Investigating acculturation orientations of patients with an immigration background and doctors in Canada: implications for medical advice adherence

Background

Increased immigration requires successful interaction of different cultures in various life domains, such as health. This study investigates acculturation orientation (AO) of immigrant patients and doctors native to the country, as a potential factor related to perceived medical advice adherence.

Data and methods

N = 171 immigrant patients (M = 54.38 years, SD = 17.94, range = 23–96, 74.3 % female) and their N = 12 doctors (M = 38.88 years, SD = 13.42, range = 27–66, 83 % female) from a hospital in Montreal, Canada, participated in a paper-based survey to assess AOs, patients’ perceived expectations of their doctor (regarding adopting the new culture or keeping their previous culture), doctors’ actual expectations, perceived quality of care and perceived adherence.

Results

AO of patients significantly related to perceived adherence, via a path model involving perceptions of doctors’ expectations and perceived quality of care. Integration was positively related to perceived adherence, while Marginalization was negatively related to it. Doctors’ AOs were not significant.

Conclusion

Patient perceptions seem to be a significant factor to be considered when striving to improve immigrant medical advice adherence.

     

Severe heart failure and the need for mechanical circulatory support and heart transplantation in pediatric patients with myocarditis: Results from the prospective multicenter registry “MYKKE”

Myocarditis represents an important cause for acute heart failure. MYKKE, a prospective multicenter registry of pediatric patients with myocarditis, aims to gain knowledge on courses, diagnostics, and therapy of pediatric myocarditis. The role of mechanical circulatory support (MCS) in children with severe heart failure and myocarditis is unclear. The aim of this study was to determine characteristics and outcome of patients with severe heart failure requiring MCS and/or heart transplantation. The MYKKE cohort between September 2013 and 2016 was analyzed. A total of 195 patients were prospectively enrolled by 17 German hospitals. Twenty‐eight patients (14%) received MCS (median 1.5 years), more frequently in the youngest age group (0‐2 years) than in the older groups (P < 0.001; 2‐12 and 13‐18 years). In the MCS group, 50% received a VAD, 36% ECMO, and 14% both, with a survival rate of 79%. The weaning rate was 43% (12/28). Nine (32%) patients were transplanted, one had ongoing support, and six (21%) died. Histology was positive for myocarditis in 63% of the MCS group. Patients within the whole cohort with age <2 years and/or ejection fraction <30% had a significantly worse survival with high risk for MCS, transplantation, and death (P < 0.001). Myocarditis represents a life‐threatening disease with an overall mortality of 4.6% in this cohort. The fulminant form more often affected the youngest, leading to significantly higher rate of MCS, transplantation, and mortality. MCS represents an important and life‐saving therapeutic option in children with myocarditis with a weaning rate of 43%.     

Health-related quality of life of carfilzomib- and daratumumab-based therapies in patients with relapsed/refractory multiple myeloma,based on German benefit assessment data

Quality of Life Research - Carfilzomib and daratumumab are licensed in relapsed/refractory multiple myeloma (RRMM), but no head-to-head trials have been conducted. We used data from dossiers...     

Echocardiographic characteristics in Fontan patients before the onset of protein‐losing enteropathy or plastic bronchitis

Background

It was this study's objective to evaluate the echocardiographic characteristics and flow patterns in abdominal arteries of Fontan patients before the onset of protein‐losing enteropathy (PLE) or plastic bronchitis (PB).

Design

In this retrospective cohort investigation, we examined 170 Fontan patients from 32 different centers who had undergone echocardiographic and Doppler ultrasound examinations between June 2006 and May 2013. Follow‐up questionnaires were completed by 105 patients a median of 5.3 (1.5–8.5) years later to evaluate whether one of the complications had occurred since the examinations.

Results

A total of 91 patients never developed PLE or PB (“non‐PLE/PB”); they were compared to 14 affected patients. Eight of the 14 patients had already been diagnosed with “present PLE/PB” when examined. Six “future PLE/PB” patients developed those complications later on and were identified on follow‐up. The “future PLE/PB” patients presented significantly slower diastolic flow velocities in the celiac artery (0.1 (0.1–0.5) m/s vs 0.3 (0.1–1.0) m/s (P = .04) and in the superior mesenteric artery (0.0 (0.0–0.2) m/s vs 0.2 (0.0–0.6) m/s, P = .02) than the “non‐PLE/PB” group. Median resistance indices in the celiac artery were significantly higher (0.9 (0.8–0.9) m/s vs 0.8 (0.6–0.9) m/s, (P = .01)) even before the onset of PLE or PB.

Conclusion

An elevated flow resistance in the celiac artery may prevail in Fontan patients before the clinical manifestation of PLE or PB.