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1.

Objective

To investigate the effect of including an online decision aid (DA) during prostate cancer treatment counseling on decisional regret and information satisfaction in a one-year follow-up.

Methods

Within a cluster RCT, 18 Dutch hospitals were randomized to DA counseling or care-as-usual, patients (n?=?382) initially completed questionnaires directly after treatment decision making. Six and twelve months later regret (Decisional Regret Scale) and information satisfaction (SCIP-B) were assessed. Anxious and depressive symptoms (HADS) was included as possible covariate.

Results

After 12 months, 43 participants (15%) regretted their treatment choice and 105 participants (36%) were dissatisfied with the information that was received at the time of decision-making, regardless of being exposed to the DA. Anxious and depressive symptoms at follow-up were associated with regret and information dissatisfaction.

Conclusion

No long-term benefical effects emerged from DA usage compared to patients who underwent standard counseling.

Practice implications

During PCa treatment counseling, healthcare providers should be aware of anxious and depressive symptoms.  相似文献   

2.

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   

3.

Objective

There is some evidence for biomarker feedback when combined with cessation counseling for reducing smoking in pregnancy. This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers.

Methods

Participants were randomly assigned to receive three study calls (10–20?min each): (1) biomarker feedback intervention (n?=?30) including personalized cotinine results and feedback on their baby’s likely exposure to carcinogen metabolite NNAL, or (2) contact control usual care condition based on the 5As (n?=?30). Assessments were conducted at baseline, post-treatment, and delivery.

Results

High rates of treatment compliance, study retention, and treatment acceptability were observed in both groups. 7-day point prevalence smoking abstinence rates at delivery verified with urinary cotinine were the same in both study groups (20% intent-to-treat analysis, 26% per-protocol). SCT-based measures did not change differentially from baseline by study group.

Conclusion

This trial supports the feasibility and acceptability of providing biomarker feedback within the clinical care delivery system, but the intervention did not promote increased smoking cessation during pregnancy compared to usual care.

Practice Implications

Efforts are needed to promote the usual care and to develop alternative biomarker feedback messaging for pregnant AN women.  相似文献   

4.

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   

5.

Introduction

Although an objective structured clinical examination (OSCE) format has been applied in Uruguay since 2004, and providing reliable performance measures, perceptions of it properties and level of student satisfaction have not been determined.

Objective

To evaluate the face validity of OSCE format as a contribution to its local feasibility study.

Material and methods

At the end of the introductory clinical course, the sub-cohort enrolled at the University Hospital responded to a 28-item questionnaire aimed at exploring perceptions about the properties of the OSCE about the potential factors ‘design’ and ‘apparent validity’. After analysing the reliability of the original questionnaire, the questionnaire was refined in an attempt to provide a shorter and more reliable tool.

Results

The original questionnaire showed good internal consistency (Cronbach alpha = 0.70), with a dominance of ‘agreement/total agreement’ opinions on authenticity of the stimuli, dynamic, relevance, and equity of the test. Students perceived organisational obstacles during the test, expressing disagreement to include some stations only aimed at assessing communication skills, and requiring personalised feedback sessions. The refined version of the questionnaire provides consistent measures on student perceptions and is a useful tool that can be widely applied. A discussion is presented on the contributions of this experience to a comprehensive feasibility study of the new format during curriculum transition.

Conclusions

The OSCE is well evaluated by students at the end of the propaedeutic course, supporting its validity. Educational potentials of the new format should be exploited, providing effective feedback to students, clinical teachers, and institutions.  相似文献   

6.

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   

7.

Objective

To test the efficacy of a hybrid model of the self-help intervention program (hSHIP), which combines a mobile version of SHIP (mSHIP) and personal coaching, to address unique cultural and motivational factors for optimal self-management of type 2 diabetes and prediabetes among Korean Americans (KAs).

Methods

A single-group feasibility study design was used. The hSHIP utilizes texts and motivational counseling based on well-tested intervention content for KAs. To facilitate the dissemination of hSHIP, we developed a web application adopting the principles of persuasive technology to motivate behavior changes.

Results

Feasibility assessment found that hSHIP was well accepted by both participants and community health workers who delivered the intervention. An average of 1.3% A1C reduction (from 7.8% to 6.5%) was achieved by KAs with diabetes (n?=?165), 51.5% of whom lowered their A1C below 6.5% in 6-months. No one with prediabetes (n?=?50) progressed to diabetes. Other clinical outcomes (e.g., weight, depression, and blood pressure) also improved significantly; 41.2% were able to reduce or discontinue antidiabetic drugs.

Conclusion

The feasibility and initial efficacy of hSHIP were demonstrated.

Practice implication

This hybrid diabetes self-management model is a viable tool for traditionally underserved groups with diabetes or prediabetes.  相似文献   

8.

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.

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   

10.

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   

11.

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   

12.

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   

13.

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   

14.

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   

15.

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   

16.

Objective

To investigate women’s preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience.

Methods

We conducted a secondary analysis of data from two randomized trials conducted between 2007–2012. Survey items assessed participants’ preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes.

Results

56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors.

Conclusion

Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making.

Practice implications

Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient’s backgrounds and desires.  相似文献   

17.

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   

18.

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.

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   

20.

Objective

To develop an educational mobile application (app) for expectant parents diagnosed with risk factors for premature birth.

Methods

Parent and medical advisory panels delineated the vision for the app. The app helps prepare for preterm birth. For pilot testing, obstetricians offered the app between 18–22 weeks gestational age to English speaking parents with risk factors for preterm birth. After 4 weeks of use, each participant completed a questionnaire. The software tracked topics accessed and duration of use.

Results

For pilot testing, 31 participants were recruited and 28 completed the questionnaire. After app utilization, participants reported heightened awareness of preterm birth (93%), more discussion of pregnancy or prematurity issues with partner (86%), increased questions at clinic visits (43%), and increased anxiety (21%). Participants reported receiving more prematurity information from the app than from their healthcare providers. The 15 participants for whom tracking data was available accessed the app for an average of 8?h.

Conclusion

Parents with increased risk for preterm birth may benefit from this mobile app educational program.

Practice implications

If the pregnancy results in preterm birth hospitalization, parents would have built a foundation of knowledge to make informed medical care choices.  相似文献   

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