Patient Brochures Research Articles

Enhancing Spanish Patient Education Materials: Comparing the Readability of Artificial Intelligence-Generated Spanish Patient Education Materials to the Society of Pediatric Dermatology Spanish Patient Brochures.

Patient education materials (PEMs) are crucial for improving patient adherence and outcomes; however, they may not beaccessibledue to high reading levels. Our study used seven readability measures to compare the readability of SpanishPEMsfromthe Society of Pediatric Dermatology (SPD) with those generated by Open-AI's ChatGPT 4.0 and Google Gemini. Our results showed that when prompted to produce material at a 6th grade level, both AI ChatBots generated significantly improved readability scores when compared to the SPD handouts. These findings suggest that AI-generated PEMs couldbetter meet readability standards and potentially improve patient outcomes, although further studies are needed to confirm this.

Impact of an evidence-based bundle on incontinence-associated dermatitis prevalence in hospital patients: A quasi-experimental translational study.

The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study,conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention.

Barriers, facilitators and needs to deprescribe benzodiazepines and other sedatives in older adults: a mixed methods study of primary care provider perspectives

BackgroundBenzodiazepines and other sedative hypnotic drugs (BSHs) are frequently prescribed for sleep problems, but cause substantial adverse effects, particularly in older adults. Improving knowledge on barriers, facilitators and needs of primary care providers (PCPs) to BSH deprescribing could help reduce BSH use and thus negative effects.MethodsWe conducted a mixed methods study (February-May 2023) including a survey, semi-structured interviews and focus groups with PCPs in Switzerland. We assessed barriers, facilitators and needs of PCPs to BSH deprescribing. Quantitative data were analyzed descriptively, qualitative data deductively and inductively using the Theoretical Domain Framework (TDF). Quantitative and qualitative data were integrated using meta-interferences.ResultsThe survey was completed by 126 PCPs (53% female) and 16 PCPs participated to a focus group or individual interview. The main barriers to BSH deprescribing included patient and PCP lack of knowledge on BSH effects and side effects, lack of PCP education on treatment of sleep problems and BSH deprescribing, patient lack of motivation, PCP lack of time, limited access to cognitive behavioral therapy for insomnia and absence of public dialogue on BSHs. Facilitators included informing on side effects to motivate patients to discontinue BSHs and start of deprescribing during a hospitalization. Main PCP needs were practical recommendations for pharmacological and non-pharmacological treatment of sleep problems and deprescribing schemes. Patient brochures were wished by 69% of PCPs. PCPs suggested the brochures to contain explanations about risks and benefits of BSHs, sleep hygiene and sleep physiology, alternative treatments, discontinuation process and tapering schemes.ConclusionThe barriers and facilitators as well as PCP needs and opinions on patient material we identified can be used to develop PCP training and material on BSH deprescribing, which could help reduce the inappropriate use of BSHs for sleep problems.

Abstract 3022: Comparison Of Stroke Mnemonics

Introduction: Strokes affect 15 million people worldwide annually, making them a leading cause of death and disability. Mnemonics have been developed in multiple languages to inform the public how to recognize stroke signs, including the English “BEFAST.” For Spanish-speaking populations, the mnemonics “AHORA” and “RAPIDO” are both circulated with pictorial brochures. This study compares the effectiveness of both mnemonics in helping people recognize stroke signs, which can guide us on how to develop mnemonics to communicate similar information in other languages. Hypothesis: The brochures with AHORA and RAPIDO mnemonics are equally effective in communicating the strokes signs to recognize to Spanish-speaking populations. Methods: Between January and December 2023, 50 Spanish-speaking patients and relatives were interviewed in the Northwell Health Neurosciences clinic in New York. Each participant was shown the AHORA and RAPIDO brochures and asked to identify for each handout the purpose, favorable features, and ranking of quality on a scale of 0-5. To mitigate presentation bias, half of the participants viewed the AHORA brochure first and the other half viewed the RAPIDO brochure first. A paired t-test was conducted to determine the statistical significance of the difference in average ranking of each brochure. Results: The AHORA brochure received an average ranking of 3.66/5.00, significantly higher than the average ranking of 3.36/5.00 for the RAPIDO brochure (p=0.0096). Positive comments about the AHORA brochure included the brochure appearing concise, the mnemonic being shorter, and the emphasis on calling 911 when stroke signs are recognized. Comments about the RAPIDO brochure included the brochure including excessive information and the mnemonic being longer and more difficult to understand. Conclusions: Participants preferred the AHORA brochure over the RAPIDO brochure due to its more concise mnemonic, clearer descriptions of stroke signs, and emphasis on calling 911 when stroke signs are recognized. These findings provide valuable guidance for physicians in selecting brochures for Spanish-speaking patients and offer insights into the elements necessary to develop effective mnemonics in other languages.

Abstract 1144: Comparison Of Ahora And Rapido Mnemonics In Effectively Communicating Stroke Signs In Spanish

Introduction: Strokes affect 15 million people worldwide annually, making them a leading cause of death and disability. Mnemonics have been developed in multiple languages to inform the public how to recognize stroke signs, including the English “BEFAST.” For Spanish-speaking populations, the mnemonics “AHORA” and “RAPIDO” are both circulated with pictorial brochures. This study compares the effectiveness of both mnemonics in helping people recognize stroke signs, which can guide us on how to develop mnemonics to communicate similar information in other languages. Hypothesis: The brochures with AHORA and RAPIDO mnemonics are equally effective in communicating the strokes signs to recognize to Spanish-speaking populations. Methods: Between January and December 2023, 50 Spanish-speaking patients and relatives were interviewed in the Northwell Health Neurosciences clinic in New York. Each participant was shown the AHORA and RAPIDO brochures and asked to identify for each handout the purpose, favorable features, and ranking of quality on a scale of 0-5. To mitigate presentation bias, half of the participants viewed the AHORA brochure first and the other half viewed the RAPIDO brochure first. A paired t-test was conducted to determine the statistical significance of the difference in average ranking of each brochure. Results: The AHORA brochure received an average ranking of 3.66/5.00, significantly higher than the average ranking of 3.36/5.00 for the RAPIDO brochure (p=0.0096). Positive comments about the AHORA brochure included the brochure appearing concise, the mnemonic being shorter, and the emphasis on calling 911 when stroke signs are recognized. Comments about the RAPIDO brochure included the brochure including excessive information and the mnemonic being longer and more difficult to understand. Conclusions: Participants preferred the AHORA brochure over the RAPIDO brochure due to its more concise mnemonic, clearer descriptions of stroke signs, and emphasis on calling 911 when stroke signs are recognized. These findings provide valuable guidance for physicians in selecting brochures for Spanish-speaking patients and offer insights into the elements necessary to develop effective mnemonics in other languages.

On subjective measures of decision quality.

In times of person-centered care, it is all the more important to support patients in making good decisions about their care. One way to offer such support to patients is by way of Patient Decision Aids (PDAs). Ranging from patient brochures to web-based tools, PDAs explicitly state the decisions patients face, inform them about their medical options, help them to clarify and discuss their values, and ultimately make a decision. However, lingering discussions surround effectiveness research on PDAs. In this article, I focus on two subjective measures of decision quality that are widely used as outcome measures in effectiveness research on PDAs (i.e., the Decisional Conflict Scale (DCS) and measures of regret). Although these measurement instruments have attracted critical attention in the scientific literature, bioethicists have hardly engaged with them. Therefore, I set myself to analyze the relationship between (the different subscales of) the DCS and measures of regret, on the one hand, and ethical principles such as beneficence and autonomy, on the other hand. In light of that analysis, I will clarify some discussions regarding the use of these measures of decision quality in effectiveness research on PDAs. This should help us to align the way we evaluate PDAs with ethical principles and avoid that our attempts to support patients in making good decisions about their care that is so central to person-centered care point in unethical directions.

Performance of Artificial Intelligence Chatbots on Glaucoma Questions Adapted From Patient Brochures.

Introduction With the potential for artificial intelligence (AI) chatbots to serve as the primary source of glaucoma information to patients, it is essential to characterize the information that chatbots provide such that providers can tailor discussions, anticipate patient concerns, and identify misleading information. Therefore, the purpose of this study was to evaluate glaucoma information from AI chatbots, including ChatGPT-4, Bard, and Bing, by analyzing response accuracy, comprehensiveness, readability, word count, and character count in comparison to each other and glaucoma-related American Academy of Ophthalmology (AAO) patient materials. Methods Section headers from AAO glaucoma-related patient education brochures were adapted into question form and asked five times to each AI chatbot (ChatGPT-4, Bard, and Bing). Two sets of responses from each chatbot were used to evaluate the accuracy of AI chatbot responses and AAO brochure information, and the comprehensiveness of AI chatbot responses compared to the AAO brochure information, scored 1-5 by three independent glaucoma-trained ophthalmologists. Readability (assessed with Flesch-Kincaid Grade Level (FKGL), corresponding to the United States school grade levels), word count, and character count were determined for all chatbot responses and AAO brochure sections. Results Accuracy scores for AAO, ChatGPT, Bing, and Bard were 4.84, 4.26, 4.53, and 3.53, respectively. On direct comparison, AAO was more accurate than ChatGPT (p=0.002), and Bard was the least accurate (Bard versus AAO, p<0.001; Bard versus ChatGPT, p<0.002; Bard versus Bing, p=0.001). ChatGPT had the most comprehensive responses (ChatGPT versus Bing, p<0.001; ChatGPT versusBard p=0.008), with comprehensiveness scores for ChatGPT, Bing, and Bard at 3.32, 2.16, and 2.79, respectively. AAO information and Bard responses were at the most accessible readability levels (AAO versus ChatGPT, AAO versusBing, Bard versusChatGPT, Bard versusBing, all p<0.0001), with readability levels for AAO, ChatGPT, Bing, and Bard at 8.11, 13.01, 11.73, and 7.90, respectively. Bing responses had the lowest word and character count. Conclusion AI chatbot responses varied in accuracy, comprehensiveness, and readability. With accuracy scores and comprehensiveness below that of AAO brochuresand elevated readability levels, AI chatbots require improvements to be a more useful supplementary source of glaucoma information for patients. Physicians must be aware of these limitations such that patients are asked about existing knowledge and questions and are then provided with clarifying and comprehensive information.

Celebrating Australian native foods through hospital foodservices: Engaging patients, staff and the broader community

Objective: The modern Australian diet is largely characterised by too few fruits and vegetables and too many discretionary foods. This is very different to how Indigenous Australians ate prior to colonisation. Native plants and seeds like bush tomatoes, warrigal greens, Kakadu plum and wattleseed are not common features of the contemporary Australian diet. We developed an initiative to incorporate native plants and seeds into a hospital inpatient menu to normalise their use and provide nutrition education to patients, staff and the community of the nutrition and sustainability benefits of native ingredients. Design: Between May and August 2022, the Chef’s Special menu (for privately funded patients) featured Australian native ingredients in all dishes. The nutritional benefits of native foods were communicated to patients through a printed brochure delivered with the menu, to foodservices staff through in-service training, and to the broader community through social media. Setting: Urban hospital in Brisbane, Australia. Method: Data were collected on acceptability, engagement and reach of the education initiative. Results: The initiative was successfully delivered, with more than 8,000 patient brochures distributed, 45 staff attending training, and social media reaching approximately 10,000 people. The most frequently ordered main meal on the menu was grilled snapper (fish) with macadamia Asian herb salad and finger lime. Conclusion: The work highlighted how the patient menu in hospital can serve as a useful tool to communicate nutrition education to patients, staff and the broader community. In addition, we reflect on the many opportunities to continue to celebrate the nutritional benefits of Australian native foods in healthcare settings.

Health literacy: educational brochure for pediatric patients with neurofibromatosis type 1

Health literacy: educational brochure for pediatric patients with neurofibromatosis type 1

Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI).

Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI). We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI. In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group, n = 153) or sham information (Control group, n = 148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA). Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2-1.8); p < 0.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4-2.2), p < 0.001]. Mean STAI score declined by 5.7 (95% CI 5.1-6.3; p < 0.001) in the Comic and 0.8 points (0.2-1.4; p = 0.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8-5.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function (p < 0.001 each). Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23/Oct/2020). Medical graphics entailed significant beneficial effects on the primary endpoints, patient understanding and periprocedural anxiety, compared to the usual patient informed consent (IC) procedure. Patient understanding of IC-related aspects was significantly higher in the Comic group, with a more pronounced benefit in patients with cognitive impairment (p for IC method and cognitive status < 0.001, respectively; p for IC method x MoCA category interaction = 0.017). There further was a significant decline of periprocedural anxiety in patients with and without cognitive impairment (p for IC method x measuring time point < 0.001; p for IC method x MoCA category x measuring time point interaction = 0.018).

10264-NQPC-10 ACTIVITY RECORD OF THE JAPAN BRAIN TUMOR ALLIANCE, AND THE NEEDS OF BRAIN TUMOR PATIENTS AND FAMILIES

Abstract Brain tumor is a major shock at diagnosis for patients and their families, and is likely to have physical, emotional, financial, and social impacts to them. These impacts are not limited to during treatment, but affect their lives even after the treatment is over. Therefore, continuous support is a must for brain tumor patients and their families. The Japan Brain Tumor Alliance (JBTA) was established in 2006 and provides nationwide patient support. Our main activities are 1) support for patients and their families, 2) provision of the latest information and networking, 3) contribution to advocacy and science, and 4) awareness-raising activities. In (1), we hold monthly social gatherings where patients and their families can share their daily problems and challenges. In (2), JBTA actively collaborated with other patient groups in Japan and abroad, and in (4), continues to provide up-to-date information via website and social media. JBTA has been particularly active in 3) by holding the seminars by health care professionals and the meetings with neurosurgeons in Japan Clinical Oncology Group to discuss newly planned clinical trials. Our cooperation with rehabilitation therapists and nurses resulted in a brochure for patients, "Brain Tumor Support Book". As members of the committee of supportive care for brain tumor patients which was established in the Japan Society of Neuro-Oncology, collaboration with various health care professionals was made to prepare leaflets for supportive care including advance care planning. Since April 2023, a survey to find out the needs of patients and caregivers is on-going. The interim report as of June 2023 showed that patients and their caregivers have difficulties to share their concerns and problems, and that they have few opportunities to receive support from multidisciplinary professionals. Therefore, more supports for brain tumor patients and their families are needed in their daily lives.

Optimizing Ophthalmology Patient Education via ChatBot-Generated Materials: Readability Analysis of AI-Generated Patient Education Materials and The American Society of Ophthalmic Plastic and Reconstructive Surgery Patient Brochures.

This study aims to compare the readability of patient education materials (PEM) of the American Society of Ophthalmic Plastic and Reconstructive Surgery to that of PEMs generated by the AI-chat bots ChatGPT and Google Bard. PEMs on 16 common American Society of Ophthalmic Plastic and Reconstructive Surgery topics were generated by 2 AI models, ChatGPT 4.0 and Google Bard, with and without a 6th-grade reading level prompt modifier. The PEMs were analyzed using 7 readability metrics: Flesch Reading Ease Score, Gunning Fog Index, Flesch-Kincaid Grade Level, Coleman-Liau Index, Simple Measure of Gobbledygook Index Score, Automated Readability Index, and Linsear Write Readability Score. Each AI-generated PEM was compared with the equivalent American Society of Ophthalmic Plastic and Reconstructive Surgery PEM. Across all readability indices, PEM generated by ChatGPT 4.0 consistently had the highest readability scores, indicating that the material generated by this AI chatbot may be most difficult to read in its unprompted form (Flesch Reading Ease Score: 36.5; Simple Measure of Gobbledygook: 14.7). Google's Bard was able to generate content that was easier to read than both the American Society of Ophthalmic Plastic and Reconstructive Surgery and ChatGPT 4.0 (Flesch Reading Ease Score: 52.3; Simple Measure of Gobbledygook: 12.7). When prompted to produce PEM at a 6th-grade reading level, both ChatGPT 4.0 and Bard were able to significantly improve in their readability scores, with prompted ChatGPT 4.0 being able to consistently generate content that was easier to read (Flesch Reading Ease Score: 67.9, Simple Measure of Gobbledygook: 10.2). This study suggests that AI tools, when guided by appropriate prompts, can generate accessible and comprehensible PEMs in the field of ophthalmic plastic and reconstructive surgeries, balancing readability with the complexity of the necessary information.

Assisted suicide: a need for clarification

In Switzerland, altruistic assisted suicide is permitted. We present here the federal regulations, the deontological rules, the provisions adopted by the cantons and other requirements applicable to assisted suicide. Given the complexity of these different rules and the legal questions that remain open, we recommend the preparation of brochures for patients, as well as better training and support for people faced with requests for assisted suicide.

Applying a knowledge translation framework for triaging low back pain and radicular pain at an emergency department: an iterative process within an uncontrolled before-and-after design

BackgroundDiagnostic imaging for low back pain (LBP) without any indication of a serious underlying cause does not improve patient outcomes. However, there is still overuse of imaging, especially at emergency...

Effectiveness of training primary care physicians about the principles of smoking treatment

Aim. To evaluate the impact of training primary care physicians about the principles of smoking treatment on the rate of successful quitting among their patients.Material and methods. Within the regional program on cardiovascular prevention among men aged 45-55 years, a study was made on the effectiveness of an educational seminar for primary care physicians (clustered quasi-experimental study). The main group consisted of 70 physicians (subjects of intervention) who underwent face-to-face training at a 3-hour interactive seminar on the principles of behavioral and drug treatment of smoking patients. In the following year, they consulted 423 smokers (subjects of analysis). The comparison group was represented by 174 doctors trained with extramural program who consulted 654 smokers. The doctors of both groups were provided with methodological and informational support in the form of short guides and brochures for patients. The main outcome studied was smoking cessation in patients one year after physician training. The comparison of outcomes was carried out taking into account the cluster structure of data using hierarchical regression. The initial imbalance of comparison groups in history of smoking, quit attempts, as well as level of alcohol consumption was corrected at the analysis stage.Results. In total, 12,6% of patients in the observed cohort quit smoking after one year, which was significantly higher than the common successful self-quit rate (3-5%). The likelihood of quitting smoking was strongly influenced by a particular doctor (ICC=0,326). Face-to-face interactive training of physicians significantly increased the probability of successful refusal in patients compared with distance learning (adjusted hazard ratio (HR) =4,8; odds ratio (OR) =5,3, 95% confidence interval (CI), 2,7-10,6, p&lt;0,001). The likelihood of successful withdrawals among patients among primary care physicians was much higher than among health center patients (adjusted HR=4,5; adjusted OR, 5, 95% CI, 1,2-20,6, p=0,027).Conclusion. Education of primary care physicians in the principles of smoking treatment, combined with the provision of information materials for patients, significantly increases the success rate among motivated smokers. At the same time, a face-to-face interactive seminar is much more effective than distance learning. General practitioners demonstrate the best professional productivity, regardless of the training form.

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

PurposeTo evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group).MethodsAll patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital.Results136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688).ConclusionsThe extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands.Level of evidenceIII.

Let\u2019s talk about sex: exploring factors influencing the discussion of sexual health among chronically Ill patients in general practice

BackgroundChronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill patients. Therefore, the aim of this study was to examine; to what extent GPs discuss SD with chronically ill patients; the barriers that may stop them; and the factors associated with discussing SD.MethodsA cross-sectional survey using a 58-item questionnaire was sent to 604 Dutch GPs. Descriptive statistics and associations were used for analysis of the data.ResultsNearly 58% (n = 350) of all GPs approached gave a response and 204 questionnaires were analysable (33.8%). Almost 60% of respondents considered discussing SD with patients important (58.3%, n = 119). During the first consultation, 67.5% (n = 137) of the GPs reported that they never discussed SD. The most important barrier stopping them was lack of time (51.7%, n = 104). The majority (90.2%, n = 184) stated that the GP was responsible for addressing SD; 70.1% (n = 143) indicated that the GP practice somatic care nurse (GPN) was also responsible. Nearly 80% (n = 161) of respondents were unaware of agreements within the practice on accountability for discussing SD. This group discussed SD less often during first and follow-up consults (p = 0.002 and p < 0.001, respectively). Of the respondents, 61.5% (n = 116) felt that they had received insufficient education in SD and 74.6% (n = 150) stated that the subject is seldom discussed during training. Approximately 62% of the GPs (n = 123) wanted to increase their knowledge, preferably through extra training. According to 53.2% of the GPs (n = 107) it was important to improve the knowledge of the GPN. The most frequently mentioned tool that could help improve the conversation about SD was the availability of information brochures for patients (n = 123, 60.3%).ConclusionsThis study indicates that Dutch GPs do not discuss SD with chronically ill patients routinely, mainly due to lack of time. An efficient tool is needed to enable GPs to address SD in a time-saving manner. Increased availability of informational materials, agreements on accountability within GP practices, and extra training for the GPs and GPNs could improve the discussion of SD.

Valproate Restrictions in Sweden and Norway: Online survey suggests implementation deficit.

To assess knowledge among neurologists in Sweden and Norway on the restrictions issued by the European Medicines Agency (EMA) regarding use of valproic acid (VPA) to female patients of childbearing potential, their use of the pregnancy prevention programme and their VPA prescription habits. We conducted an online survey from May through September 2021 inviting neurologists in Sweden and Norway to participate. The questions assessed familiarity with the EMA restrictions, knowledge and use of the information material issued by Market Authorization Holders (MAH) of VPA, and experience of VPA prescriptions to women of childbearing age in the last 2years. The survey received 202 responses (response rate≈20%). Of the responders, 51% were well acquainted with the EMA restrictions, and 49% were aware of the MAH-issued educational material. Eighty-eight (44%) had prescribed VPA to women of childbearing age in the last 2years, and of these, only a small minority (n=13) regularly used the information brochure for patients, and even fewer (n=8) the VPA risk acknowledgement forms. We found limited penetrance of the new EMA restrictions on VPA use as well as limited acceptance and use among prescribers of the current company-issued information material and risk acknowledgment forms. More information campaigns and closer collaboration with treating physicians are likely needed.

Verejní lekárnici a správna aplikácia inhalačných liekov

Inhaled medications are considered a preferred dosage form of medicine to treat respiratory diseases, such as bronchial asthma and chronic obstructive pulmonary disease (COPD), when bronchodilators or, more precisely, controlled drugs for treatment are used. The main objective of our research was to find out community pharmacists’ general knowledge of particular inhalation systems (IS) dispensed in pharmacies. All data necessary for the evaluation have been obtained by an anonymous survey questionnaire carried out between September 2020 and January 2021, which was done both in printed form and online. The questionnaire was self-construction, anonymous, consisting of sociodemographic data (age, gender, residence address – region) and 22 research questions. Both the administration of bronchodilators and inhaled corticosteroids were monitored in the survey. A total of 115 respondents participated in the survey, 86 females (75%) and 29 males (25%). Most of the respondents, 45 (39%), were aged between 23 and 29. The data show that 62 respondents (53.91%) encounter inhaler dispensing several times a day, with the prevalence of aerosol inhalers (MDI), which was confirmed by 78 pharmacists (67.83%). Most of the time, pharmacists meet patients with bronchial asthma, 80 (69.57%), and bronchodilators are prescribed for therapy mainly, 74 (64.35%). In total, 60 respondents (52.17%) provide patients with information on proper administration of inhaled medicines at their request, and only 46 of the respondents (40%) do it without being asked. The survey outcomes show that community pharmacists have minimum knowledge of nebulizers and also of the use of inhalator attachments. The vast majority of participants, 90 (78.26%), say that since they graduated, they haven’t attended any education courses aimed at proper administration of inhaled medications as part of their constant education. Up to 95 respondents (82.61%) are interested in IS mock-ups in a pharmacy, 103 pharmacists (89.97%) in information materials for their self-study, and 110 respondents (95.65%) in IS leaflets and brochures for patients. A positive finding of the survey is that the majority of the respondents, 101 (87.83%), are interested in further educating themselves to get knowledge of this matter in the future. Our survey outcomes show that our respondents’ knowledge of inhalation systems (IS) is sufficient. Most of the pharmacists who participated in the survey can provide patients with basic information regarding the proper administration of inhaled medicines.

Graphic Medicine's Possible Futures: Reconsidering Poetics and Reading

Graphic Medicine's Possible FuturesReconsidering Poetics and Reading Erin La Cour (bio) and Anna Poletti (bio) Since its coinage in 2007 by medical practitioner and comics artist Ian Williams, graphic medicine has steadily gained traction as an umbrella term for comics that explore healthcare issues, the theoretical discourse these comics engender, and the study of comics as expressive communicative tools. Embedded within comics studies, graphic medicine interacts with the interdisciplinary medical humanities, which applies insights from the humanities, the social sciences, and the arts to the study and practice of medicine. Primarily promoted as a means of engendering compassion in practitioners in training, the goal of the medical humanities is: to reconceptualize health care, through influencing students and practitioners to query their own attitudes and behaviors, while offering a nuanced and integrated perspective on the fundamental aspects of illness, suffering, and healing. In Aristotelian terms, medical humanities aim to improve health care (praxis) by influencing its practitioners to refine and complexify their judgments (phronesis) in clinical situations, based on a deep and complex understanding (sophia) of illness, suffering, personhood, and related issues. In this respect, medical humanities have a more applied function than the humanities as they are traditionally defined in the academy. (Shapiro et al. 192–93) Moving on from the use of comics in medical institutions, which predominately take the form of simple, top-down didactic infographics on posters and in patient brochures, graphic medicine aims to expand the benefits of using comics in both healthcare training and information dissemination. While the visual shorthand of infographics is easy to comprehend and can be helpful in providing patients with important information that orients them in relation to a specific illness or disability and its treatment, what they lack is an in-depth exploration of how illness and disability, as well as healthcare systems and statistics, can make one feel. Graphic medicine aims to redress this lack by focusing on how the complex affordances of the comics medium can provide subjective insights into experiences of various forms of illness and disability (Williams, "Autography" and "Graphic Medicine"; McNicol; Squier and Marks; Green and Myers). Emphasizing and examining the communicative potential of the juxtaposition of incongruent texts and images, verbal and visual metaphor, color, line, and pacing through page layout, paneling, and guttering, the study and production of graphic medicine aims to explore and expose the subjective experiences of health and healthcare systems that may be difficult for both practitioners and patients to understand or explain in either verbal or visual language alone. [End Page 1] The past decade has seen a proliferation of graphic medicine comics, produced in large part by individuals aiming to relay their personal experience living with a particular illness or disability. These works, along with those from the perspectives of doctors, nurses, social workers, carers, and family members, echo calls in the medical humanities for the urgent need for different understandings and expressions of illness and disability than those found in conventional medical discourse. Whereas medical institutions largely focus on diagnosis, prognosis, and treatment, graphic medicine takes a bottom-up approach that reveals how communication is not always easy or straightforward. With its focus on the patient as an identity that is constituted by pathology and the body, medical discourse often ignores the encounter between healthcare professionals and patients as a culturally bounded and interpersonal one, influenced by factors such as cultural context, language, gender, class, and ethnicity. To counter this tendency, graphic medicine discourse promotes comics as an important medium to depict interactions between individuals, their loved ones, a wide array of healthcare workers, and the healthcare system as scenes of intercultural, interdiscursive, and intergenerational encounter. Graphic medicine focuses on "taking back the experience of somatic dysfunction from medical authority and talking back to medical discourse" (Couser 348). Taking cues from narrative medicine, which has long advocated for the use of reading literature and writing reflectively as part of medical training and treatment (Milota et al.; Charon; and Williams, "Graphic Medicine"), a handful of medical schools have begun encouraging their students to read comics to gain insights into what their (future) patients may be experiencing. Comics about various forms of illness and disability now often...