Improving awareness,accountability, and access through health coaching: Qualitative study of patients’ perspectives

Objective

To assess patients’ experiences with and perceptions of health coaching as part of their ongoing care.

Design

A qualitative research design using semistructured interviews that were recorded and transcribed verbatim.

Setting

Ottawa, Ont.

Participants

Eleven patients (> 18 years of age) enrolled in a health coaching pilot program who were at risk of or diagnosed with type 2 diabetes.

Methods

Patients’ perspectives were assessed with semistructured interviews. Interviews were conducted with 11 patients at the end of the pilot program, using a stratified sampling approach to ensure maximum variation.

Main findings

All patients found the overall experience with the health coaching program to be positive. Patients believed the health coaching program was effective in increasing awareness of how diabetes affected their bodies and health, in building accountability for their health-related actions, and in improving access to care and other health resources.

Conclusion

Patients perceive one-on-one health coaching as an acceptable intervention in their ongoing care. Patients enrolled in the health coaching pilot program believed that there was an improvement in access to care, health literacy, and accountability, all factors considered to be precursors to behavioural change.     

Thoracoscopic surgery in elderly lung cancer patients

Age is a recognized risk factor for death after thoracotomy in elderly patients with lung cancer. Among other factors, the genesis of this risk is the physiologic debilitation that occurs after division of the intrathoracic respiratory muscles during thoracotomy, as well as the loss of lung tissue after lung resection. Recent advances in video-assisted thoracic surgery (VATS) techniques provide an alternative to standard thoracotomy in elderly lung cancer patients, resulting in decreased recovery times and fewer perioperative complications. Likewise, smaller lung resections (VATS-guided limited wedge resection versus lobectomy with thoracotomy) can be adequate oncologic procedures in patients with a limited life expectancy but resectable disease. We studied these alternative procedures in a cohort of thoracic surgical patients at the Brigham and Women's Hospital in Boston, MA. Proposed investigations of the psychosocial implications of thoracic surgery in the elderly, irrespective of the safety of these maneuvers, are addressed.     

Spontaneous bacterial peritonitis (SBP): clinical,laboratory, and prognostic features. A single-center experience

BACKGROUND: The aim of the present study was to assess the clinical and laboratory characteristics, the course, and the factors influencing the hospital mortality and relapse rate of spontaneous bacterial peritonitis (SBP) in cirrhotic patients admitted in a single University Hospital in Greece. METHODS: The study comprises the evaluation of 81 cirrhotic patients who developed SBP during a 30-month period. RESULTS: The occurrence of SBP was independent of the etiology of liver disease and was symptomatic in 66/81 patients (82%). Encephalopathy, as presenting symptom, occurred mainly in Child C patients. Ascitic fluid culture was positive in 20 patients (25%); E. coli (60%) and Enterococcus faecalis (14%) were the most common bacteria isolated. Empirical treatment was effective in 94% of patients. Renal impairment was observed in 21 patients (26%), six of whom developed hepatorenal syndrome. Total mortality was 10% and was related to the existence of symptoms (P<0.01), ascetic fluid polymorphonuclear cell count (P<0.05), bilirubin levels (P<0.01), and kidney function at the beginning of the episode (P<0.01). The relapse rate was 24.6% and was related to the Child stage (P<0.01). CONCLUSIONS: SBP was asymptomatic in a substantial number of patients. Deterioration of renal function was frequently observed and was the main cause of death. The low (10%) in-hospital mortality seems to be related to earlier diagnosis and treatment. Relapse was associated with the severity of liver disease.     

Rebalancing risk management—Part 2: The Active Risk Control (ARC) Toolkit

The adoption of systems‐focused risk assessment techniques has not led to measurable improvement in the rate of patient harm. Why? In part, because these tools focus solely on understanding problems and provide no direct support for designing and managing solutions (ie, risk control). This second installment of a 2‐part series on rebalancing risk management describes a structured approach to bridging this gap: The Active Risk Control (ARC) Toolkit. A pilot study is presented to show how the ARC Toolkit can improve the quality of risk management practice.