Comprehensive Patient Education Research Articles

Material Technologies for Improved Diabetic Foot Ulcer (DFU) Treatment: A Questionnaire Study of Healthcare Professionals’ Needs

Background/Objectives: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetic patients, with significant global prevalence and associated health burdens, including high recurrence rates, lower-limb amputations, and substantial associated economic costs. This study aimed to understand the user needs of healthcare professionals treating diabetic foot ulcers for newly developed material technologies. Methods: An open-ended questionnaire was used to identify user needs, identify the limitations of current treatments, and determine the specific requirements for ideal treatment. This information was used to develop a list of key considerations for creating innovative material technologies to improve diabetic wound treatment results. Results: Most respondents indicated that they followed published treatment guidelines for DFUs but noted that treatment often required a case-specific approach. Antibiotics and surgical debridement were commonly used for infection control. The participants showed a strong preference for wound dressings with lasting antibacterial properties. Respondents identified ideal properties for new products, including ease of use, enhanced antibacterial properties, affordability, and targeted biological activity. The respondents also highlighted the importance of a holistic approach to DFU management, integrating product development with comprehensive care strategies and patient education. Conclusions: This study highlights the complexity of DFU care, emphasizing that no single product can address all treatment needs. Future materials could focus on combination therapies and specific use cases. Additionally, understanding global variations in treatment practices and educating users on the proper application of newly developed material technologies is crucial for improving the management of DFUs and patient outcomes.

Unexpected encounter with an intracameral cilium postcataract surgery

Abstract Background: Cataract surgery, a routine and highly successful ophthalmic intervention, is not immune to unexpected challenges. While complications are infrequent, their diverse nature necessitates a thorough understanding to ensure optimal patient outcomes. Case Report: This presentation focuses on a 55-year-old female who underwent routine phacoemulsification with intraocular lens placement. Despite uneventful initial postoperative assessments, a horizontally oriented intraocular cilium was discovered on the 1st day. Prompt removal was undertaken, leading to an uneventful recovery. The case is distinguished by video evidence ruling out the presence of cilium at the surgery’s conclusion, prompting exploration into the mechanisms of delayed entry. Discussion: Delving into the intricacies of intraocular cilium postcataract surgery, this discussion emphasizes the rarity of such occurrences and explores the spectrum of ocular responses documented in the literature. Patient-specific factors, wound integrity, and the role of postoperative eye rubbing are scrutinized. The importance of patient education, vigilant postoperative monitoring, and timely interventions to mitigate complications are highlighted. The case prompts a reconsideration of preventive strategies and underscores the adaptability required in managing unexpected challenges. Conclusion: In conclusion, this case of intraocular cilium following routine cataract surgery contributes a unique perspective to the understanding of postoperative complications. The absence of cilium at the surgery’s conclusion challenges assumptions, urging a reevaluation of preventive measures. Beyond this specific case, the discussion emphasizes the broader implications for patient care and surgical practice. The adaptive approach to unforeseen challenges, coupled with comprehensive patient education, emerges as pivotal for optimal outcomes in cataract surgery.

Efficient patient preparation in computed tomography coronary angiography

In the coming years, asignificant increase in the number of computed tomography coronary angiographies (CCTA) is expected, leading to an additional burden on existing structures. Discussion of effective processes and patient preparation in the context of high-volume CCTA. The relevance of patient education and optimized workflows in clinical practice, including pharmacological heart rate control and vasodilation. To conduct resource-efficient and effective patient examinations, comprehensive and clear patient education is crucial. This can be provided to the patient during scheduling or delivered digitally, so that the patient arrives with athorough understanding of the examination process. In addition, targeted optimization of workflows tailored to CCTA is important. For high image quality, the administration of β‑blockers is necessary in most cases. This can be done intravenously to save time. The administration of nitrates immediately before the examination is recommended by current guidelines for all patients without contraindications and is ideally applied sublingually shortly before the examination. The anticipated increase in CCTA will significantly strain existing structures not only in terms of reporting. Especially standardized and structured workflows pre- and periprocedurally are essential for handling ahigh number of examinations, while maintaining sufficient image quality in clinical practice.

Risk Factors and Drug Therapy Monitoring in CKD Patients (Chronic Kidney Disease)

Chronic Kidney Disease (CKD) is a global health problem that affects millions of people, characterized by a progressive decline in kidney function. This study aims to determine Drug Related Problems (DRPs) in the treatment management of CKD (Chronic Kidney Disease) patients. This study used the literature review method. The research results from the collected literature will be summarized and presented in the form of descriptive analysis. Researchers will conduct literature searches through online sites such as Google Scholar, PubMed, ResearchGate, Elsevier, and NCBI. The keywords used are “CKD risk factors” and “drug therapy for CKD patients”. The results of the search for relevant literature will be collected and selected according to the inclusion criteria. The research results from the collected literature will be presented in the form of a descriptive table. The table will include information such as author, year of publication, article title, and summary of the study results. The prevalence of drug-related problems (DRP) in CKD patients ranges from 12% to 87%. Commonly found problems include ineffective treatment, inappropriate drug selection, and drug dosing issues. Regular drug monitoring and dose adjustment are essential to reduce adverse drug reactions and improve patient outcomes. Effective drug therapy management and patient education are essential to improve the quality of care and life of CKD patients. In conclusion, this study emphasizes the importance of identifying and addressing drug-related problems (DRPs) to improve treatment effectiveness in CKD patients. Close drug monitoring and comprehensive patient education are key components in the optimal management of CKD.

The lived experience of patients going under hyperbaric oxygen therapy in Saudi Arabia: A phenomenological study.

Hyperbaric oxygen therapy (HBOT) has emerged as an effective treatment or adjunct therapy for various disorders, prioritizing improving oxygen delivery to tissues. This qualitative inquiry aims to explore the psychological experiences of patients undergoing their first hyperbaric session, focusing on the emotional responses and information needs of patients. The study addresses the gap in understanding patient experiences and seeks to contribute to holistic care approaches and improved health outcomes for patients undergoing HBOT. Using a phenomenological-hermeneutical approach, this study engaged 6 participants from KAASH in Taif City who had undergone at least 1 HBOT session. Data were collected through in-person interviews using a semistructured guide, focusing on patients' initial HBOT experiences. Giorgi 4-step method was applied for data analysis, allowing for rich descriptions and thematic categorization of the participants' lived experiences. The analysis is centered around "Walking into the unknown" with emerged subthemes (feeling anxious or being calm; immediate or evolving outcomes; formal orientation and management; success stories and self-learning) organized under 2 revised categories, "Transitioning from fear to reassurance" and "Navigating the path of understanding." The study also highlighted the critical role of healthcare providers in addressing information gaps and enhancing patient preparedness. The findings revealed the importance of comprehensive patient education and effective communication by healthcare providers to alleviate initial fears and improve treatment experiences for HBOT patients. Future research should expand to other regions and include healthcare providers' perspectives to further validate these findings and enhance HBOT practices. Integrating psychological support into the treatment process may also benefit patients, promoting holistic care and improving overall health outcomes.

NURSE'S ROLE IN CARING FOR A PATIENT WITH FOURNIER'S GANGRENE

Fournier's gangrene is a life-threatening condition characterized by rapidly progressive necrotizing fasciitis, often leading to sepsis and multiple organ failure. While historically associated with males, the condition can affect both genders, with varying degrees of severity. This case report explores the complex management of a 59-year-old male patient with a history of alcohol abuse, diabetes, cirrhosis, and a long-term smoking habit, who presented with Fournier's gangrene. The patient's critical condition and complex medical history presented significant challenges for healthcare providers, particularly nurses, who played a pivotal role in his care. These cases occur rarely in practice and require specific care and compliance with surgical nursing techniques per protocol. This case report not only sheds light on the growing incidence of Fournier's gangrene among both genders but also underscores the indispensable role of nurses in the multidisciplinary care of patients with this challenging condition. Comprehensive nursing care, patient education, and meticulous attention to detail are essential in improving patient outcomes and reducing mortality rates associated with Fournier's gangrene.

Epiretinal membrane: diagnostics, indications and surgical treatment

An epiretinal membrane (ERM) is afrequently occurring disease affecting the macula, which can be associated with visual impairment and metamorphopsia, depending on the severity and location. Adistinction is made between an idiopathic form caused by age-related changes of the vitreous body and asecondary form associated with diseases of the posterior segment. The development of fibrocellular epiretinal membranes formed by dedifferentiation of intraretinal and extraretinal cells at the level of the vitreomacular interface plays amajor role in the pathogenesis. The diagnostics and indications for surgical treatment of ERM are based on the visual acuity, evidence of metamorphopsia, ophthalmoscopic findings and optical coherence tomography (OCT) of the macula. In addition to the possibility of observation of the course where benign spontaneous courses are not uncommon, pars plana vitrectomy (PPV) with peeling of the ERM and internal limiting membrane (ILM) to prevent recurrences is the treatment of choice in symptomatic patients. The prognosis after surgical treatment is very good. In approximately two thirds of the cases, an improvement in visual acuity and/or areduction of metamorphopsia can be achieved, with anumber of predictive, primarily OCT-based factors enabling a prediction of the functional prognosis. Comprehensive patient education regarding the generally long duration of postoperative rehabilitation and the possibility of persistent symptoms or visual deterioration despite successful membrane removal is essential.

Horseshoe Retinal Tear Minutes After Use of a New Pilocarpine Formulation in a Presbyopic, Emmetropic Man

Purpose: To examine the risks associated with the use of pilocarpine hydrochloride 1.25% ophthalmic solution prescribed for presbyopia. Methods: The adverse ocular events reported after the use of pilocarpine were compared with the symptoms experienced by a 62-year-old presbyopic man shortly after taking pilocarpine. Results: The patient reported symptoms soon after instilling pilocarpine, including eye pain, hazy vision, and floaters. An examination showed a horseshoe retinal tear, vitreous hemorrhage, and posterior vitreous detachment, for which the patient received extensive clinical and surgical management. Conclusions: This case highlights the need for comprehensive eye examinations and patient education about the warning signs of retinal tears or detachments before prescribing pilocarpine for presbyopia. Vigilance regarding the potential rare adverse effects of this new pilocarpine ophthalmic solution is warranted.

The significance of precise diabetes diagnosis: a case of euglycemic diabetic ketoacidosis induced by the introduction of empagliflozin with simultaneous reduction of insulin dosage

Euglycemic diabetic ketoacidosis (euDKA) is a rare but severe metabolic complication of diabetes mellitus characterised by elevated anion gap metabolic acidosis despite normal or mildly elevated blood glucose levels. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as effective antidiabetic medications, yet their use is associated with an increased risk of euDKA, especially when coupled with insulin dose reduction. We present the case of a 50-year-old male with a 20-year history of diabetes mellitus, initially managed with insulin and metformin, who developed euDKA following the introduction of empagliflozin and sitagliptin alongside a reduction in insulin therapy. Despite normoglycaemia the patient exhibited symptoms of ketoacidosis, including chronic fatigue, polydipsia, and polyuria. Diagnostic workup revealed metabolic acidosis, elevated inflammatory markers, acute kidney injury and ketonuria. Subsequent specialised laboratory tests confirmed type 1 diabetes mellitus (T1DM) with the presence of anti-glutamic acid decarboxylase (anti-GAD) antibodies and the absence of C-peptide secretion. Management involved fluid therapy, intravenous insulin and glucose administration. This case underscores the diagnostic challenges of euDKA and emphasises the importance of differentiating between T1DM and T2DM, as management strategies vary significantly. Patient education on insulin therapy and injection techniques is crucial to prevent complications such as improper insulin delivery and dose reduction, which can precipitate euDKA. In conclusion, clinicians should be vigilant for euDKA in patients on SGLT2 inhibitors, particularly when insulin dose reduction is involved. Comprehensive patient education and accurate differentiation between diabetes types are essential for timely diagnosis and optimal management, thereby reducing the risk of severe complications.

Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment

The Advancing Americans Kidney Health Executive order has directed substantial increases in home dialysis use for incident kidney replacement therapy (KRT). Clinical guidelines recommend patients' self-selection of KRT modality through a shared decision-making process, which, at the minimum, requires predialysis nephrology care and KRT-directed comprehensive prekidney failure patient education (CoPE). The current state of these essential services among Americans with advanced (stages 4 and 5) chronic kidney disease (CKD) and their informed preferences for home dialysis are unknown. We conducted a community-based, cross-sectional, observational cohort study across a large regional Veteran Healthcare System from October 1, 2020, to September 30, 2021. Of the 928 Veterans with advanced CKD, 287 (30.9%) were invited for needs assessment evaluations. Of the 218 (76% of invited cohort) responding, 178 (81.6%) were receiving nephrology care, with approximately half of those (43.6%) receiving such care from non-Veterans Affairs providers. The study was targeted to assess the prevalent state of ongoing nephrology care and KRT-directed pre-kidney failure education among Veterans with advanced CKD. The secondary outcome included evaluation of dialysis decision-making state among Veterans with advanced CKD. Veterans with advanced CKD with 2 sustained estimated glomerular filtration rates<30mL/min/1.73m2 were identified through an electronic database query, and a randomly selected cohort was invited for their current state of and outstanding needs for predialysis nephrology care and CoPE, essential for informed KRT selection. Basic awareness of kidney disease was high (92.2%) among Veterans with advanced CKD, although only 38.5% were aware of the severity of their CKD. KRT-directed education during clinical care was reported by 46.8% of Veterans, of which 21.1% reported having received targeted CoPE classes. Three-quarters (74.3%) of Veterans expressed interest in receiving CoPE services. Overall, awareness of CKD and its severity and receipt of KRT-directed education were significantly higher among Veterans with nephrology care than among those without. Of the 61 Veterans providing their KRT preferences, overall decision making was poor, with three-quarters (73.8%) of the cohort unable to choose any KRT modality, irrespective of ongoing nephrology care. Only 8 (13%) felt confident choosing home KRT modalities. The study results are primarily applicable to the Veterans with advanced CKD. Furthermore, a limited numbers of respondents provided data on their KRT decision-making state, prohibiting broad generalizations. In a first-of-its-kind community-based needs assessment evaluation among Veterans with advanced CKD, we found that awareness of kidney disease is positively associated with nephrology care; however, the informed KRT selection capabilities are universally poor, irrespective of nephrology care. Our results demonstrate a critical gap between the recommended and prevalent nephrology practices such as KRT-directed education and targeted CoPE classes required for informed patient-centered home dialysis selection in advanced CKD.

Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study.

Quantitative studies have provided valuable statistical insights into Health-Related Quality of Life (HRQoL) among patients with Heart Failure (HF), yet they often lack the depth to fully capture the nuanced, subjective experiences of living with HF particularly in the specific context of Jordan. This study explores the personal narratives of HF patients to understand the full impact of HF on their daily lives, revealing HRQoL aspects that quantitative metrics often miss. This is crucial in developing regions, where the increasing prevalence of HF intersects with local healthcare practices, cultural views, and patient expectations, providing key insights for tailored interventions and better patient care. Utilizing a phenomenological qualitative design, this study conducted face-to-face semi-structured interviews with 25 HF patients to deeply explore their lived experiences. Thematic analysis was employed to identify major themes related to their perceptions of HF as a disease, its impact on various HRQoL domains, and their recommended strategies to enhance HRQoL. The study involved 25 participants (13 males, 12 females), aged 26-88 years (mean 63), with diverse education and heart failure (HF) severities. It revealed three themes: HF perceptions, its impact on health-related quality of life (HRQoL) across physical, psychosocial, spiritual, cognitive, and economic domains, and HRQoL improvement strategies. Participants had varied HF knowledge; some lacked basic understanding. The physical impact was most significant, affecting daily life and causing symptoms like breathing difficulties, coughing, edema, and fatigue. This physical aspect influenced their psychosocial and spiritual lives, cognitive functions, and economic stability, leading to fear, frustration, worry, social isolation, spiritual and cognitive challenges, and employment problems. The results underscores the need for holistic healthcare approaches, integrating medical, psychological, and social support. Key recommendations include integrated care models, comprehensive patient education, support networks, and policy interventions to enhance HF patient care.

Bladder cancer: An Update.

Bladder cancer, the 10th most common cancer globally, primarily manifests as urothelial cell carcinoma. Risk factors involve acquired genetic mutations and congenital predispositions, impacting diagnosis and management. This article discusses the risk factors, clinical presentation, and treatment strategies, with emphasis on providing comprehensive nursing support and patient education to patients with bladder cancer.

Enhanced recovery after endoscopic sinus surgery: Establishing comprehensive protocols for improvement of perioperative patient care

AbstractObjectivesEnhanced recovery after surgery (ERAS) protocols for endoscopic sinus surgery (ESS) have not been widely implemented, and a critical review of ERAS recommendations and a comprehensive analysis of the supporting literature has not been undertaken. We describe an ESS ERAS protocol including key perioperative interventions for patients undergoing ESS and assess the available evidence.Data SourcesA search was conducted of all relevant ERAS literature in otorhinolaryngology, anesthesia, and surgery using Medline (via PubMed), and Scopus. Keywords included “endoscopic sinus surgery,” “sinus surgery,” “FESS,” and “ESS” for each area of intervention. Where applicable, the authors considered high‐level evidence for recommendations devised for patient cohorts in otorhinolaryngology not undergoing ESS, as well as cohorts undergoing surgical procedures for which ERAS protocols have been extensively evaluated.MethodsStudies received grades of “low,” “moderate,” or “high” quality evidence based on the Oxford Centre for Evidence‐Based Medicine criteria. Each intervention was subsequently assigned a grade of “strong,” “weak,” or “conditional” based on the available evidence.ResultsStrong recommendations include comprehensive patient education and counseling, minimization of preoperative fasting, application of topical/local anesthetics and vasoconstrictors, use of total intravenous anesthesia, avoidance of pharyngeal packing, and use of postoperative nasal irrigation and multimodal analgesia. Conditional recommendations include antibiotic prophylaxis. Weak recommendations include perioperative venous thromboembolism prophylaxis, controlled hypotension, and use of postoperative nasal packing/dressing.ConclusionA comprehensive ERAS protocol for ESS can include a variety of high yield, evidence‐based interventions that would likely improve surgical outcomes and patient satisfaction.

Risk factors associated with changes in serum anti-Müllerian hormone levels before and after laparoscopic cystectomy for endometrioma.

The objective of our study was to investigate the risk factors for a decrease in ovarian reserve in patients with endometriomas after standardized laparoscopic procedures and evaluation to provide corresponding clinical guidance for patients with fertility requirements. Anti-Müllerian hormone (AMH) levels and other clinical data from 233 patients with endometriomas and 57 patients with non-endometrioma ovarian cysts admitted to the Peking Union Medical College Hospital between January 2018 and September 2023 were prospectively analysed. The pretreatment AMH levels of the study groups were compared to assess the impact of endometrioma on ovarian reserve, and the decrease in AMH after treatment was analysed to determine potential risk factors contributing to this change. Pretreatment AMH levels did not significantly differ between patients with endometriomas and those with non-endometrioma ovarian cysts. Within the endometrioma group, older age, higher body mass index (BMI), and shorter menstrual cycles were found to be associated with decreased AMH levels prior to treatment (p<0.05). Participants presenting with bilateral cysts, advanced surgical staging, or a completely enclosed Douglas pouch demonstrated significantly lower levels of AMH prior to treatment compared to those without these conditions (p<0.05). Furthermore, their AMH levels further declined within one year after undergoing laparoscopic cystectomy (p<0.05). However, there was no difference in AMH levels after surgery between patients who successfully became pregnant and those who did not (p>0.05). Laparoscopic removal of endometriomas can adversely affect ovarian reserve, especially during bilateral cysts removal and when patients are diagnosed as having a higher stage of endometriosis, further impacting ovarian function. It should be noted that a decrease in AMH levels may not necessarily indicate an absolute decline in fertility. Therefore, it is crucial to conduct thorough patient evaluations and provide comprehensive patient education to offer appropriate guidance for fertility preservation.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Effects of a comprehensive structured patient education intervention on disease-related knowledge and behaviour change among people living with type 2 diabetes in the Philippines.

Addressing the ongoing needs of individuals with diabetes, particularly in low- and middle-income countries like the Philippines, requires a focus on regular follow-ups with healthcare teams, adherence to healthy behaviors, and effective patient education to prevent long-term complications. The aim of this study was to ascertain the impact of a comprehensive educational program for those living with diabetes in the Philippines. In a prospective study, a convenience sample of patients living with diabetes attending a cardiac rehabilitation or an outpatient diabetes clinic in the Philippines received a 12-week education intervention. Participants completed surveys at pre- and post-intervention assessing disease-related knowledge, health literacy, dietary habits, and tobacco use. Physical activity was measured by steps taken per day using wearable devices and by self-report of minutes of moderate or vigorous-intensity exercise per week. Satisfaction with the educational materials was also evaluated by a survey composed of Likert-type scale and open-ended questions. Descriptive statistics, paired t-tests or chi-square were used for data analysis. Overall, 184 individuals living with diabetes type 2 (mean age = 54.4 ± 12.4, 32% female) completed both assessments. There was significant improvement in disease-related knowledge (p < 0.001), daily steps measured by a wearable device and self-reported minutes of moderate/vigorous-intensity exercise (p < 0.001), and the number of fruit and vegetable servings consumed per day (p = 0.001). No significant changes were observed in health literacy levels. One participant stopped using tobacco at post-education. Educational materials were highly satisfactory to participants. Lack of time, family responsibilities, and poor internet access were the main barriers to learning reported by participants. Suggestions to improve the education provided included assessment of information needs at the start of the education, having short summaries about the topics, follow-ups post-intervention, and inviting family members to sessions. Results of this study demonstrated the positive effects a comprehensive structured patient education intervention on disease-related knowledge and behaviour changes among people living with type 2 diabetes in the Philippines.

Virtual Laboratories for Diabetes Education on Artificial Pancreas

A crucial aspect of diabetes management is the comprehensive education of clinical staff, patients, and caretakers. The introduction of advanced technologies in artificial pancreas devices heightens this need, as patients must learn to manage their condition and navigate the evolving technological components of their treatment. A series of self-guided virtual laboratories has been developed to aid this process. These laboratories are designed to introduce diabetes management agents to the control engineering concepts used in artificial pancreas systems, as well as to the fundamental clinical and physiological aspects of daily diabetes management.

MEDICATION ADHERENCE: UNDERSTANDING THE CHALLENGES AMONG THE ELDERLY

This study explores medication adherence challenges in the elderly population, focusing on the complexities and dynamics of managing polypharmacy in a geriatric care setting. The research was conducted in One Stop Home Care Centre, Sri Damai, Kuantan, Malaysia, involving 10 participants aged between 45 and 72. It employs a mixed-methods approach, utilizing structured questionnaires and in-depth interviews to assess medication adherence behaviours and the influencing factors. The findings indicate a significant discrepancy between self-reported medication adherence and actual practices. While 50% of participants reported managing a single medication, observational data revealed a more intricate medication regimen, with some managing up to four different medications. The study highlights the critical role of social support systems in promoting medication adherence, with all participants adhering to their prescribed schedules due to robust caregiver involvement. However, 30% reported occasional lapses due to the complexity of their medication regimens. Notably, side effects like headaches and sleepiness were identified as key factors affecting medication adherence, underscoring the need for tailored approaches to manage side effects. The study emphasizes the importance of understanding the unique characteristics and challenges of medication adherence in the elderly, especially in the context of polypharmacy. The research also points out the socio-economic impact of an aging population and the growing demand for age-appropriate healthcare services. It emphasises the need for strategic health policy and planning to cater to the unique needs of the elderly. The findings advocate for comprehensive patient education, shared responsibility between residents and caregivers, and the implementation of systems to monitor medication intake and side effects. The study therefore provides valuable insights into medication adherence among the elderly, highlighting the necessity for personalised interventions and strategies to enhance health outcomes in this demographic. The research also acknowledges limitations, including a one-time visit for data collection and the lack of long-term follow-up, suggesting areas for future research.

Understanding Prescribing Practices and Patient Experiences with Renin Angiotensin System Inhibitors Use in Chronic Kidney Disease: A Qualitative Study

Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) improve outcomes but are underutilized in patients with chronic kidney disease (CKD). Little is known about reasons for discontinuation and lack of reinitiating these medications. We aimed to explore clinicians’ and patients’ experiences and perceptions of ACEI/ARB use in CKD. Methods: A multi-profession sample of health care clinicians and patients with documented ACEI/ARB-associated side effects in the past 6 months. Participants were recruited from 2 Veterans Affairs healthcare systems in Texas and Tennessee. A total of 15 clinicians and 10 patients completed interviews. We used inductive and deductive qualitative data analysis approaches to identify themes related to clinician and patient experiences with ACEI/ARB. Thematic analysis focused on prescribing decisions and practices, clinical guidelines, and perception of side effects. Data were analyzed as they amassed, and recruitment was stopped at the point of thematic saturation. Results: Clinicians prescribe ACEI/ARB for blood pressure control and kidney protection and underscored the importance of these medications in patients with diabetes. While clinicians described providing comprehensive patient education about ACEI/ARB in CKD, patient interviews revealed significant knowledge gaps about CKD and ACEI/ARB use. Many patients were unaware of their CKD status, and some did not know why they were prescribed ACEI/ARB. Clinicians’ drug management strategies varied widely, as did their understanding of prescribing guidelines. They identified structural and patient-level barriers to prescribing and many endorsed the development of a decision support tool to facilitate ACEI/ARB prescribing and management. Discussion/Conclusion: Our qualitative study of clinicians and providers identified key target areas for improvement to increase ACEI/ARB utilization in patients with CKD with the goal to improve long-term outcomes in high-risk patients. These findings will also inform the development of a decision support tool to assist with prescribing ACEI/ARBs for patients with CKD.

Evaluation of services provided in a gender health clinic

BackgroundTransgender and gender diverse (TGD) individuals face discrimination and mistreatment in healthcare spaces, resulting in poor health. The Mountain Area Health Education Center (MAHEC) Gender Health Clinic was launched in September of 2022 to meet the healthcare needs of TGD patients. ObjectiveDescribe services provided in and patient satisfaction with an interdisciplinary Gender Health Clinic serving TGD patients. Practice DescriptionThe Gender Health Clinic is a subspecialty clinic of the MAHEC Family Health Center in Asheville, North Carolina. The clinic offers interdisciplinary services to TGD patients, including primary care, gynecology, and medication management. Practice InnovationThe interdisciplinary clinic team was assembled to create a safe environment for TGD patients to receive medical care. The pharmacy team facilitated provider training, consolidated clinical references, and provided comprehensive patient education on hormone therapy. Evaluation MethodsA quantitative description of services and patient demographic information was evaluated through a retrospective chart review of the first six months of the clinic. Patient satisfaction was evaluated through anonymous questionnaires. ResultsForty-four patient encounters were evaluated for 23 unique patients. The mean age was 26.6 years, and 65.2% of patients were assigned female at birth. Gender identities were distributed across male (39.1%), female (34.8%), and non-conforming (26.1%). Nearly all patients (97.7%) received documented general education from any provider. Most patients (79.6%) received prescriptions for hormone therapy. More than one-third (38.7%) of patients had a documented pharmacist interaction. Twenty-one questionnaires were completed out of 23 unique patients. All respondents rated their overall experience as “Excellent” or “Very Good.” Highly rated positive clinical interactions included courteous clinical staff (4.9) and having needs met (4.8). Ease of scheduling an appointment (4.3) was rated lowest among all questionnaire items. ConclusionThe positive patient experiences and level of services provided suggest a promising start to MAHEC’s Gender Health Clinic.