Patient-centered care and distal radius fracture outcomes: A prospective cohort study analysis

Study designProspective cohort.IntroductionEffects of patient-centered care on distal radius fracture recovery lacks evidence.Purpose of the studyTo understand from the perspective of a patient with a distal radius fracture: if the Patient Perception of Patient-Centeredness Questionnaire (PPPC) subscales apply to distal radius fracture populations; the strongest and weakest areas of patient-centered care; changes in patient perceptions of patient-centeredness during recovery; and, correlations between aspects of patient-centered care and patient reported pain and disability.MethodsPatients with distal radius fractures (n = 129; mean age = 54.03, SD = 14.63) completed the Patient Rated Wrist Evaluation (PRWE) and PPPC, at baseline (less than 10 days post-fracture) and at three months post-injury. Outcome measure responses were factor analyzed and tested for correlations.ResultsFactors identified were titled Clinician-Patient Dialogue, representing communication components of patient-centered care, and Clinician-Patient Alliance, representing partnership components of patient-centered care. Small significant correlations (r = 0.22) between PRWE and PPPC responses were observed with Clinician-Patient Alliance more correlated at baseline and Clinician-Patient Dialogue at follow-up.DiscussionImportant aspects of the patient-clinician dynamic were identified.ConclusionsCommunication between clinician and patient was perceived most favorably at baseline; and partnership improved by three months.Level of evidence1b.     

以患者为中心的健康教育模式对改善剖宫产初产妇切口瘢痕的影响

目的 探究剖宫产初产妇应用以患者为中心的健康教育模式对改善切口瘢痕的影响。方法 选择 2023年2月-11月我院实施剖宫产的初产妇70例,采用随机数字表法分为对照组和观察组,各35例。对照组 实施常规围术期护理干预,观察组实施以患者为中心的健康教育干预,比较两组切口愈合效果、瘢痕情 况、负性情绪、生活质量、护理满意度。结果 观察组切口愈合总有效率为91.43%,高于对照组的77.14% （P ＜0.05）;观察组瘢痕宽度及厚度低于对照组（P ＜0.05）;观察组术后SAS及SDS评分低于对照组 （P＜0.05）;观察组SF-36评分高于对照组（P＜0.05）;观察组护理满意度评分高于对照组（P ＜0.05）。 结论 以患者为中心的健康教育模式能提升剖宫产初产妇术后切口瘢痕的美观性,改善产妇负面情绪,且 产妇对护理满意度较高。     

视频化健康教育联合回授法在脊柱外科手术患者中的应用效果

目的探讨视频化健康教育联合回授法在脊柱外科手术患者健康教育中的应用效果。 方法前瞻性收集2016年3月至6月西安交通大学附属红会医院脊柱外科住院患者206例,按照入院时间顺序分为对照组102例和干预组104例。对照组实施常规健康教育,干预组制作健康教育手册和视频,并运用回授法实施健康教育,通过问卷评价两组健康教育知识知晓率及患者对健康教育的满意度。 结果干预组（95.2%）患者健康知识知晓率显著高于对照组（78.4%,χ²=12.702,P<0.01）,且对健康教育的满意度（99%）亦高于对照组（93%）,差异有统计学意义（χ²=4.804,P<0.05）。 结论视频化健康教育联合回授法的健康教育效果优于常规的健康教育,而且患者的满意度高,值得推广。     

Health literacy and abdominal aortic aneurysms

ObjectiveLittle is known about the public's knowledge of abdominal aortic aneurysms (AAA). Although preventive screening is available, millions of Americans remain unaware of their risk. Improved health literacy has been associated with increased screening and improvement in health outcomes. This study assessed the level of AAA literacy among respondents who participated in a free AAA screening event.MethodsThirteen key words used by vascular surgeons to describe the risk, diagnosis, and treatment options for AAA were extracted from the screening tool used by the nation's largest provider of free AAA diagnostic services, AAAneurysm Outreach. The National Institutes of Health recommends readability of patient education materials to be at the sixth-grade level, but a readability analysis of these words placed them at a grade level of 14.6. A self-administrated questionnaire was developed that allowed respondents to compare each of the extracted words with a definitionally correct or incorrect word that reflected a sixth-grade readability score. These scores were then compared with the available demographics.ResultsThere were 570 completed questionnaires. Of the participants, 57.6% were female, 61.4% were 60 and above, and 32.6% were veterans. The average number of correct answers was 9.31 out of 13 (72% correct). Only 4.7% answered all questions correctly, with 29.1% missing five or more answers. The most frequently missed words were asymptomatic, screening, and cholesterol (56.5%, 44%, and 41.4% incorrect, respectively). The most frequently known terms were abdominal, diagnosis, and genetic (96%, 95.3%, and 91.9% correct, respectively). The remaining words fell between these extremes. Those aged 60 and above scored significantly lower than younger respondents (P < .0001). A post hoc power analysis indicated that the power to detect the obtained effects of age at the .05 level was greater than 0.95. Gender and veteran status did not produce any significant differences.ConclusionsThese data suggest an important communication gap between the words used by clinicians to describe the risks, diagnostic results, and treatment options of AAA and the targeted at-risk population, especially those 60 years and older.     

Age- and treatment-related associations with health behavior change among breast cancer survivors

ObjectiveThe aim of this study was to identify demographic and treatment-related factors associated with health-promoting behavior changes after a breast cancer diagnosis. Changes in health behaviors were also evaluated according to weight, exercise, diet and alcohol consumption patterns before breast cancer diagnosis.Materials and methodsWe examined self-reported behavior changes among 1415 women diagnosed with breast cancer in the NIEHS Sister Study cohort. Women reported changes in exercising, eating healthy foods, maintaining a healthy body weight, drinking alcohol, smoking, getting enough sleep, spending time with family and friends, and participating in breast cancer awareness events.ResultsOn average, women were 3.7 years from their breast cancer diagnosis. Overall, 20–36% reported positive changes in exercise, eating healthy foods, maintaining a healthy weight, or alcohol consumption. However, 17% exercised less. With each 5-year increase in diagnosis age, women were 11–16% less likely to report positive change in each of these behaviors (OR = 0.84–0.89; p < 0.05), except alcohol consumption (OR = 0.97; CI: 0.81, 1.17). Women who underwent chemotherapy were more likely to report eating more healthy foods (OR = 1.47; 95% CI 1.16–1.86), drinking less alcohol (OR = 2.01; 95% CI: 1.01, 4.06), and sleeping enough (OR = 1.41; 95% CI: 1.04, 1.91). The majority of women (50–84%) reported no change in exercise, eating healthy foods, efforts to maintain a healthy weight, alcohol consumption, sleep patterns, or time spent with family or friends.ConclusionsMany women reported no change in cancer survivorship guideline-supported behaviors after diagnosis. Positive changes were more common among younger women or those who underwent chemotherapy.     

Novel approaches to support breast cancer survivorship care models

The delivery of cancer survivorship care has been increasingly recognized as an area of healthcare in need of improvement. Several survivorship care models have previously been described in the literature. Yet, there is growing evidence that current models are both unsustainable for the future and fail to meet the diverse needs of cancer survivors. As a result, there has been an emphasis on developing innovative models of survivorship care that are accessible to patients and improve outcomes. Proposed solutions to address these concerns include enhanced collaboration and communication among care providers as well as incorporating the use of technology for survivorship care delivery. This article reviews existing models of survivorship care and describes future approaches to improve the care of breast cancer survivors.     

青少年健康素养量表的编制及信效度检验

目的开发适用于我国青少年的健康素养量表,进行条目分析及信效度检验。方法以《中小学健康教育指导纲要》及《中国公民健康素养66条》作为编制量表的基本理论框架,采用Delphi专家咨询确定问卷。对442名青少年进行调查并分析问卷的信效度。结果问卷的内容效度为0.92,总量表重测信度、Cronbach′sα系数及分半信度依次为0.73、0.70和0.77,量表经因子分析,提取基本知识和理念(19个条目)、健康生活方式与行为(32个条目)、基本技能(20个条目)3个维度,累积解释总方差的58.24%。结论青少年健康素养量表具有较好的信效度,适用于评价我国青少年健康素养。     

Tumor-Specific Systemic Treatment in Advanced Breast Cancer – How Long does it Make Sense?

SUMMARY: Metastatic breast cancer (MBC) is a chronic and incurable disease which can be kept steady for a long time with continuous oncologic therapy. There are various treatment options. Disease-free as well as overall survival were prolonged in many pharmaceutical studies. The therapist focuses on these oncologic parameters as well as the patient's quality of life. One central point of the communication between doctor and patient is the prediction by the medical team of how long to continue oncologic therapy and when to start palliative medicine in terms of best palliative care. Treatment options currently available for MBC as well as the importance of this difficult communication between the involved parties are pointed out. The end of tumor-specific oncologic therapy does not necessarily mean the end of therapeutic measures for the individual patient.     

Personal health behaviors in women who have undergone risk-reducing mastectomy

BACKGROUND: Risk-reducing mastectomy (RRM) remains an effective yet controversial modality for the primary prevention of breast cancer. Is the choice of RRM consistent with a generally proactive healthy lifestyle? METHODS: The National Prophylactic Mastectomy Registry is a volunteer database comprised of 460 women who have undergone bilateral RRM. Each patient received a questionnaire drawn from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Their responses were compared with gender-specific national data from the Centers for Disease Control. RESULTS: Women in the RRM group were statistically more likely to engage in risk-reducing personal health behavior including not smoking, exercising, maintaining their health, and taking advantage of screening programs. CONCLUSIONS: Women in the registry who underwent RRM practiced a more "healthy" lifestyle than gender-matched controls. Therefore, the decision to have prophylactic surgery may have been part of a proactive approach toward their overall physical well-being.     

Effect of a health literacy training program for surgical oncologists and specialized nurses on disparities in referral to breast cancer genetic testing

BackgroundThere is an underuse of genetic testing in breast cancer patients with a lower level of education, limited health literacy or a migrant background. We aimed to study the effect of a health literacy training program for surgical oncologists and specialized nurses on disparities in referral to genetic testing.MethodsWe conducted a multicenter study in a quasi-experimental pre-post (intervention) design. The intervention consisted of an online module and a group training for surgical oncologists and specialized nurses in three regions in the Netherlands. Six months pre- and 12 months post intervention, clinical geneticists completed a checklist with socio-demographic characteristics including the level of health literacy of each referred patient. We conducted univariate and logistic regression analysis to evaluate the effect of the training program on disparities in referral to genetic testing.ResultsIn total, 3179 checklists were completed, of which 1695 were from hospital referrals. No significant differences were found in educational level, level of health literacy and migrant background of patients referred for genetic testing by healthcare professionals working in trained hospitals before (n = 795) and after (n = 409) the intervention. The mean age of patients referred by healthcare professionals from trained hospitals was significantly lower after the intervention (52.0 vs. 49.8, P = 0.003).ConclusionThe results of our study suggest that the health literacy training program did not decrease disparities in referral to genetic testing. Future research in a more controlled design is needed to better understand how socio-demographic factors influence referral to breast cancer genetic testing and what other factors might contribute.     

The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery

BackgroundAlthough cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss.SettingSingle bariatric center.MethodsPatients (N = 567) who underwent bariatric surgery from 2014–2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener.ResultsAmong participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2–4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL.DiscussionAlthough health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.     

Experiences of health professionals treating women diagnosed with cancer during pregnancy and proposals for service improvement

ObjectiveTo examine the experiences, needs, and perceptions of health professionals(HPs) treating women diagnosed with cancer during pregnancy(gestational cancer, GC).MethodsInterviews were undertaken with Australian HPs who had treated women diagnosed with GC over the previous five years. HPs were recruited via social media, and professional and community networks. Questions focussed upon HPs’ confidence caring for these women, whether current guidelines/training met their needs, psychological impacts of care provision, and service gaps. Interview data were analysed thematically.ResultsTwenty-seven HPs were interviewed; most were oncology HPs(22/27) with experience caring for women with gestational breast cancer and 13 had a breast-specific clinical focus (e.g. breast surgeon). Many were currently treating women with GC(48%) or had in the last 6–12 months(29.6%). Four themes were identified: A clinically complex case, Managing multi-disciplinary care, Centralised resources for health professionals, and Liaison, information and shared experiences for women. HPs found this population personally challenging to treat. They reported initial uncertainty regarding treatment due to infrequent exposure to GC, limited resources/information, and the need to collaborate with services with which they did not usually engage. Solutions offered include centralised resources, clinical liaison/care coordinators, and connecting women with GC with peer support.ConclusionsHPs perceived women with GC as a vulnerable, complex population and experienced challenges providing comprehensive care; particularly when treatment was delivered at geographically separated hospitals. Systemic changes are needed to optimise comprehensive care for these women. Their insights can guide the development of more integrated cancer and obstetric care, and better HP support.     

How to evaluate sexual health in cancer patients: development of the EORTC sexual health questionnaire for cancer patients

Background

The aim of the study is to describe the development of a comprehensive European Organisation for Research and Treatment of Cancer (EORTC) questionnaire to assess sexual health of female and male cancer patients and for cancer survivors.

Methods

According to the EORTC guidelines, the development of an EORTC sexual health questionnaire is typically organised in four phases. The first phases comprise a literature search following interviews with patient and health care professionals (HCPs) (phase 1) and the operationalization into items (phase 2). The translation process is formally conducted according to the EORTC QLG Translation guidelines with a rigorous forward-backward procedure supported by native speakers.

Results

Studies on sexuality in oncology patients which were identified by a literature search predominantly focused on issues of activity, experiences of sexual dysfunction, and satisfaction with sexual functioning. The literature review identified themes beyond these aspects. In total 53 potentially relevant issues were presented to 107 patients and 83 HCPs, different evaluations were found.

Conclusions

A questionnaire that includes physical, psychological, and social aspects of sexuality of cancer survivors will be needed. Pre-testing and validation of the questionnaire will be done in future (phases 3 and 4). Divergent ratings of patients and professionals should be further investigated.     

Lifestyle and metabolic approaches to maximizing erectile and vascular health

Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.     

Laparoscopic approaches to resection of suspected gastric gastrointestinal stromal tumors based on tumor location

Background Surgical resection of gastric gastrointestinal stromal tumor (GIST) should be optimized to achieve a negative pathologic surgical margin while limiting the extent of stomach volume loss. Careful identification of exact gastric tumor location using preoperative computed tomography (CT) scans and gastroscopy should allow for selection of a specific operative approach. Methods This retrospective case series involved 12 patients (7 men and 5 women; mean age, 60.5 years) with suspected gastric GIST undergoing tumor resection at Fletcher Allen Health Care, a university medical center, from January 2005 to August 2006. The main outcome measures were pathologic resection margins, operative time, estimated blood loss (EBL), morbidity, and duration of hospital stay. Results The 12 patients were separated into three groups on the basis of tumor location as follows: type 1 (fundus/greater curvature, n = 5), type 2 (prepyloric/antrum, n = 3), and type 3 (lesser curvature/perigastroesophageal junction, n = 4). Preoperative imaging (CT scan and/or endoscopy) used to identify tumor location accurately predicted the operative approach before surgery for 11 of the12 patients. The surgical approach was selected solely by tumor location as follows: type 1 (laparoscopic partial gastrectomy [LPG]), type 2 (laparoscopic distal gastrectomy [LDG]), and type 3 (laparoscopic transgastric resection [LTG]). Nine patients had a final pathologic diagnosis of GIST. The average tumor size was 4.6 cm, but this did not influence procedure selection. Histologic margins were microscopically negative in all patients. The LPG and LTG approaches had similar outcomes in terms of estimated blood loss (EBL; 80 vs 100 ml) and hospital stay (3.4 vs 3.3 days; p = 0.0198), but LTG had longer operative times (236 vs 180 min). The LDG procedure had longer operative times, greater EBL, and a longer hospital stay. The operative morbidity was 17%, and there was no operative mortality. Conclusion The selection of an operative technique for resection of gastric submucosal tumors can be based on preoperative identification of tumor location, for better definition of both the extent of gastric resection and the technical complexity of the laparoscopic procedure.     

健康教育与干预对社区健康素养、高血压和糖尿病的影响

目的探讨健康教育干预对社区健康素养、高血压和糖尿病的影响。方法采用随机抽样法从石碣镇和南城区辖区抽取2038人,高血压645人,糖尿病317人,实施健康教育。结果干预后的健康素养、基本知识和理念、健康生活方式及基本技能比例均高于干预前（P〈0．05）。干预前高血压发病率为31．65％,糖尿病发病率为15．55％,干预后分别为25．02％、10．25％,干预前后差异有统计学意义（P〈O．05）。干预后高血压及糖尿病知晓率、治疗率、控制率均提高,致残率及致死率均降低（P〈0．05）。结论健康教育干预能提高社区居民的健康素养,有利于高血压及糖尿病治疗效果的提高。