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1.
Aisha T. Langford Binhuan Wang Natasha A. Orzeck-Byrnes Sneha R. Aidasani Lu Hu Melanie Applegate Dana N. Moloney Mary Ann Sevick Erin S. Rogers Natalie K. Levy 《Patient education and counseling》2019,102(3):520-527
Background
Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID).Objective
To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID.Methods
Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes.Results
The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD?=?10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p?<?.05).Conclusions
Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs.Practical Implications
Basic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care. 相似文献2.
U. Olivia Kim K. Barnekow S.I. Ahamed S. Dreier C. Jones M. Taylor Md.K. Hasan M.A. Basir 《Patient education and counseling》2019,102(4):701-708
Objective
To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth.Methods
Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18–22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use.Results
For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8?h.Conclusion
Parents with increased risk for preterm birth may benefit from this mobile app educational program.Practice implications
If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices. 相似文献3.
Nicole Saxby Sean Beggs Malcolm Battersby Sharon Lawn 《Patient education and counseling》2019,102(4):607-622
Objective
To articulate the components of educational interventions that help children learn about managing their asthma, cystic fibrosis, or diabetes, relevant to their age/developmental status.Methods
A systematic review of chronic condition self-management (CCSM) educational interventions that included age/developmentally appropriate components, published before 27 January 2018, including evidence level and quality assessments. Teaching approaches were extracted and translated into practical components.Results
Twenty education interventions were identified, published across 30 studies. Most studies (n?=?20/30) were based on the theories of Piaget and Bandura. Similar teaching approaches were used across conditions, incorporating sequenced curriculum and a variety of active elements. Age/developmentally appropriate interventions resulted in improvements in the CCSM capabilities of children. Outcomes were improved when compared with usual care.For very young children, educational interventions were directed at parents/families. As children reached school age, interventions increasingly became child-focused, promoting autonomy. Integrated play and reinforcement were common. Adolescent interventions placed greater emphasis on communication, problem-solving, and role division.Conclusion
Eight key components were identified: structured and sequenced curricula; reinforcement; active participation; collaboration; autonomy; feedback; multiple exposures; and, problem-solving. Different components are relevant to specific life stages.Practice implications
Clinicians require age/developmentally appropriate practical education tools to provide effective paediatric health care. 相似文献4.
Miyong T. Kim Kim Byeng Kim Tam H. Nguyen Jisook Ko Jim Zabora Elizabeth Jacobs David Levine 《Patient education and counseling》2019,102(4):709-717
Objective
To test the efficacy of a hybrid model of the self-help intervention program (hSHIP), which combines a mobile version of SHIP (mSHIP) and personal coaching, to address unique cultural and motivational factors for optimal self-management of type 2 diabetes and prediabetes among Korean Americans (KAs).Methods
A single-group feasibility study design was used. The hSHIP utilizes texts and motivational counseling based on well-tested intervention content for KAs. To facilitate the dissemination of hSHIP, we developed a web application adopting the principles of persuasive technology to motivate behavior changes.Results
Feasibility assessment found that hSHIP was well accepted by both participants and community health workers who delivered the intervention. An average of 1.3% A1C reduction (from 7.8% to 6.5%) was achieved by KAs with diabetes (n?=?165), 51.5% of whom lowered their A1C below 6.5% in 6-months. No one with prediabetes (n?=?50) progressed to diabetes. Other clinical outcomes (e.g., weight, depression, and blood pressure) also improved significantly; 41.2% were able to reduce or discontinue antidiabetic drugs.Conclusion
The feasibility and initial efficacy of hSHIP were demonstrated.Practice implication
This hybrid diabetes self-management model is a viable tool for traditionally underserved groups with diabetes or prediabetes. 相似文献5.
6.
Cody Goessl Paul Estabrooks Wen You Denise Britigan Armando DeAlba Fabio Almeida 《Patient education and counseling》2019,102(5):968-975
Objective
This study evaluates the effectiveness of technology versus in-person, group-initiated diabetes prevention to enhance comprehension of learning objectives between patients with differing health literacy (HL).Methods
Evidence-based content through either a DVD (n?=?217) or in-person, group class (n?=?225) to initiate the intervention. A teach-back call was used to assess comprehension of, and reinforce, learning objectives. Chi-squared was used to determine differences between conditions (DVD vs Class) and HL levels (High n?=?361 vs. Low n?=?81) and regression analyses were used to examine relationships.Results
DVD participants performed significantly better across teach back questions (15.4?±?2.5 v. 14.8?±?2.6, p?<?0.01), demonstrated comprehension in fewer teach-back rounds (1.9?±?0.7 v. 2.1?±?0.7, p?<?0.01), and answered more questions correctly on the first try (4.2?±?1.6 v. 3.4?±?1.8, p?<?0.01). Models for HL levels and modality by HL level were statistically significant (p?<?0.01) favoring the DVD.Conclusion
Initiating a diabetes prevention program with the use of a DVD appears to be a superior option to in-person, class sessions. Teach-back and teach-to-goal strategies enables participants of both high and low health literacy levels to receive and confirm mastery of diabetes prevention objectives.Practice Implications
A teach-back call may improve information uptake increasing the likelihood of health behavior uptake. 相似文献7.
José Antonio Mirón Canelo Helena Iglesias de Sena Montserrat Alonso Sardón Sergio Sánchez Fuentes César Ignacio Fernández Lázaro Antonio Javier Chamorro Fernández Santiago Santacruz Ruiz Emiliano Hernández Galilea José Ángel. Santos García Celia Fernández Martín María Fernanda Lorenzo-Gómez 《Educación Médica》2019
Background
Inclusive higher education aims to transform and improve the competence role of the future doctors in relation to people with disabilities (PwD), a vulnerable and prevalent population group which needs Quality Care to fulfil the right to health.Aim
To analyse and assess the awareness and training received of an experience developed in the School of Medicine related to the comprehensive care for PwD.Method
A before- and after-intervention, with no control group, of 120 students enrolled in the School of Medicine.Results
Students perceive a lack of training on this topic and are aware of their health and social role to reduce inequalities in PwD. The professional knowledge that significantly improved with the intervention are the related with the rights of PwD, risk factors, degree of disability, universal design, positive action measures, and curriculum adaptations. As regards to the competences that must be acquired, the awareness of social and communications skills needed should be noted, as well as the ability to issue medical reports about disability.Conclusion
The training intervention is effective in terms of awareness about the importance of the medical role related to PwD, and consequently, the knowledge and skills needed to achieve a better Health Care are assessed. 相似文献8.
Objective
Patient education on high-risk medications such as warfarin is important, and they require quick follow-up after initiation to maximize efficacy and safety. In our Anticoagulation Clinic, two 60-minute new patient appointments are available each day, contributing to prolonged lead-time. We instituted standardized warfarin video education to shorten in-clinic-room visit time, to potentially increase new patient appointments.Methods
Patients viewed the video in the waiting area with a goal to decrease visit times by 15?min (25%), before pharmacists completed their visit. Data collected included time spent in the clinic room, education comprehension, and patient feedback.Results
Ninety patient visits were evaluated in one pre-intervention and two post-intervention phases. Patients who received video education spent less time in the clinic room versus those who had not (52.4 vs 39.4?min, p?=?0.001), and two-thirds of all post-intervention visits achieved 25% reduction in visit time. There were no significant differences in education comprehension and patient satisfaction.Conclusion
Video education significantly decreased in-clinic-room visit time, and most patients achieved a goal of 25% reduction in time spent, without a change in comprehension or patient satisfaction.Practice implications
Implementation of video education can reduce clinic times in many patients without significantly impacting patient satisfaction. 相似文献9.
Maarten Cuypers Romy E.D. Lamers Paul J.M. Kil Lonneke V. van de Poll-Franse Marieke de Vries 《Patient education and counseling》2019,102(3):424-428
Objective
To investigate the effect of including an online decision aid (DA) during prostate cancer treatment counseling on decisional regret and information satisfaction in a one-year follow-up.Methods
Within a cluster RCT, 18 Dutch hospitals were randomized to DA counseling or care-as-usual, patients (n?=?382) initially completed questionnaires directly after treatment decision making. Six and twelve months later regret (Decisional Regret Scale) and information satisfaction (SCIP-B) were assessed. Anxious and depressive symptoms (HADS) was included as possible covariate.Results
After 12 months, 43 participants (15%) regretted their treatment choice and 105 participants (36%) were dissatisfied with the information that was received at the time of decision-making, regardless of being exposed to the DA. Anxious and depressive symptoms at follow-up were associated with regret and information dissatisfaction.Conclusion
No long-term benefical effects emerged from DA usage compared to patients who underwent standard counseling.Practice implications
During PCa treatment counseling, healthcare providers should be aware of anxious and depressive symptoms. 相似文献10.
Mingxia Chen Xiaoqing Yang Min Yang Wei Zhang Lei Li Qing Sun 《Pathology, research and practice》2019,215(5):1033-1037
Purpose
To screen novel candidate biomarkers in primary colorectal cancer (CRC), and indentify their clinical valuation in progress of colorectal cancer.Methods
By using antibody microarray, 274 target proteins in tissue samples from primary colorectal cancer patients were detected. Among differently expressed proteins in CRC tissues, As promising candidate biomarker, RANTES/CCL5 was validated by enzyme-linked immunosorbentassay and immunohistochemistry (IHC), and the clinical significance of CCL5 was analyzed.Results
Totally, 25 differentially expressed proteins were indentified between colorectal cancers and matched normal mucosa. CCL5 expression was significantly associated with adverse pathological progress, apt to lymph node metastasis and higher T stage.Conclusions
CCL5 may contribute to promoting tumor growth, and CCL5 is a promising target that may help in understanding the pathogenesis of CRC. 相似文献11.
Daniel Rojas-Bolivar Fitzgerald A. Arroyo-Ramírez Jhesvith Santos Christian Moruquilca Carlos Valdivia 《Educación Médica》2019
Objective
To evaluate medical students perception of the educational environment in the “San Fernando” School of Medicine of the National University of San Marcos of Lima, Peru.Materials and methods
A quantitative and cross-sectional study was performed using the Dundee Ready Educational Environment Measure. A total of 177 medical students from second to sixth year were tested.Results
The scores obtained from the DREEM demonstrate that medical student's perceptions were positive in learning (53.7%), teachers (7.5%), environment (66.1%), and academic situation (66.1%). However, there was a negative perception of their medical school (57.1%). The overall rating of the perception of the educational environment was positive (75.7%).Discussion
The medical student's perception of the medical school educational environment was positive. It is recommended to strengthen the medical student's social environment related to medical school. 相似文献12.
Objective
Patient satisfaction had been the focus of many scientific studies worldwide. However, very few studies published had addressed the definition of the concept of patient satisfaction. Therefore this present concept analysis is to explore the attributes of the concept in the broader healthcare context.Methods
The Rodgers method, an inductive method of concept analysis, was selected to guide this concept analysis.Results
The attributes of patient satisfaction in the healthcare context identified were provider attitude, technical competence, accessibility, and efficacy. Perception in relation to expectation, patient demographics and personality, and market competition were regarded as prerequisites of patient satisfaction. Consequences of patient satisfaction identified in this analysis were: patient compliance, clinical outcomes, loyalty and referrals.Conclusion
As healthcare is becoming an increasingly competitive marketplace, studying patient experience could certainly help practitioners to better encompass patient perspectives in service delivery and improve patient satisfaction.Practice implications
To ensure the validity of patient satisfaction measurement and subsequently improve healthcare quality, practitioners should involve patients in identifying important factors relevant to each attributes of patient satisfaction. 相似文献13.
Sharon Manne Barbara Smith Anna Mitarotondo Sara Frederick Deborah Toppmeyer Laurie Kirstein 《Patient education and counseling》2019,102(5):902-908
Objectives
The study’s goals were to characterize decisional conflict and preparedness for making the decision about having CPM among breast cancer patients considering CPM who do not carry cancer-predisposing mutation and to evaluate correlates of decisional conflict and preparedness.Methods
93 women considering CPM completed a survey of decisional conflict and preparedness for the CPM decision, knowledge, perceived risk, self-efficacy, reasons for CPM, input from others and discussion with the doctor about CPM, and cancer worry.Results
Between 8% and 27% of women endorsed elevated decisional conflict. Most women were satisfied with preparatory information that they were provided. Knowledge was low. Top reasons for choosing CPM were the desire for peace of mind, lowering the chance of another breast cancer, and improving survival.Conclusions
Decisional conflict is elevated in a subset of patients considering CPM. A more well-informed decision may be fostered by a comprehensive discussion about CPM with the patient’s clinician, fostering self-efficacy in managing cancer worry, and helping patients understand their motivations for CPM.Practice implications
Clinicians working with breast cancer patients considering CPM should discuss the CPM decision, foster self-efficacy in managing cancer worry, and help patients understand their motivations for the surgery. 相似文献14.
15.
Allison A. Marshall Alessandra Zaccardelli Zhi Yu Maria G. Prado Xinyi Liu Rachel Miller Kroouze Sarah S. Kalia Robert C. Green Nellie A. Triedman Bing Lu Kevin D. Deane Maura D. Iversen Elizabeth W. Karlson Jeffrey A. Sparks 《Patient education and counseling》2019,102(5):976-983
Objective
To investigate the effect of providing comprehensive personalized risk information on concern for chronic disease development.Methods
Unaffected first-degree relatives (FDRs) of rheumatoid arthritis (RA) patients (n?=?238) were randomly allocated to: 1) disclosure of RA risk personalized to demographics, genetics, biomarkers, and behaviors using a web-based tool (PRE-RA arm, n?=?78); 2) PRE-RA with interpretation by a health educator (PRE-RA Plus arm, n?=?80); and 3) standard RA education (Comparison arm, n?=?80). Concern for developing RA was assessed at baseline and immediately, 6 weeks, 6 months, and 12 months post-intervention.Results
FDRs randomized to PRE-RA arms were less concerned about developing RA than the Comparison arm at all post-intervention assessments (p?<?0.05). Among those concerned about RA risk at baseline, the PRE-RA (OR?=?4.7, 95%CI 1.5–14.4) and PRE-RA Plus (OR?=?5.2, 95%CI 1.6–17.3) arms were more likely to have reassurance 6 months post-intervention than the Comparison arm.Conclusion
A comprehensive tool provided reassurance to those at risk for developing a chronic disease, with or without interpretation from a health educator, compared to standard education.Practice implications
Individuals may be more likely to be reassured using a personalized chronic disease risk disclosure tool than a standard non-personalized approach. 相似文献16.
Natalia Cecon Marij A. Hillen Holger Pfaff Antje Dresen Sophie E. Groß 《Patient education and counseling》2019,102(5):998-1004
Objective
To examine breast cancer patients’ reasons to seek a second opinion (SO) and the underlying variables. To find out more about the outcome of the SO, the perceived helpfulness and the effect on the physician-patient relationship.Methods
In 2017, 4626 newly diagnosed breast cancer patients from 86 hospitals in Germany completed a postoperative mail survey (response rate?=?89.04%). Data from 419 SO-seeking patients was obtained and analyzed by conducting logistic regression and non-parametric group comparisons.Results
Reasons to seek an SO were mostly unrelated to the physician-patient relationship. Reasons related to the physician-patient-relationship were associated with a lower education level. The SO mostly (72.2%) equaled the first opinion. A different treatment plan recommendation (25%) reportedly affected the patients’ relationship with their primary physician. Patients who received a different diagnosis reported more fear of progression. Most patients found the SO helpful.Conclusion
The reasons to seek an SO are primarily unrelated to the physician-patient relationship. However, less educated patients seem to have different reasons to seek an SO. These reasons were reportedly associated with the physician-patient relationship.Practice implications
Physicians may need to explicitly ascertain the patient’s needs within the physician-patient communication to avoid inequalities based on patient education. 相似文献17.
Johanna Granhagen Jungner Elisabet Tiselius Klas Blomgren Kim Lützén Pernilla Pergert 《Patient education and counseling》2019,102(4):656-662
Objectives
The objective of this study was to explore interpreters’ perceived strategies in the interaction in interpreter-mediated consultations between healthcare personnel and patients/families with limited Swedish proficiency in pediatric oncology care.Methods
This study had an inductive approach using an exploratory qualitative design. A total of eleven semi-structured interviews were performed with interpreters who had experience interpreting in pediatric oncology care.Results
The interpreters' perceived strategies were divided into four generic categories; strategies for maintaining a professional role, strategies for facilitating communication, strategies for promoting collaboration, and strategies for improving the framework of interpreting provision. These four generic categories were then merged into the single main category of carrying the bilingual conversation.Conclusions
The interpreters stretch their discretionary power in order to carry the bilingual conversation by using strategies clearly outside of their assignment.Practical implications
The study contributes to the understanding of the interpreter-mediated consultation in pediatric oncology care, and this can be used to improve the care of patients and families in pediatric oncology care with limited knowledge of a country’s majority language. 相似文献18.
Fabiola Molina Christine Dehlendorf Steven E. Gregorich Miriam Kuppermann 《Patient education and counseling》2019,102(3):595-601
Objective
To investigate women’s preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience.Methods
We conducted a secondary analysis of data from two randomized trials conducted between 2007–2012. Survey items assessed participants’ preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes.Results
56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors.Conclusion
Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making.Practice implications
Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient’s backgrounds and desires. 相似文献19.
Angela L. Palmer-Wackerly Heather L. Voorhees Sarah D’Souza Edward Weeks 《Patient education and counseling》2019,102(4):804-809