Health Treatment Decisions Research Articles

The Effect of Lost Data on the IoT Platform on the Formation of Fetal Heart Rate Graphs for Remote Diagnostic Purposes

FHR is the fetal heart rate from bpm recording detected by doppler, FHR monitoring is very important to monitor fetal health to avoid fetal distress or fetal death, FHR provides more in-depth information about how the baby is doing compared to traditional monitoring of the baby. IoT media is a medium for monitoring remote sensor values ​​using internet connections, but there are several obstacles, namely there are doubts about the data displayed by IoT media, namely the risk of missing or unsent data, this will be very dangerous if the data that is should be monitored by doctors as a reference for medical diagnosis and treatment is lost or not displayed on the IoT, because if there is missing data it will cause inaccurate diagnosis or health treatment decisions by doctors. The aim of this study to analyze the effect of lost data on the formation of the Fetal Heart Rate graph on the IoT platform as a medium for remote diagnosis. In addition, FHR data can be saved for further diagnosis by a doctor if needed. This study uses an ESP32 microcontroller which will also be used to send data to IoT (Thinger.io). The independent variable used in this study is FHR data before it is uploaded to the IoT, and the dependent variable is FHR data when it is uploaded to the IoT. The greatest data loss is at the farthest distance of 30 meters with a value of 62.47%. Based on the research that has been done, this study has the advantage that the results obtained from Doppler are close to the BPM value in humans. And also this research has developments that can be done in the future such as adding storage to the website that is used for monitoring, and placing the right position on Doppler so that the results are more stable.

Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data.

BackgroundUncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations.ObjectiveThe objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States.MethodsThis study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered “Yes” to the question “Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?”, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months.ResultsAn estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor’s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone.ConclusionsIntervention measures accounting for age, gender, marital status, and the patient’s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers.

What Matters to Patients with Rheumatoid Arthritis When Facing Medical or Non-Medical Treatment Decisions?

BackgroundIn rheumatoid arthritis care, patients and healthcare professionals regularly face health treatment decisions. Sorting out what matters to a patient as being relevant to a specific decision is therefore essential.MethodsAn explorative mixed-methods study was performed to investigate patients’ values for health treatment decisions and their importance in order to develop a future decision aid on value clarification. Ten semi-structured interviews with patient partners were conducted followed by an online survey among the broader population of patients. Qualitative content analysis was performed. Data from the online survey were analysed descriptively and quantitatively.ResultsAccording to patients, 17 important health treatment decisions in rheumatoid arthritis care can occur. The most commonly reported decisions concerned the use of medication. A variety of values may guide patients’ health treatment decisions. We found 66 values among four domains of values – decisional, situational, external and global. Among decisional values, reported main values were a) effectiveness of treatment on inflammation, functioning, pain and fatigue; b) avoiding negative side-effects; and c) keeping in good physical condition. In addition, situational values turned out to be a) staying independent; b) being able to meet people; and c) leading as normal a life as possible. Furthermore, patients prefer healthcare professionals who a) take comorbidity into account, b) have enough time, and c) take the patient seriously in their choices – the external values. Finally, as global values were expressed a) autonomy; b) self-image, and c) intimacy. All values are specified by underlying quotes, for example, the value effectiveness on inflammation; “That inflammation has got to go, because you’ve then got the risk that you’ll develop all kinds of things in the course of time”.ConclusionA variety of values may guide patients’ health treatment decisions within rheumatoid arthritis care. Patients and professionals should discuss patients’ values continuously.

APA Board Approves New Codes for Suicidal Behavior and Nonsuicidal Self-Injury, Discusses Major New Initiatives

APA Board Approves New Codes for Suicidal Behavior and Nonsuicidal Self-Injury, Discusses Major New Initiatives

Psychological distance reduces the effect of internalized stigma on mental health treatment decisions.

Although stigma is a major barrier to treatment for those with mental health concerns, it is poorly understood when stigma is more or less influential in mental health treatment decisions. In the current work, we examined whether psychological distance - the removal of an event from direct experience - reduced the influence of internalized stigma on willingness to seek treatment. Specifically, we tested the hypothesis that psychological distance versus proximity (e.g., seeking treatment in three months vs. in two days, respectively) decreases the negative influence of stigma on willingness to seek treatment. We focused on a population for whom mental health treatment decisions are personally-relevant: individuals who had previously sought mental health treatment. Experiment 1 showed that the extent to which these individuals internalized (i.e., personally endorsed) stigma about mental illness predicted lower intentions to make an appointment with a mental health care provider for themselves (but not another person). Experiment 2 replicated this result using a different measure of psychological distance (temporal distance) and extended this finding to behavior (time spent reading mental health resources). Overall, this research demonstrated that internalized stigma disrupts mental health treatment-seeking intentions and behaviors when they are psychologically proximal, but not when they are distant. Potential applications of these results are discussed.

Does measuring the bone mineral density of patients identified as having an osteopaenic X-ray appearance affect bone health treatment decisions? A real-world retrospective analysis

Does measuring the bone mineral density of patients identified as having an osteopaenic X-ray appearance affect bone health treatment decisions? A real-world retrospective analysis

Does measuring the bone mineral density of patients identified as having an osteopaenic X-ray appearance affect bone health treatment decisions? A real-world retrospective analysis

Osteoporosis is a disease characterised by low bone mass, defined by the World Health Organization as equalling or exceeding 2.5 standard deviations below the mean for healthy young adult women at any site, and is associated with increased susceptibility to fragility fractures.[1,2][1] Osteoporotic

Mental Capacity in the (Civil) Law: Capacity, Autonomy, and Vulnerability

This paper examines mental capacity as a medico-legal social construct and concludes that, while the construct works reasonably well in the contexts of property-related transactions and health-treatment decisions, it is deeply problematic and is a source of dysfunction in the context of guardianship and guardianship-type interventions. There is nothing natural, compelling, or necessary about the concept of mental capacity, and the author proposes an alternate construct more consistent with the purpose of guardianship and guardianship-type interventions: vulnerability. As the capacity construct is deeply enmeshed with a traditional liberal theory of autonomy (the capacity-autonomy equation or paradigm), so the vulnerability construct described here is more consistent with a theory of relational autonomy. The author contends that the conceptual framing provided by the capacity-autonomy paradigm in the guardianship context has precluded the coherent theorization of vulnerability, and she suggests a more coherent framework for doing so by drawing on theories of equity and relational autonomy.

Patient Involvement and Shared Decision-Making in Mental Health Care

There is growing interest in shared decision-making (SDM) in which the provider and patient go through each phase of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. Although a majority of the research evaluating SDM has been conducted under "physical" health conditions, patients' participation and SDM for mental health conditions has received increasing interest since the mid 1990s. SDM in mental health care can be more complex than in general health care because that several patient characteristics, health care provider, and system level factors may hinder normalization and implementation of this model into clinical practice. To date, in comparison with other health problems, there are few studies which have assessed SDM in this context. In spite of that, evidence points favorably towards the inclusion of SDM in mental health treatment decisions, given that the majority of patients with mental illness prefer to be involved in the process and wish to have information. However, more studies are needed to provide evidence about the impact of SDM on treatment compliance and health care outcomes. In this overview, the authors present the current state and the future perspectives of SDM in mental health.

Cultural Resources for Health Participation: Examining Biomedicine, Acupuncture, and Massage Therapy for HIV-Related Peripheral Neuropathy

In this article we use a culture-centered approach to understand people's experiences of treatment options for human immunodeficiency virus (HIV)-related peripheral neuropathy. We present from often unheard and marginalized voices the stories of how people live with this chronic illness and negotiate treatment options. Based on individual and group interviews, participants reported that biomedical pills were an important context for understanding decision making regarding neuropathy treatment. While most people spoke of the necessity of these drugs for their survival, they also expressed deep resentment and frustration with biomedically prescribed pills. Complaints about the pills worked to frame the holistic alternatives of acupuncture and massage therapy as better options for neuropathy and to establish a foundation for understanding how participants made particular health treatment decisions. Through strategically refusing certain drugs and choosing holistic treatments instead, participants asserted agency and control over their health decision making. By choosing holistic therapies, these clients were able to make choices about their neuropathy treatment in light of the many issues surrounding drug toxicity and treatment efficacy.

Choosing “The Best of the Hells”: Mothers Face Housing Dilemmas for Their Adult Children With Mental Illness and a History of Violence

Family members in the United States--especially mothers--are frequently caregivers, and provide housing for their adult relatives and children with mental illness. They often do so with little support from the mental health system. The purpose of this analysis was to explore mothers' experiences related to housing options available to their adult children with a mental illness and a history of violence (MIHV) toward the mothers. The results of this study reveal a complex mixing of desires, feelings, internal factors, and external forces experienced by mothers of adult children with MIHV when considering whether or not these children can live in their homes. The findings from this study illuminate needs for greater familial involvement in mental health treatment decisions, respite for caregiving families, and housing as a crucial element of a comprehensive mental health treatment plan.

Decision aids for patients facing health treatment decisions in Spain: Preliminary results

Objective This study presents ongoing research aimed at understanding the suitability and impact of various decision aids (DAs) on patients with different chronic conditions in the Spanish National Health System. Methods A three-phase process was employed to develop and evaluate DAs for patients with hip or knee osteoarthritis (OA), benign prostatic hyperplasia (BPH), and depression, including: (1) systematic reviews on the effectiveness of shared decision making (SDM) interventions (including DAs); (2) the development of DAs; (3) a pilot study assessing the DAs. Results Systematic reviews carried out highlight that there are few studies assessing the effectiveness of DAs for OA, BPH, and depression. The development of DAs and their assessment currently differs for each medical condition. The DAs assessed for OA and BHP are well accepted. In a pilot study with OA patients, the DA produced a significant improvement in the decisional conflict “informed” subscale. Conclusion Research on SDM and DAs for different chronic conditions is at a very early stage in Spain. It is not possible to draw any definite conclusions about the effectiveness of DAs for clinical practice. Practice implications It is necessary to conduct more high quality studies to evaluate the effects of DAs in the Spanish context.

Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature.

Disengagement from mental health services can lead to devastating consequences for individuals with schizophrenia and other serious mental illnesses who require ongoing treatment. We review the extent and correlates of dropping out of mental health treatment for individuals with schizophrenia and suggest strategies for facilitating treatment engagement. Although rates vary across studies, reviews of the literature suggest that up to one-third of individuals with serious mental illnesses who have had some contact with the mental health service system disengage from care. Younger age, male gender, ethnic minority background, and low social functioning have been consistently associated with disengagement from mental health treatment. Individuals with co-occurring psychiatric and substance use disorders, as well as those with early-onset psychosis, are at particularly high risk of treatment dropout. Engagement strategies should specifically target these high-risk groups, as well as high-risk periods, including following an emergency room or hospital admission and the initial period of treatment. Interventions to enhance engagement in mental health treatment range from low-intensity interventions, such as appointment reminders, to high-intensity interventions, such as assertive community treatment. Disengagement from treatment may reflect the consumer's perspective that treatment is not necessary, is not meeting their needs, or is not being provided in a collaborative manner. An emerging literature on patient-centered care and shared decision making in psychiatry provides suggestive evidence that efforts to enhance client-centered communication and promote individuals' active involvement in mental health treatment decisions can also improve engagement in treatment.

Shared Decision-Making Preferences of People With Severe Mental Illness

Shared Decision-Making Preferences of People With Severe Mental Illness

Social and Economic Determinants of Disparities in Professional Help‐Seeking for Child Mental Health Problems: Evidence from a National Sample

To test the role of social determinants-including race, education, income, and demographic factors-of child mental health services use, defined as having had a visit to a mental health professional for depression, attention-deficit, or for any reason. National Longitudinal Survey of Youth and the Child/Young Adult supplement, a nationally representative sample of 7-14-year-old children born to women who were 14-22 years old at the start of data collection, in 1979. African Americans and Latinos were over-sampled, and population weights are available to make nationally representative inferences. Indicators of mental health service use were regressed on social and economic determinants, family structure variables, and insurance variables, controlling for need as captured by several different symptom scales. Girls are much less likely to obtain needed treatment for externalizing behavior disorders than are boys, and are somewhat less likely to obtain needed treatment for depression than boys. Middle children are less likely to obtain needed treatment for any mental health problem than are oldest, youngest, or only children. The presence of the father inhibits the likelihood that the child will receive treatment, particularly for depression. African Americans and Latinos are less likely than white children to receive treatment. In contrast to these rich results for the social and demographic determinants of children's specialty mental health utilization, the economic and insurance variables (including maternal education and income) seem to hold little predictive power. These results argue for interventions to sensitize parents-especially fathers-to the need to pay attention to the mental health needs of their children, in particular girls and middle children. The analysis also suggests that the literature on intrahousehold decision making and on the gender dimensions of investment in children is worth extending to mental health treatment decisions.

Social Representations of Attention Deficit/Hyperactivity Disorder, 1988–1997

Considerable debate has arisen regarding many aspects of attention deficit/hyperactivity disorder (ADHD), including the existence, diagnosis and prevalence of the disorder, the use of medications in treating young children for the disorder, and the long-term side-effects of the medications. A fundamental catalyst in this debate involves the numerous and diverse social representations of ADHD: the differing ways of perceiving what ADHD is, whom it affects, and the most appropriate treatments. This paper presents a discussion of social representations theory and its previous applications to the study of mental illness, connecting this theory with research in media framing. Quantitative and qualitative content analyses of print media representations of ADHD over a ten-year period are presented. Using results from the media analysis, we examine different processes through which these representations might influence perceptions of individuals experiencing ADHD-related symptoms, particularly as these perceptions relate to mental health treatment decisions.

Patient-centered decision making: empowering women to make informed choices—: Experience in the United States

Promoting patient-centered decision making has the potential to dramatically improve quality of care and satisfaction with the care delivery process. A number of important efforts are advancing this process. The goal of my presentation is to substantiate the claim that patient involvement can improve quality and to introduce the key areas of activity in the U.S. health care delivery system. I will use two common women’s health treatment decisions as illustrations: the hormone replacement therapy (HRT) decision for menopausal women and the surgical treatment decision for women with early-stage breast cancer. My comments will touch on four topics. First, I will describe variation in the treatment of menopausal women and women with early-stage breast cancer and develop the case for promoting patient-centered decision making as a way to improve the quality of decision making. I will then summarize the literature on the value of decision-support-tools and provide some examples of current tools for promoting patient-centered decision making. From there, I will review the National Committee for Quality Assurance’s (NCQA) new measurement initiative that has been designed to encourage health plans to develop counseling programs for menopausal women. Finally, I will describe some of the health plan initiatives that have been developed in response to the NCQA’s new measurement efforts.

Affirming the Decisions Adolescents Make about Life and Death

Adolescents who are critically, chronically, and terminally ill traditionally have been given little voice in their health care treatment. But over the last three decades attitudes have begun to shift. The legal and medical professions as well as parents and children's advocates have started to recognize that cognitively normal adolescents have decisionmaking capacity and believe these patients ought to have the opportunity to participate in even the toughest of health treatment decisions. Advances directives, if used with sensitivity and care, could prove a valuable means of giving these older pediatric patients a say in their care.

Premature Probate: A Different Perspective on Guardianship for the Elderly

The management of an individual's property and health is, in large part, left to that person's discretion. The law considers most people competent to make the necessary decisions in these areas. However, for those who lack that competence, largely the elderly,l the law provides for the imposition of surrogate management in the form of guardianship or its equivalent.2 Yet the substitution of a guardian's judgment as to what is best for the ward's health or property creates a grievious potential for abuse. The guardian may make health treatment decisions for the ward which are contrary to the ward's wishes. For example, the guardian may hospitalize the ward for the ward's protection. The hospital