Preferences and needs of patients with a rheumatic disease regarding the structure and content of online self-management support

ObjectiveAim of this study was to investigate preferences and needs regarding the structure and content of a person-centered online self-management support intervention for patients with a rheumatic disease.MethodsA four step procedure, consisting of online focus group interviews, consensus meetings with patient representatives, card sorting task and hierarchical cluster analysis was used to identify the preferences and needs.ResultsPreferences concerning the structure involved 1) suitability to individual needs and questions, 2) fit to the life stage 3) creating the opportunity to share experiences, be in contact with others, 4) have an expert patient as trainer, 5) allow for doing the training at one’s own pace and 6) offer a brief intervention. Hierarchical cluster analysis of 55 content needs comprised eleven clusters: 1) treatment knowledge, 2) societal procedures, 3) physical activity, 4) psychological distress, 5) self-efficacy, 6) provider, 7) fluctuations, 8) dealing with rheumatic disease, 9) communication, 10) intimate relationship, and 11) having children.ConclusionA comprehensive assessment of preferences and needs in patients with a rheumatic disease is expected to contribute to motivation, adherence to and outcome of self-management-support programs.Practice implicationsThe overview of preferences and needs can be used to build an online-line self-management intervention.     

Management of maxillary impacted canines: A prospective study of orthodontists' preferences

BackgroundMaxillary canines are considered the most commonly impacted teeth, after the third molars. Orthodontists have different preferences on how to approach maxillary impacted canines (MIC). The objective of this article was to investigate orthodontists’ approach to managing MIC.Material and methodsA cross-sectional study comprising a comprehensive survey with 22 questions was sent to practicing orthodontists. This study explored the preferred diagnostic measures, surgical techniques, materials, and mechanics utilized to manage MIC;104 responses were returned.ResultsPalatal impaction was reported to be encountered more often than labial impaction by 60% of the respondents. In 62% of the respondents, an oral and maxillofacial surgeon was the specialist preferred to perform the surgical exposure. In 66%, the choice of required surgical techniques was reported as a joint decision between orthodontists and other specialists who perform the surgery. Cone-beam computed tomography (CBCT) was reported to be the diagnostic x-ray of choice. The gold button with a chain was the preferred bonded attachment in 86% of cases. Less than half of the respondents bonded the attachments themselves during surgical exposure. A clear plastic retainer was the preferred retainer in 61% of the respondents, and 43% of the respondents tended to use a closed exposure technique. Coe-pak^TM was the preferred surgical pack for orthodontists who prefer an open exposure technique. Piggyback (double wire) was the preferable mechanic to move a palatally impacted canine.ConclusionOur findings indicate that there are variations among orthodontists on how to manage MICs in terms of diagnostic methods, surgical management, materials, and mechanics.     

Talking about end-of-life care: Perspectives of nursing home residents

The purpose of the paper is to describe how residents express preferences for end-of-life (EOL) care. For this qualitative study, we conducted semi-structured interviews and completed conventional content analysis to describe how residents’ expressed their preferences for care at the end of life. Sixteen residents from four nursing homes (NH) in southeastern Pennsylvania participated in this study. Residents were on average 88 years old, primarily non White, and widowed. Three key domains emerged from the analyses: Preferences for Today, Anticipating the End of My Life, and Preferences for Final Days. Residents linked their everyday living and EOL preferences by using ‘if and then’ logic to convey anticipation and readiness related to EOL. These findings suggest new strategies to start discussions of EOL care preferences with NH residents.     

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment

ObjectivesTo elicit patients’ preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia.MethodsA discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis.ResultsRespondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments.ConclusionDifferences in patients’ preferences identified in the study provide information on pharmacist services that meet patients’ expectations and contribute to improve medication management among people with diabetes.Practice implicationThis study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.     

Preferences for symmetry in faces change across the menstrual cycle

Symmetry in human male faces may be a cue to heritable fitness benefits and is found attractive. Preferences for facial masculinity, another proposed marker of genetic quality, have been found to vary in ways that may maximise evolutionary relevant benefits and masculinity is found to be of increased attractiveness at peak fertility across the menstrual cycle. Here we show that women prefer more symmetric faces at peak fertility (Study 1) and that such shifting preferences may be potentially strategic preferences as we found them to occur only for judgements concerning short-term relations and when women already had a partner (Study 2). Such preferences potentially indicate a strategy that maximises the quality of extra-pair/short-term partners or a quality dependent response to hormones. Such strategic preferences for symmetry may support the role of symmetry in signalling potential good-gene benefits.     

Potential users’ preferences towards cardiac telemedicine: A discrete choice experiment investigation in Sardinia

Background

Potential users’ preferences for telemedicine services directed to cardio-vascular diseases are investigated applying a discrete choice experiment (DCE). Given the potential of telemedicine to minimize costs without reducing overall efficiency, assessing preferences for these types of services represents a priority for policy makers. This is especially true for those pathologies that absorb a relatively high quota of total health expenditure. The empirical setting is Sardinia (Italy) because of its insularity and the underdeveloped internal transport network. Telemedicine is likely to mitigate distance between healthcare providers and final users.

Sex Selection: Some Ethical And Policy Considerations

Sex selection, which refers to the attempt to choose or control the sex of a child prior to its birth, has become the subject of increasing ethical scrutiny and many jurisdictions have criminalized it except for serious sex-linked diseases or conditions that cannot easily be ameliorated or remedied. This paper argues that such a blanket prohibition is ethically unwarranted because it is based on a flawed understanding of the difference between sexist values and mere sex-oriented preferences. It distinguishes between ethics and public policy, and suggests a way of allowing preference-based sex selection as a matter of public policy without permitting value-based sex selection. It further argues that medically-based sex selection should be publicly funded but that preference-base sex selection should not be paid for by society, and that the prohibition against value-based sex selection should be enforced through legislation that controls the licensing of health care facilities and through disciplinary procedures against health care professionals.     

Where do people not want to die? A representative survey of views of general population and health care professionals in the Czech Republic

Abstract

Introduction

Dying in the preferred place of death is considered to be one of indicators of quality of end-of-life care. Research into health care professionals' knowledge of patients' preferences for place of death is therefore important. The aim of this study was to assess the difference between health care professionals and the general public in their views on where do people not want to die.

Methods

Secondary analysis of data from a representative survey of the general population and a convenience sample of health care professionals in the Czech Republic. Respondents from the general population were asked where they would not like to die and health care professionals were asked where they think the general population does not want to die. Sample consisted of 1095 respondents from the general population and 1006 health care professionals. Health care professionals were physicians (73.3%) and nurses (26.6%).

Results

Long-term care facilities and hospitals were identified as the most undesirable settings for place of death. A significant difference in views on hospices was identified: 6% of health professionals compared to 42.2% of the general population (P < 0.001) indicated a preference for people to not die in hospice.

Discussion

The most unwanted settings for place of death were places where most people die. More research is needed to understand the factors influencing preferences and should feed into policy making. Better promotion of hospice care should be developed to communicate to the general public the differences between hospices and other institutions.