide. Diabetes Ther 2024:10.1007/s13300-024-01600-y. [PMID: 38743307 DOI: 10.1007/s13300-024-01600-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Despite insulin being a lifesaving medication, insulin distress, insulin hesitancy, and insulin inertia remain oft-repeated themes in diabetes discourse. The current model lists three issues: temperament, troublesomeness, and technicality, which contribute to insulin perceptions. Therapeutic patienteducation (TPE), value-added therapy (VAT), and medication counseling are concepts that assist in optimizing insulin perceptions. Insulin icodec is a basal insulin with a half-life of 196 h and a once-weekly or circaseptan frequency of administration. Insulin icodec reduces the frequency of basal insulin administration to one-seventh, which along with the lower requirement of glucose monitoring, reduces the burden of plastic and ancillary supply disposal. Because of its unique frequency of injection, insulin icodec usage requires appropriate counseling and education. This reader-friendly counseling guide helps practitioners offer VAT, as well as TPE while prescribing icodec and other insulins.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India.
- University Center for Research and Development, Chandigarh University, Mohali, India.
| | | | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
- Non Communicable Disease Unit, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Leibowitz KA, Howe LC, Winget M, Brown-Johnson C, Safaeinili N, Shaw JG, Thakor D, Kwan L, Mahoney M, Crum AJ. Medicine plus mindset: A mixed-methods evaluation of a novel mindset-focused training for primary care teams. PATIENT EDUCATION AND COUNSELING 2024; 122:108130. [PMID: 38242012 PMCID: PMC11140761 DOI: 10.1016/j.pec.2023.108130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES Patient mindsets influence health outcomes; yet trainings focused on care teams' understanding, recognizing, and shaping patient mindsets do not exist. This paper aims to describe and evaluate initial reception of the "Medicine Plus Mindset" training program. METHODS Clinicians and staff at five primary care clinics (N = 186) in the San Francisco Bay Area received the Medicine Plus Mindset Training. The Medicine Plus Mindset training consists of a two-hour training program plus a one-hour follow-up session including: (a) evidence to help care teams understand patients' mindsets' influence on treatment; (b) a framework to support care teams in identifying specific patient mindsets; and (c) strategies to shape patient mindsets. RESULTS We used a common model (Kirkpatrick) to evaluate the training based on participants' reaction, learnings, and behavior. Reaction: Participants rated the training as highly useful and enjoyable. Learnings: The training increased the perceived importance of mindsets in healthcare and improved self-reported efficacy of using mindsets in practice. Behavior: The training increased reported frequency of shaping patient mindsets. CONCLUSIONS Development of this training and the study's results introduce a promising and feasible approach for integrating mindset into clinical practice. Practice Implications Mindset training can add a valuable dimension to clinical care and should be integrated into training and clinical practice.
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Affiliation(s)
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Marcy Winget
- Department of Medicine, Stanford University, Stanford, USA
| | | | | | | | - Deepa Thakor
- Department of Medicine, Stanford University, Stanford, USA
| | - Lawrence Kwan
- Department of Medicine, Stanford University, Stanford, USA
| | - Megan Mahoney
- Department of Family and Community Medicine, University of California San Francisco
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, USA
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Neumann M, Wirtz MA, Lutz G, Ernesti A, Edelhäuser F. Why context matters when changing the diet: A narrative review of placebo, nocebo, and psychosocial context effects and implications for outcome research and nutrition counselling. Front Nutr 2022; 9:937065. [PMID: 36386910 PMCID: PMC9650541 DOI: 10.3389/fnut.2022.937065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/11/2022] [Indexed: 09/19/2023] Open
Abstract
Placebo (PE) and nocebo effects (NE) have been subjects of systematic research in medicine and psychotherapy for many decades to distinguish between the (specific) pharmacological effect of medication and the (unspecific) effect of the context. Despite this significant research, the awareness, operationalisation, and reflection of the multiplicity of PE, NE, and psychosocial context effects (PSCE) is currently limited when researching outcomes of diet changes in studies without randomisation and placebo control. This neglection is critical as it could systematically influence outcomes by moderating and mediating them and thus reducing the validity and evidence base of these studies. Therefore, we performed a (non-systematic) narrative review (NR) on the following objectives: (1) present a concise overview about the relevance of PE, NE, and PSCE in medicine and nutrition research; (2) review the current state of research on reflecting context effects when studying diet changes; (3) provide useful theoretical foundations via consideration and integration of micro- and macro context effects; (4) operationalise as hypotheses the potential PE, NE, and PSCE which are specific for researching diet changes; and (5) derive their impact for future research as well as for nutrition counselling. The electronic search in this NR for objective (2) identified N = 5 publications and for objective (4) we found N = 61 articles retrieved in the first round of search, additional references were identified by a manual and snowball search among the cited references resulting finally in N = 37. This NR offers a synoptical basis to foster awareness and operationalisation of a variety of PE, NE, and PSCE. Interdisciplinary research teams should monitor these factors using, e.g., qualitative, mixed-method studies, process evaluation, item bank approaches, moderator and mediator analysis that might reveal substantially new insights, and outcomes of relevance to science and nutrition counselling. Nevertheless, the present NR has several limitations, especially as it is non-systematic, because it is a very heterogeneous field of research, in which the topic we are investigating is usually regarded as marginal and subordinate. Therefore, future research should conduct systematic reviews and particularly theory-based primary studies (experimental research) on hypotheses of PE, NE, and PSCE in outcome research in diet changes.
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Affiliation(s)
- Melanie Neumann
- Department of Medicine, Faculty of Health, Integrated Curriculum for Anthroposophic Medicine (ICURAM) and Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Gabriele Lutz
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Alina Ernesti
- Department of Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Friedrich Edelhäuser
- Department of Medicine, Faculty of Health, Integrated Curriculum for Anthroposophic Medicine (ICURAM) and Institute of Integrative Medicine, Witten/Herdecke University, Witten, Germany
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Assing Hvidt E, Søndergaard J, Wehberg S, Hvidt NC, Andersen CM. A cross-sectional study of student empathy across four medical schools in Denmark-associations between empathy level and age, sex, specialty preferences and motivation. BMC MEDICAL EDUCATION 2022; 22:489. [PMID: 35739548 PMCID: PMC9223265 DOI: 10.1186/s12909-022-03532-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Professional empathy has been associated with a range of positive patient- and clinician outcomes and is therefore considered important to develop for future physicians. Measuring changes in empathy scores among medical students by using the Jefferson Scale of Empathy (Student version) (JSE-S) has led to mixed results. So far, no investigation of Danish medical students' empathy development has been conducted. The aim of this study was therefore to examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession. METHODS This was a cross-sectional questionnaire study. All medical students from four medical schools in Denmark in their first, third and sixth year (N = 4,178) were invited to participate in the study in October 2020. The associations between JSE-S sum score and the above explanatory factors were analysed by uni- and multivariable linear regression models. RESULTS The JSE-S was completed by 672 medical students. The overall mean score was 112.7. There were no statistically significant differences in empathy between medical schools, first, third- and sixth- year medical students, age groups or parental status. Female students and students living with a spouse or partner scored higher on JSE-S than male students or students living alone, and the sex difference remained statistically significant in the multivariable regression. In both the univariable and multivariable setting, preference for future medical specialty was statistically significant, with a decrease in scores for students choosing surgery-specialties. Motivational factors were not statistically significantly associated with empathy, although there was a slight upwards trend for one of the motivational categories, named "personal experiences". CONCLUSIONS Overall, our results showed neither decrease nor increase but instead rather stable empathy scores across years of curriculum of medical students in Denmark, adding to the mixed picture of empathy development among medical students. Our findings are consistent with positive associations found in international studies between empathy scores and higher age, female sex, specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll. Although specialty preferences are changing during medical education, they may be used meaningfully as predictors of individual student empathy levels.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
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Lubasch JS, Lee S, Wirtz MA, Pfaff H, Ansmann L. Validation of a patient-reported measure of social support provided by nurses in breast cancer care (SuPP-N): based on a cross-sectional patient survey in 83 German hospitals. BMJ Open 2022; 12:e054015. [PMID: 35487734 PMCID: PMC9058806 DOI: 10.1136/bmjopen-2021-054015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To validate the patient-reported measure of Social Support Perceived by Patients Scale-Nurses (SuPP-N). DESIGN/SETTING A secondary data analysis based on a cross-sectional breast cancer patient survey in 83 German hospitals. Patients were asked to give written informed consent before they were discharged. If they agreed to participate, the questionnaire was sent via mail to their home address after discharge. PARTICIPANTS Of 5583 eligible patients, 4841 consented to participate in the study and 4217 returned completed questionnaires (response rate: 75.5 %). For the data analysis n=3954 respondents were included. On average, participants were 60 years old and mostly in cancer stages I and II. PRIMARY AND SECONDARY OUTCOME MEASURES Perceived social support was assessed with a three-item patient-reported scale (SuPP-N). Convergent validity and criterion-related validity were tested using the following constructs: trust in nurses, trust in the treatment team (Wake Forest Physician Trust Scale, adapted), quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire), processes organisation, availability of nurses. RESULTS The structural equation model (SEM) assuming a one-dimensional structure of the instrument showed acceptable goodness of fit (root mean square error of approximation=0.04, Comparative Fit Index=0.96 and Tucker-Lewis Index=0.96; factor loadings ≥0.83). Hypothesis-consistent correlations with trust in nurses (beta=0.615; p<0.01) and trust in the treatment team (beta=0.264; p<0.01) proved convergent validity. Criterion-related validity was proved by its association with patients' quality of life (beta=-0.138; p<0.01), processes organisation (beta=-0.107; p<0.01) and the availability of nurses (beta=0.654; p<0.01). CONCLUSION The results of the SEM identify potential important factors to foster social support by nurses in cancer care. In patient surveys, the SuPP-N can be used efficiently to measure patient-reported social support provided by nurses. The use of the scale can contribute to gain a better understanding of the relevance of social support provided by nurses for patients and to detect possible deficits and derive measures with the aim of improving the patient-nurse interaction.
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Affiliation(s)
- Johanna Sophie Lubasch
- Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Susan Lee
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Lena Ansmann
- Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Chui A, Dainty KN, Kirsh B, Dawson DR, Colquhoun H. Hope for “Continued Vitality”: Qualitative Study of Adults With Traumatic Brain Injury and Low Mood on Their Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:848575. [PMID: 36189039 PMCID: PMC9397807 DOI: 10.3389/fresc.2022.848575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022]
Abstract
Objective Depression is highly comorbid with traumatic brain injury (TBI) with often complex and interacting symptomology that contributes to the experience of disability. Comorbid depression results in poorer TBI rehabilitation and downstream participation outcomes yet perspectives of this group regarding person-centered care is unknown. Purpose This study aimed to explicate the perspectives of persons with TBI and depression on their values, preferences, and desired outcomes for optimal rehabilitation. Methods A qualitative descriptive approach was taken. Thirteen adults [mean age: 40.5 (standard deviation 9.8)] diagnosed with TBI and with self-reported low mood were recruited through convenience sampling. Participants were predominantly female (n = 12) with concussion/mild TBI and at least 6 months post-injury. One-on-one, semi-structured interviews were conducted by phone with Canadian participants (March-May 2020). Interviews were transcribed; data were analyzed thematically by two researchers and the thematic map refined by the research team. Results Three themes were identified on values, preferences, and desired outcomes in person-centered care. Participants valued “validation” from healthcare providers and the health system to feel seen and believed about their conditions and concerns. They preferred for healthcare providers to “share the burden of managing care” through improved interactions and better access to concussion care. Participants expressed that “meaningful outcomes” were to be symptom free, to resume valued life activities, and to be able to adapt/be resilient. The latter indicated hope for “continued vitality” for life participation despite past and ongoing challenges. Conclusions Many adults with TBI and self-identified low mood expressed rehabilitation experiences that were invalidating. Their identified values, preferences, and desired outcomes provide directions for better person-centered care by healthcare providers and health systems to support participation.
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Affiliation(s)
- Adora Chui
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Toronto, ON, Canada
- *Correspondence: Adora Chui
| | - Katie N. Dainty
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Bonnie Kirsh
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Deirdre R. Dawson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Glos L, Pinet-Peralta LM. The influence of institutional factors on patient–provider communication and interactions in the U.S. healthcare system. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01426-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Knudsen RK, Gregersen T, Ammentorp J, Tousig CG, Timmermann C. Healthcare professionals' experiences of using mindfulness training in a cardiology department - a qualitative study. Scand J Caring Sci 2020; 35:892-900. [PMID: 32852094 DOI: 10.1111/scs.12906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/02/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE AND AIM Person-centred communication and healthcare professionals' ability to be attentively present in their encounter with patients are essential aspects of patients' experiences of well-being, ability to cope with illness-related challenges and feelings of being recognised. However, the ability to be attentive in relational encounters can be challenging for healthcare staff for many reasons, such as time constraints and a high work pace. Research suggests that mindfulness training could increase staff attentiveness and compassion, but only few qualitative studies have explored the subject. The aim of the current study was to explore doctors' and nurses' individual experiences of how attending an 8-week Mindfulness-Based Stress Reduction course (MBSR) influenced their clinical practice and encounters with colleagues and patients in a cardiology department. METHOD Qualitative interviews were held with six doctors and nurses who had completed the 8-week MBSR course. Interpretative phenomenological analysis was applied to explore and understand the meaning of the participants' accounts. FINDINGS The MBSR course appeared to have changed the healthcare professionals' thoughts and actions, especially regarding their ability to stay focused on the task at hand, to prioritise and to stay calm in an unpredictable and busy work environment. This was facilitated by using concrete techniques learned during the course, such as breathing and taking small breaks to clear their heads and help them be attentive in relation to themselves, colleagues and patients. Furthermore, they described an increased acceptance of their own limitations, better understanding of their colleagues and greater awareness of the unique patient. CONCLUSION These findings suggest that changing healthcare professionals' actions, mindset, awareness and understanding of others may result in a more compassionate work environment and more person-centred care.
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Affiliation(s)
- Randi Karkov Knudsen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark.,Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Trine Gregersen
- Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Connie Timmermann
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark.,Health Services Research Unit, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Assing Hvidt E, Søndergaard J, Hvidt NC, Wehberg S, Büssing A, Andersen CM. Development in Danish medical students' empathy: study protocol of a cross-sectional and longitudinal mixed-methods study. BMC MEDICAL EDUCATION 2020; 20:54. [PMID: 32075639 PMCID: PMC7031973 DOI: 10.1186/s12909-020-1967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/12/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Clinical empathy has been associated with positive outcomes for both physicians and patients such as: more accurate diagnosis and treatment, increased patient satisfaction and compliance, and lower levels of burnout and stress among physicians. International studies show mixed results regarding the development of empathy among future physicians associating medical education with decline, stability or increase in empathy levels. These mixed results are due to several study limitations. In Denmark, no investigation of Danish medical students' empathy trajectory has yet been conducted wherefore such a study is needed that optimizes the study design of earlier studies. METHODS The aim of the study is to examine and analyze empathy levels and empathy changes among Danish medical students from the four medical faculties in Denmark, employing a cross-sectional and longitudinal mixed-methods design including a control group of non-medical students. By supplementing cross-sectional and longitudinal questionnaire studies with a focus group interview study it is the aim to identify and analyze factors (including educational) that are perceived by medical students to influence the development of empathy and its expression in clinical care. DISCUSSION The results of the study will provide insight into the trajectory of medical students' empathy and in undergraduate and graduate students' experiences with and perceptions of empathy development. In addition, the study will provide evidence to support further research on how targeted educational programmes can best be designed to educate empathic and patient-centered physicians.
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Affiliation(s)
- E Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark.
- Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - N C Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - S Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwsvej 9 A, 5000, Odense, Denmark
| | - A Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313, Herdecke, Germany
| | - C M Andersen
- Department for Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Gillespie E. A Qualitative Pilot Study of Spirituality in Long-term Recovery in Acquired Brain Injury. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2019; 73:96-105. [PMID: 31189453 DOI: 10.1177/1542305019853588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Increased spirituality occurring after acquired brain injury is a part of post traumatic growth (PTG). Participants were asked about their spirituality, and their responses were analyzed. Eighty-one percent exhibited a moderate spiritual impact on their recovery. Studies suggest that patients' spiritual needs are not being met, and chaplains are being underutilized. Trust and a sense of presence are essential to encouraging PTG, and, by fully utilizing the skills of our chaplain colleagues, could improve PTG.
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Affiliation(s)
- Elena Gillespie
- College of Integrative Medical Sciences, Saybrook University, Oakland, USA
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Li L, Liang LJ, Lin C, Feng N, Cao W, Wu Z. An intervention to improve provider-patient interaction at methadone maintenance treatment in China. J Subst Abuse Treat 2019; 99:149-155. [PMID: 30797387 DOI: 10.1016/j.jsat.2019.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study evaluated an intervention aiming to improve methadone maintenance therapy (MMT) service providers' interaction with their patients in China. METHODS Sixty-eight MMT clinics were randomized to either an intervention or a control condition. Providers in the intervention group attended three group training sessions to enhance their communication skills. Trained providers were encouraged to practice the taught communication skills through provider-initiated individual sessions with their patients. A total of 418 service providers completed assessments from baseline to 24-month. Linear mixed-effects regression models were used to compare self-reported short-term and sustained improvement in provider-patient interaction between the intervention and the control conditions. RESULTS The intervention group service providers perceived significantly greater short-term and sustained improvement in provider-patient interaction compared to the control group service providers (estimated difference (±SE): 1.20 (0.24) and 1.35 (0.33), respectively; p-values < 0.0001). Providers' baseline job satisfaction was significantly associated with a greater perceived improvement in provider-patient interaction for both periods (reg. coef. (±SE): 0.02 (0.01) and 0.04 (0.01) for short-term and sustained periods, respectively; p-values < 0.01). CONCLUSION Study findings suggest that the intervention could be beneficial for improving perceived provider-patient interaction in MMT programs. Service providers' job satisfaction should be addressed in training programs for the improvement of provider-patient interaction.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Wei Cao
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention, Beijing, China
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12
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Howe LC, Leibowitz KA, Crum AJ. When Your Doctor "Gets It" and "Gets You": The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Front Psychiatry 2019; 10:475. [PMID: 31333518 PMCID: PMC6619399 DOI: 10.3389/fpsyt.2019.00475] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Research demonstrates that the placebo effect can influence the effectiveness of medical treatments and accounts for a significant proportion of healing in many conditions. However, providers may differ in the degree to which they consciously or unconsciously leverage the forces that produce placebo effects in clinical practice. Some studies suggest that the manner in which providers interact with patients shapes the magnitude of placebo effects, but this research has yet to distill the specific dimensions of patient-provider interactions that are most likely to influence placebo response and the mechanisms through which aspects of patient-provider interactions impact placebo response. Methods: We offer a simplifying and unifying framework in which interactions that boost placebo response can be dissected into two key dimensions: patients' perceptions of competence, or whether a doctor "gets it" (i.e., displays of efficiency, knowledge, and skill), and patients' perceptions of warmth, or whether a doctor "gets me" (i.e., displays of personal engagement, connection, and care for the patient). Results: First, we discuss how this framework builds on past research in psychology on social perception of competence and warmth and in medical literature on models of effective medical care, patient satisfaction, and patient-provider interactions. Then we consider possible mechanisms through which competence and warmth may affect the placebo response in healthcare. Finally, we share original data from patients and providers highlighting how this framework applies to healthcare. Both patient and provider data illustrate actionable ways providers can demonstrate competence and warmth to patients. Discussion: We conclude with recommendations for how researchers and practitioners alike can more systematically consider the role of provider competence and warmth in patient-provider interactions to deepen our understanding of placebo effects and, ultimately, enable providers to boost placebo effects alongside active medications (i.e., with known medical ingredients) and treatment in clinical care.
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Affiliation(s)
- Lauren C Howe
- Department of Business Administration, University of Zurich, Zurich, Switzerland
| | - Kari A Leibowitz
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, CA, United States
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Hauenstein EJ, Clark RS, Merwin EI. Modeling Health Disparities and Outcomes in Disenfranchised Populations. Community Ment Health J 2019; 55:9-23. [PMID: 30136013 PMCID: PMC8751484 DOI: 10.1007/s10597-018-0326-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/17/2018] [Indexed: 01/06/2023]
Abstract
The Health Disparities and Outcomes (HDO) model originally created to explain the complexity of obtaining healthcare in rural settings has been revised and updated using emerging theoretical models of adversity and inequity and two decades of empirical work by the authors. With a strong orientation to explaining population-based health inequities, the HDO is applied to individuals with Serious Mental Illness (SMI), to explain their high rates of morbidity and mortality compared to the general population. Individual-, community-, and system-level factors that reflect an understanding of life-long risk, accrued hazards associated with multiple and intersecting disadvantages, and difficulty obtaining healthcare that meets accepted standards are described. The revised HDO can be applied to populations with disproportionate health challenges to identify multi-level factors that affect illness trajectory and overall health outcomes.
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Affiliation(s)
| | - Rachael S Clark
- University of Delaware, 25 N. College Avenue, Newark, DE, 19716, USA
| | - Elizabeth I Merwin
- School of Nursing, Duke University, 3027A Pearson Building, Durham, NC, 27710, USA
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14
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Lacy BE. Review article: an analysis of safety profiles of treatments for diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther 2018; 48:817-830. [PMID: 30194692 PMCID: PMC6667996 DOI: 10.1111/apt.14948] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/27/2018] [Accepted: 07/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is multifactorial in nature, and a wide range of therapies is available to manage symptoms of this common disorder. AIM To provide an overview of the safety of interventions that may be used to manage patients with diarrhoea-predominant IBS (IBS-D). METHODS Medline and Embase database searches (through 02 May 2018) to identify clinical studies that evaluated treatment safety and/or efficacy in adults with IBS-D. RESULTS IBS-D treatments include dietary modification, probiotics, serotonin receptor antagonists, opioid receptor agonists and antagonists, nonsystemic antibiotics, bile acid sequestrants, antidepressants, and complementary and alternative therapies. These treatments vary in administration frequency (eg, daily; short-course therapy) and target various pathophysiologic factors. Safety profiles vary considerably by treatment among IBS-D therapies. The number needed to harm (defined as the number of patients treated to encounter an adverse event) was lowest (worse) for antidepressants (8.5) and highest (best) for probiotics (35), and the number needed to harm (defined as the number of patients who discontinued due to an adverse event) was lowest for tricyclic antidepressants (9) and highest for rifaximin (8971). Notable safety concerns with IBS-D treatments include pancreatitis with eluxadoline, ischaemic colitis and serious complications of constipation with alosetron, and cardiac adverse events with loperamide and tricyclic antidepressants. Treatment decisions need to account for medication risks and adverse events for each patient. CONCLUSIONS Multiple treatment options are now available for patients with IBS-D. However, the safety profiles of these agents vary widely by number needed to harm value. Providers should consider both safety and efficacy of a specific intervention when determining how best to manage patients' IBS-D symptoms.
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Affiliation(s)
- Brian E. Lacy
- Section of GastroenterologyMayo ClinicJacksonvilleFlorida
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15
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Marino P, Bannier M, Moulin JF, Gravis G. Rôle et utilisation des Patient reported outcomes (PROs) dans la prise en charge des patients en oncologie. Bull Cancer 2018; 105:603-609. [DOI: 10.1016/j.bulcan.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 11/15/2022]
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16
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Deb S, Miller NA. Relationships Among Race/Ethnicity, Gender, and Mental Health Status in Patient–Provider Interactions. JOURNAL OF DISABILITY POLICY STUDIES 2018. [DOI: 10.1177/1044207318772064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient–provider interactions are associated with improved health outcomes and are of particular importance to individuals with mental health disabilities. We examine the relation between having a severe mental health–related disability (SMD) and patient–provider interactions and whether this is moderated by patient race/ethnicity and gender. We pooled Medical Expenditure Panel Survey data over multiple years and used multivariate techniques to examine the relation between having a SMD, race/ethnicity and gender and four measures of patient/provider interactions (e.g., being treated with respect). Adults with SMD had significantly higher relative risks (RRs) of reporting poorer interactions across measures. Although some effects of race/ethnicity and gender were observed, they did not moderate SMD. Individuals with Medicaid coverage or no health insurance had higher RRs of poorer interactions, while individuals with a person as a usual source of care had lower RRs. Incorporating these process measures of care into national quality initiatives may foster improved interactions. Continued policy support of models of care such as medical homes may enhance interactions as well.
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Affiliation(s)
- Shreyasi Deb
- American Academy of Orthopaedic Surgeons, Washington, DC, USA
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17
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Almario CV, Spiegel BMR. Employing Irritable Bowel Syndrome Patient-Reported Outcomes in the Clinical Trenches. Clin Gastroenterol Hepatol 2018; 16:462-466.e2. [PMID: 29555225 DOI: 10.1016/j.cgh.2017.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher V Almario
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California; Division of Digestive and Liver Diseases, Division of Health Services Research, Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, California.
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18
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Li L, Comulada WS, Lin C, Lan CW, Cao X, Wu Z. Report on Provider-Client Interaction From 68 Methadone Maintenance Clinics in China. HEALTH COMMUNICATION 2017; 32:1368-1375. [PMID: 27710137 PMCID: PMC5382133 DOI: 10.1080/10410236.2016.1221754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Provider-client interaction is an integral of clinical practice and central to the delivery of high-quality medical care. This article examines factors related to the provider-client interaction in the context of methadone maintenance treatment (MMT). Data were collected from 68 MMT clinics in China. In total, 418 service providers participated in the survey. Linear mixed effects regression models were performed to identify factors associated with provider-client interaction. It was observed that negative attitude toward drug users was associated with lower level of provider-client interaction and less time spent with each client. Other factors associated with lower level of interaction included being female, being younger, being a nurse, and fewer years in medical field. Higher provider-client interaction was associated with provider reported job satisfaction. The findings of this study call for a need to address provider negative attitudes that can impact provider-client interaction and the effectiveness of MMT. Future intervention efforts targeting MMT providers should be tailored by gender, provider type, and medical experiences.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - W. Scott Comulada
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Chiao-Wen Lan
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - Xiaobin Cao
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Centers for Disease Control and Prevention
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19
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Almario CV, Chey WD, Khanna D, Mosadeghi S, Ahmed S, Afghani E, Whitman C, Fuller G, Reid M, Bolus R, Dennis B, Encarnacion R, Martinez B, Soares J, Modi R, Agarwal N, Lee A, Kubomoto S, Sharma G, Bolus S, Spiegel BM. Impact of National Institutes of Health Gastrointestinal PROMIS Measures in Clinical Practice: Results of a Multicenter Controlled Trial. Am J Gastroenterol 2016; 111:1546-1556. [PMID: 27481311 PMCID: PMC5097031 DOI: 10.1038/ajg.2016.305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS) to allow efficient, online measurement of patient-reported outcomes (PROs), but it remains untested whether PROMIS improves outcomes. Here, we aimed to compare the impact of gastrointestinal (GI) PROMIS measures vs. usual care on patient outcomes. METHODS We performed a pragmatic clinical trial with an off-on study design alternating weekly between intervention (GI PROMIS) and control arms at one Veterans Affairs and three university-affiliated specialty clinics. Adults with GI symptoms were eligible. Intervention patients completed GI PROMIS symptom questionnaires on an e-portal 1 week before their visit; PROs were available for review by patients and their providers before and during the clinic visit. Usual care patients were managed according to customary practices. Our primary outcome was patient satisfaction as determined by the Consumer Assessment of Healthcare Providers and Systems questionnaire. Secondary outcomes included provider interpersonal skills (Doctors' Interpersonal Skills Questionnaire (DISQ)) and shared decision-making (9-item Shared Decision Making Questionnaire (SDM-Q-9)). RESULTS There were 217 and 154 patients in the GI PROMIS and control arms, respectively. Patient satisfaction was similar between groups (P>0.05). Intervention patients had similar assessments of their providers' interpersonal skills (DISQ 89.4±11.7 vs. 89.8±16.0, P=0.79) and shared decision-making (SDM-Q-9 79.3±12.4 vs. 79.0±22.0, P=0.85) vs. CONCLUSIONS This is the first controlled trial examining the impact of NIH PROMIS in clinical practice. One-time use of GI PROMIS did not improve patient satisfaction or assessment of provider interpersonal skills and shared decision-making. Future studies examining how to optimize PROs in clinical practice are encouraged before widespread adoption.
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Affiliation(s)
- Christopher V. Almario
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - William D. Chey
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Sasan Mosadeghi
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Shahzad Ahmed
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Elham Afghani
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Cynthia Whitman
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Garth Fuller
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Mark Reid
- Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Roger Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Buddy Dennis
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Rey Encarnacion
- UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA
| | - Bibiana Martinez
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Jennifer Soares
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Rushaba Modi
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Nikhil Agarwal
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Aaron Lee
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Scott Kubomoto
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Gobind Sharma
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Sally Bolus
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Brennan M.R. Spiegel
- Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA,Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
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20
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Ernstmann N, Weissbach L, Herden J, Winter N, Ansmann L. Patient-physician communication and health-related quality of life of patients with localised prostate cancer undergoing radical prostatectomy - a longitudinal multilevel analysis. BJU Int 2016; 119:396-405. [PMID: 27037732 DOI: 10.1111/bju.13495] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine whether patient-physician communication is associated with health-related quality of life (HRQoL) in a sample of patients with localised prostate cancer undergoing radical prostatectomy (RP). PATIENTS AND METHODS HAROW (Hormonal therapy, Active Surveillance, Radiation, Operation, Watchful Waiting) is a prospective, observational study designed to collect data of the different treatment options for newly diagnosed patients with localised prostate cancer under real-life conditions. At 6-months intervals, clinical data (D'Amico risk categories, Charlson comorbidity index), aspects of patient-provider communication (standardised psychosocial-care instrument for patients' assessment of communication; Cologne Patient Questionnaire), and HRQoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire) were assessed. Data were analysed by longitudinal multilevel analysis. RESULTS Completed questionnaires for 1772 patients undergoing a RP were analysed over a 3-year follow-up period. Patients rated the patient-provider communication generally high with slight variations over the course of treatment (3.2-3.8). The HRQoL of the patients varied substantial over time and between the reported subscales (global HRQoL 71.1-77.2; physical functioning 89.1-92.1; role functioning 81.0-88.1; emotional functioning 74.4-84.0; cognitive functioning 84.3-87.7; social functioning (77.7-84.0). The longitudinal multilevel models showed significant associations between patient-provider communication in terms of devotion, support and shared decision-making, and functional aspects of HRQoL. CONCLUSION Patient-provider communication is a valuable resource to support patients with prostate cancer coping with the disease and to improve their HRQoL. Future interventions should be designed especially for urologists to enhance their awareness for the importance of communication and the relationship with their patients with prostate cancer for treatment outcomes.
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Affiliation(s)
- Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Germany, Bonn
| | | | - Jan Herden
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Nicola Winter
- Department of Urology, University Hospital of Cologne, Cologne, Germany
| | - Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Manzotti G, Breda D, Di Gioacchino M, Burastero SE. Serum diamine oxidase activity in patients with histamine intolerance. Int J Immunopathol Pharmacol 2015; 29:105-11. [PMID: 26574488 DOI: 10.1177/0394632015617170] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/22/2015] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Intolerance to various foods, excluding bona fide coeliac disease and lactose intolerance, represents a growing cause of patient visits to allergy clinics.Histamine intolerance is a long-known, multifaceted clinical condition triggered by histamine-rich foods and alcohol and/or by drugs that liberate histamine or block diamine oxidase (DAO), the main enzyme involved in the metabolism of ingested histamine. Histamine limitation diets impose complex, non-standardized restrictions that may severely impact the quality of life of patients. METHODS We retrospectively evaluated 14 patients who visited allergy outpatient facilities in northern Italy with a negative diagnosis for IgE-mediated food hypersensitivity, coeliac disease, conditions related to gastric hypersecretion, and systemic nickel hypersensitivity, and who previously underwent a histamine limitation diet with benefits for their main symptoms. Serum diamine oxidase levels and the clinical response to diamine oxidase supplementation were investigated. RESULTS We found that 10 out of 14 patients had serum DAO activity<10 U/mL, which was the threshold suggested as a cutoff for probable histamine intolerance. Moreover, 13 out of 14 patients subjectively reported a benefit in at least one of the disturbances related to food intolerances following diamine oxidase supplementation. The mean value (±SD) of diamine oxidase activity in the cohort of patients with histamine intolerance symptoms was 7.04±6.90 U/mL compared to 39.50±18.16 U/mL in 34 healthy controls (P=0.0031). CONCLUSION In patients with symptoms triggered by histamine-rich food, measuring the serum diamine oxidase activity can help identify subjects who can benefit from a histamine limitation diet and/or diamine oxidase supplementation.Properly designed, controlled studies investigating histamine intolerance that include histamine provocation are indispensable for providing insights into the area of food intolerances, which are currently primarily managed with non-scientific approaches in Italy.
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Affiliation(s)
- G Manzotti
- Allergy Outpatients Service, General Hospital, P. le Ospedale n. 1, 24047 Treviglio, Italy
| | - D Breda
- Laboratory of Cellular and Molecular Allergology, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy
| | - M Di Gioacchino
- Department of Medicine and Science of Ageing, G. D'Annunzio University, Chieti, Italy
| | - S E Burastero
- Laboratory of Cellular and Molecular Allergology, San Raffaele Scientific Institute, Via Olgettina 58, 20132 Milan, Italy Department of Medicine and Science of Ageing, G. D'Annunzio University, Chieti, Italy
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22
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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23
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Sandal LF, Thorlund JB, Ulrich RS, Dieppe PA, Roos EM. Exploring the effect of space and place on response to exercise therapy for knee and hip pain--a protocol for a double-blind randomised controlled clinical trial: the CONEX trial. BMJ Open 2015; 5:e007701. [PMID: 25818278 PMCID: PMC4386269 DOI: 10.1136/bmjopen-2015-007701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Context effects are described as effects of a given treatment, not directly caused by the treatment itself, but rather caused by the context in which treatment is delivered. Exercise is a recommended core treatment in clinical guidelines for musculoskeletal disorders. Although moderately effective overall, variation is seen in size of response to exercise across randomised controlled trial (RCT) studies. Part of this variation may be related to the fact that exercise interventions are performed in different physical environments, which may affect participants differently. The study aims to investigate the effect of exercising in a contextually enhanced physical environment for 8 weeks in people with knee or hip pain. METHODS AND ANALYSIS The study is a double-blind RCT. Eligible participants are 35 years or older with persisting knee and/or hip pain for 3 months. Participants are randomised to one of three groups: (1) exercise in a contextually enhanced environment, (2) exercise in a standard environment and (3) waiting list. The contextually enhanced environment is located in a newly built facility, has large windows providing abundant daylight and overlooks a recreational park. The standard environment is in a basement, has artificial lighting and is marked by years of use; that is, resembling many clinical environments. The primary outcome is the participant's global perceived effect rated on a seven-point Likert scale after 8 weeks exercise. Patient-reported and objective secondary outcomes are included. ETHICS AND DISSEMINATION The Regional Scientific Ethical Committee for Southern Denmark has approved the study. Study findings will be disseminated in peer-reviewed publications and presented at national and international conferences. TRIAL REGISTRATION NUMBER NCT02043613.
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Affiliation(s)
- Louise Fleng Sandal
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | | | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Tucker CM, Moradi B, Wall W, Nghiem K. Roles of Perceived Provider Cultural Sensitivity and Health Care Justice in African American/Black Patients’ Satisfaction with Provider. J Clin Psychol Med Settings 2014; 21:282-90. [DOI: 10.1007/s10880-014-9397-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Calo WA, Ortiz AP, Colon-Lopez V, Krasny S, Tortolero-Luna G. Factors associated with perceived patient-provider communication quality among Puerto Ricans. J Health Care Poor Underserved 2014; 25:491-502. [PMID: 24858864 PMCID: PMC4154245 DOI: 10.1353/hpu.2014.0074] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient-provider communication is an important factor influencing patients' health outcomes. This study examined the relationship between patient-provider communication quality and sociodemographic, health care access, trusted information sources, and health status variables. Data were from a representative sample of 450 Puerto Rican adults who participated in the Health Information National Trends Survey. A composite score rating perceived patient-provider communication quality was created from five items (Cronbach's alpha = 0.87). A multivariate linear regression analysis was conducted. Patient-provider communication ratings were lower among the unemployed (p = 0.049), those who do not trust a lot in the information provided by their providers (p = 0.003), and respondents with higher depressive symptoms scores (p = 0.036). Perceived patient-provider communication quality, however, was higher among respondents who visited their providers five or more times in the last year (p = 0.023). Understanding patient perceptions of provider communication may serve to develop system-level interventions aimed at eliminating communication disparities and improving patients' health outcomes.
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Li L, Wu Z, Liang LJ, Lin C, Zhang L, Guo S, Rou K, Li J. An intervention targeting service providers and clients for methadone maintenance treatment in China: a cluster-randomized trial. Addiction 2013; 108:356-66. [PMID: 22788780 PMCID: PMC3483381 DOI: 10.1111/j.1360-0443.2012.04020.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/19/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Abstract
AIMS This study examines the preliminary outcomes of an intervention targeting service providers in methadone maintenance therapy (MMT) clinics in China. The intervention effects on both service providers and clients are reported. DESIGN The MMT CARE intervention pilot was developed and implemented collaboratively with local health educators. After three group intervention sessions, trained providers in intervention clinics delivered two individual motivational interviewing sessions with their clients. SETTINGS Six clinics in Sichuan, China, were randomized to either the MMT CARE intervention condition or a standard care condition. PARTICIPANTS A total of 41 providers and 179 clients were sampled from the six clinics. MEASUREMENTS At baseline and three-, six-, and nine-month assessments, providers completed self-administrated paper/pencil questionnaires regarding provider-client interaction, MMT knowledge, perceived job-related stigma and clinic support. Clients completed a face-to-face survey about their concurrent drug use and drug avoidance self-efficacy. Mixed-effects regression models with clinic-level random effect were used to assess the intervention effects. FINDINGS Significant intervention effects for providers were found in improved MMT knowledge, provider-client interaction and perceived clinic support. For clients, better improvements in drug avoidance self-efficacy and reduced concurrent drug use were observed for the intervention compared with the standard care group. CONCLUSIONS The MMT CARE intervention targeting providers in methadone maintenance clinics can improve providers' treatment knowledge and their interaction with clients. The intervention can also reduce clients' drug-using behavior through motivational interviewing sessions conducted by trained providers.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA 90024, USA.
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Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OBF, Aagaard P. Efficacy of Nintendo Wii Training on Mechanical Leg Muscle Function and Postural Balance in Community-Dwelling Older Adults: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2012; 68:845-52. [DOI: 10.1093/gerona/gls222] [Citation(s) in RCA: 150] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shaltout HA, Tooze JA, Rosenberger E, Kemper KJ. Time, touch, and compassion: effects on autonomic nervous system and well-being. Explore (NY) 2012; 8:177-84. [PMID: 22560756 DOI: 10.1016/j.explore.2012.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Compassion is critical for complementary and conventional care, but little is known about its direct physiologic effects. This study tested the feasibility of delivering two lengths of time (10 and 20 minutes) and two strategies (tactile and nontactile) for a practitioner to nonverbally communicate compassion to subjects who were blind to the interventions. METHODS Healthy volunteers were informed that we were testing the effects of time and touch on the autonomic nervous system. Each subject underwent five sequential study periods in one study session: (1) warm-up; (2) control-with the practitioner while both read neutral material; (3) rest; (4) intervention-with practitioner meditating on loving-kindness toward the subject; and (5) rest. Subjects were randomized to receive one of four interventions: (1) 10 minutes tactile; (2) 20 minutes tactile; (3) 10 minutes nontactile; or (4) 20 minutes nontactile. During all interventions, the practitioner meditated on loving-kindness toward the subject. For tactile interventions, the practitioner touched subjects on arms, legs, and hands; for nontactile interventions, the practitioner pretended to read. Subjects' autonomic activity, including heart rate, was measured continuously. Subjects completed visual analog scales for well-being, including relaxation and peacefulness, at warm-up; postcontrol; immediately postintervention; and after the postintervention rest and were asked about what they and the practitioner had done during each study period. RESULTS The 20 subjects' mean age was 24.3 ± 4 years; 16 were women. The practitioner maintained a meditative state during all interventions as reflected in lower respiratory rate, and subjects remained blind to the practitioner's meditative activity. Overall, interventions significantly decreased heart rate (P < .01), and although other changes did not reach statistical significance, they were in the expected direction, with generally greater effects for the tactile than nontactile strategies and for 20-minute than 10-minute doses. CONCLUSIONS Two strategies are feasible for blinding subjects to nonverbal communication of compassion; even with blinding, nonverbal communication of compassion affects subjects' autonomic nervous system. These results should be replicated in larger samples, including patient populations, and mechanisms sought to explain observed effects. Compassion is not only good care; it may also be good medicine.
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Affiliation(s)
- Hossam A Shaltout
- Center for Integrative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC, USA
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Abstract
STUDY DESIGN A single-blinded, randomized controlled trial. OBJECTIVE To determine the impact of information and advice during a disability evaluation by medical advisers on the return to work (RTW) rate and recurrence of sick leave of claimants with low back pain (LBP). SUMMARY OF BACKGROUND DATA There is evidence on the importance of advice during the course of subacute LBP. The effect of informative interventions on RTW rates in workers receiving sickness benefit is not clear. METHODS A total of 506 claimants with LBP were randomly assigned to the control group (disability evaluation) or the intervention group (combined counseling and disability evaluation). RTW, sick leave recurrence, subsequent surgery, and sick leave duration were measured during a 12-month follow-up. RESULTS Patients who were provided information and advice showed a higher RTW rate, which was statistically significant at 1 year. That result is mainly attributable to the lower relapse rate in the intervention group (38%) than in the control group (60%). There were no differences between the 2 groups regarding subsequent surgery for LBP and duration of sick leave. CONCLUSION Claimants should be routinely reassured and advised about LBP to allow early and safe RTW during a disability evaluation before any side effects of being sick-listed have settled.
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Li L, Wu Z, Cao X, Zhang L. Provider-Client Interaction in Methadone Treatment Clinics in China. JOURNAL OF DRUG ISSUES 2012; 42. [PMID: 24244048 DOI: 10.1177/0022042612446593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines provider-client interactions in the context of methadone maintenance treatment (MMT) in China. Service providers were recruited from six methadone clinics. A total of 41 providers were enrolled in the study and participated in an assessment from February to March 2010. Descriptive and multiple regression analyses were performed. Providers with a higher level of negative attitude toward drug users were less likely than others to interact with clients. Female providers were less likely to have negative attitudes toward drug users as compared with their male counterparts. Doctors were more likely than others to have negative attitudes toward drug users. Knowledge of MMT was not related to either negative attitude toward drug users or to provider-client interaction. The findings indicate an urgent need to address the issue of provider attitudes, which can impact interactions with clients and influence efforts to maintain treatment retention and outcomes for drug users.
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Affiliation(s)
- Li Li
- University of California at Los Angeles, Los Angeles, USA
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Abstract
The hypothesis in drug clinical trials is that the drug is better than a placebo in patients suffering from a disease. The unstated assumption is that the drug cures the disease or is a powerful treatment for the disease. This is an incorrect assumption. Drugs do not cure or treat diseases. The body heals itself; drugs promote this ability of the body to heal itself. Placebos are assumed to be inactive; however, placebos can also promote the ability of the body to heal itself. Placebos are actually treatments that can stimulate endogenous healing mechanisms. The possible place of placebos in health management is controversial. Clinical trial design should be altered. The hypothesis of clinical trials should be that the drug speeds up or improves the healing of the patient, putting patient healing as the first objective. Placebos should not be used as controls but could be tested as drugs in their own right. The control in clinical trials should be no treatment. Alternatively, new drugs could be compared to existing drugs in clinical trials.
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Kemper KJ, Shaltout HA. Non-verbal communication of compassion: measuring psychophysiologic effects. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2011; 11:132. [PMID: 22185349 PMCID: PMC3260157 DOI: 10.1186/1472-6882-11-132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 12/20/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Calm, compassionate clinicians comfort others. To evaluate the direct psychophysiologic benefits of non-verbal communication of compassion (NVCC), it is important to minimize the effect of subjects' expectation. This preliminary study was designed to a) test the feasibility of two strategies for maintaining subject blinding to non-verbal communication of compassion (NVCC), and b) determine whether blinded subjects would experience psychophysiologic effects from NVCC. METHODS Subjects were healthy volunteers who were told the study was evaluating the effect of time and touch on the autonomic nervous system. The practitioner had more than 10 years' experience with loving-kindness meditation (LKM), a form of NVCC. Subjects completed 10-point visual analog scales (VAS) for stress, relaxation, and peacefulness before and after LKM. To assess physiologic effects, practitioners and subjects wore cardiorespiratory monitors to assess respiratory rate (RR), heart rate (HR) and heart rate variability (HRV) throughout the 4 10-minute study periods: Baseline (both practitioner and subjects read neutral material); non-tactile-LKM (subjects read while the practitioner practiced LKM while pretending to read); tactile-LKM (subjects rested while the practitioner practiced LKM while lightly touching the subject on arms, shoulders, hands, feet, and legs); Post-Intervention Rest (subjects rested; the practitioner read). To assess blinding, subjects were asked after the interventions what the practitioner was doing during each period (reading, touch, or something else). RESULTS Subjects' mean age was 43.6 years; all were women. Blinding was maintained and the practitioner was able to maintain meditation for both tactile and non-tactile LKM interventions as reflected in significantly reduced RR. Despite blinding, subjects' VAS scores improved from baseline to post-intervention for stress (5.5 vs. 2.2), relaxation (3.8 vs. 8.8) and peacefulness (3.8 vs. 9.0, P < 0.05 for all comparisons). Subjects also had significant reductions in RR (P < 0.0001) and improved HRV (P < 0.05) with both tactile and non-tactile LKM. CONCLUSION It is possible to test the effects of LKM with tactile and non-tactile blinding strategies; even with blinding in this small preliminary study, subjects reported significant improvements in well-being which were reflected in objective physiologic measures of autonomic activity. Extending compassion is not only good care; it may also be good medicine. TRIAL REGISTRATION NUMBER US National ClinicalTrials.gov registration number, NCT01428674.
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Krueger E, Reilly D. The "cash or care" conflict in general practice--a cautionary tale with methodological reflections. PATIENT EDUCATION AND COUNSELING 2011; 82:479-481. [PMID: 21306858 DOI: 10.1016/j.pec.2011.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 01/17/2011] [Accepted: 01/20/2011] [Indexed: 05/30/2023]
Affiliation(s)
- Eckard Krueger
- Alexander-von-Humboldt-Klinik, Dr.-Gebhardt-Steuer-Straße 24, 95138 Bad Steben, Germany.
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Ammentorp J, Kofoed PE. Research in communication skills training translated into practice in a large organization: a proactive use of the RE-AIM framework. PATIENT EDUCATION AND COUNSELING 2011; 82:482-487. [PMID: 21306855 DOI: 10.1016/j.pec.2011.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/28/2010] [Accepted: 01/07/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To describe how a specific communication course for health professionals has been evaluated and implemented in clinical practice and how it will be transferred and evaluated at the entire hospital. METHODS The different phases of the research process from generating the hypothesis to implementing the results are described and exemplified by means of published studies and a study under planning. RE-AIM, an acronym for Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance, is used to describe the process. RESULTS In descriptive studies we identified a need for improving the communication with patients. By evaluating the efficacy and effectiveness of communication skills training we showed that the courses could improve clinicians' self-efficacy in specific communication tasks. After all clinicians had participated in the communication course the proportion of satisfied parents increased significantly. Based on these experiences a program for implementing the communication course at the entire hospital is being planned. CONCLUSION To succeed in translating the research results into practice, long-term commitment is needed in order to create a conducive climate for the implementation. PRACTICE IMPLICATIONS This focused and goal-oriented approach may inspire other researchers when planning, conducting, and evaluating their research.
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Affiliation(s)
- Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital/IRS University of Southern Denmark, Denmark.
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Neumann M, Kreps G, Visser A. Methodological pluralism in health communication research. PATIENT EDUCATION AND COUNSELING 2011; 82:281-284. [PMID: 21296536 DOI: 10.1016/j.pec.2011.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Broome M, Farrell M, Visser A. Decision making is an important aspect of health communication research. PATIENT EDUCATION AND COUNSELING 2010; 80:285-287. [PMID: 20691555 DOI: 10.1016/j.pec.2010.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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