Enhance Patient Acceptance Research Articles

Effect of Zinc on improving silver diamine fluoride-derived tooth discoloration in vitro.

Silver Diamine Fluoride (SDF) is effective for arresting dental caries, presenting a valuable non-invasive treatment option in dentistry. Despite its therapeutic advantages, a significant drawback is the tooth discoloration that follows its application, which can affect patient acceptance. Addressing this aesthetic concern without diminishing the treatment's efficacy remains challenging in dental practice. This study explores strategies to improve the aesthetic outcomes of SDF treatments. This in vitro study assessed the efficacy of Zinc in reducing SDF-induced discoloration on dentin blocks and examined its impact on the physical properties of dentin, including hardness and roughness. Dentin blocks were pre-treated with various concentrations of Zinc, followed by SDF application. Color changes were analyzed using Image J software, and cytotoxicity was evaluated using the CytoTox-ONE™ Homogeneous Membrane Integrity Assay. Dentin surface characteristics, including micro-hardness and roughness, were assessed using scanning electron microscopy. The study results revealed a dose-dependent efficacy of Zinc in reducing discoloration caused by SDF on dentin, with higher Zinc concentrations showing better improvement in color outcomes. The application of a 20M Zinc solution prior to SDF treatment significantly reduced discoloration compared to SDF alone, measured on day 14. Additionally, no significant changes in the hardness or roughness of etched dentin were observed in Zinc + SDF group compared to the SDF alone group. Zinc treatments demonstrated a desirable outcome on mucosal cytotoxicity, comparable to that of the negative control. Zinc significantly reduced SDF-induced tooth discoloration in a dose-dependent manner without affecting the etched dentin's micro-hardness and roughness, potentially improving patient acceptance, especially in visible areas of the mouth. Further research is warranted to validate the effectiveness of this zinc-enhanced treatment protocol in vivo. Zinc-enhanced SDF treatments could enhance patient acceptance, especially in visible areas of the mouth, offering an improved option for caries management.

Electronic Patient Reported Outcome Measures after palliative radiotherapy: evaluation of implementation.

Radiotherapy is a frequently utilized palliative treatment for cancer patients. Electronic Patient-Reported Outcome Measures (ePROMs) offer a method for patients to communicate their symptoms and concerns to healthcare providers (HCPs) remotely. While ePROMs have demonstrated significant benefits for oncology patient care, their integration into routine clinical practice of palliative radiotherapy (PRT) poses challenges. The current study aimed to evaluate the implementation of an ePROM-intervention after PRT. We conducted a two-phase study to evaluate the implementation of a self-developed ePROM intervention, known as the ePRomT diary, for symptom monitoring post-PRT. This diary offered automated self-management advice for mild symptoms and also guided patients to contact an HCP for severe symptoms. We assessed various implementation aspects using the RE-AIM framework and collected data through surveys, interviews, electronic health records, and field notes. Quantitative data analysis employed descriptive statistics, while qualitative data underwent thematic analysis using NVivo. Recruitment periods for both phases spanned 10 weeks. In Phase I, 37 out of 87 eligible patients (43%) participated, a number that rose to 40 out of 49 eligible patients (82%) in Phase II. Among participating patients, 93% in Phase I and 98% in Phase II reported the ePRomT diary as a valuable addition to their care. Additionally, 75% and 84% expressed willingness to reuse it, while 70% and 80% would recommend it to others in Phases I and II, respectively. In Phase I, 17 out of 39 patients (44%) completed at least one ePROM assessment, increasing to 26 out of 40 patients (65%) in Phase II. While patients found the self-management advice generally correct and relevant, they noted its somewhat generic nature. Moreover, while the advice to contact an HCP was deemed appropriate, adherence to it varied. HCPs expressed satisfaction with the intervention, deeming it valuable in patient care, and believed that integrating it into routine clinical practice would enhance patient acceptability with minimal workflow disruptions. Despite certain limitations, including participant bias, our study offers valuable insights into the implementation and potential implications of an ePROM intervention for symptom follow-up post-PRT, framed within the RE-AIM framework. ePROM interventions like the ePRomT diary show promise and are well-received by both patients and HCPs. However, optimizing such interventions to better align with patient needs and seamlessly integrating them into clinical workflows within the context of PRT warrants further investigation.

Active Ingredient Prescribing in Australia: exploring pharmacists' experiences

AbstractBackgroundThe Active Ingredient Prescribing (AIP) mandate was introduced Australia‐wide on 1 February 2021. The AIP legislation makes the pharmacist a stakeholder who can provide valuable information to customers and patients.AimTo explore the experiences of community pharmacists with AIP legislation with a focus on attitude, health literacy, and medication safety.MethodSemi‐structured, in‐depth interviews were conducted and guided by the Theoretical Domains Framework (TDF). Transcripts were analysed using a deductive approach to categorise data and inductive thematic analysis to identify concepts and themes. Ethical approval was granted by the Griffith University Human Research Ethics Committee (Reference no: 2021/878) and the study conforms to the Australian National Statement on Ethical Conduct in Human Research. Informed consent from all participants was obtained via a study information sheet distributed to all potential participants and completion of written consent forms prior to participation in the study. Participants received gift cards as compensation for their time.ResultsSix pharmacists participated, and thematic analysis of collected data revealed three main themes. These included education, integration, and trust. Insights on patients' acceptance of their prescriptions and the expanded patient‐facing opportunities were highlighted. Participants' opinions leaned towards enhancing the smooth integration into the AIP process of other stakeholders like prescribers and regulatory bodies. Establishing multilevel communication between stakeholders and customers was pivotal to improving health literacy and medication safety. Pharmacists' views on process integration provided unique insight into the practical challenges with the AIP mandate. In addition, ‘trust’ in the prescriber enhanced patient acceptance of generic medicines.ConclusionThe study provided baseline evidence to show that the AIP mandate enhances health literacy and empowers patients to know the active ingredients in their medicines, which in turn supports medication safety. Examining the implementation of the AIP legislation facilitated a nuanced understanding of the effect that these AIP changes have on patients.

Development of Orodispersible Tablets with Solid Dispersions of Fenofibrate and Co-Processed Mesoporous Silica for Improved Dissolution.

Poor water solubility is an important challenge in the development of oral patient-friendly solid dosage forms. This study aimed to prepare orodispersible tablets with solid dispersions of a poorly water-soluble drug fenofibrate and a co-processed excipient consisting of mesoporous silica and isomalt. This co-processed excipient, developed in a previous study, exhibited improved flow and compression properties compared to pure silica while maintaining a high specific surface area for drug adsorption. Rotary evaporation was used to formulate solid dispersions with different amounts of fenofibrate, which were evaluated for solid state properties and drug release. The solid dispersion with 30% fenofibrate showed no signs of crystallinity and had a significantly improved dissolution rate, making it the optimal sample for formulation or orodispersible tablets. The aim was to produce tablets with minimal amounts of additional excipients while achieving a drug release profile similar to the uncompressed solid dispersion. The compressed formulations met the requirements for orodispersible tablets in terms of disintegration time, and the drug release from best formulation approximated the profile of uncompressed solid dispersion. Future research should focus on reducing the disintegration time and tablet size to enhance patient acceptability further.

Patient preferences for generic substitution policies: a discrete choice experiment in China.

Background: Generic substitution policies have been widely implemented worldwide to enhance the accessibility of medications. Nevertheless, certain patients have voiced discontent with these policies. This study aimed to evaluate the patient preferences for generic substitution policies and explore the potential for optimization to enhance patient acceptance. Methods: A discrete choice experiment (DCE) was conducted to estimate the relative importance (RI) of five attributes, including generic consistency evaluation (GCE), reimbursement rate, medication use control, information disclosure, and post-marketing surveillance. Respondents were recruited among inpatients and outpatients in three cities and surveys were conducted face-to-face. Preference coefficients, RI of attributes, and the uptake rate of various policies were computed using a mixed logit model. The interaction effects were also included to examine preference heterogeneity. Results: A total of 302 patients completed the survey. All five attributes significantly impacted policy acceptance. GCE held the highest RI value at 56.64%, followed by reimbursement rate (RI = 12.62%), information disclosure (RI = 12.41%), post-marketing surveillance (RI = 9.54%), and medication use control (RI = 8.80%). Patient preferences varied depending on their gender and income. The patient uptake rate of China's current policy was only 68.56%. If all generics were to pass GCE without altering the other attributes, the uptake rate of policies would rise to 82.63%. Similarly, implementing information disclosure without changing other attributes would result in a 78.67% uptake rate, which is comparable to the effect of a 10% increase in reimbursement rate for generics (78.81%). Combining these policies could mitigate the adverse effects of mandatory substitution on patient. Conclusion: Chinese patient preferences for generic substitution policies were mainly influenced by GCE. China's current generic substitution policy has room for further optimization to enhance patient acceptance.

(080) A SEXUAL HEALTH CLINIC IN AN ONCOLOGY SETTING: PATIENT UPTAKE AND ENGAGEMENT

Abstract Introduction Sexual health issues pose significant and widespread challenges for individuals undergoing cancer treatment. Unfortunately, sexual healthcare clinics are the exception in cancer centres, underscoring the need for effective and efficient sexual health programming in oncology. Providing sexual healthcare through a traditional in-clinic approach is challenging in the current healthcare context of limited resource. Digital health interventions may offer efficient and accessible care pathways. Despite indications of the effectiveness and efficiency demonstrated by digital health innovation in cancer survivorship, patient engagement remains a significant limiting factor. Consequently, establishing digital health programming in cancer care requires the prioritizing of engagement strategies to enhance patient acceptance and encourage active participation in the intervention. This study details the development and patient engagement of a hybrid Sexual Health Clinic (SHC), integrating both in-person and virtual services, within a high-volume cancer centre. Objective The SHC offers broad-spectrum medical, psychological, and interpersonal care through an innovative blended in-person and digital clinic. The objectives of this study are to assess patient uptake and engagement during the first year of operation of the SHC within an oncology setting. Methods The study is conducted in a high-volume oncology Centre situated in a large urban setting. Participants encompass patients referred to the SHC by their oncology team between January 1st, 2023, and December 31st, 2023. The implementation of the SHC adhered to the Quality Implementation Framework. Furthermore, well-established patient engagement strategies in the online context were employed, including validation of product credibility and security, usability testing with improved functionality, training for both participants and providers, facilitation by practitioners, customization of information, guided usage, feedback mechanisms for patients and providers, and reminder features. A structured patient monitoring system was utilized to track SHC uptake, while virtual care engagement was gauged through website usage and analytics. Descriptive statistics were employed to summarize the collected data. Results The structured implementation approach resulted in 381 referrals in 2023. Of those patients referred to SHC, 23 (6%) never responded and 44 (11%) were contacted but were not interested, leaving 311 (82%) patients with intention to attend the SHC. To date, of those patients with intention to attend the SHC in-person clinic, 247 (82%) presented in clinic and a remaining 34 patients referred in late 2023 may still be scheduled (allowing for a possible 90% participation rate). Evaluation of patient engagement in the SHC virtual clinic revealed that the 178 eligible participants are very active on the platform, registering 1867 messages between patients and health counsellors, 1845 trackers completed, and an average of 247 “information slides” read per patient. Overall satisfaction with SHC is 4.1 on 5 point Likert Scale. Conclusions The patient tracking data confirms the effective integration of SHC within a busy oncology centre, while website analytics indicate promising patient involvement on the SHC virtual platform. These findings suggest that SHC holds promise in bridging the sexual health care gap for oncology patients in a effective and potentially resource-efficient manner. Disclosure No.

Green Revolution in Pharmaceutical Formulations: Banana Peel-Derived Fast-Dissolving Tablets for Enhanced NSAID Delivery

The pharmaceutical industry is undergoing a transformative shift towards sustainable practices, and this review explores the potential of utilizing banana peel-derived materials in the development of Fast-Dissolving Tablets (FDTs) for Non-Steroidal Anti-Inflammatory Drug (NSAID) delivery. Banana peels, often discarded as waste, contain bioactive compounds with promising pharmaceutical applications. This review provides a comprehensive summary of key findings, emphasizing the biocompatibility, sustainability, and cost-effectiveness of banana peel-derived materials in pharmaceutical formulations. Taste-masking techniques and flavor enhancements are discussed as crucial considerations to enhance patient acceptability. The implications for the pharmaceutical industry extend beyond therapeutic benefits, aligning with the growing demand for environmentally conscious practices. The future outlook highlights the need for further research and development, optimization of formulations, and comprehensive evaluations to establish the safety, efficacy, and regulatory compliance of banana peel-derived FDTs. Successfully integrating these materials may set a precedent for eco-friendly drug development, fostering a green paradigm in the pharmaceutical industry.

Formulation and Antimicrobial studies of Microencapsulated Musanga cecropioides Stem Bark Extract

Microencapsulation is the process of coating small droplets of liquid or solid materials with a continuous film of polymeric substances. The aim of the research was to formulate microparticles of Musanga cecropioides stem bark extract. The dried, powdered stem bark of Musanga cecropioides was extracted by maceration. The aqueous extract was microencapsulated using polymers such as alginate, pectin and hydroxylpropyl methylcellulose acetate succinate (HPMCAS) by counter-ion coacervation method using an electrostatic droplet generator. The formulated microcapsules were evaluated for flow properties, particle size, drug content, antimicrobial activity and in vitro release kinetics in simulated gastric and intestinal fluids. The microparticles were subjected to stability tests under different temperature (45°C, 25°C and 8°C) and relative humidity (100% RH, 78% RH and 0% RH) conditions for a period of three (3) months. The mean particle size of the microcapsules decreased with increasing applied voltage of the electrostatic generator. Particle size range for the batches of formulated microparticles was 68.20-223.84µm. The percentage entrapment efficiency of the batches of microparticles ranged from 80.26-86.58%. The microparticles lost a significant percent of its drug content after storage at different temperature and relative humidity conditions. The formulated microparticles and crude extract possess significant antibacterial action against both gram positive and negative bacteria as well as antifungal effect against C. albicans. Microparticles of M. cecropioides extract were formulated by counter-ion coacervation method using an electrostatic droplet generator which conferred advantages of sustained drug release, reduced frequency of dosing, masked unpalatable taste, improved stability and enhanced patient acceptance on the crude extract.

Rheumatoid arthritis patients' perspective on the use of prediction models in clinical decision-making.

A rapidly expanding number of prediction models is being developed aiming to improve rheumatoid arthritis (RA) diagnosis and treatment. However, few are actually implemented in clinical practice. This study explores factors influencing the acceptance of prediction models in clinical decision-making by RA patients. A qualitative study design was used with thematic analysis of semi-structured interviews. Purposive sampling was applied to capture a complete overview of influencing factors. The interview topic list was based on pilot data. Data saturation was reached after 12 interviews. Patients were generally positive about the use of prediction models in clinical decision-making. Six key themes were identified from the interviews. First, patients have the need for information on prediction models. Second, factors influencing trust in model-supported treatment are described. Third, patients envision the model to have a supportive role in clinical decision-making. Fourth, patients hope to personally benefit from model-supported treatment in various ways. Fifth, patients are willing to contribute time and effort to contribute to model input. And lastly, we discuss the theme on effects of the relationship with the caregiver in model-supported treatment. Within this study RA patients were generally positive about the use of prediction models in their treatment given some conditions were met and concerns addressed. The results of this study can be used during the development and implementation in RA care of prediction models in order to enhance patient acceptability.

A Review Article of Polyherbal Tablet for the Management of Osteoporosis

Osteoporosis is an aging problem. The declining bone mineral density (BMD) enhances the chances of fractures during minor falls. Effective pharmaceuticals are available for a rapid improvement of BMD Osteoporosis is an enormous and growing public health problem. Once considered an inevitable consequence of ageing, it is now eminently preventable and treatable. Ironically, despite tremendous therapeutic advances, there is an increasing treatment gap for patients at high fracture risk. In this Series paper, we trace the evolution of drug therapy for osteoporosis, which began in the 1940s with the demonstration by Fuller Albright that treatment with oestrogen could reverse the negative calcium balance that developed in women after menopause or oophorectomy. We note a watershed in osteoporosis drug discovery around the year 2000, when the approach to developing novel therapeutics shifted from one driven by discoveries in animal studies and clinical observations (eg, oestrogen, calcitonin, and teriparatide) or opportunistic repurposing of existing compounds (eg, bisphosphonates) to one driven by advances in fundamental bone biology (eg, denosumab) coupled with clues from patients with rare bone diseases (eg, romosozumab, odanacatib). Despite these remarkable advances, concerns about rare side-effects of anti-resorptive drugs, particularly bisphosphonates, and the absence of clear evidence in support of their long-term efficacy is leading many patients who could benefit from drug therapy to not take these drugs. As such, there remains an important clinical need to develop ways to enhance patient acceptance and compliance with these effective drugs, and to continue to develop new drugs that do not cause these side-effects and have prolonged anabolic effects on bone. Such changes could lead to a true reversal of this potentially devastating disease of ageing.

Periodontal Microsurgery: An Advanced Approach for Minimal Invasive Periodontal Therapy

The use of magnification and microsurgery to perform various procedures are recent developments in medical and dental field. The available literature specifically of periodontal surgical procedures was analysed and compiled, and it indicated that when magnification is incorporated in periodontal practice, it improves visual acuity, decreased patient morbidity, ergonomic benefits, rapid healing, and enhanced patient acceptance. The illumination and magnifi¬cation provided by the operating micro¬scope as well as the use of microsurgical instrumentation have allowed microsur¬geons to perform procedures with more precision. Microsurgery is an interesting concept in the minds of many dental professionals, yet the inability of most clinicians to perform such procedures shows the dental professions lack of understanding of what microsurgery truly encompasses. The objective of the present paper is to offer a brief review on periodontal microsurgery, role of magnification systems, application of microsurgical principles in various periodontal surgical procedures, advantages of microsurgery over conventional surgery and to reinforce the use of microscope into periodontal practice.

Home-based telemental health services for Indian patients during the COVID-19 pandemic: A comparison with the pre-COVID phase.

ABSTRACTBackground:Many developed countries have switched from conventional outpatient psychiatric services to tele mental health-based alternatives because of the COVID-19 pandemic. However, similar transitions might be difficult for countries like India because of a shortage of necessary resources. Therefore, the feasibility and acceptability of converting to a home-based tele mental health (HB-TMH) service during the pandemic were examined in an Indian hospital.Materials and Methods:A new and expanded version of an HB-TMH service was operated for all outpatients following the onset of the pandemic. Feasibility outcomes included operational viability, service utilization, service engagement, the need for additional in-person services, and the frequency of adverse events. Patients’ and clinicians’ satisfaction with different aspects of the service were evaluated using Likert-style questionnaires to ascertain acceptability. The outcomes during the prepandemic and pandemic phases were also compared.Results:The switch to HB-TMH services took 6 weeks during the pandemic. Patient numbers increased greatly following this transition. Attendance improved, the requirement for in-person services was low, and no serious adverse events were reported. However, patients’ satisfaction levels were relatively low during the pandemic. Clinicians were more satisfied than the patients with HB-TMH treatment during the pandemic. Differences between them were less marked but still present before the pandemic. Pre- and postpandemic comparisons revealed that both patients and clinicians were more satisfied with all aspects of HB-TMH care before the pandemic than during it.Conclusions:Though conversion to HB-TMH services was feasible during the pandemic, such services need to be improved to enhance patient acceptability.

Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients.

BACKGROUNDFour-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population.AIMTo compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG.METHODSA total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score.RESULTSAlthough there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01).CONCLUSIONThree-liter PEG shows satisfactory bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients.

The Use of Computer Guided Tall andTilted Pin Hole Immediately Loaded Implants(TTPHIL) Technique for Severe Atrophic Maxilla Rehabilitation: A One Year Follow-Up

For successful placement of dental implants, the clinician needs adequate bone in three dimensions around endo-osseous implants to enhance Bone Implant Contact (BIC) area and primary stability. The absence of optimum bone calls for complex procedures such as sinus lifts, bone augmentations using grafts that aggravates patient morbidity, dramatically higher costs and limited patient satisfaction. To overcome disadvantages of grafting, graft-less solution used in combination or alone, such as tilted implants, use of long, narrow implants, bi-cortical implants, all-on-4 techniques have enhanced patient acceptance and clinical ease. All-on-4 protocol is one such combination treatment concept whose success has been demonstrated mainly in ideal/moderate osseous structures. Further, it accommodates 10-12 teeth per arch, mostly without second molars compromising chewing efficiency and creating cantilevers especially in rehabilitations opposing complete set of natural teeth. Additionally, optimal number of implants required to support full arch prosthesis remains unclear. Therefore, to circumvent the limitations of all-on-4 technique, 6 long (16-25 mm) and tilted implants have been used to restore 14 teeth in severely atrophic maxillary arch of a healthy 75-year-old female in the following case report. Tall implants engage basal cortical bone aiding in immediate fixation and increase in surface area of osseo-integration. All implants were placed using minimally invasive flapless technique and immediately loaded within 3 days with a screw-retained multiunit DMLS prosthesis. The pterygoid cortex engagement of distal implants does not have any deleterious biomechanical effect eliminating the distal cantilever.

MICROPERIODONTICS- Refining our professionalism

Surgical Precision to restore both biologic and aesthetic demands of patients is most important in today’s periodontal practice. Technical skills of the clinician are challenged by the limited range of visual acuity. Periodontal microsurgery increases the efficiency of basic periodontal surgical procedures by improving normal vision through magnification along with advance lighting system. Incorporation of magnification in periodontal practice gives precise outcomes which are not achieved with traditional macro surgery in terms of improved visual acuity, ergonomic benefits, decreased patient morbidity, enhanced patient acceptance, rapid healing, passive wound closure and reduced tissue trauma.The aim of this review is to enlighten about periodontal microsurgery, its role in magnification, micro-surgical instrumentation, microsurgical suturing techniques, clinical advancement and application. Keywords: Ergonomics; magnification; microsurgery; precision; techniques

Periodontal microsurgery: Reaching new heights of precision.

The use of magnification to perform various procedures in medical and dental field, particularly endodontics has long been recognized. Unfortunately, its application in periodontics is not widely popularized. The objective of this article is to emphasize the application of microsurgical principles in various periodontal surgical procedures and to reinforce the incorporation of microscope into periodontal practice. The most recent periodontal journals were reviewed and a search of databases such as PubMed or Medline and Google Scholar was conducted for relevant material from published literature up to 2017. Medical Subject Headings words looked for were “periodontal microsurgery” and “minimally invasive periodontal surgery.” The available literature, specifically to periodontal surgical procedures was analyzed and compiled. The analysis indicates that incorporation of magnification in periodontal practice is associated with improved visual acuity, ergonomic benefits, decreased patient morbidity, rapid healing, and enhanced patient acceptance.

The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients

BackgroundClinical decision support systems (DSS) aimed at supporting diagnosis are not widely used. This is mainly due to usability issues and lack of integration into clinical work and the electronic health record (EHR). In this study we examined the usability and acceptability of a diagnostic DSS prototype integrated with the EHR and in comparison with the EHR alone.MethodsThirty-four General Practitioners (GPs) consulted with 6 standardised patients (SPs) using only their EHR system (baseline session); on another day, they consulted with 6 different but matched for difficulty SPs, using the EHR with the integrated DSS prototype (DSS session). GPs were interviewed twice (at the end of each session), and completed the Post-Study System Usability Questionnaire at the end of the DSS session. The SPs completed the Consultation Satisfaction Questionnaire after each consultation.ResultsThe majority of GPs (74%) found the DSS useful: it helped them consider more diagnoses and ask more targeted questions. They considered three user interface features to be the most useful: (1) integration with the EHR; (2) suggested diagnoses to consider at the start of the consultation and; (3) the checklist of symptoms and signs in relation to each suggested diagnosis. There were also criticisms: half of the GPs felt that the DSS changed their consultation style, by requiring them to code symptoms and signs while interacting with the patient. SPs sometimes commented that GPs were looking at their computer more than at them; this comment was made more often in the DSS session (15%) than in the baseline session (3%). Nevertheless, SP ratings on the satisfaction questionnaire did not differ between the two sessions.ConclusionsTo use the DSS effectively, GPs would need to adapt their consultation style, so that they code more information during rather than at the end of the consultation. This presents a potential barrier to adoption. Training GPs to use the system in a patient-centred way, as well as improvement of the DSS interface itself, could facilitate coding. To enhance patient acceptability, patients should be informed about the potential of the DSS to improve diagnostic accuracy.

Digital Workflow for Fixed Implant Rehabilitation of an Extremely Atrophic Edentulous Mandible in Three Appointments

To present a rationale to reduce treatment complexity, number of surgeries, and overall treatment time for patients with extreme mandibular ridge deficiency. A 67-year-old fully edentulous male presented with a chief complaint of poor retention and stability of the mandibular complete denture with consequent discomfort and inability to chew. A novel 3-appointment protocol from guided implant placement to definitive prosthesis delivery was implemented. At the first appointment, a guided surgery protocol with the All-on-4 concept was used in the mandible. Implant placement was followed by immediate loading with a fixed provisional prosthesis providing the patient with immediate function. Final impression, cast verification and articulation, determination of VDO, and interocclusal records were obtained in the same appointment. In the second appointment, the framework try-in was performed and a pick-up impression was taken after a new CR record. The third appointment included the delivery of the final screw-retained, one-piece, full-arch prosthesis opposed by a maxillary complete denture. This expedited protocol allows for implant placement with a surgical template generated from preoperative virtual planning of the implants and the CAD/CAM prosthodontic rehabilitation using a digital workflow. The patient was satisfied with the esthetic and functional outcome and was enrolled into a 6-month recall program. This article describes an expedited protocol illustrating a digital workflow for full arch implant rehabilitation of the extremely atrophic mandible. Flapless implant placement with a surgical template generated from virtual planning was followed by immediate loading with a fixed prosthesis. Digital impression/digitization of the working cast and CAD/CAM technology were used to mill the definitive prosthesis. From guided surgery to the definitive rehabilitation only three appointments were necessary. This digital workflow can enhance patient acceptance and comfort and serve as an alternative treatment in the indicated clinical scenario. (J Esthet Restor Dent 29:178-188, 2017).

A Survey of Perceptions and Acceptance of Wearable Technology for Health Monitoring in a Urological Patient Population

IntroductionThrough real-time monitoring of biophysical parameters, physical activity monitors may represent a medium by which urologists can actively engage patients and improve treatment outcomes. We examined patient reported acceptance of physical activity monitor technology in an ambulatory urology setting. MethodsPatients treated at a single urology department during a 6-month period were identified. A web based survey was conducted evaluating patient characteristics and acceptance of physical activity monitors. ResultsA total of 1,043 (19%) patients completed the survey, of whom 210 (20%) reported using physical activity monitors for health and wellness. Overall 854 (82%) respondents were willing to use these devices for urological care. Compared to patients who disagreed, those willing to use physical activity monitors for medical care reported greater perceived medical benefit (86% vs 14%), improved communication (85% vs 26%), confidentiality (89% vs 45%), less interference with daily activity (4% vs 55%) and improved health (81% vs 13%, all p <0.0001). Benefits and usefulness among accepting patients included health monitoring convenience (82%), goal related feedback (82%), ease of communication (57%) and monitoring of post-procedure recovery (56%). After controlling for associated patient characteristics, the degree of perceived burden, medical benefit, health improvement and enhancement in communication were modifiable, and independently associated with physical activity monitor acceptance. ConclusionsThere is a high level of acceptance for wearable technology among urology patients. This may have significant implications for improving patient engagement, perioperative care pathways and surgical outcomes. Finally, these findings may assist urologists in directing future efforts to clinically integrate physical activity monitors to enhance patient acceptance and potential outcomes.

Establishing an Ambulatory Telemedicine Service in a Urology Practice

Introduction: It is estimated that 75% of households in the United States have access to broadband Internet,1 of which, 81% of those utilizing internet services access online health information.2 As such, with the rising costs of healthcare, there has been a catalyzed interest in the development of efficient and effective healthcare delivery models.3 One such initiative has been the establishment of telemedicine.4–6 Specifically, in a urology practice, evidence suggests that ambulatory video-visits are well accepted by patients7 and provide a means for equivalent efficiency and satisfaction with significantly reduced patient-related costs.8 Herein then, we describe a step-by-step process for establishing an ambulatory telemedicine service in a urology practice. Materials and Methods: This video is a review of current literature with a step-by-step process to establish a telemedicine service within a urology practice. Results: Several unique considerations exist in establishing an effective telemedicine practice in urology. Modifiable features that may enhance patient acceptance include providing previsit education regarding the ability of the video-visits to deliver care equivalent to a traditional encounter and offering access to video-visit consultations in the presence of the patient's local referring provider. Patient technical considerations include access to broadband Internet, a smart mobile device, or personal computer, as well as speakers and a microphone. Minimum operating system requirements include Microsoft XP, Vista, or 7; or Apple OS 10.7 or greater. Accordingly, before implementing a telemedicine practice, it is important that the urologist ensures compliance with state-specific medical licensure, credentialing, and reimbursement laws. Specific physician technical considerations include the use of a secure, private, HIPAA-compliant licensed medical consultation software, providing supplemental patient education through a virtual platform and offering technical assistance when needed. For patient safety, the provider should identify and screen for indication-specific exclusion criteria, which may require a physical examination. Video-visits can be integrated into a traditional ambulatory clinic; however, to improve efficiency, we encourage the patient to perform a “test” call before their appointment and offer video-visits greater than 1 month before the anticipated visit to allow for patient accommodations. Conclusions: Establishing a telemedicine service in a urology practice is an effective and efficient way of delivering care to established patients while requiring minimal modifications to a traditional clinic model. Nevertheless, to establish a successful telemedicine practice, several important considerations do exist, including patient and provider technical requirements, compliance with state-specific telemedicine laws, and identifying patients in whom a physical examination can be safely omitted. No competing financial interests exist. Runtime of video: 5 mins 33 secs