The role of expectations in preferences of patients for a female or male general practitioner

Objective

To determine, for five health problems, whether preference for a male or female general practitioner (GP) is related to patient gender, GP gender and/or patient expectations of GP behaviour.

Methods

Cross-sectional study in 14 health centres in Spain, administering a questionnaire to 360 patients. Outcome variables were: preference for male GP, female GP or no preference in consultations for five hypothetical health problems.

Results

Mean age was 47.3 ± 16.5 years, 51% were female. Preference was more frequently expressed by females. Odds ratios (ORs) for a woman preferring a female to male GP ranged from 3 to 508, according to the hypothetical problem, and ORs for a patient with female GP preferring a female GP ranged from 2.8 to 9.1. Patient gender and GP gender had no interactive effect on preferences. Expectations of GP behaviour were related to preferences, except for chest pain. Higher expectations of communication or technical care were associated with greater preference for female or male GP, respectively.

Conclusions

Patient gender and current GP gender are related to preferences in five hypothetical clinical situations and expectations of GP behaviour to preferences in four of them.

Practice implications

Educational strategies are needed to adjust clinical encounters to patients’ preferences.     

Homeopathy enables rheumatoid arthritis patients to cope with their chronic ill health: A qualitative study of patient's perceptions of the homeopathic consultation

Objective

The role of the consultation in mediating improved clinical outcomes has been demonstrated in both conventional and complementary medicine but to date no depth study has explored how complementary medical consultations achieve such benefits. This study explored rheumatoid arthritis (RA) patients’ perceptions of the homeopathic consultation including any perceived benefit.

Methods

Qualitative study nested within a placebo-controlled multi-centre trial assessing adjunctive homeopathic intervention for RA. In-depth face to face interviews (with 16 participants) were analysed using interpretative phenomenological analysis.

Results

RA participants perceived homeopathic consultations helped them cope better through either enabling improved physical health, wellbeing and/or illness management. Four themes associated with improved coping were: receiving emotional support; exploring the illness; exploring self; and gaining advice. Exploring the wider narrative of their illness, enabled participants to address their individual needs and for some, this process of increased awareness changed their perception resulting in the perceived benefits.

Conclusion

Homeopathic consultations enable RA patient to cope better.

Practice implications

Homeopathic consultations may provide an additional resource for RA patients. Identifying and employing the “active ingredients” that confer benefit may be appropriate for other clinicians to maximise patient benefits from consultations.     

Effects of a multidisciplinary cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE:

To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatric symptoms in patients with mild Alzheimer''s disease.

METHOD:

The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer''s patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer''s patients in waiting lists for future intervention.

INTERVENTION:

Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings.

MEASUREMENTS:

The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer''s disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments.

RESULTS:

Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer''s subjects. The treatment was also beneficial for the patients'' quality of life.

CONCLUSION:

This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer''s patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment.     

Development of a questionnaire to assess communication preferences of patients with chronic illness

Objective

The objectives of the study are to develop a patient-oriented and theory-based questionnaire on the communication preferences of chronically ill patients (KOPRA questionnaire) and to carry out psychometric testing of the instrument.

Methods

Following two preliminary studies (focus groups, cognitive interviews), a total of 472 patients with chronic back pain or chronic ischemic heart disease were surveyed. In the main sample (N = 333), communication preferences regarding the physician were assessed; for N = 89 (or N = 50) patients, preferences regarding nursing staff (or therapists) were analyzed. Psychometric testing was done with respect to unidimensionality, fit to an item response theory (IRT) model, and for reliability. The questionnaire was developed and validated in German.

Results

In the physician version with a total of 32 items, there are four scales (“Patient participation and patient orientation”, “Effective and open communication”, “Emotionally supportive communication”, and “Communication about personal circumstances”) that are unidimensional, fulfill the demands for a 1-parameter IRT model, and are reliable (Cronbach's alpha between .80 and .92). The psychometric properties with respect to nursing staff and therapists are slightly worse.

Conclusion

The KOPRA questionnaire has good psychometric properties.

Practice implications

Clinical use of the questionnaire appears useful to determine patients’ communication preferences.     

The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial

ObjectiveExamine the impact of a PACE (Prepare, Ask, Check, Express) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals for patients suffering from chronic diseases (CDs), compared to usual care.MethodsThree arm single-blind RCT in community primary care (PC) practices. PC practitioners (n = 18) had a CD patient caseload, and practicing >5 years. Patients >40 years old, English speaking, computer literate, not reaching treatment goals for hypertension, type II diabetes, and/or dyslipidemia.Interventions(1) web-intervention and (2) web intervention and nurse facilitated workshop and (3) usual care.OutcomeProportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for.ResultsPatients (n = 322) were randomized, and of these 221 returned for follow up. Patients in the web group were 1.42 times more likely to meet targets compared to usual care [95% CI: 1.00–2.00], a statistical difference not seen in the combined group. Sensitivity analyses were performed to mitigate bias due to loss to follow up.ConclusionsTraining patients in communication skills using a website positively affects reaching treatment goals for hypertensive, diabetic and dyslipidemic patients.Practice implicationsWeb communication interventions are an effective tool that can be used in primary care.     

Effectiveness and impact of networked communication interventions in young people with mental health conditions: a systematic review

Objective

Examine the effectiveness and impacts of the networked communication technologies used by health care professionals for the treatment of adolescents/young adults with mental health disorders.

Methods

Nine electronic databases were searched. Quantitative and qualitative study designs were included, technologies were described and a narrative synthesis of all included studies was undertaken.

Results

20,925 papers were identified from which 12 interventions met the inclusion criteria. Three categories of networked communication were identified: email and/or web-based electronic diary (n = 6); videoconference (n = 5); and virtual reality (n = 1). Three studies reported statistically significant improvements in symptoms post intervention; all involved email communication. Patients were willing to use networked communication in routine care in nine studies.

Conclusions

Networked communication technologies can increase the opportunity for communication between patient and health care professionals. Limited improvements in quality of life and continuity of care for patients were reported. Patients and health care professionals expressed some satisfaction with technologies. Further research exploring concerns over privacy and security is needed.

Practice implications

Networked communication technologies have the potential to be a useful addition to mental health services delivery, however the impact and effectiveness of these technologies is inconclusive.     

Effectiveness of a standardized back school program for patients with chronic low back pain after implementation in routine rehabilitation care

ObjectiveTo evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.MethodsA multi-center, quasi-experimental controlled study of patients with low back pain (n = 535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients’ illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.ResultsWe found a significant small between-group intervention effect on patients‘ illness knowledge in medium- to long term (6 months: η² = 0.015; 12 months: η² = 0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η² = 0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.ConclusionsThe standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice implicationsFurther dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes.     

Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients

ObjectiveThere is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients’ personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.MethodsParticipants were recruited by a press report in local newspapers. Inclusion criteria: adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.ResultsIn total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.ConclusionEmpathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.Practice implicationsMore explicit attention should be given to empathy during medical education in general and during vocational GP-training.     

Optimising anticoagulant education in the paediatric setting using a validated model of education

Objective

Providing education to patients requiring anticoagulant therapy may be associated with improved outcomes. This study investigated the knowledge outcomes of a validated educational intervention.

Methods

Parents of children with congenital heart disease requiring warfarin therapy took part in an educational intervention. Warfarin knowledge was assessed prior to commencing the program, immediately following its completion and 6 months following completion.

Results

Parents demonstrated a statistically significant improvement in their warfarin knowledge immediately following completion of the program (p < 0.0001), with this improvement being sustained over time.

Conclusion

Current approaches to educating parents of children requiring warfarin therapy are likely suboptimal. Using a validated model of education may be associated with improved knowledge outcomes for patients.

Practice implications

Consideration to the processes used in delivering patient education may result in improved patient knowledge outcomes.     

Social support in cyberspace: a content analysis of communication within a Huntington's disease online support group

OBJECTIVE: Huntington's disease (HD) is an inherited disorder, characterized by a progressive degeneration of the brain. Due to the nature of the symptoms, the genetic element of the disease, and the fact that there is no cure, HD patients and those in their support network often experience considerable stress and anxiety. With an expansion in Internet access, individuals affected by HD have new opportunities for information retrieval and social support. The aim of this study is to examine the provision of social support in messages posted to a HD online support group bulletin board. METHODS: In total, 1313 messages were content analyzed using a modified version of the social support behavior code developed by [Cutrona CE, Suhr J. Controllability of stressful events and satisfaction with spouse support behaviors. Commun Res 1992;19:154-74]. RESULTS: The analysis indicates that group members most frequently offered informational (56.2%) and emotional support (51.9%) followed by network support (48.4%) with esteem support (21.7%), and tangible assistance (9.8%) least frequently offered. CONCLUSION: This study suggests that exchanging informational and emotional support represents a key function of this online group. PRACTICE IMPLICATIONS: Online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals affected by HD and explore where and why gaps may exist between evidence-based medicine and consumer behavior and expectations.     

The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial

Objectives

Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods.

Methods

Fifth year medical students (N = 103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N = 34) or SP (N = 35) or to a control group (CG, N = 34). We assessed self-efficacy, as well as objective performance in parent–physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively.

Results

The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p < .021 and p < .001 respectively) and SP-training (p < .007 and p < .006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p < .021) due to significantly higher performance in the domain understanding of parents’ perspective (p < .001).

Conclusion

Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives.

Practice implications

Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients’ concerns justifying its prominent role in medical curricula.     

慢性阻塞性肺疾病稳定期患者应用远程康复效果的Meta分析

文题释义：肺康复：指对有症状、日常生活能力下降的慢性呼吸系统疾病患者采取的多学科综合干预措施,是慢性肺部疾病的一项非药物治疗措施,其目标是缓解症状和降低未来急性加重的发生风险。远程康复：是以多媒体技术为基础,通过计算机和网络技术手段,与大型医院的医疗技术相结合,提供远距离在线康复医疗信息和技术服务。背景：由于行动不便,缺乏交通和旅行费用,使慢性阻塞性肺疾病稳定期患者难以获得以中心为基础的肺康复服务,而远程康复技术使这些患者获得肺康复的机会。目的：分析远程康复在慢性阻塞性肺疾病稳定期患者肺康复中的应用效果。方法：以 “远程”“康复”“慢性阻塞性肺疾病”和“telerehabilitation”“Chronicobstructive pulmonary disease”等为中、英文检索词,从PubMed、The Cochrane library和中国知网等数据库中检索文献,根据纳入和排除标准独立筛选文献、提取数据,并行文献质量评价。运用RevMan5.3软件对数据进行荟萃分析。结果与结论：共纳入21篇RCT研究,共3 033例慢性阻塞性肺疾病稳定期患者。Meta分析结果显示：干预组与对照组比较,第1秒用力呼气容量/用力肺活量比值显著升高[MD=5.11,95%CI(4.05,6.17),Z=9.49,P < 0.00001]和CAT评分明显降低[MD=-3.54,95%CI(-5.61,-1.46),Z=3.34,P=0.000 8],差异均有显著性意义(P < 0.05)。干预组与对照组比较,6 min步行距离、第1秒用力呼气容量/预计值%、mMRC评分和SGRQ得分,差异均无显著性意义(P > 0.05)。结果表明,远程康复为慢性阻塞性肺疾病稳定期患者提供了一种新的肺康复方式,能促进患者疾病康复和加强自我管理能力。ORCID: 0000-0003-4506-8394(丁美祝)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Efficacy of a dyadic intervention to improve communication between patients with cancer and their caregivers: A randomized pilot trial

ObjectiveCancer-related communication is critical for patients’ and caregivers’ adaptation to illness. This randomized pilot study was conducted to test the feasibility, acceptability, and efficacy of a specific dyadic intervention to improve communication.MethodsA four weekly-session intervention was developed to reinforce cancer-related patient-caregiver communication. Patients receiving treatment for any diagnosed cancer, and their caregivers, were recruited from two oncology clinics in Belgium. Sixty-four patient-caregiver dyads were assigned randomly to intervention and waitlist groups. Cancer-related dyadic communication, dyadic coping and emotional distress were assessed at baseline and post-intervention.ResultsThe intervention attrition rate was 6 %. Linear mixed models were performed on 60 dyads. Significant two-way group × time interaction indicated improvement in participants’ cancer-related dyadic communication frequency (β = ?1.30; SE = 0.31; p = .004), self-efficacy (β = ?10.03; SE = 3.90; p = .011) and dyadic coping (β = ?5.93; SE = 2.73; p = .046) after the intervention.ConclusionThese results indicate that the brief dyadic communication intervention is feasible and acceptable, and show preliminary evidence of efficacy.Practice implicationsEncouraging patients and caregivers to discuss personal cancer-related concerns may improve their ability to cope with the illness together.     

Donepezil combined with natural hirudin improves the clinical symptoms of patients with mild-to-moderate Alzheimer's disease: a 20-week open-label pilot study

Aim:To evaluate the efficacy and safety of donepezil plus natural hirudin in patients with mild-to-moderate Alzheimer''s Disease. Methods: In the 20-week, randomized, open-label and controlled study, 84 patients received either donepezil (5 mg/day for the first 4 weeks and 10 mg/day thereafter) or donepezil plus natural hirudin (3 g/day) treatment. Efficacy was reflected by the change of the total scores of Alzheimer''s Disease Assessment Scale cognitive subscale (ADAS-Cog), Activities of Daily Life (ADL) and Neuropsychiatric Inventory (NPI). Results: The patients with the donepezil plus natural hirudin treatment showed more significant improvement in the daily activities and the decline of the cognition than those with donepezil treatment. Significant difference was present in the groups since the 8th week. No group difference was found in the NPI change. However, within the hirudin treatment group, more powerful efficacy including NPI assessment was found in the patients with vascular risk factors (VRF) as comparing to with those without VRF. The combination of donepezil and natural hirudin was well tolerated. The dropout rate was greater in the donepezil and natural hirudin (50%) treatment group than in the donepezil (39%) treatment group. Similar result was found in the incidence of adverse events (23.8% vs 19.0%), but there was no statistical difference between the two groups. Adverse events were the most common reason for the dropout. Although hemorrhage and hypersensitiveness were more common in donepezil plus Maixuekang treatment (11.9% and 7.1%) group than in donepezil treatment (2.4% and 2.4%) group, no significant difference was present between the two groups. Economic problem was another important reason for the patients'' withdrawal. Conclusions: Compared with the donepezil treatment in the patients with mild-to-moderate AD, our results suggest that donepezil combined with natural hirudin may improve the treatment effects in the ADL, BPSD and cognition of the patients. Furthermore, this joint treatment is safe.     

Treatment of Hodgkin's disease: a twenty-year follow-up of patients at a center in Korea

Hodgkin's disease (HD) is a hematologic malignancy which shows common features regardless of race, but racial differences may be considered with certain clinical characteristics. HD in Korea shows somewhat different characteristics when compared to cases in Western countries. We evaluated the clinical and histopathologic characteristics of HD, the outcomes of various chemotherapy regimens, and prognostic factors of HD in Korea. One hundred and five patients with initial histopathologic diagnosis of Hodgkin's disease were retrospectively reviewed 20 years after diagnosis at Yonsei University College of Medicine. Nodular sclerosis was the most common histopathologic subtype (41%) and mixed cellularity was nearly as common (40%). The overall complete remission rate (CR) was 87.6%. The disease-free survival (DFS) and overall survival (OS) rate were 79.2% and 84.8% at 5-years, 70% and 79.2% at 10- and 20-years. There were no significant differences in CR rate and DFS, but OS rates were significantly higher in m-BACOP and ABVD regimen. Univariate analysis revealed that age, B-symptom, ECOG scale, Ann Arbor stage, international prognostic index, and serum beta2-microglobulin level were significant prognostic factors for both DFS and OS. Multivariate analysis demonstrated that age, B symptoms, and ECOG scale were significant prognostic factors for OS only. In conclusion, the survival rates of HD patients in our center were superior to those of previous reports in Korea and Western countries. Considering the higher OS rate and decreased incidence of side effects, the ABVD regimen may be recommended for the initial treatment of Hodgkin's disease.     

Evaluating a counselling strategy for diagnostic WES in paediatric neurology: an exploration of parents' information and communication needs

As whole exome sequencing (WES) is just starting to be used as a diagnostic tool in paediatric neurology for children with a neurological disorder, and patient experiences and preferences with regard to counselling are relatively underexplored. This article explores experiences and preferences of parents with pre‐test and post‐test counselling in a trial that uses WES for diagnostics. Second, it maps information and communication needs which exceed the counselling protocol, in order to acquire insight into how it can be improved. Data were gathered through in‐depth interviews with parents of 15 children who were included in the trial. Information and communication needs of parents differed from the protocol with respect to (i) the type and amount of information provided about WES research, (ii) incidental findings, (iii) communication about progress of the study, and (iv) the communication of the results. Furthermore, parents preferred to have more of a communicative exchange with health care providers about their daily struggles and concerns related to their life with a diseased child and wanted to know how a diagnosis could offer help. There are different ways to meet parental needs, but we suggest that assigning a case manager might be a helpful option that deserves further exploration.     

Analysis of the PINK1 gene in a cohort of patients with sporadic early-onset parkinsonism in Taiwan

Mutations in the PINK1 gene have been shown to cause autosomal recessive Parkinson's disease (PD) and/or early onset sporadic PD in Italy, Spain, North America, Ireland, and Asia. However, there are limited data on PINK1 mutations in sporadic early onset Asian PD patients. To determine the prevalence of PINK1 mutation in Taiwanese population, we conducted genetic analysis of PINK1 mutation in 73 early onset sporadic PD and 94 normal control subjects. We only identified a novel single heterozygous mutation R 407Q mutation in exon 6 of this gene in one patient at the age onset of 54. Overall, these data indicate that PINK1 mutations are rare in our population. Based on our results, unless common mutational hotspots are identified, routine testing for this mutation at least in our population may not be cost-effective.