Radiofrequency for Facial & Neck Rejuvenation: A Bibliometric Analysis

BackgroundDespite the increasing use of patient-reported outcome measures (PROMs) for collecting self-reported data among hospital outpatients, clinicians’ use of these data remains suboptimal. Insight into this issue and strategies to enhance the use of PROMs are critical but limited.ObjectiveThis study aimed to examine clinicians’ use of PROM data for value-based outpatient consultations and identify efforts to enhance their use of PROMs in a Dutch university hospital. First, we aimed to investigate clinicians’ use of outpatients’ PROM data in 2023, focusing on adoption, implementation, and maintenance. Second, we aimed to develop insights into the organizational-level strategies implemented to enhance clinicians’ use of PROM data from 2020 to 2023. This included understanding the underlying rationales for these strategies and identifying strategies that appeared to be missing to address barriers or leverage facilitators. Third, we aimed to explore the key factors driving and constraining clinicians’ use of PROMs in 2023.MethodsWe integrated data from 4 sources: 1-year performance data on clinicians’ use of PROMs (n=70 subdepartments), internal hospital documents from a central support team (n=56), a survey among clinicians (n=47), and interviews with individuals contributing to the organizational-level implementation of PROMs (n=20). The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to analyze clinicians’ adoption, implementation, and maintenance of PROMs. Strategies were analyzed using the Expert Recommendations for Implementing Change taxonomy, and results were structured around the constructs of capability, opportunity, and motivation.ResultsOn average, around 2023, clinicians accessed PROM data for approximately 3 of 20 (14%) patients during their outpatient consultation, despite numerous strategies to improve this practice. We identified issues in adoption, implementation, and maintenance. The hospital’s strategies, shaped organically and pragmatically, were related to 27 (37%) out of 73 Expert Recommendations for Implementing Change strategies. These strategies focused on enhancing clinicians’ capability, opportunity, and motivation. We found shortcomings in the quality of execution and completeness of strategies in relation to addressing all barriers and leveraging facilitators. We identified variations in the factors influencing the use of PROMs among frequent PROM users, occasional users, and nonusers. Challenges to effective facilitation were apparent, with certain desired strategies being unfeasible or impeded.ConclusionsEnhancing clinicians’ use of PROMs has remained challenging despite various strategies aimed at improving their capability, opportunity, and motivation. The use of PROMs may require more substantial changes than initially expected, necessitating a shift in clinicians’ professional attitudes and practices. Hospitals can facilitate rather than manage clinicians’ genuine use of PROMs. They must prioritize efforts to engage clinicians with PROMs for value-based outpatient care. Specific attention to their professionalization may be warranted. Tailored strategies, designed to address within-group differences in clinicians’ needs and motivation, hold promise for future efforts.

Category: Other; Ankle Introduction/Purpose: Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation. This randomized, controlled trial study objectives: 1) Determine if the active use and discussion of PROMs during new patient visits are associated with patient satisfaction and experience 2) Determine if the active use and discussion of PROMs during new patient clinic visits are associated with patient activation; and 3) To determine if the objectives (1) and (2) differ based on surgeon or sociodemographic factors. Methods: This Institutional Review Board (IRB) approved singled-blinded RCT was registered prior to data collection on ClinicalTrials.gov (NCT04654910). As a standard of care, new foot and ankle patients completed PROMIS Physical Function (PF), Pain Interference (PI), and Depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). CG-CAHPS findings and PAM responses were compared between the two groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored. Results: After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses, nor PAM scores between the two groups (p>0.05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate “top box” scores for the understanding domain of the CG-CAHPS question (OR:0.51;p < 0.001) and had decreased odds of high patient activation compared to control subjects (OR:0.67;p=0.005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (p=0.09). Conclusion: Well perceived foot and ankle surgeons who show and discuss PROMs results may not improve the patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROMs discussions are most beneficial and how best to present PROMs data. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs.

Purpose: We aimed to map the physiotherapy practice in Sweden of clinical tests and patient-reported outcome measures in low-back pain (LBP), and to study advantages and barriers in using patient-reported outcome measures.Methods: An online survey was mailed to 4934 physiotherapists in primary health care in Sweden. Multiple choice questions investigated the use of clinical tests and patient-reported outcome measures in assessing patients with LBP. Open questions investigating the advantages and barriers to the use of patient-reported outcome measures were analyzed with content analysis.Results: The response rate was 25% (n = 1217). Clinical tests were used “always/often” by >60% of the participants, while most patient-reported outcome measures were used by <15%. Advantages in using patient-reported outcome measures were: the clinical reasoning process, to increase the quality of assessment, to get the patient’s voice, education and motivation of patients, and communication with health professionals. Barriers were lack of time and knowledge, administrative aspects, the interaction between physiotherapist and patient and, the applicability and validity of the patient-reported outcome measures.Conclusion: Our findings show that physiotherapists working in primary health care use clinical testing in LBP to a great extent, while various patient-reported outcome measures are used to a low-to-very-low extent. Several barriers to the use of patient-reported outcome measures were reported such as time, knowledge, and administrative issues, while important findings on advantages were to enhance the clinical reasoning process and to educate and motivate the patient. Barriers might be changed through education or organizational change-work. To enhance the use of patient-reported outcome measures and thus person-centered care in low-back pain, recommendation, and education on various patient-reported outcome measures need to be advocated.Implications for rehabilitationTo increase the effects of rehabilitation in low-back pain, yellow flags, and other factors need to be taken into the consideration in the assessment which means the use of patient-reported outcome measures in addition to clinical testing.The use of patient-reported outcome measures is an advantage in the clinical reasoning process to enhance the quality of assessment and to educate and motivate the patient.Barriers to use patient-reported outcome measures are mainly lack of time and knowledge, and administrative aspects.Through education or organizational change-work, barriers to the use of patient-reported outcome measures might be changed.

Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy. A sample of N=109 clinicians completed an online survey. Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self-efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self-efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self-efficacy regarding PROMs. Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice.

Trends in shoulder surgery patient-reported outcome measures

Different patient-reported outcome (PRO) measures have been used and validated in studies of patients with heart failure (HF), including disease-specific measures like the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ). However, there is limited research available regarding the content validity (i.e., comprehensiveness, relevance, and comprehensibility) of those measures specifically as it relates to patients with acute HF (AHF). This study used a stepwise approach to identify PRO measures used in AHF studies and evaluate their content validity through a landscape analysis, concept mapping, and cognitive debriefing (CD) interviews with US-based patients. A landscape analysis was performed to identify PRO measures used in AHF studies. To assess concept coverage, items in each PRO measure were mapped to concepts (i.e., signs/symptoms and impacts on daily life) from the AHF conceptual model developed by Moshkovich et al. (2020). PRO measures with the most comprehensive and/or appropriate concept coverage were further evaluated through CD interviews with US adults who had been hospitalized for AHF within the last six months. The landscape analysis resulted in the identification of 15 PRO measures for use in AHF; nine were deemed appropriate for concept mapping. Following mapping, four measures were selected for further research based on their comprehensive concept coverage (KCCQ, PROMIS®+HF-27), effectiveness at measuring health utility (EQ-5D-5L), and suitability for measuring shortness of breath (a dyspnea numeric rating scale [NRS]). The KCCQ, in particular, showed good concept coverage, addressing more than half (n=12) of the key concepts in the Moshkovich et al. (2020) model. Twenty adults with AHF, representing NYHA classes I (n=4), II (n=8), and III (n=8), a mean age of 64 years (range: 39-81), and an average of 110 days since hospitalization (range: 26-183), participated in CD interviews. Participants found each measure easy to understand and answer, with items relevant to their experience of AHF. Participants found the recall periods, ranging from 24-hours to 2-weeks, appropriate and easy to use. This study’s stepwise approach allowed for the systematic identification and evaluation of the content validity of four PRO measures—the KCCQ, dyspnea NRS, EQ-5D-5L, and PROMIS®+HF-27—for use with adults with AHF. This research fills a gap in the current published literature regarding measures appropriate for use with adults with AHF.

Barriers and Best Practices for the Use of Patient-Reported Outcome Measures in Emergency Medicine.

ObjectiveWe aimed to provide an up-to-date synthesis of the effectiveness of patient reported outcome measures (PROMs) to self-monitor symptoms compared to conventional follow-up care in rheumatic disease patients. The effect of providing feedback via PROMs was also evaluated.MethodsThis review was guided by the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Articles published before December 2024 were retrieved from PubMed®, Cochrane Library®, Embase®, and PsycINFO® (Ovid). Studies were included if they (1) compared PROMs against no PROMs use, or (2) or if they utilized PROMs as an intervention with feedback provided to healthcare professionals or patients for comparison against PROMs use without feedback. Non-English articles and abstract-only articles were excluded. Results were synthesized in a narrative manner. Methodological quality was assessed using the Risk of Bias tool and the Risk of Bias in Non-randomized Studies of Interventions tool.ResultsA total of 18, 159 articles were screened, and 9 articles were included. All 9 studies reported on the use of PROMs as an intervention against a control where no PROMs were used. 4 of the studies included reported improvements in symptom control; 1 study observed improvement in health-related quality of life (HRQoL) when PROMs were used. High patient satisfaction was observed in 5 studies, but the results were statistically insignificant. 1 found that PROMs use facilitated shared decision making. 3 studies reported on clinic visits with mixed results. No studies reported on survival/mortality. Out of the 9 studies, 2 studies compared PROMs with feedback to patients and/or healthcare professionals against PROMS without feedback. There was conflicting evidence whether PROMs with feedback improved patient satisfaction in clinical care. Three studies were identified to be of moderate to high risk of bias.ConclusionThe use of PROMs self-symptom monitoring may contribute to improving symptom control, HRQoL, patient perception, promote shared decision making, and reduce clinic visits. Our study may have limited generalizability to other rheumatic disease beyond RA as most of our study is in rheumatoid arthritis. More studies in other rheumatic diseases are needed.RegistrationThe protocol was registered in OpenSci Framework (https://doi.org/10.17605/OSF.IO/ZU9XM).

BackgroundOlder people with severe frailty (OPWSF) have palliative needs but typically do not receive specialist palliative care (SPC). Patient-Reported Outcome Measures (PROMs) may offer valuable means to capture these needs. There is a limited understanding of what to include and how to implement PROMs in settings where this group receive most care. The study aimed to: (1) Critically examine how existing PROMs are currently implemented with OPWSF within a SPC setting. (2) Understand how the items with the PROMs are used (3) Develop a programme theory to determine how PROMs can be optimally designed and implemented to effectively capture the needs and priorities of OPWSF in the care setting where they receive most care.MethodologyMixed methods study in SPC community service in an urban area in the UK including: • Healthcare professionals (HCPs) providing care to OPWSF with a minimum of 6 months experience in a patient-facing role were purposively sampled: semi-structured interviews (n11); non-participatory observations (n10) - thematically analysed. • One-year retrospective case-note review of 357 episodes of care involving service-users identified with frailty at referral. Exploratory descriptive statistics were used to analyse the use of the Integrated Palliative Outcome Scale (IPOS) alongside additional clinical-led outcome measures. • Date integration using the Consolidation Framework for Implementation Research (CFIR) to develop a programme theory.ResultsPROMs can be effectively used with OPWSF, yet existing PROMs require adapting to ensure they capture the needs that matter most. • Completion of PROMs for this group largely depends on the assistance of others. • HCPs’ use of PROMs may be driven by immediate care and priorities of the care system rather than determining changes over time, with the psycho-social aspect of the PROMs being more challenging to complete.ConclusionBy utilising the CFIR, the study highlights the complexities and variabilities of using PROMs with OPWSF. Future research should focus on adapting and validating existing PROMs to ensure they are fit for purpose with this population, with the involvement of older people with frailty and unpaid carers. Providers should extend support and training for professionals in the use and value of PROMs and psychosocial-spiritual care.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41687-025-00951-9.

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel

While access-related dysfunction is a clear driver of clinical outcomes and costs, the full impact of vascular access dysfunction on patient experience and quality of life is not fully characterized in the literature. One way to more comprehensively characterize the patient experience from the patient perspective is through patient reported outcomes (PROs). However, the limited implementation of PROs in clinical trials, patient registries, quality measurement, and other research settings has significantly constrained the patient voice in evaluation of vascular access outcomes and vascular access decision-making. To address these issues, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the U.S. Food and Drug Administration, assembled an interdisciplinary workgroup to enhance uptake of access-related PROs with the aims of: (1) reviewing the domains of HRQOL that are affected by vascular access, collect information on existing instruments that measure access-specific HRQOL in hemodialysis, and identify gaps in existing measures; (2) identifying and critically assessing barriers to widespread use of access-specific PRO measures; and (3) defining initiatives to overcome barriers and make recommendations for strategies to improve the use and utility of access-specific PRO measures. A consensus group process identified potential barriers to use of PRO measures in six categories: (1) PRO misperceptions, (2) patient factors, (3) regulators and payers, (4) instrument factors, (5) study design, and (6) physicians. The workgroup provided recommendations for actions to promote the widespread utilization of vascular access-related PRO measures in five categories: (1) development of vascular access-specific PRO measures, (2) ensuring comprehensive assessment when using vascular access PRO measures, (3) ensuring accessibility and applicability of vascular access PRO measures to all end stage kidney disease populations, (4) establishing universal guidelines and accepted vascular access PRO measures, and (5) engaging stakeholders across all facets.

ObjectiveTo gain information about the advantages/disadvantages of an implementation of patient-reported outcome measures (PROM) into the clinical routine of trauma/orthopaedic surgeons, and to identify the technical constraints confronting a successful...

BackgroundPersons with high-grade glioma face both neurological and cancer-related symptoms from the tumor itself and its treatment affecting their daily lives. Survival alone is not an adequate outcome, the quality of the survivorship experience needs to be regarded with equal importance. Patient-reported outcome (PRO) measures can be used to evaluate treatment effects and symptom management interventions.PurposeThe aim of this review was to identify the use, challenges, and potential of PRO measures in survivors of high-grade glioma.MethodsA narrative expert opinion review was performed on the subject. In addition to our own experiences we searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and PsycINFO for brain tumor-specific PRO measures used in the population of adult patients with high-grade glioma, both original articles and reviews were included.ResultsThere are several PRO measures that have been validated for patients with primary brain tumors including high-grade glioma. PRO measures are used both in clinical trials to evaluate the effect of treatment on health-related quality of life, and in daily clinical practice for holistic needs assessment and symptom management. Common PRO measures used for patients with high-grade glioma are European Organization for Research and Treatment of Cancer general instrument for patients with cancer together with brain tumor module, Functional Assessment of Cancer Therapy-Brain, and MD Anderson Symptom Inventory for Brain Tumor. Neurologic and cognitive disorders often occur in patients with high-grade glioma, which affects patients’ ability to self-report over time, making it more challenging in this population. PRO as a primary outcome seems underutilized.ConclusionFor clinical research, PRO measures need to be used together with other clinical outcome measures rather than replacing traditional outcome measures. Moving to more use of PRO measures in survivorship care has potential to improve patient-caregiver-healthcare team communication, symptom management, and quality of care. Implementing PROs in survivorship care should also involve caregivers and a response based on the results.

Patient-reported outcome measurements (PROMs): Use during the physical therapy practice and associated factors

ObjectiveTo discuss the opportunities and challenges of implementing patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) within advanced practice nursing services in cancer care. MethodsThis discussion paper has been informed by an environmental scan of evidence from systematic reviews and primary studies evaluating the use and implementation of PROMs and PREMs. Literature from the contexts of cancer and chronic disease, including nursing and multidisciplinary supportive care literature, has been included. ResultsAdvanced practice nurses are well-positioned to evaluate and respond to PROMs and PREMs data; several studies have highlighted improved patient outcomes concerning quality of life, symptom distress, and functional status within nurse-led services. Nevertheless, the implementation of PROMs and PREMs in cancer care and nurse-led services is variable. Previous studies have highlighted implementation challenges, which can hinder comparability and generalizability of PROMs and PREMs instruments. Advanced practice nurses should consider these challenges, including ways to use standardized PROM instruments. Electronic PROMs, while efficient, may exclude individuals at risk of inequity. Complex, lengthy, and frequent administration of PROMs may also overburden people living with or after cancer, with people affected by cancer expressing preference for flexible use in some studies. Therefore, the involvement of people affected by cancer in planning for PROMs/PREMs implementation may overcome this challenge. Finally, organizational considerations in implementation should address financial investments, including initial costs for technology and training and consideration of the operationalization of PROMs within existing infrastructure for the seamless utilization of PROMs data. ConclusionDespite the potential of advanced practice nursing services to enhance patient-reported outcomes and experiences, variability in the implementation of PROMs and PREMs poses challenges. Use of validated measures, electronic or paper-based instruments, and the preferences of people affected by cancer for the use of PROMs and PREMs must be carefully considered in consultation with end users for successful implementation. Implications for PracticeIn planning for the implementation of PROMs and PREMs within nurse-led services, implementation risks may be mitigated through establishing clear guidelines for their use, investment in the development of the required infrastructure, user education, and rigorous implementation processes, including patient involvement in PROMs/PREMs selection.