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151.
Mariano E. Menendez Bastiaan T. van Hoorn Michael Mackert Erin E. Donovan Neal C. Chen David Ring 《Clinical orthopaedics and related research》2017,475(5):1291-1297
Background
In the midst of rapid expansion of medical knowledge and decision-support tools intended to benefit diverse patients, patients with limited health literacy (the ability to obtain, process, and understand information and services to make health decisions) will benefit from asking questions and engaging actively in their own care. But little is known regarding the relationship between health literacy and question-asking behavior during outpatient office visits.Questions/purposes
(1) Do patients with lower levels of health literacy ask fewer questions in general, and as stratified by types of questions? (2) What other patient characteristics are associated with the number of questions asked? (3) How often do surgeons prompt patients to ask questions during an office visit?Methods
We audio-recorded office visits of 84 patients visiting one of three orthopaedic hand surgeons for the first time. Patient questions were counted and coded using an adaptation of the Roter Interaction Analysis System in 11 categories: (1) therapeutic regimen; (2) medical condition; (3) lifestyle; (4) requests for services or medications; (5) psychosocial/feelings; (6) nonmedical/procedural; (7) asks for understanding; (8) asks for reassurance; (9) paraphrase/checks for understanding; (10) bid for repetition; and (11) personal remarks/social conversation. Directly after the visit, patients completed the Newest Vital Sign (NVS) health literacy test, a sociodemographic survey (including age, sex, race, work status, marital status, insurance status), and three Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity Function, Pain Interference, and Depression. The NVS scores were divided into limited (0–3) and adequate (4–6) health literacy as done by the tool’s creators. We also assessed whether the surgeons prompted patients to ask questions during the encounter.Results
Patients with limited health literacy asked fewer questions than patients with adequate health literacy (5 ± 4 versus 9 ± 7; mean difference, ?4; 95% CI, ?7 to ?1; p = 0.002). More specifically, patients with limited health literacy asked fewer questions regarding medical-care issues such as their therapeutic regimen (1 ± 2 versus 3 ± 4; mean difference, ?2; 95% CI, ?4 to ?1]; p < 0.001) and condition (2 ± 2 versus 3 ± 3; mean difference, ?1; 95% CI, ?3 to 0; p = 0.022). Nonwhite patients asked fewer questions than did white patients (5 ± 4 versus 9 ± 7; mean difference, ?4; 95% CI, ?7 to 0; p = 0.032). No other patient characteristics were associated with the number of questions asked. Surgeons only occasionally (29%; 24/84) asked patients if they had questions during the encounter, but when they did, most patients (79%; 19/24) asked questions.Conclusions
Limited health literacy is a barrier to effective patient engagement in hand surgery care. In the increasingly tangled health-information environment, it is important to actively involve patients with limited health literacy in the decision-making process by encouraging question-asking, particularly in practice settings where most decisions are preference-sensitive. Instead of assuming that patients understand what they are told, orthopaedic surgeons may take “universal precautions” by assuming that patients do not understand unless proved otherwise.Level of Evidence
Level II, therapeutic study.152.
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154.
Johanna G. Kalf MSc Marten Munneke PhD Lenie van den Engel‐Hoek MSc Bert J. de Swart PhD George F. Borm PhD Bastiaan R. Bloem MD PhD Machiel J. Zwarts MD PhD 《Movement disorders》2011,26(9):1670-1676
Drooling is an incapacitating feature of Parkinson's disease. Better pathophysiological insights are needed to improve treatment. In this study, we tested the hypothesis that the cause of drooling is multifactorial. We examined 15 patients with Parkinson's disease with distinct diurnal saliva loss (“droolers”) and 15 patients with Parkinson's disease without drooling complaints (“nondroolers”). We evaluated all factors that could potentially contribute to drooling: swallowing capacity (maximum volume), functional swallowing (assessed with the dysphagia subscale of the Therapy Outcome Measures for rehabilitation specialists), unintentional mouth opening due to hypomimia (Unified Parkinson's Disease Rating Scale item), posture (quantified from sagittal photographs), and nose‐breathing ability. We also quantified the frequency of spontaneous swallowing during 45 minutes of quiet sitting, using polygraphy. Droolers had more advanced Parkinson's disease than nondroolers (Unified Parkinson's Disease Rating Scale motor score 31 vs 22; P = .014). Droolers also scored significantly worse on all recorded variables except for nose breathing. Swallowing frequency tended to be higher, possibly to compensate for less efficient swallowing. Logistic regression with adjustment for age and disease severity showed that hypomimia correlated best with drooling. Linear regression with hypomimia as the dependent variable identified disease severity, dysphagia, and male sex as significant explanatory factors. Drooling in Parkinson's disease results from multiple risk factors, with hypomimia being the most prominent. When monitored, patients appear to compensate by increasing their swallowing frequency, much like the increased cadence that is used to compensate for stepping akinesia. These findings can provide a rationale for behavioral approaches to treat drooling. © 2011 Movement Disorder Society 相似文献
155.
Hendrikus J. Dubbink Zandra C. Deans Bastiaan B.J. Tops Folkert J. van Kemenade S. Koljenovi? Han J.M. van Krieken Willeke A.M. Blokx Winand N.M. Dinjens Patricia J.T.A. Groenen 《Molecular oncology》2014,8(4):830-839
Tumor evaluation in pathology is more and more based on a combination of traditional histopathology and molecular analysis. Due to the rapid development of new cancer treatments that specifically target aberrant proteins present in tumor cells, treatment decisions are increasingly based on the molecular features of the tumor. Not only the number of patients eligible for targeted precision medicine, but also the number of molecular targets per patient and tumor type is rising. Diagnostic molecular pathology, the discipline that determines the molecular aberrations present in tumors for diagnostic, prognostic or predictive purposes, is faced with true challenges. The laboratories have to meet the need of comprehensive molecular testing using only limited amount of tumor tissue, mostly fixed in formalin and embedded in paraffin (FFPE), in short turnaround time. Choices must be made for analytical methods that provide accurate, reliable and cost‐effective results. Validation of the test procedures and results is essential. In addition, participation and good performance in internal (IQA) and external quality assurance (EQA) schemes is mandatory. In this review, we critically evaluate the validation procedure for comprehensive molecular tests as well as the organization of quality assurance and assessment of competence of diagnostic molecular pathology laboratories within Europe. 相似文献
156.
Merel M. van Gilst Bastiaan R. Bloem Sebastiaan Overeem 《Parkinsonism & related disorders》2013,19(7):654-659
Sleep disorders are common among patients with Parkinson's disease (PD). However, there are also reports of PD patients experiencing a beneficial effect of sleep. Upon awaking in the morning some patients experience good mobility, as if they are in an “on” state induced by medication, contrary to what would be expected after a night without medication. This intriguing phenomenon is known as sleep benefit. Here, we review the available research on sleep benefit in PD, describing its prevalence, clinical effects and determinants. We also discuss the possible mechanisms underlying sleep benefit, and the potential clinical applicability. Finally, we propose a new definition of sleep benefit to allow for improved standardization and homogeneity in future research. Important research targets include the development of objective measures of sleep benefit, as a basis for obtaining a better understanding of sleep benefit, its underlying mechanisms and its potential therapeutic application. 相似文献
157.
Martijn van der Eijk Frouke A.P. Nijhuis Marjan J. Faber Bastiaan R. Bloem 《Parkinsonism & related disorders》2013,19(11):923-927
Today's society is changing rapidly and individuals increasingly favor an active role in designing their own lives. Contemporary patients are no exception, but the present health care system–which is organized primarily from the provider's perspective–is not yet prepared for this development. Here, we argue that an alternative way to organize health care, namely more from the patient's perspective, may help to contain costs, while improving the quality, safety and access to care. This involves a redefinition of the patient–doctor relationship, such that patients are no longer regarded as passive objects, but rather as active subjects who work as partners with health care professionals to optimize health (‘participatory medicine’). The opportunities that come with such a collaborative and patient-centered care model are reviewed within the context of patients with Parkinson's disease. We also discuss societal and Parkinson-specific barriers that could impede implementation of this alternative care model to the management of Parkinson's disease and other chronic conditions. 相似文献
158.
Balance confidence in Parkinson's disease. 总被引:1,自引:0,他引:1
Lars B Oude Nijhuis Suzanne Arends George F Borm Jasper E Visser Bastiaan R Bloem 《Movement disorders》2007,22(16):2450-2451
159.
Nordic walking improves mobility in Parkinson's disease 总被引:1,自引:0,他引:1
Frank J.M. van Eijkeren PT Ruud S.J. Reijmers PT Mirjam J. Kleinveld PT Angret Minten RN Jan Pieter ter Bruggen MD PhD Bastiaan R. Bloem MD PhD 《Movement disorders》2008,23(15):2239-2243
Nordic walking may improve mobility in Parkinson's disease (PD). Here, we examined whether the beneficial effects persist after the training period. We included 19 PD patients [14 men; mean age 67.0 years (range 58–76); Hoehn and Yahr stage range 1–3] who received a 6‐week Nordic walking exercise program. Outcome was assessed prior to training (T1), immediately after the training period (T2) and—in a subgroup of 9 patients—5 months after training (T3). At T2, we observed a significant improvement in timed 10‐m walking, the timed get‐up‐and‐go‐test (TUG), the 6‐min walking test and quality of life (PDQ‐39). All treatment effects persisted at T3. Compliance was excellent, and there were no adverse effects. These preliminary findings suggest that Nordic walking could provide a safe, effective, and enjoyable way to reduce physical inactivity in PD and to improve the quality of life. A large randomized clinical trial now appears justified. © 2008 Movement Disorder Society 相似文献
160.
Mart-Jan G. M. Rongen M.D. Frans A. Dekker M.Sc. Bastiaan P. Geerdes M.D. Ph.D. Erik Heineman M.D. Ph.D. Cor G. M. I. Baeten M.D. Ph.D. 《Diseases of the colon and rectum》1999,42(6):776-780
PURPOSE: Until recently, patients who underwent abdominoperineal resections had to cope with a colostomy for the rest of their lives. For some of these patients this colostomy was a terrible burden, physically and mentally. Publications about abdominoperineal pull-through and double dynamic graciloplasty immediately after a Miles resection showed good results. The purpose of this study was to investigate the procedure as a secondary approach after abdominoperineal resections. METHODS: In this study seven patients were evaluated. All had had an abdominoperineal resection and proved to have unbearable problems with their stoma. All had a secondary pull-through and double dynamic graciloplasty, a mean of 8.5 (range, 1.1–34.8) years after the Miles resection. RESULTS: In five patients continence was regained; two were reversed to colostomy because of several complications. Patients who had a successful outcome also suffered from numerous complications, with a total mean hospital stay of 73.8 (range, 27–167) days, a mean of 3.1 (range, 1–6) additional operations, and 1.8 (range, 0–4) readmissions. CONCLUSION: Secondary anorectal reconstruction after abdominoperineal resection is a feasible option, but with a high morbidity. Because of this the procedure was stopped at the beginning of 1997.This study was funded by a grant from the National Fund for Investigational Medicine (Ministry of Health), the Netherlands.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998. 相似文献