Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study

Background

The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients.

Objective

The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service.

Methods

This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC.

Results

Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems.

Conclusions

Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00971139","term_id":"NCT00971139"}}NCT00971139; http://clinicaltrial.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00971139","term_id":"NCT00971139"}}NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).     

基于大数据平台分析影响南京市孝陵卫地区胃食管反流病患病的危险因素

目的通过大数据平台分析影响南京市孝陵卫地区胃食管反流病(GERD)患病的危险因素。方法从胃食管反流病健康大数据管理平台随机抽取100例病例,GERD患者50例,为病例组;非GERD患者50例,为对照组。运用单因素分析及二元Logistic回归分析影响南京市孝陵卫地区人群GERD患病的危险因素。结果单因素分析结果显示,病例组的吸烟、饮酒、偏嗜高脂肪食物患者占比高于对照组(P<0.05)。Logistic回归分析结果显示,偏嗜高脂肪食物是影响该地区人群GERD患病的独立危险因素(P<0.05)。结论南京市孝陵卫地区人群GERD患病与偏嗜高脂肪食物相关。     

视听觉联合干预在改善住院新生儿头部转向偏好中的应用研究

目的 探讨视听联合干预在改善住院新生儿头部转向偏好中的应用效果。方法 采用随机对照研究,选取2020年1月-2020年4月在苏州市某三甲儿童医院新生儿科住院的所有入院时具有一侧头部转向偏好的患儿实验组67例和对照组59例,对照组实施常规干预方法,实验组在对照组基础上应用视听联合干预方法。分别记录两组七天内头部转向偏好变化、转向方向改变情况,以及患儿入睡的时间,并根据是否有效进行组间相关因素比较。结果 实验组转向转归率高于对照组,差异有统计学意义（P ＜0.05）;实验组入睡时间短于对照组（P ＜0.05）;七天后相关因素比较,除对照组日龄外,其他无统计学意义（P ＞0.05）;实验组转向改变的发生率高于对照组。结论 使用视听联合干预法有助于头部转向偏好的转归,且不受其他因素影响,实施过程中应选择合适的音乐和图片,注意评估避免干预过度。     

Breeding ecology of visceral leishmaniasis vector sandfly in Bihar state of India

Soil samples weighing 255.3 kg, collected from 50 villages of 5 visceral leishmaniasis (VL) endemic districts of Bihar state were examined for sandfly breeding, using the soil incubation method. Breeding of sandflies was detected in 46% of the villages and 7.3% of the soil samples examined. Intra-domestic soil was found to be infested with 2 species of sandflies, Phlebotomus argentipes Annandale and Brunetti and Phlebotomus papatasi (Scopoli). In comparison with human houses, P. argentipes was found to show greater propensity to breed in cattle sheds; breeding prevalences in villages and soil samples, for the species, were significantly higher in cattle sheds than in human houses. The preference for breeding sites by the sandflies appeared to be associated with the pH of the soil. P. argentipes thus preferred to breed in the alkaline soil of cattle shed, and P. papatasi in the soil with neutral pH, of human houses. The emergence of adult P. argentipes from soil samples was mainly observed from April to October.     

Mastopexy for breast ptosis: Utility outcomes of population preferences

BACKGROUND:

Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.

OBJECTIVE:

To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.

METHODS:

Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student’s t test were used for statistical analysis; P<0.05 was considered to be statistically significant.

RESULTS:

Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.

DISCUSSION:

For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to ‘perfect health’ than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.

CONCLUSIONS:

Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.     

End-of-life expectations and experiences among nursing home patients and their relatives—A synthesis of qualitative studies

Objective

Synthesize research about patients’ and relatives’ expectations and experiences on how doctors can improve end-of-life care in nursing homes.

Methods

We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane Systematic Reviews and Cochrane Trials). We included 14 publications in the analysis with meta-ethnography.

Results

Patients and families emphasized the importance of health personnel anticipating illness trajectories and recognizing the information and palliation needed. Family members who became proxy decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients’ ability to consent, and patients’ preferences were not always recognized.

Conclusion

Nursing home patients and their relatives wanted doctors more involved in end-of-life care. They expected doctors to acknowledge their preferences and provide guidance and symptom relief.

Practice implications

High-quality end-of-life care in nursing homes relies on organization, funding and skilled staff, including available doctors who are able to recognize illness trajectories and perform individualized Advance Care Planning.     

Examining the variation in GPs’ referral practice: a cross-sectional study of GPs’ reasons for referral

Background

There is a large variation in referral rates to secondary care among GPs, which is partly unexplained.

Aim

To explore associations between reasons for referral to secondary care and patient, GP, and healthcare characteristics.

Design and setting

A cross-sectional study in Northern Norway.

Method

Data were derived from 44 (42%) of 104 randomly selected GPs between 2008 and 2010. GPs scored the relevance of nine predefined reasons for 595 referrals from 4350 consecutive consultations on a four-level categorical scale. Associations were examined by multivariable ordered and multivariable multilevel logistic regression analyses.

Results

Medical necessity was assessed as a relevant reason in 93% of the referrals, 43.7% by patient preference, 27.5% to avoid overlooking anything, and 14.6% to reassure the patient. The higher the referral rates, the more frequently the GPs referred to avoid overlooking anything. Female GPs referred to reassure the patient and due to perceived deficient medical knowledge significantly more often than male GPs. However, perceived easy accessibility of specialists was significantly less frequently given as a reason for referral by female GPs compared with male GPs. When the GPs scored the referrals to be of lesser medical necessity, male GPs referred significantly more frequently than female GPs to reassure the patient due to patient preference and perceived deficient medical knowledge.

Conclusion

There are striking differences in reasons for referral between Norwegian male and female GPs and between GPs with high and low referral rates, which reflects difficulties in handling professional uncertainty. Referring to reassure the patients, especially when referrals are less medically necessary, may reflect consideration and acquiescence towards the patients.     

Museum specimens reveal loss of pollen host plants as key factor driving wild bee decline in The Netherlands

Evidence for declining populations of both wild and managed bees has raised concern about a potential global pollination crisis. Strategies to mitigate bee loss generally aim to enhance floral resources. However, we do not really know whether loss of preferred floral resources is the key driver of bee decline because accurate assessment of host plant preferences is difficult, particularly for species that have become rare. Here we examine whether population trends of wild bees in The Netherlands can be explained by trends in host plants, and how this relates to other factors such as climate change. We determined host plant preference of bee species using pollen loads on specimens in entomological collections that were collected before the onset of their decline, and used atlas data to quantify population trends of bee species and their host plants. We show that decline of preferred host plant species was one of two main factors associated with bee decline. Bee body size, the other main factor, was negatively related to population trend, which, because larger bee species have larger pollen requirements than smaller species, may also point toward food limitation as a key factor driving wild bee loss. Diet breadth and other potential factors such as length of flight period or climate change sensitivity were not important in explaining twentieth century bee population trends. These results highlight the species-specific nature of wild bee decline and indicate that mitigation strategies will only be effective if they target the specific host plants of declining species.Pollinating insects such as bees play an essential role in the pollination of wild plants (1) and crops (2). However, reported population declines in both wild and managed bees (3–5) have raised concerns about loss of pollination services and triggered interest in identifying the underlying causes for bee decline (6). Land use change and agricultural intensification are major drivers of biodiversity loss in general (7, 8) and are considered the most important environmental drivers of loss of wild bee diversity in particular (6, 9). It is generally believed that these drivers affect bees, which depend on floral resources in both their larval and adult life stages, through repercussions on the availability of floral resources in contemporary anthropogenic landscapes (9–11), but, so far, scientific evidence that loss of floral resources is driving bee decline is lacking. Nevertheless, current strategies to mitigate bee decline focus primarily on enhancing floral resources (12). To prioritize and develop effective mitigation strategies, it is essential to identify the mechanisms underlying bee population trends and assess whether these are mediated by floral resources.Although bees as a group are declining, individual species show more variable responses, with some species declining sharply while others remain stable or even increase under current land use change and agricultural intensification (3, 4, 13). These differential responses can be used to disentangle the effects of floral resource availability from those of other potential factors affecting bee population trends. The proportion of the floral resources in contemporary anthropogenic landscapes that can be used for forage by a bee species depends on its diet breadth and host plant preference, and it may be expected that species that have declined have a narrower diet breadth and prefer host plants that have declined (14, 15). However, diet breadth and host plant preference of bee species is difficult to assess. Presently observed host plant use does not necessarily reflect actual preference, as preferred host plants may have gone locally extinct and bees that have declined may have become restricted in their food choice in their remaining habitats (15). In addition, if host plant use is measured for more individuals of abundant, widespread species than for rare ones, an apparent link between diet breadth and population trend may simply arise as a sampling artifact (16). Furthermore, the relationship between host plant use and population trend may be confounded by species’ rarity prior to the onset of major environmental changes (17), as rarity in itself increases susceptibility to stochastic events (18) and has been shown to be one of the most important factors predicting population decline in various taxa (19–21). Surprisingly, to our knowledge, none of the studies that have so far examined the relationship between diet breadth and/or host plant preference and bee population trends have taken species’ initial rarity into account (e.g., refs. 3, 4, 15, and 22). Other factors, such as body size (4, 23), phenology (4, 22), and sensitivity to climate change (4, 24, 25) may be associated with bee decline as well, and, to date, the relative importance of diet breadth and pollen host plant preference in explaining bee population trends remains unclear.Here we solve this problem by analyzing historical pollen preferences of wild bees (15). Bees are generally more selective in their choice of food plants when foraging for pollen (source of protein and minerals for both larvae and adults) than nectar (source of energy) (26, 27). Distributional changes in plant species from which pollen is collected therefore probably exerts a larger influence on bee populations than changes in nectar plants. We investigate whether and to what extent loss of preferred floral resources drives bee population trends in The Netherlands, one of the most human-modified and intensively farmed countries in the world. Over the course of the twentieth century, agriculture has intensified in The Netherlands (Fig. S1) and the area of seminatural habitat preferred by bees has diminished to only one-fifth of the area at the beginning of the twentieth century (Fig. S2). More than half of the bee species are currently on the national Red List (28). As such, this country is a particularly suitable study area to identify critical factors associated with bee population decline.We assessed pollen host plant use of bee species independently from their population trends by analyzing pollen loads on the bodies of bee specimens that were collected before 1950 (15), before the onset of agricultural intensification in The Netherlands. Altogether, our analysis included trend and trait data of 57 bee species in 10 genera and 4 subfamilies (Table S1). We calculated population trend indices for bee species and their host plants (period 1902–1949 vs. 1975–1999) using extensive national species distribution datasets (13, 29). Linear mixed models, with bee subfamily as a random factor to account for phylogeny, and a multimodel inference approach were used to examine the relationship between bee population trends and pollen host plant use, simultaneously taking into account differences in species’ rarity before the onset of agricultural intensification and other factors that have been proposed to explain bee population trends.     

A cross-cultural comparison of pressures to switch left-hand writing: Brazil versus Canada

Attempts to switch left-hand preferences towards the right side are socialisation practices found in many countries (Perelle & Ehrman, 1994). Although researchers acknowledge that pressures against left-hand use contribute to the cross-cultural fluctuations in the prevalence of left- versus right-hand preference, there has been little systematic cross-cultural study of how these pressures are applied, and who are the major agents applying the pressures to change. Our study explored specific rightward conversion practices and the results of these practices among individuals from two countries. One sample of participants was from a culture categorised as formal, Brazil, and the second sample was from Canada, a nonformal culture (Hofstede, 2001). Researchers have argued that prevalence rates of right-handedness should be higher in cultures that value conformity, called formal cultures, and lower among members of nonformal cultures where conformity pressures are lax (Medland, Perelle, De Monte, & Ehrman, 2004). The socialisation practices used to foster a change from the left to the right side are also predicted to differ in frequency and in kind in formal versus nonformal cultural settings. These cultural differences are assumed to result in differences in success rates of the conversion attempts, with formal cultures producing higher numbers of successfully converted right-handers. Our findings indicate that the formal versus nonformal cultural explanation for cross-cultural fluctuations in the prevalence of hand preference types does not account for the characteristics of the rightward conversion experiences reported by participants in the two groups. We propose that hypotheses concerning the effects of cultural differences on hand preference formation be expanded to include possible biological or genetic variance between groups.