Increased Patient Awareness Research Articles

POS-300 Patient-reported early stage chronic kidney disease

The diagnosis of chronic kidney disease (CKD) occurs predominantly during advanced disease (stages 4, 5) when there are few opportunities to delay further progression and avoid complications. Patients’ knowledge about their disease can improve self-management leading to better outcomes. However, limited evidence exists regarding patients’ awareness of their CKD diagnosis. Health Survey for England (HSE) is a population-based cross-sectional survey conducted annually to monitor health care of adults and children living in private households in England. We utilised three waves of HSE data (2009, 2010 and 2016 – due to their focus on CKD) to identify patients aged ≥ 16 years with an eGFR between 30 and 59 ml/min/1.73m2 to assess the proportion of patients (95% confidence interval (CI)) aware of their CKD diagnosis (self-reported CKD). Results were tabulated incorporating the HSE survey design using weighting for the blood sample survey component as supplied by NHS Digital as part of the datasets. A total of 32,781 participants were included in the survey, with self-reported CKD prevalence reported for 18,114 and blood / urine samples for 8,970. We identified 555 (6.3%) patients with laboratory evidence indicating stage 3 CKD (including both stages 3a and stage 3b). Among them, 92.7% (90.4-94.4) did not report having CKD (Table 1). Those with a history of cardiovascular disease (CVD) were more likely to report CKD compared to those without CVD (p-value <0.05), but no difference was observed for those with diabetes mellitus (Type 1 or Type 2). No statistically significant differences were observed in self-reported CKD status by age and sex. Utilising population-based survey data in England, a large majority of patients with laboratory evidence of early CKD were unaware of their condition. An opportunity to increase patient awareness clearly exists, and proactive strategies to improve affected patients’ knowledge of their CKD are recommended.

An analysis of Google Trends following athletic injuries by high profile NBA players during the 2019 NBA finals.

Injuries are common among high profile players in the National Basketball Association (NBA), and could provide an opportunity for physicians to provide accurate sports injury information and reliable rehabilitation data to the general public in the immediate aftermath. To evaluate social media trends to investigate public interest in athletic injuries in the NBA and to evaluate the length of maintained interest in these injuries. The Google Trends tool was used to analyze search data around two high profile players-Kevin Durant and Klay Thompson-who suffered injuries during the 2019 NBA Finals. The results were compared to the expected search forecast derived from an autoregressive integrated moving algorithm model. Both players were associated with a mean increase of 1,052.4% (standard deviation [SD], 703.96%) in relative search volumes for terms related to their injuries. This data showed a significant increase in search engine activity related to injuries associated with NBA players in the first 6.13days (SD, 3.14days) following the injuries, marking a substantial timeframe for public engagement. Search traffic information may be beneficial to the sports medicine community, as social media can provide a platform for patient education in a limited timeframe. By increasing patient awareness and knowledge regarding athletic injuries, social media can expand the pool of potential patients for physicians and surgeons.

Increasing Cybercrime Since the Pandemic: Concerns for Psychiatry

Purpose of ReviewSince the pandemic, the daily activities of many people occur at home. People connect to the Internet for work, school, shopping, entertainment, and doctor visits, including psychiatrists. Concurrently, cybercrime has surged worldwide. This narrative review examines the changing use of technology, societal impacts of the pandemic, how cybercrime is evolving, individual vulnerabilities to cybercrime, and special concerns for those with mental illness.Recent FindingsHuman factors are a central component of cybersecurity as individual behaviors, personality traits, online activities, and attitudes to technology impact vulnerability. Mental illness may increase vulnerability to cybercrime. The risks of cybercrime should be recognized as victims experience long-term psychological and financial consequences. Patients with mental illness may not be aware of the dangers of cybercrime, of risky online behaviors, or the measures to mitigate risk.SummaryTechnology provides powerful tools for psychiatry but technology must be used with the appropriate safety measures. Psychiatrists should be aware of the potential aftermath of cybercrime on mental health, and the increased patient risk since the pandemic, including from online mental health services. As a first step to increase patient awareness of cybercrime, psychiatrists should provide a recommended list of trusted sources that educate consumers on cybersecurity.

Challenges and Opportunities in Expanding Home Hemodialysis for 2025.

The Advancing American Kidney Health Initiative has set an aggressive target for home dialysis growth in the United States, and expanding both peritoneal dialysis and home hemodialysis (HHD) will be required. While there has been a growth in HHD across the United States in the last decade, its value in controlling specific risk factors has been underappreciated and as such its appropriate utilization has lagged. Repositioning how nephrologists incorporate HHD as a critical renal replacement therapy will require overcoming a number of barriers. Advancing education of both nephrology trainees and nephrologists in practice, along with increasing patient and family education on the benefits and requirements for HHD, is essential. Implementation of a transitional care unit design coupled with an intensive patient curriculum will increase patient awareness and comfort for HHD; patients on peritoneal dialysis reaching a modality transition point will benefit from Experience the Difference programs acclimating them to HHD. In addition, the potential link between HHD program size and patient outcomes will necessitate an increase in the size of the average HHD program to more consistently deliver quality dialysis results. Addressing the implications of the nursing shortage and need for designing in scope staffing models are necessary to safeguard HHD growth. Seemingly, certain government payment policy changes and physician documentation requirements deserve further examination. Future HHD innovations must result in decreasing the burden of care for HHD patients, optimize the level of device and biometric data flow, facilitate a more functional centralized patient management care approach, and leverage computerized clinical decision support for modality assignment.

Designing a Pragmatic Intervention to Help Improve the Bladder Cancer Patient Experience.

Bladder cancer (BC) is the 10th most common malignancy worldwide and the patient experience is found to be worse than that for patients diagnosed with other cancer types. We aimed to develop a wellbeing intervention to help improve the bladder cancer patient experience by ameliorating their health-related Quality of Life (HRQoL). We followed the 3 phases of the modified Medical Research Council (MRC) Framework for development of complex interventions. Following a systematic review of the literature on mental, sexual, and physical wellbeing, we conducted discussion groups with patients and healthcare professionals on these 3 themes. A consultation phase was then conducted with all relevant stakeholders to co-design a wellbeing intervention as part of a feasibility study. A pragmatic wellbeing feasibility trial was designed based on the hypothesis that a wellbeing program will increase patient awareness and attendance to services available to them and will better support their needs to improve HRQoL. The primary feasibility endpoints are patient attendance to the services offered and changes in HRQoL. The principle of patient centered care has strengthened the commitment to provide a holistic approach to support BC patients. In this study, we developed a wellbeing intervention in collaboration with patients and healthcare professionals to meet an unmet need in terms of the BC patient experience.

Exploring the Barriers Toward Colorectal Cancer Screening: A Literature Review

Background: Colorectal cancer is the third most common cancer and the second leading cause of death worldwide. Bowel cancer screening helps prevent colon cancer by early detection of polyps, leading to efficient treatment and reduced mortality. Within Qatar, primary health facilities promote bowel screening by using the faecal occult blood test. However, the popularity and use of this test is still low. Aim: The aim of this literature review is to explore barriers related to colorectal cancer bowel screening using the faecal occult blood test in primary health care settings to facilitate colorectal cancer screening in Qatar. Method: Cronin’s five step framework for literature reviews was utilized for this paper. This review included nine articles that were peer-reviewed and published between 2009 and 2019. The nine articles were appraised by using the Mixed Methods Appraisal Tool. This tool has separate criteria to assess the quality of the qualitative, quantitative, and mixed-method studies. Result: Three main barriers to bowel cancer screening included knowledge deficit, personal beliefs and organizational barriers. Conclusion: The main barriers are related to the patients’ lack of knowledge and personal beliefs. Overcoming these barriers is essential to raising awareness about this issue among all nurses, physicians, and patients. It is necessary to involve stakeholders in order to mitigate barriers. Developing educational activities for healthcare professionals will provide information that they can share with patients to encourage screening and decrease the fear of the test. Developing a pamphlet to increase patient awareness will also encourage screening and work toward decreasing fear. Key words: faecal occult blood test, faecal immunochemical test, barriers

Real-world mapping of allergy immunotherapy in the United States: The argument for improving adherence.

Background: There is a dearth of real-world evidence studies focused on allergy immunotherapy (AIT) use among patients with allergic rhinitis (AR). Objective: This study examined claims data of AR patients residing in the United States to assess patient characteristics and health outcomes. Methods: AR patients were identified in the IBM MarketScan database between January 1, 2014, and March 31, 2017. Patients receiving AIT were identified with relevant billing codes (earliest AIT claim for vaccine as the index date); patients without AIT were identified with claims that contained a diagnosis code for AR (earliest AR claim as the index date). All the patients were required to have continuous enrollment 12 months prior to and following their index date. AIT patients reaching 25+ injection claims were analyzed as a separate maintenance cohort. Patients were assessed for demographic characteristics, comorbid conditions, and health care utilization. Results: A total of 2,334,530 AR patients were included; 103,207 had at least one AIT claim, with 45,279 (43.9%) of these patients reaching maintenance. Patients who reached AIT maintenance presented higher rates of baseline comorbidities than both the full AIT cohort and the patients with no AIT claims, including asthma (34.6% versus 30.1% versus 7.5%) and upper respiratory tract infections (63.1% versus 60.3% versus 34.2%). From baseline to follow-up, maintenance AIT patients demonstrated reductions in all AR-related comorbidities assessed, along with reductions in all-cause and AR-related service utilization. Conclusion: Patients initiating AIT presented the greatest need for therapeutic intervention, as evidenced by higher allergy-related comorbidities; those who reached maintenance demonstrated improved outcomes following the initiation of therapy. Continued efforts to increase patient awareness and adherence to AIT are needed.

Interproximal contact loss between implant-supported restorations and adjacent natural teeth: A retrospective cross-sectional study of 83 restorations with an up to 10-year follow-up

Statement of problemInterproximal contact loss between implant-supported restorations and adjacent natural teeth is a frequently encountered complication that could negatively affect surrounding tissues and/or patient satisfaction with treatment. The effect of interproximal contact loss on peri-implant tissue health and patient awareness of food impaction is currently unknown. PurposeThe purpose of this retrospective cross-sectional study was to explore the effect of interproximal contact loss on peri-implant tissue health and determine whether interproximal contact loss leads to increased patient awareness of food impaction around the affected area. This study also aimed to identify whether specific patient or local factors could cause interproximal contact loss. Material and methodsEighty-three participants with posterior single-unit implant-supported restorations were examined. The mean follow-up time after prosthesis insertion was 4 ±2.2 years (range 4 months to 10.6 years). Interproximal contacts were evaluated by using waxed dental floss. Patient age, sex, implant location, opposing tooth status, presence of endodontically treated adjacent tooth, and regular use of an occlusal device at night were recorded. Peri-implant probing depths and the presence of bleeding on probing were also recorded. Each participant was asked to indicate whether they had noticed increased food impaction around their implant-supported restoration. Statistical analysis included nonparametric Mann-Whitney U tests, the Spearman rank-order correlation, the Pearson chi-squared tests, and the paired t test (α=.05). ResultsAmong all examined mesial contacts, 34.1% were recorded as open, with an overall mesial interproximal contact loss (open and loose contacts combined) incidence of 48.8%. Restorations placed in premolar sites exhibited significantly tighter mesial interproximal contacts compared with those placed in molar sites (U=566, P=.041). A significant negative correlation was found between follow-up time after insertion and mesial contact tightness (rs=−0.226, P=.041). ConclusionsInterproximal contact loss appears to increase over time, with more surfaces being affected after longer periods of service. This study did not find an association between interproximal contact loss and peri-implant inflammation as measured by bleeding on probing, with the exception of the distolingual implant surface. Participants with interproximal contact loss were more aware of food impaction around their implant crown. Use of an occlusal device at night did not prevent interproximal contact loss.

Implementation and operational feasibility of SAMBA I HIV-1 semi-quantitative viral load testing at the point-of-care in rural settings in Malawi and Uganda.

We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load=SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. Between August 2013 and December 2016 a total of 60889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.

15723 Use of educational pamphlets in dermatology clinics to increase patient awareness of tobacco’s effects on the skin and to provide resources: impact on patient knowledge and tobacco cessation

Background: Tobacco use contributes to cutaneous diseases, skin aging, and poor wound healing. Tobacco cessation counseling focusing on dermatologic disease has not been well studied. In-clinic educational interventions can facilitate quit attempts among patients.

Abstract 16673: Empowering Heart Failure Patients Through Technology and Focused Education

Introduction: Heart Failure (HF) patient engagement after hospital discharge is key to preventing readmission and compliance. According to Medicare Hospital Compare the average rate of unplanned readmission is 21.6% Objective: The Rise Above Heart Failure™(RAHF) pilot program was created to identify strategies to reduce the burden of common HF complications and ultimately reduce hospitalization. The pilot included targeted quality improvement strategies, provider engagement, and a redesigned patient journey. Methods: Three North Texas pilot sites received quality improvement consultation and measured their progress towards improved guideline-directed care by tracking the impact to the 1,347 patients discharged with heart failure in Get With The Guidelines®-Heart Failure (GWTG-HF). The RAHF Pilot Program focused on engaging key stakeholders who working in partnership with AHA staff, developed a new patient journey for patients in the pilot. Results: The percent of HF patients who received 60 minutes of heart failure education by a qualified heart failure educator was analyzed and yielded the following results: the program hospitals saw an average adherence of 51.0% in Q2 and 53.9% adherence in Q4 (%Δ =5.8%). Additionally, the pilot program’s average of 50.47% during Q2-Q4 was more than 10% greater than the national average during the same time period. In the outpatient setting, HF PATH app users completed both a pre and post knowledge assessment between Oct 2019 - March 2020. A perfect score on the assessment is 19. The average pre-score for these participants is 16.33, while the average post-score for these participants is 17. Conclusions: Midterm results indicate that the program is successfully increasing HF patient education to increase patient awareness and understanding of HF, as represented by higher adherence to the 60 Minutes of Heart Failure Education measure and positive trends in the HF Path app knowledge assessment scores.

Public Online Interest in Injuries Sustained by National Football League Quarterbacks

PurposeTo use Google search data to determine the public’s interest in learning about athletic injuries sustained by NFL quarterbacks and to investigate how long this interest persists after the injuries.MethodsWe identified starting NFL quarterbacks during the 2019–2020 season online and used the official NFL injury report to determine whether an injury had occurred to a quarterback. We used the Google Trends tool to analyze search trends around a quarterback’s injuries from July 22, 2019, to October 22, 2019. Google trends data was extracted as relative search volume over time. We then compared the results to the expected search forecast derived from an autoregressive integrated moving algorithm (ARIMA) model.ResultsAll 6 injured quarterbacks were associated with increases (64% to 100%) in relative search volumes for terms related to their injury. Furthermore, the data showed a consistent increase in search engine activity around the injuries associated with NFL quarterbacks in the first 3 days, marking a particularly influential time frame for public engagement.ConclusionOur data show an increase in Google traffic surrounding the injuries of prominent NFL quarterbacks within the first 3 days following their injuries.Clinical RelevanceSocial media can provide a platform for patient education through increasing patient awareness and knowledge regarding athletic injuries.

Contributing Factors for Underutilization of Inhaled Corticosteroids Among Asthmatic Patients Attending at Adama Hospital Medical College, Adama, Ethiopia.

IntroductionInhaled corticosteroids (ICSs) are a cornerstone medicine for preventive therapy of persistent severe asthma. Although ICs are very effective for the treatment of severe persistent asthma, the majority of the prescribers worldwide aren’t aware of ICs use for the treatment of severe persistent asthma.ObjectiveTo evaluate factors contributing to underutilization of ICS by asthmatic patients.MethodsPatient interview was conducted among asthmatic patients using a cross-sectional study design who were attending at the Adama Hospital Medical College from March 1 to July 25, 2017. The total number of patients involved in the study was 94. Semi-structured questionnaire through patient interview was used for data collection and data from physicians who were working at the chest clinic of AHMC were collected by self-administered semi-structured questionnaire focusing their perspectives and experiences on patients’ ICS.ResultsGenerally 73.5% of underutilization of ICS was reported from the total number of patients involved in the study according to the patient’s perception. Monthly income, comorbid disease, and behaviors of ICS use were the main factors contributing to underutilization of ICS. According to patient’s report, some of the reasons for underutilization of ICS were unaffordability, using the drugs only when symptoms appear, inaccessibility, side effects and recommendation by physicians. There were also similar reports by the physicians working in the AHMC.ConclusionIn our study setting, prevalence of underutilization of ICS was high and the contributing factors were increased cost of ICS, inaccessibility of ICS, poor knowledge of the patients on asthma disease and ICS, bad attitude toward ICS, and lack of recently reviewed local guideline for asthma treatment. Thus, concerned experts need to take actions that guarantee accessibility of ICS at a reasonable price and increase awareness of patients about asthma disease and use of ICS.

Measuring Perceived Service Quality in Healthcare Setting in Developing Countries: A Review for Enhancing Managerial Decision-making

Healthcare is vital for the overall well-being of an individual. The service quality in healthcare is a matter of great importance for health institutions across the world. With increasing patient awareness and rising competition among hospitals, patient perception of healthcare quality has become very relevant. This study aims to review the literature to explore the concepts of perceived service quality, customer satisfaction, and behavioural intentions. The study has attempted to look into the relationship between perceived healthcare service quality, patient satisfaction, and behavioural intentions of patients. Healthcare service quality is measured using SERVQUAL dimensions as well as other dimensions specific to the healthcare sector. The findings clearly show that perceived healthcare service quality, patient satisfaction, and behavioural intentions are closely related to each other, and high-quality services lead to satisfied patients who further exhibit positive behavioural intentions.

The challenges of ethical behaviors for drug supply in pharmacies in Iran by a principle-based approach

BackgroundPharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies.MethodsThis qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians (n = 5), patients (n = 6), pharmacists (n = 8), inspectors of insurance companies (n = 4), and inspectors of food and drug administration (n = 3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles.ResultsAfter data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies.ConclusionsAccording to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies.

Investigation of a Mobile Health Texting Tool for Embedding Patient-Reported Data Into Diabetes Management (i-Matter): Development and Usability Study.

BackgroundPatient-reported outcomes (PROs) are increasingly being used in the management of type 2 diabetes (T2D) to integrate data from patients’ perspective into clinical care. To date, the majority of PRO tools have lacked patient and provider involvement in their development, thus failing to meet the unique needs of end users, and lack the technical infrastructure to be integrated into the clinic workflow.ObjectiveThis study aims to apply a systematic, user-centered design approach to develop i-Matter (investigating a mobile health [mHealth] texting tool for embedding patient-reported data into diabetes management), a theory-driven, mobile PRO system for patients with T2D and their primary care providers.Methodsi-Matter combines text messaging with dynamic data visualizations that can be integrated into electronic health records (EHRs) and personalized patient reports. To build i-Matter, we conducted semistructured group and individual interviews with patients with T2D and providers, a design thinking workshop to refine initial ideas and design the prototype, and user testing sessions of prototypes using a rapid-cycle design (ie, design-test-modify-retest).ResultsUsing an iterative user-centered process resulted in the identification of 6 PRO messages that were relevant to patients and providers: medication adherence, dietary behaviors, physical activity, sleep quality, quality of life, and healthy living goals. In user testing, patients recommended improvements to the wording and timing of the PRO text messages to increase clarity and response rates. Patients also recommended including motivational text messages to help sustain engagement with the program. The personalized report was regarded as a key tool for diabetes self-management by patients and providers because it aided in the identification of longitudinal patterns in the PRO data, which increased patient awareness of their need to adopt healthier behaviors. Patients recommended adding individualized tips to the journal on how they can improve their behaviors. Providers preferred having a separate tab built into the EHR that included the personalized report and highlighted key trends in patients’ PRO data over the past 3 months.ConclusionsPRO tools that capture patients’ well-being and the behavioral aspects of T2D management are important to patients and providers. A clinical trial will test the efficacy of i-Matter in 282 patients with uncontrolled T2D.Trial RegistrationClinicalTrials.gov NCT03652389; https://clinicaltrials.gov/ct2/show/NCT03652389

Association of continuity of care with readmission, mortality and suicide after hospital discharge among psychiatric patients.

The objective of this study was to identify the association between continuity of ambulatory psychiatric care after hospital discharge among psychiatric patients and readmission, mortality and suicide. Nationwide nested case-control study. South Korea. Psychiatric inpatients. Continuity of psychiatric outpatient care was measured from the time of hospital discharge until readmission or death occurred, using the continuity of care index. Readmission, all-cause mortality and suicides within 1-year post-discharge. Of 18702 psychiatric inpatients in the study, 8022 (42.9%) were readmitted, 355 (1.9%) died, and 108 (0.6%) died by suicide within 1 year after discharge. Compared with the psychiatric inpatients with a high continuity-of-care score, a significant increase in the readmission risk within 1 year after discharge was found in those with medium and low continuity of care scores. An increased risk of all-cause mortality within 1 year after hospital discharge was shown in the patients in the low continuity group, relative to those in the high-continuity group. The risk of suicide within 1 year after hospital discharge was higher in those with medium and low continuity of care than those with high continuity of care. The results of this study provide empirical evidence of the importance of continuity of care when designing policies to improve the quality of mental health care, such as increasing patient awareness of the importance of continuity and implementation of policies to promote continuity.

Direct-to-Consumer Advertising for Cancer Centers and Institutes: Ethical Dilemmas and Practical Implications.

In the United States, many cancer centers advertise their clinical services directly to the public. Although there are potential public benefits from such advertising, including increased patient awareness of treatment options and improved access to care and clinical trials, there is also potential for harm through misinformation, provision of false hope, inappropriate use of health care resources, and disruption in doctor-patient relationships. Although patient education through advertising is appropriate, misleading patients in the name of gaining market share, boosting profits, or even boosting trial accrual is not. It is critical that rigorous ethical guidelines are adopted and that oversight is introduced to ensure that cancer center marketing supports good patient care and public health interests. Patients with cancer have been identified as an especially vulnerable population because of fears and anxiety related to their diagnosis and the very real need to identify optimal sources of care. Cancer organizations have a fiduciary duty and a moral and legal obligation to provide truthful information to avoid deceptive, inaccurate claims associated with treatment success. In this article, actionable recommendations are provided for both the oncologist and the cancer center's marketing team to promote ethical marketing of services to patients with cancer. This tailored guidance for the oncology community includes explicit communication on (1) ensuring fair and balanced promotion of cancer services, (2) avoiding exaggeration of claims in the context of reputational marketing, (3) providing data and statistics to support direct and implied assertions of treatment success, and (4) defining eligible patient groups in the context of marketing for research. These recommendations for cancer centers are designed to promote ethical quality marketing information to patients with cancer.

A qualitative study of knowledge, behaviour and attitudes regarding vitamin D acquisition among patients with photosensitivity disorders.

Cutaneous exposure to sunlight is a major source of vitamin D. Individuals with photosensitivity disorders have symptoms provoked by sunlight and may not achieve the brief sunlight exposures that convey vitamin D acquisition. To explore knowledge, behaviour and attitudes towards vitamin D and its acquisition in patients with photosensitivity. Patients (n=19) diagnosed with solar urticaria, erythropoietic protoporphyria or polymorphic light eruption at a specialist photoinvestigation centre participated in semi-structured focus groups to discuss vitamin D knowledge, acquisition behaviours and attitudes towards vitamin D acquisition through sunlight and diet. Discussions were analysed by thematic analysis using MAXQDA11. Knowledge of vitamin D was variable. There was good awareness that sunlight exposure is an important source but knowledge of dietary sources was poor. Patients had little concern for their own vitamin D status prior to attending the photoinvestigation centre. Most patients avoided sunlight exposure, were unable to achieve the guidance on sun exposure for healthy individuals and were aware this could affect their vitamin D status. Use of oral vitamin D supplements was common, and all were willing to consider supplements if required. Patients recommended improving education of clinicians to increase patient awareness of vitamin D, CONCLUSIONS: More targeted guidance is required on acquisition of vitamin D for patients with photosensitivity, supported by increased patient and clinician education.

Internet and its Impact on the Patient-Physician Relationship Patient Visiting Various Dental Clinics in Northern India

INTRODUCTION: Readily available health-related information over the internet has led to increased patient awareness, and this might be a possible factor straining the patient-physician relationship.&#x0D; AIM: To assess the impact of the internet on the patient-physician relationship amongst patient visiting various dental clinics in Northern India.&#x0D; MATERIALS AND METHODS: Of the 600 pre-tested online questionnaires distributed, a total of 456 (response rate 76%) adequately filled questionnaires were analysed for the impact of internet on the patient-physician relationship. Responses were subsequently tabulated and analysed using SPSS Version 21.0. Statistical significance was kept as p≤0.05.&#x0D; RESULTS: A statistically significant difference (p=.04) was seen amongst males and females regarding their internet usage with a higher proportion of health information being seeked by males. Most internet users (66.6%) followed their physician’s advice before they began using the internet with behavioural changes seen mostly in the 18-30 years age group (75.64%), yet only 14.38% of them informing their physician about such changes.&#x0D; CONCLUSION: It is important that people be advised about the potential risks of believing in sources from the internet with physicians also being advised to spend more quality time with their patients to alleviate them of their fears and doubts.