Journal articles on the topic 'Patient perceived changes'
To see the other types of publications on this topic, follow the link: Patient perceived changes.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Patient perceived changes.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Vehling, Sigrun, Karin Oechsle, Michael Hartmann, Carsten Bokemeyer, and Anja Mehnert-Theuerkauf. "Perceived Positive and Negative Life Changes in Testicular Cancer Survivors." Medicina 57, no. 9 (September 20, 2021): 993. http://dx.doi.org/10.3390/medicina57090993.
Full textAbstract:
Background and objectives: Despite a generally good prognosis, testicular cancer can be a life-altering event. We explored perceived positive and negative life changes after testicular cancer in terms of frequency, demographic and disease-related predictors, and associations with depression and anxiety. Materials and methods: All testicular cancer survivors receiving follow-up care at two specialized outpatient treatment facilities were approached at follow-up visits or via mail. We assessed a total of N = 164 patients (66% participation rate, mean time since diagnosis: 11.6 years, SD = 7.4) by the Posttraumatic Growth Inventory (PTGI, modified version assessing positive and negative changes for each of 21 items), Patient-Health-Questionnaire-9 (PHQ-9), and Generalized-Anxiety-Disorder-Scale-7 (GAD-7). We conducted controlled multivariate regression analyses. Results: Most survivors (87%) reported at least one positive change (mean number: 7.2, SD = 5.0, possible range: 0–21). The most frequent perceived positive changes were greater appreciation of life (62%), changed priorities in life (62%), and ability rely on others (51%). At least one negative change was perceived by 33% (mean number of changes: 1.1, SD = 2.5). Negative changes were most frequent for decreases in self-reliance (14%), personal strength (11%), and ability to express emotions (9%). A higher socioeconomic status was associated with more positive changes (β = 0.25, 95% CI 0.08 to 0.42); no other association with demographic and disease-related predictors emerged. While positive life changes were not associated with depression (β = −0.05, 95% CI −0.17 to 0.07) and anxiety (β = 0.00, 95% CI −0.13 to 0.13), more negative life changes were significantly associated with higher depression (β = 0.15, 95% CI −0.03 to 0.27) and anxiety (β = 0.23, 95% CI 0.11 to 0.36). There was no significant interaction of positive and negative changes on depression or anxiety. Conclusions: Although positive life changes after testicular cancer are common, a significant number of survivors perceive negative changes in life domains that have been primarily investigated in terms of personal growth. Early identification of and psychosocial support for patients who perceive predominantly negative changes may contribute to prevention of prolonged symptoms of anxiety and depression.
2
Greszta, Elżbieta, and Maria J. Siemińska. "Patient-Perceived Changes in the System of Values After Cancer Diagnosis." Journal of Clinical Psychology in Medical Settings 18, no. 1 (March 2011): 55–64. http://dx.doi.org/10.1007/s10880-011-9221-z.
Full text
3
Behrman, Alison, Mark J. Shikowitz, and Seth Dailey. "The Effect of Upper Airway Surgery on Voice." Otolaryngology–Head and Neck Surgery 127, no. 1 (July 2002): 36–42. http://dx.doi.org/10.1067/mhn.2002.126589.
Full textAbstract:
OBJECTIVE: Our goal was to assess patient perception and acoustic characteristics of voice before and after upper airway surgery. STUDY DESIGN AND SETTING: We conducted a prospective assessment of 44 surgical patients preoperatively and postoperatively at a tertiary care, academic hospital. Operations included septoplasty and turbinectomy (n = 28) and septoplasty, turbinectomy, uvulopalatopharyngoplasty, and tonsillectomy (n = 16). Patient opinion measures included Voice Handicap Index score, perception of vocal resonance, and change in voice. Acoustic measures included assessment of the relative amplitude of selected formants (resonances) of the vocal tract. RESULTS: Mean Voice Handicap Index scores were unchanged after surgery. Nine patients (20%) perceived their voice to be improved after surgery. None perceived the voice to be worse. Postoperative changes in relative formant amplitudes were statistically significant. These changes caused the acoustic features to become more representative of normative data than the preoperative values. CONCLUSION: Upper airway oeprations can affect acoustics and perception of voice. SIGNIFICANCE: Patients are unlikely to perceive a change in voice as a result of upper airway surgeries, but in those cases where a difference is perceived, it is likely to be a positive change.
4
Kelly, Timothy A., and Hans H. Strupp. "Patient and therapist values in psychotherapy: Perceived changes, assimilation, similarity, and outcome." Journal of Consulting and Clinical Psychology 60, no. 1 (1992): 34–40. http://dx.doi.org/10.1037/0022-006x.60.1.34.
Full text
5
Philpot, Lindsey M., Sunni A. Barnes, Rachel M. Brown, Jessica A. Austin, Cameron S. James, Richard H. Stanford, and Jon O. Ebbert. "Barriers and Benefits to the Use of Patient-Reported Outcome Measures in Routine Clinical Care: A Qualitative Study." American Journal of Medical Quality 33, no. 4 (December 19, 2017): 359–64. http://dx.doi.org/10.1177/1062860617745986.
Full textAbstract:
Patient-reported outcomes (PROs) provide information on how health care affects patient health and well-being and represent a patient-centered approach. Despite this potential, PROs are not widely used in clinical settings. Semi-structured focus groups were conducted with 3 stakeholder groups (patients, providers, and health care administrators) to determine the top 5 perceived barriers and benefits of PRO implementation. The Delphi technique was employed to obtain consensus and rank order responses. Patients perceived survey length to be important, whereas providers and administrators perceived time to collect data and patient health literacy, respectively, as the greatest barriers to PRO implementation. The greatest perceived benefits were the ability to track changes in clinical symptoms over time, improved quality of care, and better disease control among patients, providers, and administrators, respectively. These results may guide the development of novel frameworks for PRO implementation by addressing perceived barriers and building on the perceived benefits to encourage adoption of PROs.
6
Büel-Drabe, Natalie, Hans Steinert, Hanspeter Moergeli, Steffi Weidt, Annina Seiler, and Josef Jenewein. "Thyroid cancer has a small impact on patient–partner relationships and their frequency of sexual activity." Palliative and Supportive Care 16, no. 3 (May 31, 2017): 335–46. http://dx.doi.org/10.1017/s1478951517000384.
Full textAbstract:
ABSTRACTObjective:This cross-sectional survey examined changes in perceived relationships and sexual activity in a sample of thyroid cancer patients and their partners, taking into account sociodemographic and disease-related variables, as well as such outcome measures as anxiety, depression, fatigue, and quality of life (QoL).Method:A total of 38 patients with thyroid cancer who were being treated at the department of nuclear medicine in Zürich or Lucerne over the preceding seven years, as well as their partners, completed questionnaires about the quality of their relationships (RQ), about perceptions of changes in their relationships, and about their frequency of sexual activity. They also filled out prevalidated questionnaires related to anxiety, depression, fatigue, and QoL.Results:Some 17 patients (44.7%) and 16 partners (42.1 %) reported that the cancer diagnosis had changed their relationships. Of these, 10 (26.3%) patients and 9 (23.7%) partners reported positive changes only, while 7 patients (18.4%) and 7 partners (18.4%) reported mixed or negative changes. A perceived mixed/negative relationship change was associated with increased depression and lower RQ in patients and partners, as well as with increased anxiety in patients. While the frequency of sexual activity only changed in roughly half of patients and partners (16 patients [42.1%] and 20 partners [52.6%]), increased sexual activity was associated with lower physical QoL scores and a higher depression score than in counterparts who reported no change.Significance of Results:Compared to other cancer sites, in our sample thyroid cancer had a relatively small impact on patient–partner relationships and levels of intimacy. We found that screening patients and their partners with a simple question—“Did the diagnosis of cancer change your relationship?”—can lead to early detection of couples who are potentially at risk for perceived negative relationship changes and can facilitate timely psychosocial referral for couple's therapy.
7
Levine, Mitchell, Kathryn Gaebel, and Michael Spino. "A Study of Patient Responses to a Perceived Change in Salbutamol Metered Dose Inhalers." Journal of Generic Medicines: The Business Journal for the Generic Medicines Sector 2, no. 3 (April 2005): 201–8. http://dx.doi.org/10.1057/palgrave.jgm.4940070.
Full textAbstract:
Experience in the clinic reveals that some patients have attributed negative changes in their respiratory health status to generic substitution of inhaled medications, even though — from a pharmacological perspective — therapeutic equivalence would be expected. The objective of this study was to evaluate patient-reported changes in efficacy or toxicity following a perceived switch of an inhaled drug product. Forty-eight patients with air flow limitation had their usual brand of salbutamol metered-dose inhaler (MDI) replaced for one week with a new MDI. Patients were not informed that the replacement MDI was exactly the same brand as their usual MDI, and the product identity was disguised by a label. Forced expiratory volume in one second, respiratory symptoms and MDI use were compared between the week when the patients knew they were using their usual brand of MDI and the week they were using the perceived new MDI. Patient MDI preference was assessed at the end of the study. Even though there was no change in the brand of salbutamol MDI, 46 per cent of patients thought that the new MDI was better at managing their symptoms, 27 per cent thought that the new MDI was worse and 27 per cent perceived no difference (p<0.05 for rejecting the null hypothesis that all responses would be for no difference). Seventy per cent of patients stated that they had a preference for one MDI over the other, even though there had been no change in inhaler. Factors other than product differences are likely to be responsible for patient claims of changes in respiratory health status subsequent to generics substitution with inhaled medications when equivalent products are used. If such changes are reported following the introduction of a new generic product, the changes may be incorrectly attributed to the new product, confounding the ability to assess the quality of the new product in post-marketing evaluation.
8
Robertson, Derrick, Angela Aungst, Ryan Collier, Jhulianna Vivar, Natalie Moreo, Lise Casady, and Tuan Vu. "Patient perceived changes in sexual dysfunction after initiation of natalizumab for multiple sclerosis." Multiple Sclerosis Journal - Experimental, Translational and Clinical 4, no. 2 (April 2018): 205521731878198. http://dx.doi.org/10.1177/2055217318781989.
Full textAbstract:
Purpose Sexual dysfunction is a common but often overlooked secondary symptom of multiple sclerosis (MS) and can be associated with a decreased health-related quality of life (HRQoL). Natalizumab is a disease-modifying therapy approved for the treatment of relapsing forms of MS. In addition to its efficacy, those using natalizumab have shown improvement in HRQoL parameters, including fatigue and cognition. The idea that improvement in fatigue may also correlate with improvement in sexual dysfunction is the impetus for this study. Methods A single-center, open-label, single-arm, 24-week study was performed to evaluate perceived change in sexual dysfunction in MS patients treated with natalizumab. Adults with relapsing MS initiating natalizumab treatment and had a baseline level of sexual dysfunction were enrolled. The primary endpoint was change in the MS Intimacy and Sexuality Questionnaire-19 (MSISQ-19) score from baseline to week 24. Mean age of patients was 41 years, median disease duration was 7 years, and 73% of patients used at least one prior MS disease-modifying therapy. Results Natalizumab-treated patients experienced improvement in sexual dysfunction within the first 24 weeks of starting therapy, as demonstrated by the primary subscale of the MSISQ-19 questionnaire (–0.6976, p = 0.02). Conclusions Given the high prevalence of sexual dysfunction in MS patients and the significant impact it has on HRQoL, more research on this often overlooked symptom of MS could be very informative for patients that are deciding to initiate a new disease modifying therapy.
9
Brouillard, Cynthia, Véronique Pepin, Sally Singh, Sue Revill, Yves Lacasse, and François Maltais. "Interpreting Changes in Endurance Shuttle Walking Performance." Clinical & Investigative Medicine 30, no. 3 (June 1, 2007): 28. http://dx.doi.org/10.25011/cim.v30i3.1722.
Full textAbstract:
Rationale: The endurance shuttle walk has recently been shown to be highly responsive to both bronchodilation and pulmonary rehabilitation. The degree to which changes in endurance shuttle walking performance are perceptible to patients is unknown.
Objective: To evaluate the relationship between objective and subjective measures of change in endurance shuttle walking performance.
Methods: 129 comparison points were obtained from 69 patients with COPD (FEV1: 47±16%) who completed two or more endurance shuttle walking tests as part of a bronchodilation study. Patients were asked to rate their performance of the day in comparison to their previous performance on a 7&S209; point scale ranging from -3 (large deterioration) to +3 (large improvement). These ratings were related to changes in walking distance and endurance time, expressed both as delta and percent change.
Results: Patient ratings of change were significantly correlated with delta walking distance (r=0.44, P < 0.001), delta endurance time (r=0.46, P < 0.001), percent change in walking distance (r=0.54, P < 0.001), and percent change in endurance time (r=0.55, P < 0.001). Deteriorations in walking performance were perceived in 34% of cases, while improvements were detected in 81% of cases.
Conclusion: Changes in endurance shuttle walking performance, especially improvements, are well perceived by patients with COPD. From this set of data, it should be possible to identify the smallest change in walking performance with a high likelihood of being perceived by the patients (MCID).
10
Wang, Judy J., Jessica R. Levi, and Heather A. Edwards. "Changes in Care Provision During COVID-19 Impact Patient Well-Being." Journal of Patient Experience 8 (January 1, 2021): 237437352110340. http://dx.doi.org/10.1177/23743735211034068.
Full textAbstract:
The fast onset and extensive impact of COVID-19 necessitated strict public health measures and temporary diversion of personnel and resources from other types of medical care. This study examined the prevalence of such disruptions and their impacts on patient-perceived well-being using an untargeted survey. The majority of surveyed patients experienced changes in their routine medical care. Of those whose appointments were postponed or canceled, most patients indicated an overall negative impact on their emotional and physical well-being. We highlighted the impact of disruptions in nonurgent medical care during a large-scale public health emergency.
11
Denneson, Lauren M., Maura Pisciotta, Elizabeth R. Hooker, Amira Trevino, and Steven K. Dobscha. "Impacts of a web-based educational program for veterans who read their mental health notes online." Journal of the American Medical Informatics Association 26, no. 1 (November 16, 2018): 3–8. http://dx.doi.org/10.1093/jamia/ocy134.
Full textAbstract:
Abstract Objective This study evaluates whether a web-based educational program for patients who read their mental health notes online improves patient-clinician communication and increases patient activation. Methods The web-based educational program, developed with end-user input, was designed to educate patients on the content of mental health notes, provide guidance on communicating with clinicians about notes, and facilitate patients’ safe and purposeful use of their health information. Eligible patients were engaged in mental health treatment (≥1 visit in the prior 6 months) and had logged into the Veterans Health Administration (VHA) patient portal at least twice. Participants completed measures of patient activation, perceived efficacy in healthcare interactions, patient trust in their clinicians, and patient assessment of the therapeutic relationship before and after participating in the program. A total of 247 participants had complete data and engaged with the program for 5 minutes or more, comprising the analytic sample. Multivariate analysis using mixed effects models were used to examine pre-post changes in outcomes. Results In bivariate analyses, patient activation, perceived efficacy in healthcare interactions, and trust in clinicians increased significantly between pre- and post-training assessments. In fully adjusted models, changes in patient activation [b = 2.71 (1.41, 4.00), P < 0.01] and perceived efficacy in healthcare interactions [b = 1.27 (0.54, 2.01), P < 0.01)] remained significant. Conclusions Findings suggest that this educational program may help empower mental health patients who read their notes online to be active participants in their care, while also providing information and tools that may facilitate better relationships with their clinicians.
12
Squance, Marline L., Glenn E. M. Reeves, and Howard Bridgman. "The Lived Experience of Lupus Flares: Features, Triggers, and Management in an Australian Female Cohort." International Journal of Chronic Diseases 2014 (2014): 1–12. http://dx.doi.org/10.1155/2014/816729.
Full textAbstract:
Individuals living with lupus commonly experience daily backgrounds of symptoms managed to acceptable tolerance levels to prevent organ damage. Despite management, exacerbation periods (flares) still occur. Varied clinical presentations and unpredictable symptom exacerbation patterns provide management and assessment challenges. Patient perceptions of symptoms vary with perceived impact, lifestyles, available support, and self-management capacity. Therefore, to increase our understanding of lupus’ health impacts and management, it was important to explore lupus flare characteristics from the patient viewpoint. Lupus flares in 101 Australian female patients were retrospectively explored with the use of a novel flare definition. Qualitative methods were used to explore patient-perceived flare symptoms, triggers, and management strategies adopted to alleviate symptom exacerbations. A mean of 29.9 flare days, with 6.8 discrete flares, was experienced. The study confirmed that patients perceive stress, infection, and UV light as flare triggers and identified new potential triggers of temperature and weather changes, work, and chemical exposure from home cleaning. The majority of flares were self-managed with patients making considered management choices without medical input. Barriers to seeking medical support included appointment timings and past negative experiences reflecting incongruence between clinician and patient views of symptom impact, assessment, and ultimately flare occurrence.
13
Manne, Sharon L., Deborah A. Kashy, David W. Kissane, Melissa Ozga, Shannon Myers Virtue, and Carolyn J. Heckman. "The course and predictors of perceived unsupportive responses by family and friends among women newly diagnosed with gynecological cancers." Translational Behavioral Medicine 9, no. 4 (September 5, 2018): 682–92. http://dx.doi.org/10.1093/tbm/iby087.
Full textAbstract:
Abstract Perceived unsupportive responses from close others play an important role in psychological adaptation of patients with cancer. Little is known about whether these negative responses change after someone experiences a serious life event, and even less is known about the individual characteristics and related factors that might contribute to both the levels of and changes in perceived unsupportive responses over the course of adaptation to an experience. This longitudinal study aimed to evaluate changes in perceived unsupportive behavior from family and friends among women newly with gynecologic cancer as well as initial demographic, disease, and psychological factors that predict the course of perceived unsupportive behavior over time. Women (N = 125) assigned to the usual care arm of a randomized clinical trial comparing a coping and communication intervention with a supportive counseling intervention to usual care completed six surveys over an 18 month period. Growth models using multilevel modeling were used to predict unsupportive responses over time. Average levels of perceived unsupportive responses from family and friends were low. Unsupportive responses varied from patient to patient, but patients did not report a systematic change in perceived unsupportive responses over time. Cultivating meaning and peace and coping efficacy were associated with fewer perceived unsupportive responses as well as reductions in perceived unsupportive responses over time. Emotional distress, cancer concerns, functional impairment, holding back sharing concerns, and cognitive and behavioral avoidance predicted higher perceived unsupportive responses over time. The findings are discussed in terms of the self-presentation theory and social network responses to persons undergoing difficult life events.
14
Fisher, Mark, Stephen M. Lu, Kevin Chen, Ben Zhang, Marcelo Di Maggio, and James P. Bradley. "Facial Feminization Surgery Changes Perception of Patient Gender." Aesthetic Surgery Journal 40, no. 7 (November 2, 2019): 703–9. http://dx.doi.org/10.1093/asj/sjz303.
Full textAbstract:
Abstract Background The goal of facial feminization surgery (FFS) is to feminize the sexually dimorphic characteristics of the face and enable transwomen to be correctly gendered as female. Studies have demonstrated high patient satisfaction with FFS. However, the correct gendering of patients after FFS has never been objectively studied. Objectives The aim of this study was to determine if FFS changed the perceived gender of patients in the public eye. Methods An online survey platform with control photographs of cis-gender males and cis-gender females as well as preoperative and postoperative FFS patients was created. Respondents were asked to identify patients as “male” or “female” and to assign a confidence score ranging from –10 (masculine) to +10 (feminine) (n = 802). Results Cis-gender male and female controls were gendered correctly 99% and 99.38% of the time and with a confidence metric (CM) of –8.96 and 8.93, respectively. Preoperative FFS patients were gendered as female 57.31% of the time with a CM of 1.41 despite hormone therapy, makeup, and hairstyle. Postoperative FFS patients were gendered as female 94.27% of the time with a CM of 7.78. Ninety-five percent of patients showed a significant improvement in CM after FFS. Conclusions This study illustrates that FFS changes the social perception of a patient’s gender. Patients after FFS are more likely to be identified as female and with greater confidence than before surgery. This is despite preoperative female hormone therapy, and nonsurgical methods that patients use to feminize their appearance. Level of Evidence: 4
15
George, Ajimon, and Jobin Sahadevan. "A Conceptual Framework of Antecedents of Service Loyalty in Health Care: Patients’ Perspective." IIM Kozhikode Society & Management Review 8, no. 1 (January 2019): 50–59. http://dx.doi.org/10.1177/2277975218812952.
Full textAbstract:
As the health care sector in India is becoming more and more competitive, researchers and practitioners are getting increasingly interested in exploring how post-purchase behaviour of patients can be managed and high level of patient loyalty can be ensured. Patient loyalty has gained immense importance in health care service sector in India because of the drastic changes that have taken place in health care market in the last two decades. Today, the health care market is characterized by intense competition and specialization. Hospital management is increasingly recognizing the need to focus on patient loyalty as a means to achieve profitability and also to improve their competitive position. In this article, we theoretically explore the relationship of the antecedents of patient loyalty (service quality, perceived value, corporate image and perceived price fairness) and its outcomes (patients’ satisfaction and patient loyalty). The outcome of this research is a conceptualization of antecedents of patients’ loyalty in the context of health care supported by research propositions based on the existing literature. The article contributes to the existing literature a hypothesized model that permits the examination of consumer behavioural procedures with regard to service quality, perceived value, perceived price fairness, corporate image, patient satisfaction and patient loyalty. Exploring these processes through empirical studies in future will provide new insights, which will help hospital management retain existing customers and attract new customers.
16
Brown, D. M., EF Myers, B. Johnson, and S. Sloat. "Changes in Perceived Satisfaction of Patients, Nursing Staff, and Dietetics Staff When Dietetics Staff Pass Patient Meal Trays." Journal of the American Dietetic Association 95, no. 9 (September 1995): A38. http://dx.doi.org/10.1016/s0002-8223(95)00488-2.
Full text
17
Sohrabi, Aydin, Shabnam Tahamtan, Ali Rafighi, Seyed Hossein Moslemzadeh, and Sana Seyedshariatdoost. "Patient-centered evaluation of alignment changes during the first stage of orthodontic treatment: A longitudinal observational study." Journal of Dental Research, Dental Clinics, Dental Prospects 13, no. 1 (April 24, 2019): 75–83. http://dx.doi.org/10.15171/joddd.2019.012.
Full textAbstract:
Background. The aim of this longitudinal observational study was to evaluate patients’ perceptions of alignment changes during the first stage of fixed orthodontic treatment. Methods. Ninety-three non-extraction patients (mean age: 17.6 years) who were scheduled to undergo fixed-appliance treatment in the first author's private office were included. Patients assessed the alignment of their teeth subjectively using visual analogue scale at the bonding session and four, eight and 12 weeks later. The amount of Little's irregularity index at each session was calculated on stone casts. Freidman test was used to compare the "alignment changes" between different intervals. Correlation coefficients were calculated using Spearman test between Little’s irregularity indices and alignment scores reported by the patients in each session. Results. No patients reported regression in alignment changes during three-month course of treatment. The final changes (from bonding session to the 12th-week visit) were smaller than the sum of the three intervals, which indicated that patients became more perceptive as the treatment progressed. Comparison of two scores reported for each session (in the same session and in the next session) revealed that patients could not recall their previous situation well. Patients do not perceive alignment changes in the same way as clinicians. Furthermore, patients who were 16 or older perceived smaller alignment changes during the first four-week period and smaller final alignment changes. Conclusion. To obtain better patient compliance and improve their motivation throughout orthodontic treatment, patientspecific measures should be undertaken, including reminding them about their initial conditions and highlighting the changes as the treatment progresses.
18
Cohen, Genna R., and Julia Adler-Milstein. "Meaningful use care coordination criteria: Perceived barriers and benefits among primary care providers." Journal of the American Medical Informatics Association 23, e1 (November 13, 2015): e146-e151. http://dx.doi.org/10.1093/jamia/ocv147.
Full textAbstract:
Abstract Background Stage 2 and proposed Stage 3 meaningful use criteria ask providers to support patient care coordination by electronically generating, exchanging, and reconciling key information during patient care transitions. Methods A stratified random sample of primary care practices in Michigan ( n = 328) that had already met Stage 1 meaningful use criteria was surveyed, in order to identify the anticipated barriers to meeting these criteria as well as the expected impact on patient care coordination from doing so. Results The top three barriers, as identified by >65% of the primary care providers surveyed, were difficulty sending and receiving patient information electronically, a lack of provider and practice staff time, and the complex workflow changes required. Despite these barriers, primary care providers expressed strong agreement that meeting the proposed Stage 3 care coordination criteria would improve their patients’ treatment and ensure they know about their patients’ visits to other providers. Conclusion The survey results suggest the need to enhance policy approaches and organizational strategies to address the key barriers identified by providers and practices in order to realize important care coordination benefits.
19
Forinash, Alicia B., Danielle Chamness, Abigail M. Yancey, Jamie Koerner, Katherine Mathews, Collin Miller, Judy Thompson, and Thomas Myles. "Impact of Clinical Pharmacy on Asthma in Pregnancy in a Maternal-Fetal Care Clinic." Journal of Pharmacy Technology 32, no. 6 (September 23, 2016): 240–44. http://dx.doi.org/10.1177/8755122516667127.
Full textAbstract:
Background: Asthma complicates 4% to 8% of pregnancies. The impact of clinical pharmacists providing asthma management and education to obstetric patients is unknown. Objective: Evaluate the impact of and patient satisfaction with clinical pharmacy services on asthma in pregnancy. Methods: This prospective quasi-experimental study enrolled 30 pregnant patients with asthma and assessed perceived asthma understanding, control, and inhaler technique before and after a clinical pharmacist visit and education. The primary outcome was change in pre- and postsurvey scores. Items were rated on a 5-point Likert-type scale; higher scores represented higher perceived knowledge or satisfaction. Secondary outcomes included inhaler technique scores, asthma control, correlating patient-specific factors with the primary outcome, and level of patient satisfaction with clinical pharmacy services. Results: Perceived knowledge of asthma in pregnancy median score (maximum score 50) significantly increased with clinical pharmacy education (37.5 pre vs 49 post, P = .001). Prior to clinical pharmacy services, patients highly rated their perceived knowledge of asthma in pregnancy with median scores on 7 of 10 items between 4 and 5. Despite this, significant changes were observed on 9 items. The proportion of patients with controlled asthma significantly increased after the pharmacist visit (33.3% vs 90%, P < .001). Satisfaction with clinical pharmacy services was overwhelmingly positive with average scores on all items 4.5 to 5. Inhaler technique scores significantly increased from baseline to follow-up (4 vs 7, P = .001). Conclusions: Pharmacists significantly improved patient perceived knowledge about asthma, asthma control, and inhaler technique. Patients were overwhelmingly satisfied with the care provided by the pharmacist.
20
Bakker, Jacqueline I., Suzanne Apeldoorn, and Luanne M. Metz. "Foreign Accent Syndrome in a Patient with Multiple Sclerosis." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 31, no. 2 (May 2004): 271–72. http://dx.doi.org/10.1017/s0317167100053956.
Full textAbstract:
AbstractBackground:Foreign accent syndrome is a speech disorder which leads listeners to perceive the patient as having a foreign accent. It has been recognized previously after stroke, brain injury or unknown causes.Case report:A 52-year-old woman with clinically definite relapsing remitting multiple sclerosis (MS) presented with episodes of what was perceived as a Dutch accent along with other neurologic symptoms that would resolve simultaneously. She was assessed by a speech therapist both during an episode and after complete recovery. Speech and MRI changes (showing deep white matter lesions in the corpus callosum, left pariental lobe and left frontal lobe) were consistent with previous reports of foreign accent syndrome.Conclusions:This patient's episodes of foreign accent are thought to be due to her MS. This is the first case reported of a patient with foreign accent syndrome secondary to MS.
21
Forsyth, Katherine L., Hunter J. Hawthorne, Wesley D. Cammon, Anna R. Linden, and Renaldo C. Blocker. "Perceived Workload and an Automated Workload Alert System: A Comparison in the Emergency Department." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 62, no. 1 (September 2018): 573–77. http://dx.doi.org/10.1177/1541931218621131.
Full textAbstract:
The aim of this study was twofold—(1) to compare the current ED staffing workload alert system to clinicians’ perceptions of workload in the ED, and (2) to examine the potential impact of a multi-faceted, systems-level intervention on clinicians’ perceptions of workload. Constant flow of patients into the Emergency Departments (ED) regularly increases the workload of clinicians and can compromise the quality of care delivery and patient safety. An automatic staffing workload alert system was created and implemented in response to an observed shift in patient volume to the overnight hours at one academic quaternary care center. Surveys addressing workload and interruptions were administered to ED clinicians, pre-and post-intervention implementation. Output from the staffing workload alert system was recorded for each clinician shift. Clinicians’ perceptions of workload were able to predict swing shift activations, χ2(6) = 14.14, p = 0.028. Only the performance subscale significantly correlated with swing shift activations, p=0.006. A Kruskal-Wallis H test found perceived interruptions changed following systems-level changes, χ2(1) = 7.195, p = 0.007. Utilizing subjective measure of clinicians’ workload validated an objective, automated staffing workload alert system that determined if swing shift activations are necessary.
22
Hollabaugh, Brian A., Jon Perenack, and Brian J. Christensen. "Endoscopic Brow Lift Without Muscle Resection: Objective and Subjective Changes in Intereyebrow Width." American Journal of Cosmetic Surgery 37, no. 2 (November 8, 2019): 97–103. http://dx.doi.org/10.1177/0748806819884424.
Full textAbstract:
The purpose of this study is to evaluate the objective and subjective changes in medial intereyebrow distance following endoscopic brow lift without corrugator resection. The authors designed a retrospective cohort study. The eligible patients included those receiving endoscopic brow lifts at Williamson Cosmetic Center in Baton Rouge, LA between June 1, 2014 and March 31, 2018. The primary outcome variable was the distance between the left and right medial brow. The secondary outcome variables were nonsurgeon evaluator’s perception of the change in intereyebrow distance and the aesthetics of the intereyebrow region. The relationship of the outcome variables to the primary predictor (time point—preoperative and postoperative) was analyzed using paired sample t-tests. The relationship of the outcome variables to the other predictors was analyzed using Pearson correlations. A P-value of less than .05 was considered significant. A total of 41 patients were included in the study. The average age was 55.3 ± 8.5 years and all patients were women. The average time from surgery to postoperative photos was 6.2 ± 3.2 (range: 3-15) months. The average preoperative intereyebrow width was 31.5 mm, and the average postoperative width was 33.1 mm ( P < .0001). Correct perception of the intereyebrow change was found to be positively correlated with increasing patient age ( P = .047) and increasing change in intereyebrow width ( P = .008). The intereyebrow distance was perceived as aesthetic for 73.4% ± 31.0% of preoperative patients and 76.1% ± 27.6% of postoperative patients ( P = .346). Patients with a preoperative intereyebrow distance perceived as aesthetic are very likely to be perceived as aesthetic postoperatively (correlation coefficient 0.817, P-value < .0001). Following endoscopic brow lift without corrugator muscle resection, there is a small, but statistically significant increase in the intereyebrow distance. However, this change was not associated with negative perception of the aesthetic appearance of the intereyebrow region.
23
Saleh, Mariam A., Loay Kassem, Hanaa Atteya, Mohamed Mousa, and Samy Alsirafy. "Changes in Perceived Social Support after Starting Treatment in Egyptian Patients with Operable Breast Cancer: A Longitudinal Observational Study." Tumori Journal 106, no. 1_suppl (April 2020): 28. http://dx.doi.org/10.1177/0300891620914160.
Full textAbstract:
Background: Social support (SS) has been proven to be associated with improved outcome of early breast cancer. Little is known about the magnitude of social support available for Egyptian breast cancer patient and much less is known about the changes that occur in such support after the diagnosis of breast cancer and starting treatment. Methods: We designed a longitudinal questionnaire based prospective cohort study using the six item form of the Medical Outcomes Study- Social Support Survey (MOS-SSS) questionnaire and included patients with pathologically proven non-metastatic breast cancer 18-70 years of age. Patients completed the self administered questionnaire at 2 time points: at first diagnosis of breast cancer and after 3-6 months of starting treatment. Comparison of the pre and post treatment questionnaires was done using paired sample T test. Results: A total of 48 patients completed the 2 questionnaires. Median age was 48 years (range: 24-65 years). Seventy percent of our patients were married, 67% had more than 2 children and 77.8% were housewives. Around half of the patients (45.2%) had monthly income below 1200 EGP. Patients who had higher education level (p=0.002) and those who were living in Cairo (p=0.033) reported higher SS at baseline. Mean MOS-SSS score at baseline was 64.4 (±24.8) while after treatment was 76.4 (±22.3); p<0.001. The increase in SS was consistent in most of the patient subgroups but was more prominent in illiterate patients compared to educated (p=0.033), those who work a handy job compared to housewife (p=0.04), and those who lived in Upper Egypt compared to Cairo residents (p=0.029). Conclusion: The majority of Egyptian breast cancer patients had a supportive environment after the diagnosis of breast cancer. A special attention should be paid to the at-risk groups with no sufficient SS during that period.
24
Zippel-Schultz, Bettina, Alexander Palant, Casper Eurlings, Chantal F Ski, Loreena Hill, David R. Thompson, Donna Fitzsimons, et al. "Determinants of acceptance of patients with heart failure and their informal caregivers regarding an interactive decision-making system: a qualitative study." BMJ Open 11, no. 6 (June 2021): e046160. http://dx.doi.org/10.1136/bmjopen-2020-046160.
Full textAbstract:
ObjectiveHeart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution—a doctor-at-home system.DesignWe applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis.SettingA multicentred study in four European countries.ParticipantsWe interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms.ResultsFour main categories emerged from the data: needs and expectations, preferences regarding the care process, perceived risk and trust. Participants expressed clear wishes and expectations regarding a doctor-at-home, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, trust was identified as an important basis for acceptance and use. Finally, perceived risk for decision-making errors is a crucial topic in need of attention.ConclusionPatients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers’ perceived risks.
25
Kletzien, Heidi, Cameron L. Macdonald, Jason Orne, David O. Francis, Glen Leverson, Elizabeth Wendt, Rebecca S. Sippel, and Nadine P. Connor. "Comparison Between Patient-Perceived Voice Changes and Quantitative Voice Measures in the First Postoperative Year After Thyroidectomy." JAMA Otolaryngology–Head & Neck Surgery 144, no. 11 (November 1, 2018): 995. http://dx.doi.org/10.1001/jamaoto.2018.0309.
Full text
26
Kragt, J. J., F. AH van der Linden, J. M. Nielsen, B. MJ Uitdehaag, and C. H. Polman. "Clinical impact of 20% worsening on Timed 25-foot Walk and 9-hole Peg Test in multiple sclerosis." Multiple Sclerosis Journal 12, no. 5 (September 2006): 594–98. http://dx.doi.org/10.1177/1352458506070768.
Full textAbstract:
Introduction: Quantitative tests of motor function, like the Timed 25-foot Walk (T25FW) and 9-hole Peg Test (9HPT), are increasingly being applied as outcome measures in multiple sclerosis (MS) clinical trials. The quantitative nature of the data has a favorable impact on responsiveness, but the clinical impact of the changes is uncertain. The goal of this study was to assess whether a change on T25FW and 9HPT does indeed have a clinical meaning. This was accomplished by comparing 20% changes on these quantitative measurements to concomitant changes on the Guy’s Neurological Disability Scale (GNDS), a scale which measures patient-perceived daily life disability. Methods: From a longitudinal database, we selected patients with at least two measurements of T25FW, 9HPT and GNDS with a minimal time interval of 350 days. In those patients who experienced at least a 20% change on T25FW or 9HPT, GNDS score changes were examined more closely. Results: Of 527 patients, 143 experienced a >20% worsening on their T25FW and 71 on their 9HPT, respectively. Patients with a 20% increase in T25FW or 9HPT had more GNDS worsening than patients without such an increase. GNDS worsening associated with an increase in T25FW was mainly due to an increase in perceived disability related to lower extremity function and fatigue; GNDS worsening associated with an increase in 9HPT was more diffuse with respect to domains involved. Conclusion: Worsening on T25FW or 9HPT has a clinical impact on disability, as perceived by MS patients during daily life functioning.
27
Alencar, Maria de Jesus Freitas de, Jaqueline Caracas Barbosa, Thayza Miranda Pereira, Suen Oliveira Santos, Klaas Hendrik Eggens, and Jorg Heukelbach. "Leprosy reactions after release from multidrug therapy in an endemic cluster in Brazil: patient awareness of symptoms and self-perceived changes in life." Cadernos Saúde Coletiva 21, no. 4 (2013): 450–56. http://dx.doi.org/10.1590/s1414-462x2013000400014.
Full textAbstract:
We assessed diagnosis and consequences of leprosy reactions as perceived by affected individuals. A cross-sectional study was performed in five municipalities in an endemic disease cluster in Brazil. Structured interviews included 280 leprosy-affected individuals who had experienced reactions after release from treatment (RFT), 2007-2009. Open questions included information on diagnostic features of leprosy reactions, sensory loss and self-perceived changes in life after experiencing leprosy reactions. In this study, 43.2% were diagnosed with reaction during multi-drug therapy. In the majority of cases, the patient himself/herself perceived disease symptoms first (n=240; 85.8%). Primary Health Care Centres were the first entry point into the health system for 95/150 (63.3%). In 72.6% of these, leprosy diagnosis was made within the primary care setting. Patientperceived signs and symptoms of reactions included skin lesions (42%) and neurological symptoms (39%). In total, 216/280 (77.1%) stated that they had perceived changes in life. Physical impairments limiting possibilities to work and reduced income were mentioned commonly (n=118; 54.6%). Discrimination and social isolation were also experienced. Our study indicates an inadequate response of health services for individuals with reactions after RFT. An integrated approach is needed, including physical, psychological care and self-care groups.
28
Lanzi, Stefano, Luca Calanca, André Berchtold, and Lucia Mazzolai. "Improvement in 6-Minute Walking Distance after Supervised Exercise Training Is Related to Changes in Quality of Life in Patients with Lower Extremity Peripheral Artery Disease." Journal of Clinical Medicine 10, no. 15 (July 28, 2021): 3330. http://dx.doi.org/10.3390/jcm10153330.
Full textAbstract:
This study aimed to investigate the relationship between supervised exercise training (SET)-induced changes in treadmill performance and 6 min walking distance, and changes in general (physical and mental) self-perceived health-related quality of life (HRQoL) in symptomatic patients with lower extremity peripheral artery disease (PAD). This is an observational study investigating Fontaine stage II PAD patients participating in 3-month SET. Before and following SET, treadmill performance (pain-free (PFWD) and maximal (MWD)), and 6 min walking distance (6MWD) were assessed. Self-perceived HRQoL was assessed with the Medical Outcomes Study Short-Form 36 (SF-36). Ankle- and toe-brachial indexes were also measured. One-hundred forty-seven patients with PAD were included (64.9 ± 9.6 y, 70% men). After SET, PFWD (+102%, p ≤ 0.001), MWD (+87%, p ≤ 0.001), and 6MWD (+14%, p ≤ 0.001) significantly increased. All eight SF-36 subscale scores significantly improved following SET (p ≤ 0.04). SET significantly improved physical and mental component summaries of the SF-36 (p ≤ 0.001). Larger increases in 6MWD were associated with greater improvements in physical (β = 0.19; p = 0.02) and mental (β = 0.24; p = 0.005) component summaries of the SF-36. No significant relationship was observed between changes in treadmill performance and changes in physical and mental component summaries of the SF-36. These results show that improvements in 6MWD following SET are related to improvements in general self-perceived HRQoL in patients with symptomatic lower extremity PAD. On the contrary, changes in treadmill performance were not related to improvements in HRQoL. These results suggest that the 6 min walking test is an essential outcome measure to assess overall patient functional status following interventions in patients with PAD.
29
Bolosi, Maria, Vaios Peritogiannis, Petros Tzimas, Athanasios Margaritis, Konstantinos Milios, and Dimitrios V. Rizos. "Depressive and Anxiety Symptoms in Relatives of Intensive Care Unit Patients and the Perceived Need for Support." Journal of Neurosciences in Rural Practice 09, no. 04 (October 2018): 522–28. http://dx.doi.org/10.4103/jnrp.jnrp_112_18.
Full textAbstract:
ABSTRACT Background: Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members. Objectives: This study aimed to explore the families’ psychological symptoms and their evolution over the 1st week of patients’ ICU stay. Additional objectives were the estimation of the families’ need for support and the estimation of satisfaction regarding the information provided by ICU physicians. Methods: A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients’ ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients’ care; and the support of the families by medical and nursing staff. Results: Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives’ views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed. Conclusions: Over the 1st week of ICU admission, depressive symptoms in patients’ relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients’ condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.
30
Ozdoganoglu, Tunis, Murat Songu, and Hasan Mete Inancli. "Quality of life in allergic rhinitis." Therapeutic Advances in Respiratory Disease 6, no. 1 (October 27, 2011): 25–39. http://dx.doi.org/10.1177/1753465811424425.
Full textAbstract:
Allergic rhinitis is a global health problem that causes major illness and disability worldwide. Although nasal and nonnasal symptoms are directly attributable to inflammation in the upper respiratory tract, individuals also experience generalized symptoms that include fatigue, mood changes, depression, anxiety and impairments of work and school performance, and cognitive function. Health-related quality of life focuses on patients’ perceptions of their disease and measures impairments that have a significant impact on the patient. The burden of disease, as the patient perceives it, forms the basic motivation to seek medical aid or to undergo therapy. Adherence to therapy requires changes in health, perceived by patients as relevant and outweighing eventual disadvantages of intervention. Because so many factors are involved in health-related quality of life, there are multiple ways in which it can be measured. A variety of validated and standardized questionnaires have been developed including assessments of school performance, work performance, productivity, and other parameters that quantify the impact of allergic rhinitis and its treatment on quality of life. The aim of this review is to highlight the impact of allergic rhinitis on the quality of life and to analyze the most commonly used health-related quality of life instruments.
31
Ajwa, Nancy, Lamya Makhdoum, Hadeel Alkhateeb, Alanoud Alsaadoun, Samiah Alqutub, and Hajer Alkhumayes. "The Impact of Orthodontic Appliance on Body Weight Changes, Dietary Habits, and Self-Perceived Discomfort in Early Stages of Orthodontic Treatment." Global Journal of Health Science 10, no. 9 (August 1, 2018): 11. http://dx.doi.org/10.5539/gjhs.v10n9p11.
Full textAbstract:
AIMS: To assess and compare the changes in body weight, dietary habits, and pain perception of patient’s undergoing orthodontic treatment at the initial stage.MATERIAL & METHODS: This was an observational prospective cohort study to assess patient’s changes in body weight, dietary habits, and pain perception undergoing orthodontic treatment at the initial stage. Thirty patients who received orthodontic treatment “for the first time” and those who will get comprehensive orthodontic treatment within the age group of 18-30 years old including both genders were included in the study. The weight as well as dietary habits of patients were measured at the initial visit, “prior reserving of any the orthodontic treatment” as (T0). Re-evaluation of patient’s weight, dietary habits, and pain perception were re-assessed on the next visit” after fixed orthodontic appliance bonding” as (T1) one month later. The pain, discomfort, and dietary habits changes were evaluated using a validated questionnaire.RESULTS: The mean (SD) patient weight at first and second visit of orthodontic treatment was 67.43 (24.42) and 64.98 (22.7) kg respectively. The difference in the patient weight between first and second visit was statistically significant. Patients with discomfort and patients who used medication to relieve pain were reported to have more weight loss.CONCLUSIONS: This study confirms the initial loss of weight, pain and discomfort among patients who undergo orthodontic treatments. The findings of this study are of importance among the orthodontic centres and practitioners highlighting the importance of their guidance in structured diet planning and advice after treatment.
32
Kageyama, Masako, Keiko Yokoyama, and Yuichiro Horiai. "Perceptions of Stages of Family Violence and their Perceived Solutions in Persons with Schizophrenia." Open Nursing Journal 13, no. 1 (September 30, 2019): 156–67. http://dx.doi.org/10.2174/1874434601913010156.
Full textAbstract:
Background: Family violence committed by persons with schizophrenia is a serious problem in the context of the accelerated deinstitutionalization in Japan. Community nurses could play an important role in resolving family violence by persons with schizophrenia. Objective: This study aimed to clarify the reasons for family violence as perceived by adult children with schizophrenia and ways to resolve this problem. Methods: A qualitative descriptive design was employed. Group interviews with 10 participants—five individuals with schizophrenia and five parents of adult children with schizophrenia-were conducted. Transcriptions were segmented according to the following three research questions: “How do parents recognize and cope with violence committed by persons with schizophrenia?,” “How do persons with schizophrenia perceive committing violence toward their parents and how do they change themselves after doing so?” and “How do persons with schizophrenia perceive ways to resolve the issue of violence toward parents?” The data were categorized and subcategorized based on the similarity of codes and organized in chronological order. Categories concerning reasons for violence and the subsequent changes in persons with schizophrenia made up the stages of their experiences. Results: Parents could not understand the reasons for violence committed by persons with schizophrenia. Experiences of committing violence and changes after violence as perceived by persons with schizophrenia involved the following five stages: complicated causes of occurrence, environment conducive to violence, onset of violence, gaining power, and regret and growth. Persons with schizophrenia wanted to be observed from a distance and were desirous of establishing relationships beyond the home. Conclusion: It is necessary for nurses to bridge the gap between patients and their parents by serving as a communication channel between them. In this way, there is hope to promote recovery even if the patient with schizophrenia commits violent acts toward the parent.
33
Stier, David M., Douglas Gause, Warren S. Joseph, Jeffrey R. Schein, Jeanette M. Broering, Karen L. Warolin, and Joseph J. Doyle. "Patient Satisfaction with Oral versus Nonoral Therapeutic Approaches in Onychomycosis." Journal of the American Podiatric Medical Association 91, no. 10 (November 1, 2001): 521–27. http://dx.doi.org/10.7547/87507315-91-10-521.
Full textAbstract:
The follow-up results of a 9-month observational study of 150 onychomycosis patients treated with a variety of mechanical, topical, and oral therapies by podiatric physicians and dermatologists are presented. Changes from baseline in toenail condition and patient satisfaction were assessed at 4- and 9-month follow-up. At 9 months, patients who had received oral therapy reported significantly fewer onychomycosis-related problems in social situations, including embarrassment or self-consciousness about the appearance of nails, avoidance of contact by others, being perceived as unclean or untidy, and the desire to keep their nails concealed. Patient-reported satisfaction with the treatment program was significantly higher for those receiving oral therapy than for those receiving nonoral therapy. (J Am Podiatr Med Assoc 91(10): 521-527, 2001)
34
Kempert, Heidi, Ethan Benore, and Rachel Heines. "Easily Administered Patient-Reported Outcome Measures: Adolescents' Perceived Functional Changes After Completing an Intensive Chronic Pain Rehabilitation Program." Archives of Physical Medicine and Rehabilitation 98, no. 1 (January 2017): 58–63. http://dx.doi.org/10.1016/j.apmr.2016.08.471.
Full text
35
Trask, P. C., C. Tellefsen, D. Espindle, C. Getter, K. Yost, and M. Hsu. "Clinical variables are associated with treatment satisfaction in patients with breast, lung, and colorectal cancer." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6608. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6608.
Full textAbstract:
6608 Background: The association between clinical variables (e.g. disease stage/type, side effects, ECOG performance status (PS)) and patient-reported treatment satisfaction has received little attention, despite the potential implications for treatment adherence and decision-making. We examined the relation between clinical variables and treatment satisfaction in a U.S. sample of patients with breast (BC), lung (LC), or colorectal (CRC) cancer using the Cancer Treatment Satisfaction Questionnaire (CTSQ), a recently validated 16-item measure designed to assess expectations of therapy (ET), feelings about side effects (FSE), and satisfaction with therapy (SWT). Methods: Cancer stage, line of therapy, physician-reported ECOG PS, presence vs. absence of medication side effects, and perceived change in cancer over the last two weeks were obtained on patients. These clinical variables were examined in relation to the ET, FSE, and SWT scales of the CTSQ. Higher scale scores indicated better outcomes (e.g., better satisfaction). Group means were compared using one-way ANOVAs; trends of scale scores across clinical variables were also examined. Results: Participants were 349 patients with early and late stage BC (n=137), CRC (n=121), or LC (n=91) who had ≥ 1 cycles of chemo-, bio-, or hormonal therapy in the last 6 months. In all cancer types, FSE differed by presence of side effects (BC<.03; CRC<.01; LC<.02). In BC patients, FSE differed by stage, and ET differed significantly depending on ECOG PS (p<.006) and perceived change (p<.05). For CRC patients, ET significantly differed by stage (p<.05) and perceived change (p<.02); and SWT by presence of side effects (p<.01). SWT also differed by perceived change (p<.01) for LC patients. Most trends were in the expected direction. Conclusions: These results indicate that patient-reported satisfaction with therapy is correlated with clinical variables. On average, patients who perceive less improvement in their cancer, have side effects, and poorer ECOG PS are less satisfied with their current cancer therapy. Unknown is the impact of this relation on adherence and decision-making. Recent changes in healthcare suggests that treatment satisfaction may become an increasingly important measure of clinical outcome. No significant financial relationships to disclose.
36
Görges, Matthias, Kathy L. Rush, Lindsay Burton, Mona Mattei, Selena Davis, Heidi Scott, Mindy A. Smith, and Leanne M. Currie. "Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives." Applied Clinical Informatics 12, no. 01 (January 2021): 041–48. http://dx.doi.org/10.1055/s-0040-1721397.
Full textAbstract:
Abstract Background Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas. Objectives The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers. Methods We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges. Results Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1–38) years and had used an electronic medical record for 7.0 (1–20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team). Conclusion Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits.
37
Sherman, Michelle D., and Stephanie A. Hooker. "Family medicine physicians’ confidence and perceived effectiveness in delivering health behaviour change interventions." Family Practice 37, no. 4 (January 22, 2020): 493–98. http://dx.doi.org/10.1093/fampra/cmaa001.
Full textAbstract:
Abstract Background Approximately 40% of deaths in the USA are attributable to modifiable health behaviours. Despite clear recommendations and practice guidelines, primary care physicians (PCPs) generally do not dedicate much time to addressing health behaviours, thereby missing opportunities to improve patient well-being. Objective(s) To examine what health behaviour change techniques PCPs use with their patients, including frequency of use, confidence in and perceived effectiveness of those interventions. Methods Using a cross-sectional study design, family medicine resident and faculty physicians (n = 68) from three residency training programs completed an anonymous online survey. Questions explored their use of, confidence in and perceived effectiveness of health behaviour change interventions for six domains: physical activity, healthy eating, medication adherence, smoking cessation, sleep and alcohol reduction. Qualitative responses to open-ended questions were double coded by two independent raters. PCPs’ open-ended responses to questions regarding specific intervention techniques were coded using an evidence-based behaviour change taxonomy. Results Although PCPs indicated that they address health behaviour topics quite frequently with their patients, they reported only moderate confidence and low-to-moderate perceived effectiveness with their interventions. The most frequently cited technique was providing instruction (telling patients what to do). PCPs reported lowest frequency of addressing, lowest confidence and lowest effectiveness regarding helping patients decrease their use of alcohol. Insufficient time and perceived low patient motivation were commonly cited barriers. Conclusion These findings highlight the need for the development and evaluation of educational curricula to teach physicians brief, evidence-based approaches to helping patients make these changes in their health-related behaviours.
38
Gibbs, Ronald S., Carolyn Wieber, Leslie Myers, and Timothy Jenkins. "A Continuing Medical Education Campaign to Improve Use of Antibiotics in Primary Care." Journal of Biomedical Education 2014 (May 25, 2014): 1–6. http://dx.doi.org/10.1155/2014/537681.
Full textAbstract:
Because inappropriate use of antibiotics is common, it is an important area for continuing medical education. At an annual review, we conducted a two-year campaign to achieve appropriate use. Our methods included two surveys, directed course content, programmatic evaluation, and a sample practice audit. Ninety percent of learners perceived inappropriate antibiotic use as a “very big” or “big” problem in the United States, but only 44% perceived this about their practice (P<0.001). Top perceived barriers to appropriate antibiotic use were patient expectations, breaking old habits, and fear that patients would go elsewhere. Top strategies to overcome these barriers were patient educational materials, having guidelines accessible, and developing practice policies. In a hypothetical patient with acute bronchitis, 98% would likely prescribe an antibiotic in certain clinical scenarios even though The Centers for Disease Control and Prevention does not recommend empiric antibiotic treatment. The most common scenarios leading to likely antibiotic prescription were symptoms over 15 days (84%), age over 80 years (70%), and fever (48%). Practitioners are under multiple pressures to prescribe antibiotics even in situations where antibiotics are not recommended (such as acute bronchitis). To achieve complex practice changes such as avoiding inappropriate antibiotic use, no one strategy predominated.
39
Furness, Penny J., Ivan Phelan, Nathan T. Babiker, Orla Fehily, Shirley A. Lindley, and Andrew R. Thompson. "Reducing Pain During Wound Dressings in Burn Care Using Virtual Reality: A Study of Perceived Impact and Usability With Patients and Nurses." Journal of Burn Care & Research 40, no. 6 (June 12, 2019): 878–85. http://dx.doi.org/10.1093/jbcr/irz106.
Full textAbstract:
AbstractBurns patients often suffer severe pain during interventions such as dressing changes, even with analgesia. Virtual Reality (VR) can be used to distract patients and reduce pain. However, more evidence is needed from the patients and staff using the technology about its use in clinical practice and the impact of different VR strategies. This small-scale qualitative study explored patient and staff perceptions of the impact and usability of active and passive VR during painful dressing changes. Five patients took part in three observed dressing changes—one with an active VR scenario developed for the study, one with passive VR, and one with no VR—following which they were interviewed about their experiences. Three nurses who performed the dressing changes participated in a focus group. Thematic analysis of the resulting data generated four themes: “Caution replaced by contentment,” “Distraction and implications for pain and wound care,” “Anxiety, control and enjoyment,” and “Preparation and communication concerns.” Results suggested that user-informed active VR was acceptable to burn patients, helped manage their perceived pain, and was both usable and desirable within the clinical environment. Further testing with larger samples is now required.
40
Bombard, Yvonne, Linda Rozmovits, Maureen E. Trudeau, Natasha B. Leighl, Ken Deal, and Deborah Marshall. "Access to personalized medicine: Factors influencing the use and value of gene expression profiling in treatment decision making." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 10. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.10.
Full textAbstract:
10 Background: Genomic information is increasingly used to personalize health care. One example is gene-expression profiling (GEP) tests that estimate recurrence risk to inform chemotherapy decisions in breast cancer treatment. Recently, GEP tests were publicly funded in Ontario. We assessed the clinical utility of GEP tests, exploring the factors facilitating their use and value in treatment decision-making. Methods: As part of a mixed-methods clinical utility study, we conducted interviews with oncologists (n=14), and focus groups and interviews with breast cancer patients (n=28) who underwent GEP, recruited through oncology clinics in Ontario. Data were analyzed using content analysis and constant comparison. Results: Various factors governing access to GEP have given rise to challenges for patients and oncologists. Oncologists are positioned as gatekeepers of GEP, providing access in medically appropriate cases. However, varying perceptions of appropriateness led to perceived inequities in access and negative impacts on the doctor-patient relationship. Media attention facilitated patient awareness of GEP but complicated gatekeeping. Additional administration burden and long waits for results led to increased patient anxiety and delayed treatment. Collectively, these factors inadvertently heightened GEP’s perceived value for patients relative to other prognostic indicators because of barriers to access. Conclusions: This study delineates the factors facilitating and restricting access to GEP, and highlights the roles of the media and organization of services in GEP’s perceived value and utilization. Results identify a need for administrative changes and practice guidelines to support streamlined and standardized utilization of the test.
41
Robinson, Amanda, Edith Pituskin, and Colleen M. Norris. "Patient-Reported Cognitive Outcomes Following Cardiac Surgery: A Descriptive Review." Journal of Patient Experience 8 (January 1, 2021): 237437352198925. http://dx.doi.org/10.1177/2374373521989250.
Full textAbstract:
A descriptive review was conducted to evaluate the evidence of cognitive patient-reported outcome measures (PROMs) following cardiac surgery. The search of electronic databases resulted in 400 unique manuscripts. Nine studies met the criteria to be part of the final review. Results of the review suggest that there are few validated PROMs that assess cognitive function in the cardiac surgical population. Furthermore, PROMs have not been used to assess overall cognitive function following cardiac surgery within the past decade. However, one domain of cognitive function—memory—was described, with up to half of patients reporting a decline postoperatively. Perceived changes in cognitive function may impact health-related quality of life and a patient’s overall view of the success of their surgery. Early identification of cognitive changes measured with PROMs may encourage earlier intervention and improve patient-centered care. In clinical practice, nurses may be in the best position to administer PROMs preoperatively and postoperatively.
42
Fitzpatrick, N. K., C. J. Thompson, H. Hemingway, T. R. E. Barnes, A. Higgitt, C. Molloy, and S. Hargreaves. "Acute mental health admissions in inner London: changes in patient characteristics and clinical admission thresholds between 1988 and 1998." Psychiatric Bulletin 27, no. 1 (January 2003): 7–11. http://dx.doi.org/10.1192/pb.27.1.7.
Full textAbstract:
Aims and MethodWe undertook a retrospective case-note review of three cohorts of mental health admissions to determine the extent to which patient and service characteristics changed between 1988 and 1998. Changes in clinical admission thresholds were investigated by a psychiatrists' review of handwritten medical admission assessments.ResultsPatients admitted in 1998 were demographically less stable and clinically more complex than those admitted 10 years earlier. Clinical admission thresholds remained consistent.Clinical ImplicationsOur findings suggest that the perceived increase in pressure on psychiatric services over this period was a response to a change in population need. This study highlights important questions about the clinical decision-making process leading to use of alternatives to admission and the appropriateness of acute admissions.
43
Hoogervorst, E. LJ, N. F. Kalkers, G. R. Cutter, B. MJ Uitdehaag, and C. H. Polman. "The patient's perception of a (reliable) change in the Multiple Sclerosis Functional C omposite." Multiple Sclerosis Journal 10, no. 1 (February 2004): 55–60. http://dx.doi.org/10.1191/1352458504ms972oa.
Full textAbstract:
Objective: To prospectively character ize the relation between two-year changes in functional impairment as measured by the Multiple Sclerosis Functio nal C omposite (MSFC) and changes in patient perceived disability as measured by the Guy’s Neurological Disability Scale (GNDS). Methods: O ne hundred and eighty-eight patients with multiple sclerosis (MS) were recruited at our outpatient clinic. Impairment and disability were assessed using the MSFC and G NDS at baseline and follow-up. Longitudinal correlations were studied between changes in MSFC and GNDS and their corresponding components. We also studied changes in G NDS in relation to what can be classified as a reliable change in MSFC; for example, 20% change in each MSFC component or a change of 0.5 in total MSFC score. In addition, we studied the change in total number of GNDS subcategories with a score of 3 or higher in relation to the predefined MSFC changes, these subcategories being indicative of the requirement for help by another person. Results: Despite good cross-sectional correlations between MSFC and GNDS, no significant correlation was found between longitudinal changes in MSFC and GNDS. A nalysing the change in GNDS in relation to the predefined MSFC changes shows that G NDS changes are nicely rank ordered when more stringent definitions of reliable change were applied. In addition, analysing the number of G NDS subcategories scored 3 or higher indicate that there is a profile of worsening on the MSFC being associated with increase in the amount of help required from others. Conclusion: O ur longitudinal data suggest that a reliable change is associated with a likewise change in patient perceived disability, the smallest reliable change being identified by at least 20% change in each MSFC component.
44
Köpke, S., J. Kasper, I. Mühlhauser, M. Nübling, and C. Heesen. "Patient education program to enhance decision autonomy in multiple sclerosis relapse management: a randomized-controlled trial." Multiple Sclerosis Journal 15, no. 1 (January 2009): 96–104. http://dx.doi.org/10.1177/1352458508095921.
Full textAbstract:
Background Contrary to strong recommendations for high-dose intravenous corticosteroid treatment for relapses in multiple sclerosis (MS), uncertainty remains about most aspects of relapse management. Oral corticosteroids administered by physicians or patients themselves or no corticosteroids also appear justifiable. Objective To evaluate an education program that aims to involve patients with MS in decisions on relapse management. Methods In three German MS centers, 150 patients with relapsing MS were randomly assigned to a single, 4-h group session or a standard information leaflet. The primary outcome measure was the proportion of relapses with oral or no corticosteroid therapy as an indicator of patient autonomy in treatment decision making. Other outcomes included perceived decision autonomy, quality of life, and disability status. Results In the intervention group (IG), 108/139 (78%) relapses were treated with oral or no corticosteroids compared with 101/179 (56%) in the control group; P < 0.0001. Patients’ perceived autonomy of treatment decision making was significantly higher in the IG; P < 0.0001. Quality of life, disability status, and adverse events of corticosteroid therapies were comparable. Conclusion The patient education program led to more autonomous decision making in patients with relapsing MS. Relevant changes in relapse management were observed.
45
Robinson, Peter G., Gail V. A. Douglas, Barry J. Gibson, Jenny Godson, Karen Vinall-Collier, Sue Pavitt, and Claire Hulme. "Remuneration of primary dental care in England: a qualitative framework analysis of perspectives of a new service delivery model incorporating incentives for improved access, quality and health outcomes." BMJ Open 9, no. 10 (October 2019): e031886. http://dx.doi.org/10.1136/bmjopen-2019-031886.
Full textAbstract:
ObjectiveThis study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes.DesignData were collected through observations, interviews and focus groups.SettingThis was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract.ParticipantsObservations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups.ResultsUsing a qualitative framework analysis informed by Andersen’s model of access, we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist.ConclusionThe incentive-driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice.
46
Sterenborg, Bernadette A. M. M., Stanimira I. Kalaykova, Simone Knuijt, Bas A. C. Loomans, and Marie-Charlotte D. N. J. M. Huysmans. "Speech changes in patients with a full rehabilitation for severe tooth wear, a first evaluation study." Clinical Oral Investigations 24, no. 9 (December 19, 2019): 3061–67. http://dx.doi.org/10.1007/s00784-019-03174-7.
Full textAbstract:
Abstract Objective The aim of this study was to evaluate changes in speech characteristics and self-perceived quality of speech in tooth wear patients, after occlusal rehabilitation. Materials and methods Patients with tooth wear were included in this study after informed consent. The amount of tooth wear was scored with Tooth Wear Evaluation System (TWES). To assess the perspective of the patient, the Dutch Speech Handicap Index was used (SHI). Acoustic analysis was performed to evaluate changes with the use of voice recordings. These were made before treatment, T0; directly after treatment, T1; 1 month after treatment, T2. With the use of PRAAT software, the spectral characteristic centre of gravity (COG) was evaluated for the sounds /s/, /f/, /v/, /d/, /t/, /m/. Results Recordings of 17 patients (14 men, 3 women, mean age 41.2 ± 10.4 years) were included. SHI scores did not change significantly between T0 and T2 (p = 0.054). A multiple regression model showed that for all sounds the intercept was negative, but statistically significant only for /s/ and /f/ between T0 and T1. The effect of the initial change (between T0 and T1) on the change between T1 and T2 was clearly negative for all sounds (p < 0.001), showing a rebound effect ranging between 29 and 68% of the initial change. Conclusion Tooth wear patients perceive improvement in speech function after treatment. Clinical significance Clinicians may explain to patients that speech is likely to alter for a short period due to treatment but that there will be a good adaption to the new situation.
47
Breaux, Samantha, Francis Arthur Derek Desrosiers, Mauricio Neira, Sunita Sinha, and Corey Nislow. "Pharmacogenomics at the Point of Care: A Community Pharmacy Project in British Columbia." Journal of Personalized Medicine 11, no. 1 (December 24, 2020): 11. http://dx.doi.org/10.3390/jpm11010011.
Full textAbstract:
In this study 180 patients were consented and enrolled for pharmacogenomic testing based on current antidepressant/antipsychotic usage. Samples from patients were genotyped by PCR, MassArray, and targeted next generation sequencing. We also conducted a quantitative, frequency-based analysis of participants’ perceptions using simple surveys. Pharmacogenomic information, including medication changes and altered dosing recommendations were returned to the pharmacists and used to direct patient therapy. Overwhelmingly, patients perceived pharmacists/pharmacies as an appropriate healthcare provider to deliver pharmacogenomic services. In total, 81 medication changes in 33 unique patients, representing 22% of all genotyped participants were recorded. We performed a simple drug cost analysis and found that medication adjustments and dosing changes across the entire cohort added $24.15CAD per patient per year for those that required an adjustment. Comparing different platforms, we uncovered a small number, 1.7%, of genotype discrepancies. We conclude that: (1). Pharmacists are competent providers of pharmacogenomic services. (2). The potential reduction in adverse drug responses and optimization of drug selection and dosing comes at a minimal cost to the health care system. (3). Changes in drug therapy, based on PGx tests, result in inconsequential changes in annual drug therapy cost with small cost increases just as likely as costs savings. (4). Pharmacogenomic services offered by pharmacists are ready for wide commercial implementation.
48
Crocker, Robert L., Jason T. Hurwitz, Amy J. Grizzle, Ivo Abraham, Rick Rehfeld, Randy Horwitz, Andrew T. Weil, and Victoria Maizes. "Real-World Evidence from the Integrative Medicine Primary Care Trial (IMPACT): Assessing Patient-Reported Outcomes at Baseline and 12-Month Follow-Up." Evidence-Based Complementary and Alternative Medicine 2019 (June 26, 2019): 1–9. http://dx.doi.org/10.1155/2019/8595409.
Full textAbstract:
Purpose. The University of Arizona Integrative Health Center (UAIHC) was an innovative membership-supported integrative medicine (IM) adult primary care clinic in Phoenix, Arizona. UAIHC delivered healthcare using an integrative medicine model that combined conventional and complementary medical treatments, including nutrition, mind-body medicine, acupuncture, manual medicine, health coaching, educational classes, and groups. Results from pre-post evaluation of patient-reported outcomes on several standardized measures are presented here. Methods. UAIHC patients completed surveys at baseline and after 12 months of continuous integrative primary care. Patients reported on perceived changes in health outcomes as measured by Short-Form Health Survey (SF-12 general, mental, and physical health), Perceived Stress Scale (PSS4), Work Productivity and Activity Impairment Questionnaire (WPAI), World Health Organization Well-Being Index (WHO-5), Pain Visual Analog Scale (VAS), Fatigue Severity Scale (VAS; FSS), Generalized Anxiety Disorder Scale (GAD2), Patient Health Questionnaire for depression (PHQ2), Pittsburgh Sleep Quality Index (PSQI) global rating of sleep quality, and the Behavioral Risk Factor Surveillance System (BRFSS; nutrition, exercise, and physical activity). Overall differences between time points were assessed for statistical significance. Patient demographics are also described. Results. 177 patients completed baseline and follow-up outcome measures. Patients were predominantly white, female, college-educated, and employed. Baseline to one-year follow-up results indicate statistically significant improvements (p < .05) on all but perceived stress (PSS-4) and work absenteeism (WPAI). Clinical impact and/or practical effects are reported as percent change or standardized effect sizes whenever possible. Other demographic and descriptive information is summarized. Conclusions. Following one year of IM primary care at UAIHC, patient-reported outcomes indicated positive impacts in several areas of patients’ lives: mental, physical, and overall health; work productivity; sleep quality; pain; fatigue; overall well-being; and physical activity.
49
Eaton, Bree Ruppert, Tian Liu, Xiaofeng Yang, Donna Mister, Yize Zhao, Andrew H. Miller, Qi Long, and Mylin Ann Torres. "Perceived stress to predict for acute radiation-induced skin toxicity: The mind-body connection." Journal of Clinical Oncology 31, no. 26_suppl (September 10, 2013): 62. http://dx.doi.org/10.1200/jco.2013.31.26_suppl.62.
Full textAbstract:
62 Background: Previous studies have reported that breast cancer patients with high stress levels at diagnosis develop more frequent and severe side effects of chemotherapy treatment. However, the relationship between stress and radiotherapy (RT) related treatment toxicity has not been evaluated. We investigated whether baseline stress is associated with worse acute skin toxicity in women undergoing breast RT. Methods: Between March 2010 and April 2013, 80 post-lumpectomy breast cancer patients were enrolled on a prospective study prior to undergoing definitive whole breast RT (50 Gy plus a 10 Gy boost). Prior to RT (baseline), at week 6 of RT (T2), and 6 weeks post RT (T3), subjects completed the Perceived Stress Scale (PSS) and underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and in all four quadrants of the treated breast. A skin thickness ratio (STRA) was generated by normalizing for measurements taken of the untreated breast. RT-induced skin toxicity was assessed by measuring the change in STRA from baseline to T2 and T3. Results: Mean STRA increased by 23% (SD 27%) and 33% (SD 25%) from baseline to T2 and T3, respectively. Univariate analysis revealed PSS score at baseline (p=.04), body mass index (p=.03), maximum RT dose (Dmax) (p=.02) and whole breast volume (p<.001) were significantly associated with increased changes in STRA during RT. Depression, fatigue, race, chemotherapy, patient age, and tumor stage were not associated with changes in STRA. On multivariate analysis, PSS (p=.05), breast volume (p=.004), and Caucasian race (p=.04) were associated with greater acute changes in STRA from baseline to T2. Breast volume (p=.01), but not PSS, predicted for greater changes in STRA 6 weeks after RT was completed. Conclusions: In women with breast cancer, a high level of perceived stress prior to RT is associated with more severe acute skin toxicity during RT but not after RT is completed. Strategies to reduce stress prior to RT may improve tolerance of treatment.
50
Poot, Antonius J., Daisy M. Wopereis, Wendy P. J. den Elzen, Jacobijn Gussekloo, and Jeanet W. Blom. "Changes in patient satisfaction related to their perceived health state during implementation of improved integrated care for older persons." PLOS ONE 14, no. 5 (May 16, 2019): e0216028. http://dx.doi.org/10.1371/journal.pone.0216028.
Full text