Communication Between HIV Patients and Their Providers: A Qualitative Preference Match Analysis

Since the introduction of cART (combination antiretroviral therapy), HIV has evolved into a chronic disease such that it requires lifelong medical treatment to which patients must adhere. Communication with health care providers is pivotal in supporting patients to adapt to having HIV and adhering to treatment, in order to maintain health and quality of life. Previous research indicates that communication is optimal when it matches patient preferences for information exchange, relationship establishment, and involvement in treatment decisions. The aim of the present study is to explore HIV patient communication preferences as well as patient experiences with their providers (not) matching their preferences. A second aim is to explore provider beliefs about patient preferences and provider views on optimal communication. Data were collected through interviews with 28 patients and 11 providers from two academic hospitals. Results indicate that patient preferences reflect their cognitive, emotional, and practical needs such that patients look to increase their sense of control over their HIV. Patients aim to further increase their sense of control (by proxy) through their relationship with their providers and through their decisional involvement preferences. Providers are well aware of patient communication preferences but do not explicate underlying control needs. Implications for clinical practice are discussed.     

Airbag-induced thumb avulsion: two case reports

Although airbags are designed to save lives and protect victims from serious injuries, airbag deployment can cause unwanted lesions. In this case report, two cases are presented of young women who sustained an important fracture dislocation of the first carpometacarpal joint (CMC I joint) caused by airbag deployment during a car collision.     

Three-year clinical effectiveness of a two-step self-etch adhesive in cervical lesions

A 3-yr randomized, controlled prospective study evaluated the clinical effectiveness of a mild two-step self-etch adhesive, Clearfil SE, in Class-V non-carious lesions. The hypothesis tested was that prior selective etching of enamel with phosphoric acid does not affect the 3-yr clinical performance of this adhesive. A total of 100 lesions in 29 patients were randomly restored in one or two pairs, according to two experimental protocols: (i) application of Clearfil SE according to the instructions of the manufacturer (C-SE non-etch); and (ii) similar application of Clearfil SE with prior etching of enamel cavity margins with phosphoric acid (C-SE etch). Clearfil AP-X was used as a restorative material. At 3 yr, 90% of the restorations were examined for retention, marginal integrity, marginal discoloration, caries recurrence, postoperative sensitivity, and preservation of tooth vitality. An excellent retention rate (100%) was noted after 3 yr of clinical functioning. Only one restoration of the C-SE etch group was clinically unacceptable owing to the presence of a severe cervical marginal defect. A pairwise comparison between both groups showed a significant difference only in the number of small marginal defects at the enamel side, which was higher in the C-SE non-etch group. These incisal defects were small and clinically irrelevant. Superficial marginal discoloration increased slightly in the C-SE non-etch group and was related to the higher frequency of small incisal marginal defects. In this latter group, localized marginal discoloration was observed significantly more in smokers. In conclusion, the clinical performance of the mild two-step self-etch adhesive, Clearfil SE, remained excellent after 3 yr of clinical functioning. Additional etching of the enamel cavity margins was not critical for its clinical performance.     

One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair

Surgical Endoscopy - Single-visit (SV) totally extraperitoneal (TEP) inguinal hernia repair is an efficient service without impairment of safety or complication rate. Data on the economic impact of...     

Elimination of daily routine chest radiographs in a mixed medical–surgical intensive care unit

Objective To determine the impact of elimination of daily routine chest radiographs (CXRs) in a mixed medical–surgical intensive care unit (ICU) on utility of on demand CXRs, length of stay (LOS) in ICU, readmission rate, and mortality rate. Design and setting Prospective, nonrandomized, controlled study in a 28-bed ICU. Analysis included data of all admitted ICU patients during 5 months before and after elimination of daily routine CXRs. Results Before elimination, 2457 daily routine CXRs and 1437 on demand CXRs were obtained from 754 patients. After elimination, 1267 CXRs were obtained from 622 patients. The ratio of CXRs/patient day decreased from 1.1 ± 0.3 to 0.6 ± 0.4 (p < 0.05). Elimination did not result in a change in utility and timing of on demand CXRs. The absolute diagnostic and therapeutic value of on demand CXRs increased with elimination of daily routine CXRs: before intervention, 147 unexpected predefined abnormalities were found (10.2% of all on demand CXRs in 15.9% of all patients), of which 57 (3.9%) in 6.4% of all patients led to a change in therapy. After intervention, 156 unexpected predefined abnormalities were found (11.6%; p < 0.05), of which 61 (4.8%) in 9.5% of all patients (p < 0.05) led to a change in therapy. The LOS in ICU, readmission rate and ICU, and hospital mortality rate were not influenced by the change in strategy. Conclusions Elimination of daily routine CXRs reduced the number of CXRs in a mixed medical–surgical ICU, while not affecting readmission rate and ICU and hospital mortality rates. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users