Patient Acceptance Research Articles (Page 1)

This study aimed to comparatively evaluate the effects of polyherbal, chlorhexidine (CHX), and normal saline (NCC) mouthwashes on oral microbiome composition, microbial metabolic pathways, and patient-reported outcomes, with the goal of assessing the potential of polyherbal mouthwash as a natural alternative to CHX for managing gingivitis, while aiming to minimize CHX-associated microbial dysbiosis. A randomized, double-blind trial was conducted among 27 patients with gingivitis, randomly assigned to polyherbal, CHX, or NCC mouthwash groups. Participants used the assigned mouthwash twice daily for 7 days. Saliva samples were analyzed via 16S rRNA sequencing to assess microbial diversity (alpha and beta) and taxonomic composition. Differential taxa and pathways were identified using FDR-corrected Wilcoxon tests and log₂ fold-change analysis. Patient-reported outcomes were evaluated using numerical rating scales (NRS). The polyherbal mouthwash demonstrated significantly higher patient acceptability than CHX and NCC, with superior scores in taste, smell, texture, moisture retention, overall satisfaction, and willingness for continued use (p < 0.05). While CHX exhibited strong antimicrobial activity, its alcohol-containing formulation markedly disrupted microbial diversity, increased potentially dysbiotic genera (Streptococcus, Porphyromonas), and altered 23 metabolic pathways associated with dysbiosis. In contrast, the polyherbal mouthwash-which also contained cetylpyridinium chloride (CPC)- selectively increased beneficial genera (Amnipila, Absconditabacteriales [SR1], Peptostreptococcus), preserved overall microbial diversity, and modulated only two pathways, notably upregulating L-isoleucine biosynthesis. The polyherbal mouthwash represents a promising alternative to CHX, demonstrating selective microbial modulation, preservation of microbiome stability, and enhanced patient acceptability. These findings support its potential integration into routine oral healthcare as a microbiome-friendly and patient-acceptable solution. Further studies are warranted to evaluate CPC-free polyherbal formulations across larger and more diverse populations over extended durations.

Deprescribing, the process of stopping unnecessary medications, is essential for optimizing pharmacotherapy in older adults but is hindered by systemic, knowledge and patient-related barriers. This study explored physicians' perspectives on barriers and facilitators to deprescribing in older adults using the Theoretical Domains Framework (TDF), in an LMIC setting with limited evidence. A qualitative study was conducted using in-depth interviews with physicians (n = 52) to explore barriers, facilitators and potential improvements in deprescribing practices. Thematic analysis was applied to identify key insights and patterns from the collected data. This study identified several barriers to deprescribing, including limited healthcare access in rural areas and knowledge gaps in geriatric pharmacology among resident doctors. Patient-specific challenges, such as advanced age and multiple comorbidities, further complicated the process. The chronic use of medications like proton pump inhibitors (PPIs) and benzodiazepines was also a prominent barrier. Systemic and logistical issues, such as inefficient workflows and poor interdisciplinary coordination, were noted as critical impediments. Key facilitators included patient acceptance, which was pivotal for adherence and outcomes, and the active participation of educated patients in shared decision-making processes. A growing acceptance of deprescribing among doctors, especially in government healthcare, was observed, with effective communication key to overcoming patient resistance and building trust. Overcoming systemic barriers, enhancing patient education and implementing structured guidelines are key to improving deprescribing. Interdisciplinary collaboration and digital tools like electronic health records can further ensure safe medication discontinuation. Targeted interventions are essential to optimizing deprescribing and improving older adult's health outcomes.

The prevalence of anxiety and depression is increasing globally, outpacing the capacity of traditional mental health services. Digital mental health interventions (DMHIs) provide a cost-effective alternative, but user engagement remains limited. Integrating artificial intelligence (AI)-powered conversational agents may enhance engagement and improve the user experience; however, with AI technology rapidly evolving, the acceptability of these solutions remains uncertain. This study aims to examine the acceptability, engagement, and usability of a conversational agent-led DMHI with human support for generalized anxiety by exploring patient expectations and experiences through a mixed methods approach. Participants (N=299) were offered a DMHI for up to 9 weeks and completed postintervention self-report measures of engagement (User Engagement Scale [UES]; n=190), usability (System Usability Scale [SUS]; n=203), and acceptability (Service User Technology Acceptability Questionnaire [SUTAQ]; n=203). To explore expectations and experiences with the program, a subsample of participants completed qualitative semistructured interviews before the intervention (n=21) and after the intervention (n=16), which were analyzed using inductive thematic analysis. Participants rated the digital program as engaging (mean UES total score 3.7; 95% CI 3.5-3.8), rewarding (mean UES rewarding subscale 4.1; 95% CI 4.0-4.2), and easy to use (mean SUS total score 78.6; 95% CI 76.5-80.7). They were satisfied with the program and reported that it increased access to and enhanced their care (mean SUTAQ subscales 4.3-4.9; 95% CI 4.1-5.1). Insights from pre- and postintervention qualitative interviews highlighted 5 themes representing user needs important for acceptability: (1) accessible mental health support, in terms of availability and emotional approachability (Accessible Care); (2) practical and effective solutions leading to tangible improvements (Effective Solutions); (3) a personalized and tailored experience (Personal Experience); (4) guidance within a clear structure, while retaining control (Guided but in Control); and (5) a sense of support facilitated by human involvement (Feeling Supported). Overall, the DMHI met participant expectations, except for theme 3, as participants desired greater personalization and reported frustration when the conversational agent misunderstood them. Incorporating factors critical to patient acceptability into DMHIs is essential to maximize their global impact on mental health care. This study provides both quantitative and qualitative evidence for the acceptability of a structured, conversational agent-driven digital program with human support for adults experiencing generalized anxiety. The findings highlight the importance of design, clinical, and implementation factors in enhancing engagement and reveal opportunities for ongoing optimization and innovation. Scalable models with stratified human support and the safe integration of generative AI have the potential to transform patient experience and increase the real-world impact of conversational agent-led DMHIs. ISRCTN Registry ISRCTN 52546704; https://www.isrctn.com/ISRCTN52546704.

Digital technologies are reshaping dental implantology, with dynamic navigation and robotic systems offering high implant placement accuracy within clinically acceptable error ranges, the latter often achieving slightly higher accuracy. These systems enhance surgical accuracy and minimise trauma; however, high costs, extended preparation time, steep learning curves and uncertain patient acceptance limit their widespread adoption. This review summarises current principles, applications, benefits and limitations of dynamic navigation and robotic computer-assisted implant surgery (d-CAIS and r-CAIS), highlighting the need for clinicians to refine system proficiency and adapt their roles for future implant treatment procedures.

Abstract Background Malnutrition and antimicrobial-resistant (AMR) infections are major causes of morbidity and mortality in low-income countries (LICs). These conditions have been associated with the gut microbiome, however little is known about the acceptability of microbiota therapies like fecal microbiota transplantation (FMT). We explored the acceptability of FMT among healthcare providers (HCPs) and patients in Addis Ababa, Ethiopia. Methods In this qualitative study, we purposively sampled patients with bacterial infections and acute malnutrition, caregivers, and HCPs at two hospitals. Eight focus group discussions were held. Amharic and English discussion guides covered knowledge of FMT and perceived barriers or facilitators for uptake. Data were transcribed and translated into English when necessary. MAXQDA software was used for a thematic analysis: Trained researchers closely reading transcripts to identify issues, develop a codebook, iteratively cod data, and assessed inter-coder agreement. Description, comparison, and categorization were conducted to discern core themes, and validity checks ensured findings were grounded in the data. Results HCPs indicated a general willingness to prescribe FMT, provided there was sufficient evidence supporting its efficacy and safety, and they were confident on patient adherence. Patient acceptability of FMT was categorized along a continuum, from those who were unconvinced, persuadable, amenable, and accepting of salvage treatment. Conclusions FMT may be acceptable for HCPs and patients in Addis Ababa, though interventions, such as marketing it as standard medication, obtaining endorsement by religious leaders, providing multiple formulations, and/or thoughtful health communication, are needed to enhance acceptance among some groups.

In 2010, we observed missed opportunities for earlier human immunodeficiency virus (HIV) diagnosis among people newly diagnosed with HIV attending our service. We reached out to clinical services with low HIV testing rates. In the oncology service, <5% of all patients seen were tested for HIV between 2010 and 2012. With the rationale of excluding HIV-related immunosuppression prior to prescribing immunosuppressive treatment, we aimed to identify barriers to HIV testing (Plan). In 2013, we conducted the Investigating Barriers in HIV-Testing Oncology Patients (IBITOP I) study among people newly diagnosed with non-AIDS-defining cancers (non-ADCs) (Do). We observed that 18% of patients were offered HIV testing, 16% of physicians gave reasons for not offering testing and 91% of patients accepted testing offered (Study). The Swiss HIV testing recommendations were updated in November 2013, listing aggressive immunosuppressant treatment as a testing indication. In 2015, we organized interactive training sessions on HIV testing with oncology staff (Act) and conducted a follow-up study, IBITOP II, to examine residual barriers to testing. The primary endpoints of IBITOP II were (1) physician HIV testing offer rates, (2) physician reasons for not offering testing and (3) patient acceptance of testing offered. Training sessions were designed following engagement with senior oncology colleagues and covered the 2013 national testing recommendations, the rationale for excluding HIV prior to prescribing immunosuppressive treatment, the excellent prognosis of HIV on antiretroviral therapy and the practical aspects of offering HIV testing. Of 423 patients of unknown HIV status with newly diagnosed non-ADCs, 257 (60.8%) were offered HIV testing. The most frequent physician reasons for not offering testing were forgetting (19.9%), patients tested recently (19.3%) and lack of time (11.5%). Patient acceptance of testing offered was 83.2%. No HIV test was positive. Since the IBITOP II study, cancer treatment options have shifted from chemotherapy to targeted therapies or immunotherapies. Consequently, HIV is now included in baseline oncology workups, circumventing the testing barriers of forgetting and lack of time and increasing HIV testing rates to almost 100%. HIV testing rates at our oncology service have improved following two IBITOP studies, updated national testing recommendations and the broader oncology workup required by new therapies. By including HIV testing in the baseline workup, residual barriers to HIV testing have been circumnavigated. Modelling improvement in testing practice has stemmed from engagement with oncology colleagues, despite the fact that HIV testing is mentioned in a minority of specialist oncology guidelines.

Effectiveness and acceptability of interventions to improve readability of patient healthcare materials: A narrative systematic review.

Efficacy and safety of a New D-sorbitol, Ascorbic Acid, and Picosulfate Bowel Cleansing Solution for colonoscopy: A prospective, multicenter, randomized study.

An integrated drug delivery device for the localized treatment of the genitourinary syndrome of menopause.

Allied Health Assistants (AHAs) have been shown to increase both workforce and service capacity. To date, there has been positive evidence reported for the safe and effective delegation of dysphagia management tasks to AHAs for key roles, including dysphagia screening, mealtime monitoring and providing patient-end support during clinical swallowing assessments conducted via telehealth. The utilisation of AHA delegation to support dysphagia rehabilitation, however, has not been previously examined within an outpatient setting. To (1) identify the proportion and type of dysphagia-related tasks suitable for AHA delegation within an Australian outpatient setting, (2) evaluate the safety and acceptability of AHA delegated tasks and (3) determine implementation feasibility in an Australian outpatient context guided by the Practical Robust Implementation and Sustainability Model (PRISM) framework. A mixed method pre-implementation study design was used combining (a) a time and motion study to identify suitable dysphagia rehabilitation tasks for delegation; (b) a pilot trial of AHA delegated dysphagia rehabilitation to determine patient safety and satisfaction with the model and (c) semi-structured qualitative interviews with staff to explore the factors influencing the model's feasibility, aligned to the PRISM domains. While only 25% of the outpatient speech pathology caseload was noted to be dysphagia related, more than half (65%) of the dysphagia tasks completed in the outpatient setting were deemed suitable for AHA delegation. Patient outcomes from the pilot implementation were noted to be positive, with 78% of patients demonstrating improved swallowing. Patient satisfaction and AHA confidence were also noted to be high. However, the model's feasibility within the current context was noted to be influenced by several contextual barriers, primarily within the PRISM domains of 'organisational characteristics' and 'patient characteristics'. AHA delegation in the outpatient setting was identified to be safe and acceptable to patients within the pilot trial, though contextual barriers were reported to impact the model's feasibility. Engagement of AHAs in delegated dysphagia rehabilitation tasks has the potential to provide further opportunity to improve patient access to dysphagia services, without increasing demand on finite speech pathology resources. However, careful consideration of the local context is required to ensure future feasibility. Task delegation to trained AHAs can offer opportunities to improve access and intensity of dysphagia rehabilitation services in the outpatient setting. AHA delegation in the outpatient setting was identified to be safe and was considered acceptable to patients by the patients in this pilot trial. Clinicians reported several contextual barriers to delegated AHA dysphagia rehabilitation practices in the outpatient setting. These barriers are related primarily to 'organisational characteristics' and 'patient characteristics'. Contextual facilitators and barriers must be thoroughly investigated prior to full-scale implementation to ensure model suitability within services. What is already known on this subject To date, the delegation to Allied Health Assistants (AHAs) for certain dysphagia management tasks, including dysphagia screening, mealtime monitoring and their role in supporting telehealth has identified positive benefits for services. What this paper adds to existing knowledge Delegation of dysphagia rehabilitation tasks to trained AHAs could offer opportunities to improve access to, and intensity of, dysphagia rehabilitation services offered in the outpatient setting. However, patient acceptance and contextual facilitators and barriers must be investigated prior to full-scale implementation. AHA delegation in an Australian outpatient setting was identified to be safe and acceptable within the small number of patients in this pilot trial. However, clinicians reported several contextual barriers to delegated AHA dysphagia rehabilitation in the current outpatient setting. These barriers are related primarily to 'organisational characteristics' and 'patient characteristics' domains of the PRISM framework. What are the potential or actual clinical implications of this work? This study supports clinicians to identify opportunities for AHA delegation in outpatient dysphagia rehabilitation management. It provides a summary of potential contextual barriers which should be considered and addressed prior to full-scale implementation.

Implementation of community pharmacy-based testing and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia (Swab-Rx study).

Patient perspectives on artificial intelligence in healthcare: A global scoping review of benefits, ethical concerns, and implementation strategies.

Remote evaluation of general skin diseases using three-dimensional total body photography: An observer agreement study.

Effective pain management can reduce its negative impact and increase the overall quality of life of patients. This study aimed to investigate the experiences of oncology nurses in managing pain in patients with cancer. This qualitative study, employing a grounded theory approach, examined 19 nurses, two physicians, three patients, and two companions. Data collection consisted of in-depth, individual, and semi-structured interviews that continued until data saturation was achieved. The analytical framework proposed by Corbin &amp; Strauss (2014) led to the development of a coherent theory. The main theory derived from the data revolved around “trying to relieve patients’ pain and suffering”. Persistent pain, patient internal conflicts, reliance on pharmacological pain relief, contradictory effects of complementary medicine, cultural differences, different characteristics, lack of standardized pain management protocols, and limitations in the healthcare environment and resources emphasize the necessity of addressing patients’ suffering. In response to this concern, nurses used a variety of strategies, including developing a comprehensive roadmap, utilizing pharmacological and non-pharmacological interventions, reducing anxiety during pain, improving patient acceptance, and effective communication. The results of these strategies varied, with some cases providing pain relief and stability, while others were ineffective and resulted in persistent pain. Multiple factors can facilitate or hinder effective pain management. Insights gained from the experiences of nurses in this study provide valuable knowledge for physicians and nurses to enhance effective pain management.

Bariatric surgery has transformed metabolic outcomes for individuals with type 2 diabetes mellitus (DM) and obesity. While traditional Roux-en-Y gastric bypass (RYGB) shows significant efficacy, only 1% of eligible North Americans undergo this surgery, largely due to associated morbidity and mortality. Endoscopic bariatric therapies (EBT), offering incisionless options, have emerged but demonstrate limited long-term efficacy. This study introduces the Natural Orifice Transluminal Endoscopic Gastric Bypass (NOTES-GB) as a potential advancement in bariatric treatments. Nine adolescent male pigs were acclimated and fed a customized obesogenic diet for 3months to induce obesity. The NOTES-GB procedure was performed under general anesthesia, utilizing an endoscopic approach to create a gastrojejunal anastomosis and pyloric exclusion. All procedures were technically successful, with a mean operation time of 215.4min. Complications included one case of stent migration and one sudden death due to ischemic bowel. A staged approach combining single anastomosis sleeve jejunal (SASJ) followed by conversion to one-anastomosis gastric bypass (OAGB) minimized the risk of severe malnutrition. Our findings suggest that NOTES-SASJ followed by OAGB may effectively replicate the metabolic benefits of traditional bypass surgery while ensuring animal safety as a staged procedure. This novel approach could potentially enhance patient acceptance of bariatric procedures. The staged NOTES-GB technique demonstrates promise in managing DM and obesity, warranting further investigation in clinical settings. Future studies will assess its efficacy in human trials, aiming to revolutionize minimally invasive bariatric surgery.

Novel Insights into Noninvasive Assessment of Liver Fibrosis in Chronic Hepatitis C Patients.

Patient-reported preferences for sleep apnoea treatments in an Australian community sample.

Trigeminal herpetic neuralgia, a common type of Zoster-associated Pain (ZAP), affects individuals across all ages groups and poses a significant societal burden all over the world. Electroacupuncture (EA) is increasingly used in the treatment of ZAP due to its affordability, high safety profile, absence of adverse reactions, and high patient acceptance. Consequently, it is essential to conduct randomized controlled trials to evaluate the efficacy and safety of EA in treating ZAP and to determine if EA can be used as an alternative to pregabalin. A total of 102 patients with trigeminal herpetic neuralgia will be enrolled from 2 hospitals and randomly assigned to the EA group, pregabalin group, or EA + pregabalin group in a 1:1:1 ratio using a simple random number table. The study will consist of a 4-week treatment period followed by a 4-week follow-up period. The primary outcome measure will be pain intensity, while secondary outcomes will include mood state, sleep quality, and quality of life. Adverse reactions will be thoroughly evaluated. This study aims to elucidate the clinical efficacy of EA combined with pregabalin for trigeminal herpetic neuralgia and to objectively compare the efficacy and safety of EA versus oral pregabalin in the treatment of trigeminal herpetic neuralgia. Ethical approval has been obtained from the Ethics Committee of Hangzhou Third People's Hospital (No.2023KA010). Informed consent will be obtained from all participants prior to enrollment. The trial results will be published in international journals and presented at relevant international conferences. This protocol has been registered in the China Clinical Trial Registration Center with the identification code NCT06261801.

Miniaturised sampling and extraction are redefining therapeutic drug monitoring (TDM) by enabling low-volume sampling, simplifying collection, and improving patient acceptability, while also promoting decentralised workflows and more sustainable laboratory practices. This review critically appraises the current landscape, with emphasis on analytical performance, matrix compatibility, and readiness for clinical implementation. It examines validation requirements, the extent of alignment and existing gaps across major regulatory guidelines, and recurrent challenges such as haematocrit bias, real-world stability and transport, incurred sample reanalysis, device variability, commutability with conventional matrices, and inter-laboratory reproducibility. To make the evidence actionable, operational recommendations are distilled into a practical ten-point checklist designed to support validation and translation of miniaturised approaches into routine laboratory practice. Looking ahead, priorities include automation and portable platforms, advanced functional materials, and integration with digital tools and biosensors, alongside the development of harmonised frameworks tailored to miniaturised methods and prospective clinical studies that demonstrate impact on dosing decisions, adherence, and clinical outcomes. Overall, this review aims to equip researchers, laboratory professionals, and regulators with the knowledge to implement miniaturised bioanalysis and advance personalised medicine through TDM.

In low-resource settings, adults with unrepaired cleft palate often have limited access to surgery. Palatal obturators have been proposed as an alternative to surgery in older patients. This study explored the experiences of 5 adults fitted with obturators while awaiting primary palatoplasty in Paraguay. Despite initial discomfort, patients reported improved eating, speech, and self-esteem. Ultimately, however, all chose surgery, viewing it as a more permanent solution for speech issues. These findings highlight that while obturators offer benefits, patients prioritize surgery for long-term outcomes. This study points to the need for further research to identify strategies to optimize patient acceptance and outcomes of obturator use before they can be considered a feasible alternative to surgery for adults in low-resource settings.