Inpatient small group psychotherapy: A survey

The inpatient small group psychotherapy literature is organized with reference to issues of historical background, goals, individual versus group treatment, medications, therapist style, pretraining, cotherapy, alternate sessions, types of group approaches, selection and group composition, and conducting groups in short stay settings. Methods for conceptualizing group therapy are reviewed; a heuristic model based on the findings of the present survey is proposed.     

The influence of online health information on health decisions: A systematic review

ObjectivesThis systematic review assessed the influence of online health information (OHI) search behaviour on health and medical decisions.MethodsEligible studies were identified by searching electronic databases PubMed, Scopus, and CINAHL in February 2020 for studies reporting OHI search behaviour and its influence on health decisions. Information was extracted pertaining to either consumers’ (self-reported) perceptions of the influence of OHI on decision-making or the association between online search behaviour and health decision-making.ResultsA total of 3995 articles were screened, with 48 included in the final analysis. The reviewed studies indicated that OHI assisted in making subsequent health related decisions such as asking questions during a consultation, increased professional visits, improved adherence to the advice of a physician, being more compliant with taking medication, and improved self-care.ConclusionConsumers largely used OHI to support information provided by their physicians. The strength of the patient-provider relationship was considered important in moderating the potential negative outcomes of OHI.Practice implicationsHealth care systems have a unique opportunity to direct OHI search behaviours towards empowering consumers to engage as an informed, active and joint decision-maker in their own health care.     

The use of online control: a developmental perspective

To date very little research has addressed the abilities of young participants to respond to a change in visual information provided during movement execution. This study attempted to determine the ability of 45 participants (5, 7, 9 years) to respond to a change in visual information during a discrete rapid aiming movement. A perturbation paradigm where the target size changed after movement onset was used. In the control context, movements were made to each target size (small, medium, large) with no perturbation. In contrast, during the experimental context the target always began as a medium target. Upon movement initiation, the target size could remain constant or might unexpectedly become larger or smaller. Temporal, kinematic, and correction data were collected to determine the control process underlying the aiming movement. No interaction was found between age and condition for movement time (MT), and results indicated that all ages scaled movement time to final target size. The accuracy data revealed the 9-year-old participants were more accurate than the 5- and 7-year-old participants. To determine where the changes in duration were made, the time to and after peak velocity (TTPV, TAPV), and peak velocity values (PV) were examined. The PV values indicated that, during the control context, the participants scaled their movement to the target size. However, during the experimental condition generally no significant differences were found in either measure, suggesting a programmed response based on the original target size. This was supported by the correction data collected prior to peak velocity, lending further support to a programmed response. Following peak velocity, it was found that differences in MT were as a result of time spent in deceleration. This increased TAPV, and increased number of corrections observed, suggest that all participants were using on-line control following peak velocity in response to the change in visual information. The data collected supports a model of control that incorporates both open-loop control during the initial impulse phase, and closed-loop control during the current control phase for participants as young as 5 years.     

Internet use for information seeking in clinical practice: a cross-sectional survey among French general practitioners

BackgroundMedical information needs regarding patient care are particularly large for general practitioners (GPs). The Internet seems to be a relevant but underused tool to seek medical information.ObjectiveWe aimed to describe the characteristics of the French GPs using the Internet for information seeking, to identify the barriers to its use and the factors that could facilitate it.MethodWe conducted a cross-sectional survey among GPs currently practicing in France, using an online questionnaire, in July 2009. We analysed the answers of 721 respondents.ResultsMost of the respondents used the Internet to seek information. They were significantly younger, worked in group practice, had Internet training and had Internet access at the practice. The main barriers were related to the physician (lack of knowledge or specific skills), to the practice conditions (lack of time, concerns about relationship with patient, financial non-recognition) and to the information (information overload, quality concerns, low relevance, language barrier). Practitioners wanted more reliable and more relevant documents for daily practice. Websites with already selected resources could increase the GPs use of the Internet for medical information seeking.ConclusionThe reported obstacles were largely common with those previously described in other countries, except the language barrier and the financial non-recognition. Even if the generalization of our results to all French GPs should be cautious, the study provided better insights into the obstacles to the Internet use to seek clinical information in family practice and the factors that could facilitate it.     

An online resource of digital stories about cancer genetics: qualitative study of patient preferences and information needs

Background

The Cancer Genetics Service for Wales (CGSW) was established in 1998 as an all-Wales service for individuals with concerns about their family history of cancer. CGSW offers a range of services such as risk assessment, genetic counseling, and genetic testing. Individuals referred to cancer genetics services often have unmet information and support needs, and they value access to practical and experiential information from other patients and health professionals. As a result of the lifelong nature of genetic conditions, a fundamental challenge is to meet the ongoing needs of these patients by providing easily accessible and reliable information.

Objectives

Our aims were to explore how the long-term information and support needs of CGSW patients could be met and to assess whether an online bank of digital stories about cancer genetics would be acceptable to patients.

Methods

In 2009, CGSW organized patient panels across Wales. During these events, 169 patients were asked for their feedback about a potential online resource of digital stories from CGSW patients and staff. A total of 75 patients registered to take part in the project and 23 people from across Wales agreed to share their story. All participants took part in a follow-up interview.

Results

Patient preferences for an online collection of cancer genetics stories were collected at the patient panels. Key topics to be covered by the stories were identified, and this feedback informed the development of the website to ensure that patients’ needs would be met. The 23 patient storytellers were aged between 28 and 75 years, and 19 were female. The digital stories reflect patients’ experiences within CGSW and the implications of living with or at risk of cancer. Follow-up interviews with patient storytellers showed that they shared their experiences as a means of helping other patients and to increase understanding of the cancer genetics service. Digital stories were also collected from 12 members of staff working at CGSW. The digital stories provide reliable and easily accessible information about cancer genetics and are hosted on the StoryBank website (www.cancergeneticsstorybank.co.uk).

Conclusions

The Internet is one mechanism through which the long-term information and support needs of cancer genetics patients can be met. The StoryBank is one of the first places where patient and staff stories have been allied to every aspect of a patient pathway through a service and provides patients with an experiential perspective of the cancer genetics “journey.” The StoryBank was developed in direct response to patient feedback and is an innovative example of patient involvement in service development. The stories are a useful resource for newly referred patients, current patients, the general public, and health care professionals.     

Educational considerations based on medical student use of polygenic risk information and apparent race in a simulated consultation

PurposeTo craft evidence-based educational approaches related to polygenic risk score (PRS) implementation, it is crucial to forecast issues and biases that may arise when PRS are introduced in clinical care.MethodsMedical students (N = 84) were randomized to a simulated primary care encounter with a Black or White virtual reality–based patient and received either a direct-to-consumer–style PRS report for 5 common complex conditions or control information. The virtual patient inquired about 2 health concerns and her genetic report in the encounter. Data sources included participants’ verbalizations in the simulation, care plan recommendations, and self-report outcomes.ResultsWhen medical students received PRSs, they rated the patient as less healthy and requiring more strict advice. Patterns suggest that PRSs influenced specific medical recommendations related to the patient’s concerns, despite student reports that participants did not use it for that purpose. We observed complex patterns regarding the effect of patient race on recommendations and behaviors.ConclusionEducational approaches should consider potential unintentional influences of PRSs on decision-making and evaluate ways that they may be applied inconsistently across patients from different racial groups.     

Responding to GPs' information resource needs: implementation and evaluation of a complementary medicines information resource in Queensland general practice

Background

In Germany, Iscucin^® Populi (IP), a preparation from mistletoe growing on the poplar tree, is used in cancer therapy while Viscum Mali e planta tota (VM), a preparation from mistletoe growing on the apple tree, is used in patients with osteoarthritis. Since mistletoe preparations are suspected to induce production of potentially tumor promoting cytokines like interleukin (IL)-6, further studies on the immunological effects are of interest.

Methods

In this 3-armed randomized, double blind clinical trial healthy volunteers received increasing doses of either IP (strength F, 0.0125%, G, 0.25% and H, 5%, each for 4 weeks), or VM (1:1000 [D3], 1:100 [D2] and 2% each for 4 weeks) or placebo (isotonic solution) subcutaneously twice per week over a period of 12 weeks. Physical examination was performed weekly. Routine laboratory parameters and immunological parameters (C-reactive protein (CRP), differential blood count, lymphocyte subsets, immunoglobulins, IL-6 and tumor necrosis factor (TNF)-α) were analysed every 4 weeks.

Results

71 subjects were included in the study (IP = 30, VM = 21, placebo = 20) of whom 69 concluded it according to protocol. Application of IP strengths G and H caused strong local reactions at the site of injection. In parallel, a distinct eosinophilia (p < 0.001 compared to placebo) occurred. Furthermore, application of all IP concentrations resulted in an increase of CD4 cell counts (p < 0.05) compared to placebo. Stimulation of IL-6 production, CRP or relevant deviations in other laboratory parameters were not observed. Because of local reactions, IP strengths G and H were considered less tolerable than placebo. VM 2% was slightly less tolerable than placebo, caused only mild local reactions and an only small increase in eosinophile counts.

Conclusion

Treatment with IP results in eosinophilia and an increase of CD4 cells but not in an increase of IL-6 or CRP. No safety concerns regarding the two mistletoe preparations have been raised by this study. EudraCT-Number 2007-002166-35.

Trial registration

ClinicalTrials.gov: NCT01378702     

Allied health professionals' use of online evidence: a survey of 790 staff working in the Australian public hospital system

OBJECTIVE: To measure the impact of a state health department policy to provide allied health professional staff with access to a point-of-care, 24h, online evidence system in terms of awareness, use and clinical impact of the system on clinical practice; to identify perceived barriers to use, and differences in measures between seven professional groups (physiotherapists, occupational therapists, speech pathologists, dieticians, clinical psychologists, pharmacists and social workers). METHOD: A convenience sample of 790 allied health professionals from 65 randomly selected hospitals in New South Wales, Australia. A self-administered questionnaire was distributed. Rates of use, frequency and types of resources accessed were calculated. Comparisons between professional groups were undertaken using Chi-square analyses and t-tests. RESULTS: The results showed that 82% of allied health professionals had heard of the online evidence system, and of those 76% had used it. Pharmacists had the highest rates of use and social workers the lowest. Of users, 90% agreed that use of the system had the potential to improve patient care and 45% reported direct experience of this. Computer skills and easy access were significantly associated with use and frequency of use. Among non-users, lack of specific training in the use of the online evidence system and lack of time were the most frequently reported reasons for not using the system. However, among users there was no relationship between this training and the frequency or effectiveness of use, i.e. the ability to find the information required. CONCLUSIONS: Allied health professionals will use an online evidence system when it is provided, however there are marked differences in use by professional groups. General training aimed at improving computer skills appears more important in encouraging use of an online evidence system, than specific system-based training. Perceptions of organisational and professional support for allied health professionals to use online evidence as a legitimate part of their work play an important role in influencing system use.     

Internet use for health-related information via personal computers and cell phones in Japan: a cross-sectional population-based survey

Background

The Internet is known to be used for health purposes by the general public all over the world. However, little is known about the use of, attitudes toward, and activities regarding eHealth among the Japanese population.

Objectives

This study aimed to measure the prevalence of Internet use for health-related information compared with other sources, and to examine the effects on user knowledge, attitudes, and activities with regard to Internet use for health-related information in Japan. We examined the extent of use via personal computers and cell phones.

Methods

We conducted a cross-sectional survey of a quasi-representative sample (N = 1200) of the Japanese general population aged 15–79 years in September 2007. The main outcome measures were (1) self-reported rates of Internet use in the past year to acquire health-related information and to contact health professionals, family, friends, and peers specifically for health-related purposes, and (2) perceived effects of Internet use on health care.

Results

The prevalence of Internet use via personal computer for acquiring health-related information was 23.8% (286/1200) among those surveyed, whereas the prevalence via cell phone was 6% (77). Internet use via both personal computer and cell phone for communicating with health professionals, family, friends, or peers was not common. The Internet was used via personal computer for acquiring health-related information primarily by younger people, people with higher education levels, and people with higher household incomes. The majority of those who used the Internet for health care purposes responded that the Internet improved their knowledge or affected their lifestyle attitude, and that they felt confident in the health-related information they obtained from the Internet. However, less than one-quarter thought it improved their ability to manage their health or affected their health-related activities.

Conclusions

Japanese moderately used the Internet via personal computers for health purposes, and rarely used the Internet via cell phones. Older people, people with lower education levels, and people with lower household incomes were less likely to access the Internet via cell phone. The Internet moderately improved users’ health-related knowledge and attitudes but seldom changed their health-related abilities and activities. To encourage communication between health providers and consumers, it is important to improve eHealth literacy, especially in middle-aged people. It is also important to make adequate amendments to the reimbursement payment system and nationwide eHealth privacy and security framework, and to develop a collaborative relationship among industry, government, and academia.     

Perceived impact of resident work hour limitations on medical student clerkships: a survey study.

PURPOSE: To assess medical students' perceptions of the impact of recent Accreditation Council for Graduate Medical Education policies limiting resident work hours on students' clerkship experiences, resident teaching, and quality of patient care. METHOD: In May/June 2003 and May/June 2004, an original questionnaire was administered to 252 medical students completing required clinical rotations at two teaching hospitals to assess students' perceptions of endpoints that might be affected by resident work hours limits. Response data were analyzed to determine statistical significance of differences between the two years studied. RESULTS: Questionnaires were completed by 129 students in 2003 (98%) and 112 students in 2004 (93%), for an overall response rate of 96%. A higher proportion of students perceived limits on work hours in 2004 [46 (41%)] than 2003 [36 (28%), p = .03]. Ratings of resident availability and primary resident's interest in teaching improved in 2004. Otherwise, ratings of the interest, skill, and availability of resident teachers and attending physicians remained stable between 2003 and 2004. Students reported spending similar amounts of time in formal teaching sessions and rated feedback similarly between 2003 and 2004. In 2004, fewer students [28 (25%)] reported considering leaving medicine due to long hours in training than in 2003 [49 (38%), p = .04]. No significant differences in the proportion of students reporting suboptimal care were found [44 (34%) in 2003, 34 (35%) in 2004, p = .57]. CONCLUSION: This small, early study suggests that reductions in resident work hours might be implemented without a significant negative impact upon medical students' self-assessed learning experiences, and that limiting resident work hours may even have a positive impact on medical students.     

Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation

Objective

To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).

Methods

We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.

Results

In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups - the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors - were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.

Conclusion

In order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.     

Therapist use of silence in therapy: a survey

Eighty-one therapists responded to a mailed survey about their use of silence during a specific event in therapy and about their general attitudes about using silence in therapy. For the specific event, therapists used silence primarily to facilitate reflection, encourage responsibility, facilitate expression of feelings, not interrupt session flow, and convey empathy. During silence, therapists observed the client, thought about the therapy, and conveyed interest. In general, therapists indicated that they would use silence with clients who were actively problem solving, but they would not use silence with very disturbed clients. Therapists learned about using silence mostly through clinical experience.     

The influence on blood pressure during daily activities of a single session of aerobic exercise

Previous research has examined the effectiveness of a single session of aerobic exercise in lowering blood pressure responsivity to the subsequent presentation of a nonexercise stressor in the laboratory. This case study was designed to explore the possibility that a single session of aerobic exercise might lower blood pressure for up to 4 hours postexercise as the subject engaged in his usual activities at home and at work. The subject was an untrained, unmedicated, borderline hypertensive who underwent ambulatory blood pressure monitoring as he maintained a normal schedule of activities over a 5-day period. On 2 of the 5 days, the subject exercised at 8:30 AM for 30 minutes at 70% VO2max. Blood pressure readings on days when the subject read for 30 minutes were compared with readings on days when he exercised. He showed an average reduction in systolic blood pressure of 26.4 mm Hg at 2 hours after exercise, 24.2 mm Hg at 4 hours afterward, and 12.2 mm Hg at 9 hours after the exercise. Changes in diastolic blood pressure and heart rate were smaller and less consistent. The authors concluded that the modifying influence of a single session of aerobic exercise on blood pressure responsivity to subsequent laboratory-based stressors may also extend to the natural environment. The discussion addresses theoretical, methodological, and clinical considerations in the use of aerobic exercise to modify excessive blood pressure reactivity.