共查询到20条相似文献，搜索用时 31 毫秒
1.
Andrea M. Russell Deesha A. Patel Laura M. Curtis Kwang-Youn A. Kim Michael S. Wolf Megan E. Rowland Danielle M. McCarthy 《Patient education and counseling》2019,102(4):749-752
Objective
To determine the reliability of the Newest Vital Sign (NVS) administered via telephone by examining test-retest properties of the measure.Methods
Data were obtained from a randomized controlled trial promoting opioid safe use. Participants were 18 or older and English-speaking. NVS assessment occurred in-person at baseline and in-person or via telephone at follow-up. Intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability using raw NVS scores by mode of administration of the second NVS assessment. Kappa statistics were used to examine test-retest agreement based on categorized NVS score. Internal consistency was measured with Cronbach’s alpha.Results
Data from 216 patients (70 completing follow-up in-person and 146 via telephone) were included. Reliability was high (ICCs: in-person?=?0.81, phone?=?0.70). Agreement was lower for three category NVS score (Kappas: in-person?=?0.58, 95% CI [0.39-0.77]; phone?=?0.52, 95% CI [0.39-0.65]) compared to two category NVS (Kappas: in-person?=?0.65, 95% CI [0.46-0.85]; phone?=?0.64, 95% CI [0.51-0.78]). Correlations decreased as time between administrations increased. Internal consistency was moderately high (baseline NVS in-person (α?=?0.76), follow-up NVS in-person (α?=?0.76), and phone follow-up (α?=?0.78).Conclusion
The test-retest properties of the NVS are similar by mode of administration.Practice implications
This data suggests the NVS measure is reliably administered by telephone. 相似文献2.
Objectives
Pregnancy options counseling, or nondirective counseling of patients with unintended pregnancy, is a “necessary competency” for medical students according the Association of Professors of Gynecology and Obstetrics. Narrative Medicine (NM) utilizes stories of illness to inform clinical practice and promotes self-reflection in medical education. The authors analyzed the effect of a NM workshop on medical students’ ability to provide pregnancy options counseling.Methods
The authors randomized students in the major clinical year at Columbia University Medical Center (CUMC) to either a 2-hour NM workshop or to a control intervention. The NM group participated in reading and reflective writing exercises addressing varying perspectives on pregnancy. Students then completed a video-taped and numerically-scored OSCE (Objective Structured Clinical Examination) regarding pregnancy options counseling. The authors compared mean OSCE scores between the groups.Results
The study analyzed 103 participants. Overall mean OSCE scores were higher in the NM group (11.9?±?1.5, n?=?51) than the control group (11.3?±?1.6, n?=?52) (p?=?0.049).Conclusions
Students undergoing a NM workshop had higher scores on a pregnancy options counseling OSCE.Practice implications
This brief intervention may aid future physicians in providing nondirective pregnancy options. This novel approach to teaching is an easily shared learning tool. 相似文献3.
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4.
Patient knowledge and attitudes toward cervical cancer screening after the 2012 screening guidelines
Jayanti M. Clay Joanne K. Daggy Sunetris Fluellen Brownsyne Tucker Edmonds 《Patient education and counseling》2019,102(3):411-415
Objective
To assess women’s attitudes and preferences related to recent changes in cervical cancer screening guidelines.Methods
We distributed 380 surveys in three University based and Community clinics. Study participants anonymously completed surveys, which included questions related to demographics, cervical cancer, screening practices, risk perception and attitudes towards changing practices.Results
315 women agreed to participate (83%). 60% (185/310) of participants had some college education or higher and 12% (36/305) worked in the medical field. On average, participants answered 4.1 (SD?=?1.3) of the 8 knowledge questions correctly. Knowledge scores significantly increased with education level (Kruskal-Wallis test p-value?<?0.001). The majority (72%, n?=?228) reported that they should be screened annually, and that screening should be initiated with the onset of sexual activity (63%, n?=?197). Participants that were more knowledgeable of current screening practices were more comfortable extending screening intervals (Kruskal-Wallis test p?<?0.001).Conclusion
Even among a relatively highly educated population of women, participants had limited knowledge of cervical cancer and current screening guidelines. Many participants reported discomfort with less frequent screening intervals.Practice implications
This study supports the need for improvement in cervical cancer prevention education especially with regards to the new screening guidelines. 相似文献5.
Jayanthi J. Chandar David A. Ludwig Juan Aguirre Adela Mattiazzi Malgorzata Bielecka Marissa Defreitas Alan M. Delamater 《Patient education and counseling》2019,102(5):1035-1039
Objective
The objective of this study was to facilitate functional health literacy (FHL) with a modified “Teach Back” method. A computer-based program was developed for adolescent and young adult kidney transplant recipients (KTR) to knowledgeably answer questions about their medical condition, medications, and create a simple synopsis of their personal health record with the help of the heath care provider (HCP).Methods
In a pre-post quasi-experimental design, 16 patients received the computer intervention in which they navigated questionnaires and brief informational video clips. Knowledge scores were assessed at baseline and 3 months. The binomial sign test was used to evaluate change in knowledge and purpose of medications.Results
Mean age was 17.3?±?2.4 years and 94% were non-Caucasian. Seven of 16 patients were academically below grade level. Twelve of 16 patients improved their overall knowledge (P?=?0.0002) and purpose of medications (P?=?0.0017).Conclusions
A Modified “Teach Back” during clinic visits was associated with improvements in FHL.Practice Implications
This modified ‘teach back’ program has the potential to improve FHL which could contribute to long-term preservation of kidney transplants. 相似文献6.
Objectives
To investigate the effects of various diets on structure and function of the bladder in both normal and obstructed bladders of male Wistar rats.Methods
Sham-operated rats and rats with experimentally-induced bladder outlet obstruction (BOO) were fed with standard rats’ feed (control), High-carbohydrate (HCD), High-fat (HFD) and High-protein (HPD) diets. Feeding was continued for 4 weeks after BOO surgery. Bladder weight, detrusor contractility, Rho-Kinase (ROK) and Myosin Light Chain Kinase (MLCK) expressions were determined using standard methods.Results
In comparison with control, bladder weight was increased in HFD (164?±?9?mg), BOO (437?±?21?mg), HFD-BOO (523?±?19?mg) and HPD-BOO (268?±?18?mg). Detrusor contractility was reduced in BOO and HFD-BOO. The ROK- I and II expressions were high in HCD-BOO and low in HPD-BOO but ROK-I was also elevated in BOO. However, MLCK increased only in HCD-BOO.Conclusion
The results of the study reveal that diets with varying macronutrient compositions have variable effects on the bladder with and without obstruction. High-fat diets especially, affect detrusor morphology and function in both obstructed and unobstructed bladders. 相似文献7.
8.
Binnari Kim Yun-jeong Jang Sujin Park Jung-Il Lee Hong Kwan Kim Joungho Han 《Pathology, research and practice》2019,215(4):807-815
Background
Studies have shown that 30–50% of non-small cell lung cancer (NSCLC) patients develop brain metastasis (BM). Since BM shortens overall survival and decreases the quality of life, early detection and treatment of BM are vital. While data are available for clinical risk factors of NSCLC with BM, histopathological factors are not well understood. Therefore, we evaluated the histopathological related factors which will help early detection and selection of effective treatment options.Materials and methods
A total of 117 surgical lung specimens diagnosed as NSCLC with BM were included as a study group. We included 237 cases without BM as a control group. One pathologist reviewed H&E slides and analyzed the histopathologic factors of all cases.Results
In pulmonary adenocarcinoma, vascular invasion, N stage, micropapillary pattern and necrosis were significantly associated with BM in multivariate analysis (vascular invasion, p?=?0.009; micropapillary pattern, p?=?0.024; others, p?<?0.001). Tumor with extensive necrosis had higher hazard ratio and shorter time to BM (p?<?0.001).Conclusion
Our findings suggest that necrosis is a new predictive factor of BM in pulmonary adenocarcinoma. Short term follow-up is needed especially when extensive necrosis is present. 相似文献9.
Ken Dewitte Marc Claeys Emeline Van Craenenbroeck Koen Monsieurs Hein Heidbuchel Vicky Hoymans Tibor Stoop 《Pathophysiology》2019,26(1):53-59
Aims
We explored the effect of remote ischaemic conditioning (RIC) on endothelial function and on circulating mediators.Methods and results
In 20 healthy male volunteers (mean age 31?±?10 years), flow-mediated dilation (FMD) was measured before and after 20?min of arm ischaemia, followed by reperfusion. Remote ischaemic conditioning (RIC) was performed by applying 3 cycles of 5?min of ischaemia of the leg at the onset of index arm ischaemia. Each volunteer underwent the IR-induced vascular injury protocol with and without RIC in a crossover study design.In the control group, IR significantly reduced FMD (5.9?±?2.9% before IR vs. 2.2?±?3.7% after IR; p?<?0.001). This effect was significantly attenuated by performing RIC (FMD of 5.5?±?3.1% before IR vs. 4.0?±?3.4% % after IR; p for interaction?=?0.01). Serum levels of SOD and ADMA increased significantly whereas MCP-1 and VEGF levels decreased significantly.Only changes in SOD levels were significantly related to the degree of RIC induced protection (r²?=?0.34; p?=?0.018).Conclusion
RIC has protective effects against endothelial IR injury. Our biomarker study suggests that anti-oxidative stress mediators, such as SOD, seem to be more involved in the pathogenesis of RIC-induced protection in humans than angiogenesis factors or chemo-attractant cytokines. 相似文献10.
Sucharita Kher Hillary Landau Stephanie M. Hon Janis L. Breeze Nadine Al-Naamani Jessica K. Paulus Andrew Martin Rosemary Tsacoyianis 《Patient education and counseling》2019,102(5):932-936
Objective
Identify inhaler use characteristics among English (ESP) and non-English speaking patients (NSP) to develop quality improvement efforts.Methods
Outpatients were surveyed for technique confidence, education, preferences and disease control. We compared characteristics between ESP and NSP.Results
Of 197 respondents, 75% were ESP, 25% were NSP. Compared to NSP, ESP responders were more likely female (57% vs 31%, p?=?0.001), used inhalers for a longer time (10 vs 6 years, p?=?0.008) and had higher rates of metered dose inhaler use (85% vs. 60%, p?<?0.001). Both language groups had similar confidence in inhaler use, after adjustment for age, gender and duration of use. Similar rates of inhaler technique education were reported by ESP and NSP at the initial visit. More NSP reported receiving education at subsequent visits (54% vs. 72%, p?=?0.03). Education for both groups was mostly performed by a clinician. Both language groups reported low internet use for learning proper technique, low interest in a separate education session, preferred an active learning method.Conclusions
These findings will be used to further develop quality inhaler education efforts at our institution.Practical implications
Local patient preferences should be considered when designing inhaler education programs. 相似文献11.
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12.
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13.
Scott A. Davis Delesha M. Carpenter Susan J. Blalock Donald L. Budenz Charles Lee Kelly W. Muir Alan L. Robin Betsy Sleath 《Patient education and counseling》2019,102(5):937-943
Objective
To determine the effectiveness of an online video intervention in improving self-efficacy and eye drop application technique in glaucoma patients.Methods
We randomized ninety-two patients with primary open-angle glaucoma, all who self-administer their eye drops, to either watch the 4-minute Meducation® eye drop technique video in the intervention group, or a nutrition video in the control group. We assessed five eye drop technique steps using objective video recordings at baseline, immediately after watching the video, and 1 month later. We used linear regression models to determine whether the intervention group had better self-efficacy and technique than the control group.Results
Adjusted for baseline technique and other covariates, eye drop technique averaged 0.73 steps better in intervention patients than controls immediately after the video (p?=?0.003) and 0.63 steps better at 1 month (p?=?0.01). Adjusted for baseline self-efficacy, intervention patients had better eye drop technique self-efficacy than controls immediately after the video (p?=?0.02) and at 1 month (p?=?0.02).Conclusion
A short educational video can significantly improve glaucoma patients’ short-term self-efficacy and eye drop technique.Practice implications
Videos may provide an inexpensive, convenient way to deliver eye drop technique education in any provider’s office or online. 相似文献14.
Michael Anthony Fajardo Guy Balthazaar Alexandra Zalums Lyndal Trevena Carissa Bonner 《Patient education and counseling》2019,102(3):467-473
Objective
The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy.Methods
Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator.Results
Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD?=?19%) and the mean actionability score was 42% (SD?=?30%).Conclusions
Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation.Practice Implications
Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator. 相似文献15.
Karen A. Lindsley 《Patient education and counseling》2019,102(5):944-951
Objective
To develop a patient-centered informed consent and assessment tool written at a 6th grade-level that is multimodal, affordable, transportable, and readily modifiable for protocol updates.Methods
This quality improvement initiative was performed in two phases on an actively-recruiting study at a pediatric diabetes clinic. In phase I, 38 volunteers underwent the standard-paper consent process, a comprehension assessment and provided feedback. Using feedback and the structure of the Plan-Do-Study-Act cycle a multimodal consent and assessment were developed. In phase II, volunteers were randomized to the standard (n?=?25) or the multimodal consent (n?=?25) and all completed the same comprehension assessment via touch-screen tablet. Primary outcomes were comparison of the individual and total comprehension assessment scores.Results
Total comprehension scores were higher in the multimodal versus the standard consent group (p?<? 0.001) and on the elements of benefits (p?<? 0.001), risks (p?<? 0.001), volunteerism (p?<? 0.012), results (p?<? 0.001), confidentiality (p?<? 0.004) and privacy (p < 0.001).Conclusion
A multimodal consent and assessment presented sequentially on a touch-screen tablet were patient-centered enhancements to standard consent.Practice implications
Multimodal standardization of delivery with improved readability may strengthen the informed consent process. 相似文献16.
Megan Jarman Laura Adam Wendy Lawrence Mary Barker Rhonda C. Bell 《Patient education and counseling》2019,102(5):924-931
Objective
In a pilot RCT we assessed training a dietitian in “Healthy Conversation Skills” (HCS) to support behavior change. This study describes the acceptability of the intervention from the participant and practitioner perspective.Methods
Seventy pregnant women participated (intervention?=?33; control?=?37). The evaluation included: i)audio-recording sessions to assess use of HCS from the intervention dietitian; ii)semi-structured interview with the intervention dietitian to assess experiences of using HCS; iii)Quality of Prenatal Care Questionnaire and focus groups to assess participants’ views of study experience.Results
Intervention sessions involved conversations where the dietitian used HCS. The dietitian reflected on the simplicity of learning HCS in training but the challenges of embedding these new skills in practice and highlighted the need to review and reflect on practice as an ongoing process. Intervention participants were more satisfied with the study (p?=?0.05) and more likely to agree that the dietitian took time to ask about things that were important to them (p?=?0.04) than control participants.Conclusion
Use of HCS by practitioners is an acceptable way to support lifestyle changes in pregnancy.Practice implications
Use of HCS provide opportunities to support behaviour change. Review of and reflecting on practice may facilitate the application of new skills in practice. 相似文献17.
Peter Scalia Marie-Anne Durand Julia L. Berkowitz Nithya P. Ramesh Marjan J. Faber Jan A.M. Kremer Glyn Elwyn 《Patient education and counseling》2019,102(5):817-841
Objective
To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows.Methods
Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies.Results
We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD?=?0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD?=?0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR?=?1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level.Conclusion
Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers.Practical implications
The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice. 相似文献18.
Nahed A. Soliman Shaimaa M. Yussif Abdelhadi M. Shebl 《Pathology, research and practice》2019,215(5):977-982
Introduction
Syndecan-1 is heparan sulfate proteoglycans (HSPGs) that is used as coreceptors for signaling of growth factors. The comprehensive effect of syndecan-1 is to augment receptor stimulation at little ligand concentrations.The goal of this research
is to study syndecan-1 expression in breast carcinoma and its value in predicting the prognosis in comparison to other clinicopathological parameters.Material &methods
immunohistochemistry study for syndecan-1 is done on 103 cases of invasive breast carcinoma. Its expression is assessed and correlated to other clinicopathological parameters and prognosis.Results
overexpression was significantly related to high histologic grade (p?=?0.001), large tumor size (p?=?0.043), HER2-positive status (p?=?0.001), and ER&PR-negative status (p?=?0.001). It was also have a negative impact on the overall survival (p=0.012) and disease free survival (p?=?0.009). Syndecan-1 expression showed weak positive correlation with Her 2 expression (Correlation Coefficient (co): 0.332, p?=?0.001).Conclusion
syndecan-1 is a good predictor of poor overall survival and recurrence/ metastasis free survival. It is associated with aggressive phenotype as HER2 enriched and Triple negative rather than luminal subtypes of breast carcinoma. So it can be added to the hormonal receptors and HER 2 assay in the routine management of invasive breast cancer after confirmation on a more larger study. 相似文献19.
Marleen Kunneman Michael R. Gionfriddo Freddy J.K. Toloza Fania R. Gärtner Gabriela Spencer-Bonilla Ian G. Hargraves Patricia J. Erwin Victor M. Montori 《Patient education and counseling》2019,102(3):452-466
Objective
To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy).Methods
We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication.Results
Of the 154 eligible studies, 14 (9%) included ≥1 statements regarding humanistic communication, either in framing the study (N?=?2), measuring impact (e.g., empathy, respect, interpersonal skills; N?=?9), as patients’/clinicians’ accounts of SDM (N?=?2), in interpreting study results (N?=?3), and in discussing implications of study findings (N?=?3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication.Conclusion
Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication.Practice implications
Considering SDM as merely a technique may reduce SDM’s patient-centeredness and undermine its’ contribution to patient care. 相似文献20.
Dana Ragouzeos Julie Gandrup Beth Berrean Jing Li Marie Murphy Laura Trupin Jinoos Yazdany Gabriela Schmajuk 《Patient education and counseling》2019,102(3):503-510