Differences In Patient Preferences Research Articles

Comparative study of optimal compression pressure between conventional Barton's dressing and prefabricate garment in parotidectomy patients.

Excessive compression after parotidectomy can lead to flap necrosis, while inadequate pressure can cause fluid accumulation. This study aimed to determine the optimal pressure and compression properties of different types of dressings. Initially, pressure measurements were taken for conventional Barton's dressing and a pre-fabricated facial garment. In the subsequent phase, patients were randomly assigned to receive one of three types of pressure dressings: conforming bandage Barton's dressing, elastic bandage Barton's dressing or pre-fabricated facial garment. The dressing types were randomly crossed over the following day. The mean pressure exerted by conventional Barton's dressing and the pre-fabricated facial garment was 15.86 and 14.81 mmHg, respectively. There was no significant difference in the proportion of optimal pressure among the three types of pressure dressing (p-values of 0.195, 0.555 and 0.089 at pre-auricular, angle of mandible and post-auricular sites, respectively). The pre-auricular area demonstrated the highest proportion of optimal pressure, while suboptimal pressure was noted at the angle of the mandible and post-auricular area. Dressing types had no effect on pressure stability (p = 0.37), and there was no significant difference in patient preference (p = 0.91). Conforming bandage Barton's dressing, elastic bandage Barton's dressing and pre-fabricated facial garment exhibit comparable compressive properties, with no significant difference in patient preference and pressure stability.

Disparities in Adult Patient Selection for Extracorporeal Membrane Oxygenation in the United States: A Population-Level Study.

Rationale: Disparities in patient selection for advanced therapeutics in health care have been identified in multiple studies, but it is unclear if disparities exist in patient selection for extracorporeal membrane oxygenation (ECMO), a rapidly expanding critical care resource. Objectives: To determine if disparities exist in patient selection for ECMO based on sex, primary insurance, and median income of the patient's neighborhood. Methods: In a retrospective cohort study using the Nationwide Readmissions Database 2016-2019, we identified patients treated with mechanical ventilation (MV) and/or ECMO with billing codes. Patient sex, insurance, and income level for patients receiving ECMO were compared with the patients treated with MV only, and hierarchical logistic regression with the hospital as a random intercept was used to determine odds of receiving ECMO based on patient demographics. Results: We identified 2,170,752 MV hospitalizations with 18,725 cases of ECMO. Among patients treated with ECMO, 36.1% were female compared with 44.5% of patients treated with> MV only (adjusted odds ratio [aOR] for ECMO, 0.73; 95% confidence interval [CI], 0.70-0.75). Of patients treated with ECMO, 38.1% had private insurance compared with 17.4% of patients treated with MV only. Patients with Medicaid were less likely to receive ECMO than patients with private insurance (aOR, 0.55; 95% CI, 0.52-0.57). Patients treated with ECMO were more likely to live in the highest-income neighborhoods compared with patients treated with MV only (25.1% vs. 17.3%). Patients living in the lowest-income neighborhoods were less likely to receive ECMO than those living in the highest-income neighborhoods (aOR, 0.63; 95% CI, 0.60-0.67). Conclusions: Significant disparities exist in patient selection for ECMO. Female patients, patients with Medicaid, and patients living in the lowest-income neighborhoods are less likely to be treated with ECMO. Despite possible unmeasured confounding, these findings were robust to multiple sensitivity analyses. On the basis of previouswork describing disparities in other areas of health care, wespeculate that limited access in some neighborhoods, restrictive/biased interhospital transfer practices, differences in patient preferences, and implicit provider bias may contribute to the observed differences. Future studies with more granular data are needed to identify and modify drivers of observed disparities.

A comparative assessment of efficacy and preference between needleless device INJEX and insulin syringe for anesthetizing primary maxillary teeth in children aged 4-9 years: A split-mouth crossover randomized clinical study.

This randomized clinical study included 46 children aged 4-9 years. The patients were digitally allotted to receive 4% articaine for extractions of primary maxillary teeth, either using needleless device INJEX or insulin syringe on each side of the maxillary arch, in two different appointments after a 1-week washout period. Pain perception was measured by the subjective (Faces Pain Scale-Revised [FPS-R]) and objective pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC]) and hemodynamic parameters (heart rate and oxygen saturation) during LA administration and during extractions. After the second appointment, children were asked about their preference between needleless device INJEX and insulin syringe. On evaluating subjective pain scores with FPS-R, intergroup differences between the INJEX and insulin syringe groups were found statistically insignificant, both during LA administration (P = 0.101) and extraction (P = 0.080). However, on assessing pain objectively during extraction using FLACC, the mean pain score was less with insulin syringe (2.78) as compared to INJEX (4.72) and the difference was statistically significant (P = 0.000). There was no significant difference in patient preference between the two methods. Pain perception was minimal during local anesthesia administration using needleless device INJEX; however, its clinical efficacy during extractions was reported to be lower than insulin syringe. Managing pain in children is the most challenging task as it forms the foundation for instilling positive behavior toward dental treatment. Adequate local anesthesia (LA) is the cornerstone of pain management. However, the fear of needles, particularly in young children, can result in complete avoidance and refusal of treatment. This study aimed to evaluate and compare the efficacy and preference between needleless device INJEX and.

The feasibility of needleless jet injection versus conventional needle local anesthesia during dental procedures: a systematic review.

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

Effect of a Patient Decision Aid on Preferences for Colorectal Cancer Screening Among Older Adults

Guidelines recommend individualized decision-making for colorectal cancer (CRC) screening among adults aged 76 to 84 years, a process that includes a consideration of health state and patient preference. To determine whether a targeted patient decision aid would align older adults' screening preference with their potential to benefit from CRC screening. This is a prespecified secondary analysis from a randomized clinical trial. Participants aged 70 to 84 years who were not up to date with screening and had an appointment within 6 weeks were purposively sampled by health state (poor, intermediate, or good) at 14 community-based primary care practices and block randomized to receive the intervention or control. Patients were recruited from March 1, 2012, to February 28, 2015, and these secondary analyses were performed from January 15 to March 1, 2022. Patient decision aid targeted to age and sex. The primary outcome of this analysis was patient preference for CRC screening. The a priori hypothesis was that the decision aid (intervention) group would reduce the proportion preferring screening among those in poor and intermediate health compared with the control group. Among the 424 participants, the mean (SD) age was 76.8 (4.2) years; 248 (58.5%) of participants were women; and 333 (78.5%) were White. The proportion preferring screening in the intervention group was less than in the control group for those in the intermediate health state (34 of 76 [44.7%] vs 40 of 73 [54.8%]; absolute difference, -10.1% [95% CI, -26.0% to 5.9%]) and in the poor health state (24 of 62 [38.7%] vs 33 of 61 [54.1%]; absolute difference, -15.4% [95% CI, -32.8% to 2.0%]). These differences were not statistically significant. The proportion of those in good health who preferred screening was similar between the intervention and control groups (44 of 74 [59.5%] for intervention vs 46 of 75 [61.3%] for control; absolute difference, -1.9% [95% CI, -17.6% to 13.8%]). The findings of this secondary analysis of a clinical trial did not demonstrate statistically significant differences in patient preferences between the health groups. Additional studies that are appropriately powered are needed to determine the effect of the decision aid on the preferences of older patients for CRC screening by health state. ClinicalTrials.gov Identifier: NCT01575990.

Assessment of Spine Patient Preferences for the Location of Surgery Between a Hospital and an Ambulatory Surgical Center in the Time of COVID-19: An Analysis of Patient Surveys.

Introduction There has been a recent increase in the number of spinal procedures that can be performed in ambulatory surgical centers (ASCs). Studies have found that patients who undergo procedures at ASCs tend to have lower complication rates following procedures, including lower infection rates. Furthermore, ASCs offer significantly lower costs of procedures to patients and health insurance companies as compared to the costs of procedures performed in a hospital. Despite precautions and screening in place by ASCs, patients may be hesitant to undergo procedures outside of the hospital. Conversely, the ongoing COVID-19 pandemic has created hesitancy for many to go to the hospital for caredue to the presence of COVID patients. Objective To assess patient preferences in the location of elective spine procedures between ASCs and hospitals, the authors conducted a survey of spine surgery candidates in a single practice. Methods A survey measuring patient age, vaccination status, fear of contracting COVID-19, and preference of surgery location was given to spinal surgery candidates at a single practice between fall 2021 and winter 2022. Statistical differences between the means of response groups were measured by a two-sample Z-score test. Results A total of 58 surveys were completed by patients. No difference in preference was observed by age. A difference was observed between genders, with 66% of females preferring ASCs to 40% of males (α=0.03). Patients with a fear of contracting COVID-19 preferred to have their procedure performed in an ASC. No difference was observed in location due to vaccination status, but unvaccinated patients had a significantly lower fear of contracting COVID-19(α=0.02). Conclusion The differences in patient preferences have no clear cause, highlighting the need for better patient education in regardto the risks and benefits of each location of surgery. The fear of contracting COVID-19 on the day of surgery appears to be more ideological than rational for unvaccinated patients, who had less fear of contracting COVID-19 than vaccinated patients, despite being more likely to contract COVID-19 than vaccinated patients.

Anything but Cookbook Medicine: Exploring the Influence of Supervisor Practice Variability on Resident Learning in Thrombosis Medicine

Introduction Clinical practice variability is characterized by two or more expert clinicians who make different treatment decisions despite encountering a similar case. Thrombosis Medicine is an example of a specialty that has a large evidence base to support decision-making and where practice variability is common. Our objective was to explore how residents experience and interpret inter-supervisor clinical practice variability in Thrombosis Medicine, and how these variations influence learning. Methods Seventeen senior residents in Internal Medicine, Hematology or Thrombosis Medicine (Postgraduate Year [PGY] 3-6) participated in semi-structured interviews. Data collection and analysis occurred iteratively and concurrently in a manner consistent with constructive grounded theory methodology. Variation theory was used as a sensitizing concept. A central tenet of this theory is that learning occurs by experiencing three sequential patterns of variation: contrast, generalization, and fusion. All transcripts were coded in duplicate by paired members of the study team. Participants were recruited purposively with regard to their field of training until thematic saturation was reached. The primary investigator maintained an audit trail and reflexivity journal. Member checking was performed. Dedoose (version 8.0.35) was used for all analyses. The Hamilton Integrated Research Ethics Board reviewed the study. Results Clinical practice variability was common and generally viewed positively. Residents attributed clinical practice variability to supervisor personality differences, inter-institutional differences, availability and interpretation of evidence, differences in patient preferences and characteristics, and their own participation in the decision-making process. Inherent differences between supervisors, including personality traits, risk tolerance, and prior educational and clinical experiences were a major contributor. Clinical practice variability was felt to be most common when the clinical problem had scant or conflicting evidence to guide practice, for example, in the treatment of subsegmental pulmonary embolism or splanchnic vein thrombosis. Supervisors and learners often took patient preferences into account when making a decision, especially when the net clinical benefit of anticoagulation was uncertain. Supervisor-learner discussions were critical to learning from clinical practice variability. Through these interactions, residents asked clarifying questions, and supervisors shared tacit knowledge, elaborated on their prior experiences, compared and contrasted similar cases, and articulated their clinical reasoning. Residents endorsed the view that a certain baseline level of knowledge is required to appreciate the nuances that are uncovered by clinical practice variability. Junior residents (PGY 2-4) were often assessment-focused and made note of practice patterns between their supervisors in order to predict their supervisors' preferences for future cases. More experienced residents (PGY 5-6), especially those pursuing advanced training in Thrombosis Medicine, were more likely to view clinical practice variability as a means to improve their own decision-making skill in preparation for independent practice. Consistent with variation theory, clinical practice variability helped residents to discern critical aspects that influenced decision-making (contrast), group similar cases together so that the appropriate evidence could be applied (generalization), and weigh multiple variables to make a treatment decision (fusion). Observing practice variability was more helpful for senior learners and less so for junior learners as inexperience and knowledge gaps made it difficult to reconcile differences. Conclusion Residents had a generally positive perception of clinical practice variability in the workplace. Practice variability helped residents discern critical aspects, group similar patients together and practice individualized medicine. Reflection, literature review, and case discussions were felt to maximize learning from practice variability. Clinical supervisors and curriculum designers can promote learning from practice variability through first and second order scaffolding, modeling, coaching, and thinking aloud.

Satisfaction with new patient telehealth visits for reproductive endocrinology patients in the era of COVID-19.

PurposeTo study patient satisfaction with new patient telehealth visits in a reproductive endocrinology and infertility (REI) office.MethodsA cross-sectional study in a university-based fertility clinic was completed including all new patients seen via telehealth between March 1, 2021, and August 19, 2021. Primary outcomes were perceived patient satisfaction, access, and preferences to telehealth visits.ResultsA total of 351 participants were contacted, 61.8% (n = 217) agreed to participate in the study, and 28.8% (n = 101) completed the survey. There were no significant differences in age, BMI, distance from clinic, or length of infertility with response to survey. Ninety-three percent of responders would use telehealth services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 88% and travel time for 96%. The median distance from clinic was 24 miles, and there was no significance difference in preference for telehealth visits over in person visits (p = 0.696).ConclusionsIn the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telehealth services. Based on our survey, majority of patients were satisfied with telehealth visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telehealth depending on their distance from clinic, this is reassuring because patients are satisfied with telehealth for reasons other than distance from clinic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-022-02539-4.

PATIENT SATISFACTION WITH TELEMEDICINE VISITS FOR REPRODUCTIVE ENDOCRINOLOGY PATIENTS IN THE ERA OF COVID-19

Due to the COVID-19 pandemic, video-based telemedicine visits have become the standard in many clinical practices. Many reproductive endocrinology consultations do not require a physical exam, allowing for integration of telemedicine. The purpose of this study is to evaluate patient satisfaction with telemedicine visits in the Reproductive Endocrinology and Infertility (REI) office. This is a prospective cross-sectional study that includes any person undergoing a new patient visit at Washington University’s Reproductive Endocrinology clinic from March 1st-April 20th 2021. After the visit, patients were contacted via telephone to obtain consent to participate in an online one-time research survey. A link was sent to their email with the survey through RedCap secure web application. The survey is 25 questions which includes the telehealth usability questionnaire (TUQ) survey, a previously published tool to evaluate usability and quality of telehealth interaction, along with questions specific to the REI clinic and the participation of learners during visits. Baseline patient demographics including age, race/ethnicity, BMI, distance from clinic, and recommended treatment were collected. 117 participants were contacted, 78% (n=91) agreed to participate in the study, and 45% (n=41) completed the survey. There were no significant differences in age, BMI, distance from clinic or length of infertility with response to survey. 92.5% responders would use telemedicine services again and were satisfied with the telehealth system. Telehealth improved access to healthcare for 82.5% and travel time for 95%. The mean distance from clinic was 76 miles, and there was no significance difference in satisfaction with telemedicine services (p=0.46) or perceived access to healthcare services (p= 0.43) between those living closer or further than 76 miles. Those living further also had no preference for telemedicine visits over in person visits (p=0.134). In the era of COVID-19, healthcare implementation has dramatically changed with a drastic increase in telemedicine services. Based on our survey, majority of patients were satisfied with telemedicine visits and believed it saved travel time while improving access to REI care. Despite no differences in patient preference for in person versus telemedicine depending on their distance from clinic, this finding is reassuring because patients are satisfied with telemedicine for reasons other than distance from clinic.

Taking into Account Patient Preferences: A Consensus Study on the Assessment of Psychological Dimensions Within Patient Preference Studies.

Patient preferences are gaining recognition among key stakeholders involved in benefit-risk decision-making along the medical product lifecycle. However, one of the main challenges of integrating patient preferences in benefit-risk decision-making is understanding differences in patient preference, which may be attributable to clinical characteristics (eg age, medical history) or psychosocial factors. Measuring the latter may provide valuable information to decision-makers but there is limited guidance regarding which psychological dimensions may influence patient preferences and which psychological instruments should be considered for inclusion in patient preference studies. This paper aims to provide such guidance by advancing evidence and consensus-based recommendations and considerations. Findings of a recent systematic review on psychological constructs having an impact on patients’ preferences and health-related decisions were expanded with input from an expert group (n = 11). These data were then used as the basis for final recommendations developed through two rounds of formal evaluation via an online Delphi consensus process involving international experts in the field of psychology, medical decision-making, and risk communication (n = 27). Three classes of recommendations emerged. Eleven psychological constructs reached consensus to be recommended for inclusion with the strongest consensus existing for health literacy, numeracy, illness perception and treatment-related beliefs. We also proposed a set of descriptive and checklist criteria to appraise available psychological measures to assist researchers and other stakeholders in including psychological assessment when planning patient preference studies. These recommendations can guide researchers and other stakeholders when designing and interpreting patient preference studies with a potential high impact in clinical practice and medical product benefit-risk decision-making processes.

Comparison of commercially available 0.2% chlorhexidine mouthwash with and without anti-discoloration system: A blinded, crossover clinical trial.

To evaluate clinical performance and side effects of two commercially available 0.2% chlorhexidine mouthwashes after periodontal surgery, one with (test) and one without (control) an anti-discoloration system. This single-centre, crossover clinical trial included 38 patients undergoing two sessions of periodontal flap surgery. The participants used two different 0.2% chlorhexidine products, one with and one without an anti-discoloration system, in the 14-day post-operative periods. Plaque, gingival inflammation, tooth staining, side effects and patient preference were evaluated. The control mouthwash (without an anti-discolouring system) produced significantly lower plaque (p=0.02) and gingival index (p=0.01) compared to the test mouthwash. The test mouthwash produced significantly less staining in the gingival (p=0.002) and approximal areas (p=0.0004), but no difference was detected in the buccal area of the teeth. The patients did not show preference for any of the mouthwashes. Chlorhexidine mouthwash without an anti-discoloration system resulted in significantly lowered plaque and gingival index compared to chlorhexidine mouthwash with an anti-discoloration following periodontal surgery. No difference in patient preference was found despite less side effects produced by the chlorhexidine mouthwash with the anti-discoloration system.

Non-health outcomes affecting self-care behaviors and medical decision-making preference in patients with type 2 diabetes: a cross-sectional study

BackgroundThe effects of patient sustained self-care behaviors on glycemic control are even greater than the effects of medical treatment, indicating the value of identifying the factors that influence self-care behaviors. To date, these factors have not been placed in a single model to clarify the critical path affecting self-care behaviors. The aims of this study were to explore the relationships of these factors and the differences in patient preference for medical decision-making.MethodsA cross-sectional study was conducted among outpatients with type 2 diabetes at a regional teaching hospital. Purposive sampling was adopted to recruit 316 eligible patients via self-administered questionnaires. Partial least squares structural equation modeling was used for analysis.ResultsSignificant direct pathways were identified from health literacy to self-efficacy, patient empowerment, and self-care behaviors; from self-efficacy to self-care behaviors; and from patient empowerment to self-care behaviors. Indirect pathways were from health literacy to self-care behaviors via self-efficacy or patient empowerment. The pathway from health literacy to self-efficacy was significantly stronger in those preferring shared decision-making than in those who preferred physician decision-making.ConclusionsHealth literacy is a critical factor in improving self-care behaviors in patients with type 2 diabetes, and the effect of health literacy on self-efficacy was more significant in the shared decision-making than in the physician decision-making. Therefore, developing an effective health strategy to strengthen health literacy awareness and designing friendly, diverse health literacy materials, and application tools is the most important factor to facilitate self-care behaviors in this population.

Summarizing Patient Preferences for the Competitive Landscape of Multiple Sclerosis Treatment Options.

Objective. Quantitatively summarize patient preferences for European licensed relapsing-remitting multiple sclerosis (RRMS) disease-modifying treatment (DMT) options. Methods. To identify and summarize the most important RRMS DMT characteristics, a literature review, exploratory physician interviews, patient focus groups, and confirmatory physician interviews were conducted in Germany, the United Kingdom, and the Netherlands. A discrete choice experiment (DCE) was developed and executed to measure patient preferences for the most important DMT characteristics. The resulting DCE data (n=799 and n=363 respondents in the United Kingdom and Germany, respectively) were analyzed using Bayesian mixed logit models. The estimated individual-level patient preferences were subsequently summarized using 3 additional analyses: the quality of the choice data was assessed using individual-level R2 estimates, individual-level preferences for the available DMTs were aggregated into DMT-specific preference shares, and a principal component analysis was performed to explain the patients' choice process. Results. DMT usage differed between RRMS patients in Germany and the United Kingdom but aggregate patient preferences were similar. Across countries, 42% of all patients preferred oral medications, 38% infusions, 16% injections, and 4% no DMT. The most often preferred DMT was natalizumab (26%) and oral DMT cladribine tablets (22%). The least often preferred were mitoxantrone and the beta-interferon injections (1%-3%). Patient preferences were strongly correlated with patients' MS disease duration and DMT experience, and differences in patient preferences could be summarized using 8 principle components that together explain 99% of the variation in patients' DMT preferences. Conclusion. This study summarizes patient preferences for the included DMTs, facilitates shared decision making along the dimensions that are relevant to RRMS patients, and introduces methods in the medical DCE literature that are ideally suited to summarize the impact of DMT introductions in preexisting treatment landscapes.

Patient’s Race May Influence Access to MH Care Following Overdose

Back to table of contents Previous article Next article Clinical & ResearchFull AccessPatient’s Race May Influence Access to MH Care Following OverdoseTerri D’ArrigoTerri D’ArrigoSearch for more papers by this authorPublished Online:13 Aug 2019https://doi.org/10.1176/appi.pn.2019.8b23AbstractA study finds disparities among those who receive a mental health assessment after a deliberate overdose.Patients who are members of racial or ethnic minorities may be less likely than white patients to receive a mental health assessment during hospitalization for a deliberate overdose, a study in Psychiatric Services in Advance has found.All patients who are suspected of intentional overdose should receive a mental health assessment before discharge, says Elizabeth Charron, M.P.H.Elizabeth Charron, M.P.H., of the Department of Public Health Sciences at Clemson University and colleagues reviewed the records of 2,489 adults aged 18 to 64 years who were hospitalized for deliberate drug overdose in South Carolina in 2012 or 2013. They found that the vast majority of patients—94%—received a mental health assessment during their hospitalization. However, compared with white patients, black patients were 48% less likely to receive an assessmen, and patients who identified as other races or ethnicities (such as Asian or Hispanic) were 76% less likely to receive an assessment. They also found that black patients were 40% less likely than white patients to be discharged to an inpatient psychiatric facility. Patients of other races and ethnicities were slightly more likely than whites to be discharged to an inpatient psychiatric facility.“It is unclear whether the disparities we observed were due to implicit provider bias, cultural differences in patient preferences for care, socioeconomic differences between groups, or other clinically relevant factors,” the researchers wrote.Charron told Psychiatric News that she was not surprised by the findings.“In South Carolina, there are perpetual disparities in health and health care among racial-ethnic minorities, particularly African Americans. This study fits into the broader body of evidence highlighting the scope of disparities in American health care,” Charron said. “Understanding factors related to receiving [mental health] services is important in developing strategies for closing gaps in mental health care service delivery.”The researchers also analyzed the types of drugs used in the overdoses. They found that patients who had overdosed on drugs such as psychotropics, central nervous system stimulants, and central nervous system depressants were nearly 70% more likely to receive a mental health assessment than those who overdosed on opioids or sedative-hypnotics.“This result stood out to us given the scope of the opioid epidemic. Opioid abuse has been linked to increased risk of depression and suicide, so we did not expect that mental health assessments would be lower in this group,” Charron said.One possible explanation, noted in the study, is that patients who overdose on opioids and sedative-hypnotics generally do not present with psychological symptoms, whereas those who overdose on drugs such as cocaine or methamphetamine often have symptoms such as agitation or acute psychosis.The researchers acknowledged limitations of their study, notably that they could not determine whether the patients intended suicide or self-harm by deliberately overdosing. Nonetheless, mental health screening in this population should be routine, said Charron.“Anyone suspected of being admitted for an intentional overdose should receive a mental health assessment before discharge,” Charron said. “Hospitals and health systems can establish a standardized discharge planning protocol for persons receiving inpatient treatment for intentional overdose.”The authors reported no outside funding for this study. ■Disparities in Access to Mental Health Services Among Patients Hospitalized for Deliberate Drug Overdose” is posted here. ISSUES NewArchived

PEG vs. sennosides for opioid-induced constipation in cancer care.

This randomized double-blind, double-dummy, 2-treatment, 2-period crossover study aimed to compare the efficacy and tolerability of polyethylene glycol (PEG) and sennosides in ambulatory cancer patients with opioid-induced constipation. Outpatients ≥ 18years old with cancer, at risk of or already experiencing opioid-induced constipation, were randomly assigned to begin a standard bowel protocol of escalating doses of sennosides or PEG, plus a dummy preparation. After 3weeks, the patients switched to the alternate active product and dummy preparation. Constipation was assessed using the revised Victoria Bowel Performance Scale (rBPS) at the end of each of the 2 consecutive 21-day study periods for the number of days with a satisfactory bowel movement, the time in days to goal rBPS (G), and the treatment preference of each patient. Seventy patients were recruited, with 42 completing their first treatment period and 28 completing both treatment periods. For the typical patient, the expected number of days with a satisfactory bowel movement per days of treatment was found to be 1.21 times higher on PEG than on sennosides in a particular period (95% credible interval 0.96 to 1.55). Patients taking PEG were 1.47 times more likely to reach a rBPS of G before patients taking sennosides in the first period (95% confidence interval 0.74 to 2.94). There was no evidence of a difference in patient preference between laxatives. Our study found weak evidence that PEG is superior to sennosides with respect to overall effectiveness in cancer patients with opioid-induced constipation.

Orthopaedic Physician Attire Influences Patient Perceptions in an Urban Inpatient Setting.

Prior research suggests that physician attire has an important effect on patient perceptions, and can influence the patient-physician relationship. Previous studies have established the effect of specialty, location, and setting on patient preferences for physician attire, and the importance of these preferences and perceptions on both the physician-patient relationship and first impressions. To date, no studies have examined the influence of attire in the inpatient orthopaedic surgery setting on these perceptions. (1) Do differences in orthopaedic physician attire influence patient confidence in their surgeon, perception of trustworthiness, safety, how caring their physician is, how smart their surgeon is, how well the surgery would go, and how willing they are to discuss personal information with the surgeon? (2) Do patients perceive physicians who are men and women differently with respect to those endpoints? Ninety-three of 110 patients undergoing orthopaedic surgery at an urban academic medical center participated in a three-part survey. In the first part, each patient was randomly presented 10 images of both men and women surgeons, each dressed in five different outfits: business attire (BA), a white coat over business attire (WB), scrubs alone (SA), a white coat over scrubs (WS), and casual attire (CA). Respondents rated each image on a five-point Likert scale regarding how confident, trustworthy, safe, caring, and smart the surgeon appeared, how well the surgery would go, and the patient's willingness to discuss personal information with the surgeon. In the second part, the respondent ranked all images, by gender, from the most to least confident based on attire. Pair-wise comparisons for women surgeons demonstrated no difference in patient preference between white coat over business attire compared with white coat over scrubs or scrubs alone, though each was preferable to business attire and casual attire (WS versus WB: mean difference [MD], 0.1 ± 0.6; 95% CI, 0.0-0.2; p = 1.0; WS versus SA: MD, 0.2 ± 0.7; 95% CI, 0-0.3; p = 0.7; WB versus SA: 0.1 ± 0.9; 95% CI, -0.1 to 0.2; p = 1.0). The same results were found when rating the surgeon's perceived intelligence, skill, trust, confidentiality, caring, and safety. In the pair-wise comparisons for male surgeons, white coat over scrubs was not preferred to white coat over business attire, scrubs alone, or business attire (WS versus WB: MD, -0.1 ± 0.6; 95% CI, 0-0.1; p = 1.0; WS versus SA: MD, 0 ± 0.4; 95% CI, -0.2 to 0; p = 1.0; WS versus BA: MD, 0.2 ± 0.8; 95% CI, 0-0.4; p = 0.6). WB and SA were not different (MD, 0.0 ± 0.6; 95% CI, -0.1 to 0.2; p = 1.0), though both were preferred to BA and CA (WB versus BA: MD, 0.3 ± 0.8; 95% CI, 0.1-0.5; p = 0.02; WB versus CA: 1.0 ± 1.0; 95% CI, 0.8-1.2; p < 0.01). We found no difference between SA and BA (MD, 0.3 ± 0.7; 95% CI, 0.1-0.4; p = 0.06). We found that each was preferred to CA (SA versus CA: 0.9 ± 1.0; 95% CI, 0.7-1.2; p < 0.01; BA versus CA: 0.7 ± 1.0; 95% CI, 0.5-0.9; p < 0.01), with similar results in all other categories. When asked to rank all types of attire, patients preferred WS or WB for both men and women surgeons, followed by SA, BA, and CA. Similar to findings in the outpatient orthopaedic setting, in the inpatient setting, we found patients had a moderate overall preference for physicians wearing a white coat, either over scrubs or business attire, and, to some extent, scrubs alone. Respondents did not show any difference in preference based on the gender of the pictured surgeon. For men and women orthopaedic surgeons in the urban inpatient setting, stereotypical physician's attire such as a white coat over either scrubs or business attire, or even scrubs alone may improve numerous components of the patient-physician relationship and should therefore be strongly considered to enhance overall patient care. Level II, therapeutic study.

Characterizing Patient Preferences Surrounding Total Knee Arthroplasty.

Background:Episode-based bundled payments for total knee arthroplasty emphasize cost-effective patient-centered care. Understanding patients’ perceptions of components of the total knee arthroplasty care episode is critical to achieving this care. This study investigated patient preferences for components of the total knee arthroplasty care episode.Methods:Best-worst scaling was used to analyze patient preferences for components of the total knee arthroplasty care episode. Participants were selected from patients presenting to 2 orthopaedic clinics with chronic knee pain. They were presented with descriptions of 17 attributes before completing a best-worst scaling exercise. Attribute importance was determined using hierarchical Bayesian estimation. Latent class analysis was used to evaluate varying preference profiles.Results:One hundred and seventy-four patients completed the survey, and 117 patients (67%) were female. The mean age was 62.71 years. Participants placed the highest value on surgeon factors, including level of experience, satisfaction rating, and complication rates. Latent class analysis provided a 4-segment model of the population.Conclusions:This study demonstrated differences in patient preferences for the components of a total knee arthroplasty care episode and characterized distinct preference profiles among patient subsets. Stakeholders can use this information to focus efforts and policy on high-value components and to potentially create customized bundles guided by preference profiles.Clinical Relevance:This study is clinically relevant because the patient preferences identified here may help providers to design customized bundles for total knee arthroplasty care.

Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.

Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults.

A multivariate investigation into the relationship between pharmaceutical characteristics and patient preferences of bioequivalent ibuprofen tablets

BackgroundIn Spain the price of all ibuprofen 600 mg tablet generic products is the same due to reimbursement existing rules so for the patient there is not any economic incentive to choose a particular one. Bearing in mind that the quality of generic products should be similar, it could be questioned if differences in patient preferences evaluated as sales could be related to differences on their pharmaceutical properties. The aims of this work were to study the variability on the pharmaceutical characteristics of marketed bioequivalent tablet formulations and its impact on patient preferences.MethodsThirty-six batches corresponding to fourteen different generic products were chosen among the best-selling products of the Spanish market in the years 2011 and 2015 and were compared to the reference product. The effect on patient preferences of six variables was studied through a multivariate analysis. The first two variables were marketing characteristics: 1) years in the market and 2) the number of other generic products marketed by the same manufacturer, which could be related to the size and service provided by the manufacturer. The other four variables studied were pharmaceutical tablet properties: 3) mean weight, 4) hardness, 5) disintegration, and 6) dissolution. A multiple linear regression analysis was performed to identify the effect on sales of the six variables studied.ResultsThe disintegration time was the most significant (P=0.018) factor affecting the sales of Ibuprofen tablets which may be related to the onset of action.ConclusionThe faster the tablet disintegration, the higher its sales. Two possible explanations are suggested: 1) the most specialized ibuprofen tablet manufacturer considers fast disintegration as a key parameter and/or 2) habitual consumers of ibuprofen can detect small differences on the onset of action among different marketed formulations. In this work, all marketed ibuprofen tablets comply with the pharmacopoeia specifications.

How Do Patients With Chronic Conditions Prefer to Get Health Information and Advice? Results From the 2014 Kaiser Permanente Northern California Member Health Survey

Background: Management of chronic conditions requires patient engagement in health promoting self-care, which ongoing health education, advice and reinforcement may enhance. Information about sociodemographic differences in patient preferences for patient health information/advice services (HIA), especially regarding web-based/digital (eHIA) versus more traditional modalities, can inform development and delivery of interventions.