Residents’ knowledge in transfusion medicine and educational programs: A pilot study

BackgroundResidents’ knowledge in transfusion medicine significantly impacts the optimal use of blood and patient safety. Little is known regarding this topic in France in particular. The objectives were to evaluate their basic knowledge, to determine whether the objectives of the curricula were attained and subsequently to suggest ways for improvement.MethodsA cross-sectional study was conducted on 50 first year medical and surgical specialty residents rotating in a French university hospital.ResultsMajor gaps in the knowledge were noted among residents of various specialties, equally between those with low and sustained transfusion practice. The majority of these young doctors expressed difficulties in prescribing and handling transfusions, identifying and managing its complications and understanding their responsibilities. The roles of hemovigilance practitioners were further somehow unclear for participants.ConclusionGiven these results, action plans appear needed to limit consequences. A special transfusion medicine educational program should be added to the currently available medical education curriculum in order to ensure physicians have adequate knowledge of transfusion basics; at least a practical assisted situation during residency would be of valuable interest.     

A cross-sectional study into medical students’ perceptions of healthcare regulation and self-reported compliance: a study conducted in the City of Al Ain,United Arab Emirates, 2016

Background

Although healthcare regulation is commonplace, there is limited evidence of its impact. Making sure that healthcare professionals comply with the regulatory requirements is a prerequisite to achieving effective regulation. Therefore, investigating factors that influence compliance may provide better insights into how regulators can be more effective. This study aimed to find out if medical students’ perceptions of regulation in the United Arab Emirates are associated with self-reported regulatory compliance.

Methods

In the cross-sectional study, we administered a structured questionnaire to students of medicine with different statements concerning their perceptions of healthcare regulation and self-reported compliance. The statements included statement regarding the legitimacy, fairness and regulatory performance, as well as the risk to getting caught and being punished. The association between perceptions and self-reported compliance was analyzed using multiple regression models.

Results

One hundred and six Year 3 and 4 pre-clinical medicine students (56.4% response rate) completed the survey. Almost 40% of the students rated their level of awareness and understanding of regulation as Good or Very Good., despite their lack of direct contact with the regulatory authorities (less than 10% reported monthly or more frequent contact). Self-reported compliance was high with almost 85% of the students either agreeing or strongly agreeing with the four compliance statements (mean score 4.1 out of 5). The findings suggest that positive perceptions of the regulator’s performance (β 0.27; 95% CI 0.13–0.41), fairness of the regulatory processes (β 0.25; 95% CI 0.11–0.38) and its legitimacy (β 0.23; 95% CI 0.05–0.41), are stronger associated with compliance than the perceived risks of getting caught and being punished (β 0.10; 95% CI -0.04 – 0.23).

Conclusions

To improve compliant behavior, healthcare regulators should pay more attention to their own perceived performance, as well as the perceived fairness and legitimacy of their regulatory processes rather than focusing on more traditional methods of deterrence, such as perceived risk of getting caught and being published.

     

Integrative medicine smart phrase pilot study: Evaluating an EHR tool to improve providers’ attitudes,knowledge and use of herbal and dietary supplements

ContextWhile many patients use herbal and dietary supplements (H/DS) for wellness, disease prevention and treatment, providers still cite a lack of resources and formal training as barriers to responding to patients’ inquiries about H/DS. Although the federal government, academic institutions and the private sector now offer more opportunities for education and research on H/DS, greater support in real time is needed to facilitate providers during the clinical encounter.ObjectiveThis small, pilot study evaluates the effects of implementation of smart phrases in the electronic health record (EHR) and an educational intervention on providers’ knowledge, attitude and use of H/DS in the clinical encounter.Design, Setting and ParticipantsThe study was conducted at The Institute for Family Health (IFH), a Federally Qualified Health Center and academic health center which operates the Department of Family Medicine and Community Health in affiliation with the Icahn School of Medicine at Mount Sinai. Baseline and post-intervention surveys were conducted to explore providers’ attitudes, knowledge and use of integrative medicine (IM) smart phrases on H/DS.Main Outcome MeasuresProviders’ awareness of smart phrases of H/DS, knowledge of the content, confidence in using smart phrases to discuss H/DS, self-reported use of smart phrases were measured.ResultsA total of 32 subjects participated in the intervention and completed the baseline survey. Only half of the participants were familiar with the IM smart phrases in our system and 12.5% felt they were aware of the information covered in these smart phrases. Eighteen of 32 participants completed the post-intervention assessment. The intervention was successful in statistically increasing participants’ self-reported awareness of the information covered in the IM smart phrases (p<0.01). Increased confidence in using IM smart phrases to initiate patients on a new supplement showed statistical significance (p=0.03). There were no clear patterns in reported behavior changes following the training with the exception of a significant increase in the self-reported frequency of past month use of IM smart phrases during a patient visit (p=0.01). Lastly, there were no changes in the frequency of smart phrase use in the EHR.ConclusionThe implementation and adoption of evidence-based use of H/DS in the clinical encounter requires a sustained educational component to make the availability of smart phrases via technology (EHR) an effective strategy.     

Social media use and parent–child relationship: A cross-sectional study of adolescents

We examined the association between social media use and parent–child relationship quality and tested whether this association is independent of total screen time. Data on 9,732 students (48.4% female) aged 11–20 years were obtained from a provincially representative school-based survey. Heavy use of social media (daily use of more than 2 hr) was associated with greater odds of negative relationships between mother–daughter (odds ratio [OR] = 1.79; 95% confidence interval [CI]: 1.27–2.52), father–daughter (OR = 1.56; 95% CI: 1.16–2.09), father–son (OR = 2.19; 95% CI: 1.58–3.05) but not mother–son (OR = 1.17; 95% CI: 0.88–1.55). Results were similar after further adjusting for total screen time. There were no significant associations between regular use of social media (2 hr or less) and parent–child relationships. These findings suggest that heavy use of social media is associated with negative parent–child relationships. Longitudinal research is necessary to disentangle the pathways between social media use and the parent–child relationship.     

Treatment decision-making in chronic diseases: What are the family members’ roles,needs and attitudes? A systematic review

ObjectiveThis systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making.MethodologyA comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria.ResultsOut of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients’ culture.ConclusionFMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process.Practice implicationsPhysicians should include FMs in treatment decision-making when the patients and their FMs wish to be included.     

Do hospital physicians’ attitudes change during PACS implementation? A cross-sectional acceptance study

PurposeThe purpose of this study is to gain a better insight into the reasons why hospital physicians accept and use a Picture Archiving and Communication System (PACS). Two research questions are put forward, pertaining to (1) factors that contribute to physicians’ acceptance of PACS, and (2) whether these factors change as physicians gain experience in using PACS.MethodsQuestionnaires were administered at three moments in time during the PACS implementation process in a private hospital: just before its introduction (T1), four months later (T2), and about fifteen months after the introduction of PACS (T3). The Unified Theory of Acceptance and Use of Technology was chosen as the theoretical framework for this study. Hence, the following scales were measured: performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, and self-reported frequency of use.ResultsForty-six usable responses were obtained at T1, 52 at T2 and 61 at T3. Three variables directly influenced PACS acceptance (measured as behavioral intention and use of PACS): effort expectancy, performance expectancy, and social influence; and their influence evolved over time. Effort expectancy was of particular importance at T1, whereas performance expectancy influenced acceptance at T2 and T3; social influence was the only consistent predictor of PACS acceptance at all times. Variance explained in behavioral intention ranged from .26 at T1 to .58 at T3.ConclusionsIn this setting, the main motivation for physicians to start using PACS is effort expectancy, whereas performance expectancy only becomes important after the physicians started using PACS. It is also very important that physicians perceive that their social environment encourages the use of PACS.     

Shared decision making,patient-centered communication and patient satisfaction – A cross-sectional analysis

ObjectivesThe integration of shared decision making (SDM) and patient-centered communication (PCC) is needed to actively involve patients in decision making. This study examined the relationship between shared decision making and patient-centered communication.MethodsIn 82 videotaped hospital outpatient consultations by 41 medical specialists from 18 disciplines, we assessed the extent of shared decision making by the OPTION⁵ score and patient-centered communication by the Four Habits Coding Scheme (4HCS), and analyzed the occurrence of a high versus low degree (above or below median) of SDM and/or PCC, and its relation to patient satisfaction scores.ResultsIn comparison to earlier studies, we observed comparable 4HCS scores and relatively low OPTION⁵ scores. The correlation between the two was weak (r = 0.29, p = 0.009). In 38% of consultations, we observed a combination of high SDM and low PCC scores or vice versa. The combination of a high SDM and high PCC, which was observed in 23% of consultations, was associated with significantly higher patient satisfaction scores.ConclusionShared decision making and patient-centered communication are not synonymous and do not always co-exist.Practice implicationsThe value of integrated training of shared decision making and patient-centered communication should be further explored.     

Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients’ and observers’ perceptions

Objective

To identify determinants of older patients’ perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions.

Oncology healthcare professionals’ knowledge,attitudes, and practices regarding young carers

ObjectiveIncreasing numbers of youths are facing a relative’s cancer. In this context, some are required to provide significant support and are called young carers (YCs). However, little is known about how these youth are viewed and supported by health professionals. The aim of this study was to investigate the knowledge, attitudes, and practices of oncology healthcare professionals regarding YCs.MethodsThirty-one oncology professionals working in France (adult and pediatric departments and homecare services) participated in semi-structured interviews.ResultsThe results indicated that almost all professionals had already met a YC and could identify several situations in their professional context. Their knowledge of YCs appeared to influence their attitudes and practices. They perceived this situation in a rather superficial way when their discourse and ideas were explored in-depth. They mentioned some ideas for improving support for YCs, but also many barriers.ConclusionThe results highlight a moderate level of awareness. Thus, it is necessary to enhance providers’ awareness and knowledge of YCs.Practice implicationsAwareness campaigns and training programs need to be developed for oncology healthcare professionals to help them better identify, understand, and support YCs and their families. This type of action would positively impact patient care.     

Physician self-disclosure in primary care: a mixed methods study of GPs’ attitudes,skills, and behaviour

Background

There is a debate in medicine about the use and value of self-disclosure by the physician as a communication tool. There is little empirical evidence about GPs and self-disclosure.

Aim

To explore what GPs’ attitudes, skills, and behaviour are with regard to self-disclosure during a clinical consultation and whether there is a need for the development of training resources.

Design and setting

Mixed methods using open-ended and semi-structured interviews in Auckland, New Zealand, and the surrounding districts.

Method

Sixteen GPs were interviewed on the issue of self-disclosure in clinical practice. A general inductive approach was used for data analysis.

Results

Self-disclosure was common in this group of GPs, contrary to training in some of the groups, and was seen as a potentially positive activity. Family and physical topics were most common, yet psychological and relationship issues were also discussed. Knowing patients made self-disclosure more likely, but a GP’s intuition played the main role in determining when to self-disclose, and to whom. GPs have developed their own guidelines, shaped by years of experience; however, there was a consensus that training would be helpful.

Conclusion

Self-disclosure is common and, in general, seen as positive. Major personal issues were acceptable for some GPs to self-disclose, especially to known patients. Although participants had developed their own guidelines, exposure of trainees to the issue of self-disclosure would be of value to prevent future mistakes and to protect both doctor and patient from any unintended harm, for example, developing a dependent relationship.     

The effect of widowhood on husbands’ and wives’ physical activity: the cardiovascular health study

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64–91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.     

Shared decision-making in cardiology: Do patients want it and do doctors provide it?

Objective

Doctors should involve their patients in making decisions about their care. We studied patients with heart disease to assess if shared decision-making occurs and to study factors that predict patients’ choices or influence cardiologists’ behaviour.

Methods

85 patients attending for arteriography were assessed to elicit preferred involvement in decision-making, perception of involvement, and confidence in the decision.

Results

40% of patients wished to be involved in decisions. Preferences were unrelated to demographic factors. Cardiologists involved patients more in decisions concerning severe disease (p = 0.056). Involvement varied between cardiologists (p = 0.001). The mean duration of consultations was 5.5 min. Patients’ confidence in decisions correlated with duration (p = 0.001), explicit reference to a decision that needed to be made (p = 0.0026), and perceived, but not observed, involvement in decision-making (p = 0.05).

Conclusion

This study highlighted the complexity of doctor–patient communication. Irrespective of preferences for involvement, patients were more confident in decisions in which they perceived more involvement or which were the products of longer consultations.

Practice implications

Patients’ confidence in clinical decisions can be increased by increasing consultation length and increasing their perception of involvement. Patients perceive more involvement in decisions when doctors specifically identify the need for treatment decisions early in the consultation.     

Facilitators and barriers to clinicians’ use of COPD action plans in self-management support: A qualitative study

ObjectiveWritten action plans for patients with chronic obstructive pulmonary disease (COPD) aim at early recognition of exacerbations and self-initiation of interventions. Previous research suggest underuse of COPD action plans. We wanted to 1) examine which factors clinicians in specialist healthcare perceived as influencing clinicians’ use of written action plans in COPD-self management support and 2) propose a framework for understanding the factors affecting clinicians’ use of action plans in routine practice.MethodsWe performed a theory-driven retrospective qualitative study. Documentary data were collected to describe the COPD action plan in context. In-depth interviews with clinicians (n = 8) were carried out. Interview data were thematically analyzed, using a predetermined model for understanding behavior.ResultsOur study revealed that a number of factors influenced clinicians’ use of action plans, including their capabilities (knowledge and skills to identify “the right patient” and to individualize the plan template) and motivations (beliefs, reinforcements, and emotions s.a. frustration, fear, and distrust), together with organizational and social opportunities (resources, patient, and GP preferences).ConclusionA multilevel understanding of factors that affect clinicians’ use of action plans in self-management support is needed.Practice implicationThe proposed framework can be used to guide future initiatives to promote targeted self-management support.     

Shared perturbations in the metallome and metabolome of Alzheimer’s,Parkinson’s,Huntington’s,and dementia with Lewy bodies: A systematic review

Despite differences in presentation, age-related dementing diseases such as Alzheimer’s (AD), Parkinson’s (PD), and Huntington’s diseases (HD), and dementia with Lewy bodies (DLB) may share pathogenic processes. This review aims to systematically assemble and compare findings in various biochemical pathways across these four dementias.PubMed and Google Scholar were screened for articles reporting on brain and biofluid measurements of metals and/or metabolites in AD, PD, HD, or DLB. Articles were assessed using specific a priori-defined inclusion and exclusion criteria. Of 284 papers identified, 198 met criteria for inclusion.Although varying coverage levels of metals and metabolites across diseases and tissues made comparison of many analytes impossible, several common findings were identified: elevated glucose in both brain tissue and biofluids of AD, PD, and HD cases; increased iron and decreased copper in AD, PD and HD brain tissue; and decreased uric acid in biofluids of AD and PD cases. Other analytes were found to differ between diseases or were otherwise not covered across all conditions.These findings indicate that disturbances in glucose and purine pathways may be common to AD, PD, and HD. However, standardisation of methodologies and better coverage in some areas – notably of DLB – are necessary to validate and extend these findings.     

Is shared decision-making vanishing at the end-of-life? A descriptive and qualitative study of advanced cancer patients’ involvement in specific therapies decision-making

Background

Little is known about what is at stake at a subjective level for the oncologists and the advanced cancer patients when they face the question whether to continue, limit or stop specific therapies. We studied (1) the frequency of such questioning, and (2) subjective determinants of the decision-making process from the physicians’ and the patients’ perspectives.

Methods

(1) All hospitalized patients were screened during 1 week in oncology and/or hematology units of five institutions. We included those with advanced cancer for whom a questioning about the pursuit, the limitation or the withholding of specific therapies (QST) was raised. (2) Qualitative design was based on in-depth interviews.

Results

In conventional units, 12.8 % of cancer patients (26 out of 202) were concerned by a QST during the study period. Interviews were conducted with all physicians and 21 advanced cancer patients. The timing of this questioning occurred most frequently as physicians estimated life expectancy between 15 days and 3 months. Faced with the most frequent dilemma (uncertain risk-benefit balance), physicians showed different ways of involving patients. The first two were called the “no choice” models: 1) trying to resolve the dilemma via a technical answer or a “wait-and-see” posture, instead of involving the patients in the questioning and the thinking; and 2), giving a “last minute” choice to the patients, leaving to them the responsibility of the decision. In a third model, they engaged early in shared reflections and dialogue about uncertainties and limits with patients, proxies and care teams. These schematic trends influenced patients’ attitudes towards uncertainty and limits, as they were influenced by these ones. Individual and systemic barriers to a shared questioning were pointed out by physicians and patients.

Conclusions

This study indicate to what extent these difficult decisions are related to physicians’ and patients’ respective and mutually influenced abilities to deal with and share about uncertainties and limits, throughout the disease trajectory. These insights may help physicians, patients and policy makers to enrich their understanding of underestimated and sensitive key issues of the decision-making process.

     

Is physical deconditioning a perpetuating factor in chronic fatigue syndrome? A controlled study on maximal exercise performance and relations with fatigue, impairment and physical activity

BACKGROUND: Chronic fatigue syndrome (CFS) patients often complain that physical exertion produces an increase of complaints, leading to a greater need for rest and more time spent in bed. It has been suggested that this is due to a bad physical fitness and that physical deconditioning is a perpetuating factor in CFS. Until now, studies on physical deconditioning in CFS have shown inconsistent results. METHODS: Twenty CFS patients and 20 matched neighbourhood controls performed a maximal exercise test with incremental load. Heart rate, blood pressure, respiratory tidal volume, O2 saturation, O2 consumption, CO2 production, and blood-gas values of arterialized capillary blood were measured. Physical fitness was quantified as the difference between the actual and predicted ratios of maximal workload versus increase of heart rate. Fatigue, impairment and physical activity were assessed to study its relationship with physical fitness. RESULTS: There were no statistically significant differences in physical fitness between CFS patients and their controls. Nine CFS patients had a better fitness than their control. A negative relationship between physical fitness and fatigue was found in both groups. For CFS patients a negative correlation between fitness and impairment and a positive correlation between fitness and physical activity was found as well. Finally, it was found that more CFS patients than controls did not achieve a physiological limitation at maximal exercise. CONCLUSIONS: Physical deconditioning does not seem a perpetuating factor in CFS.