Patient Brochures Research Articles

LONG-TERM OUTCOMES OF TREATMENT IN PATIENTS WITH DRUG-RESISTANT PULMONARY TUBERCULOSIS AND NON-EFFICIENCY OF PREVIOUS THERAPY

In 2018 key changes were made to the recommended treatment for multi-drug resistant tuberculosis, the priority of oral medications over injectables was indicated. For the first time in history, a new, completely oral 20-month treatment regimen was proposed. The regimen recommends bedaquiline and linezolid together with levofloxacin / moxifloxacin, cycloserine / clofazimine. This treatment regimen differs from the standard 4 MDR-TB chemotherapy regimens adopted in Russia. Until recently, bedaquiline and linezolid were relatively unobtainable in the conditions of tuberculosis dispensaries, patients who needed such treatment were referred to specialized Federal tuberculosis facilities. The aim of the study was to study the long-term results of treatment of patients with drug-resistant pulmonary tuberculosis in cases of the ineffectiveness of previous therapy in an antituberculosis dispensary and referral to a specialized Federal tuberculosis institution. In 2010-2014, 143 people of both sexes in the age group from 20 to 60 years old were treated in the Tver Regional Clinical Antituberculosis Dispensary. Individual conversations, organizing communication with other patients who received effective anti-tuberculosis treatment, watching the training video “Tuberculosis: Questions and Answers”, studying the materials of the brochure “School of the Patient. A brochure for patients suffering from tuberculosis” developed by the charitable organization “Partners in the name of health” was used in the process of increasing adherence to treatment. When carrying out measures to increase adherence to treatment among patients with pulmonary tuberculosis, a positive result was obtained in 143 people. These patients agreed to possible surgical intervention in the Federal Tuberculosis Institution. Immediately after the surgical stage of treatment, cavity closure and/or abacillation were achieved in 132 (92.3%) people. In the postoperative period anti-tuberculosis therapy was continued in accordance with the drug-resistant pathogen, the discipline of patients in receiving anti-tuberculosis drugs increased significantly.

Affecting emergency department oxycodone discharge prescribing: An educational intervention.

To describe the impact of an educational intervention for ED prescribers on discharge oxycodone prescribing both for the number of oxycodone prescriptions per 1000 discharged patients, and the number of tablets per prescription. Secondary outcomes included the quality of general practitioner communication. An interrupted time series assessment was conducted in the ED of a tertiary referral hospital to establish the pre-intervention, peri-intervention and post-intervention prescribing profile of ED medical practitioners. Prescriber numbers were used to obtain drug data for all oxycodone-containing prescriptions from the Queensland Health Medicines Regulation and Quality Unit database. The intervention included education sessions, a staff information email, posters within the ED, and a patient brochure. It was conducted with relevant nurses, pharmacists and prescribing doctors. In the pre-intervention period, 656/17 371 (38 per 1000) discharged patients were prescribed oxycodone, compared to 180/5938 (30 per 1000) during the intervention, and 602/20 505 (29 per 1000) post-intervention. This equated to a decrease of 8 per 1000 (95% CI 5-12 per 1000) and a 22% (95% CI 13-31%) relative prescribing reduction. The mean total number of tablets of oxycodone per prescription decreased from 16.7 (SD 16.5) pre-intervention, to 12.7 (SD 6.0) peri-intervention, to 10.7 (SD 5.2) post-intervention. After the intervention, there was an increase in discharge communications to general practitioners by 15.4% (95% CI 9.7-21.1%). An ED prescriber-targeted intervention reduced overall prescribing of oxycodone and improved communication at discharge. The prescribing intervention is one strategy that may be used by ED medical staff to improve patient safety and opioid stewardship in Australia.

Contraceptive Desert? Black-White Differences in Characteristics of Nearby Pharmacies.

Race differences in contraceptive use and in geographic access to pharmacies are well established. We explore race differences in characteristics of nearby pharmacies that are likely to facilitate (or not) contraceptive purchase. We conducted analyses with two geocode-linked datasets: (1) the Relationship Dynamics and Social Life (RDSL) project, a study of a random sample of 1003 women ages 18-19 living in a county in Michigan in 2008-09; and (2) the Community Pharmacy Survey, which collected data on 82 pharmacies in the county in which the RDSL study was conducted. Although young African-American women tend to live closer to pharmacies than their white counterparts (1.2miles to the nearest pharmacy for African Americans vs. 2.1miles for whites), those pharmacies tend to be independent pharmacies (59vs. 16%) that are open fewer hours per week (64.6 vs. 77.8) and have fewer female pharmacists (17 vs. 50%), fewer patient brochures on contraception (2 vs. 5%), more difficult access to condoms (49% vs. 85% on the shelf instead ofbehind glass, behind the counter, or not available), and fewer self-check-out options (3 vs. 9%). More African-American than white women live near African-American pharmacists (8 vs. 3%). These race differences are regardless of poverty, measured by the receipt of public assistance. Relative to white women, African-American women may face a "contraception desert," wherein they live nearer to pharmacies, but those pharmacies have characteristics that may impede the purchase of contraception.

L’éducation thérapeutique du patient à l’officine : retour sur un siècle de pédagogie

The therapeutic education of the patient in the pharmacy : return on one century of pedagogy – The chemist is a health educator. Its mission of therapeutic education of the patient (inscribed in the French Code of the public health since 2009) helps the patients to become actors of their medical care. The understanding of pathologies, their prevention and their treatments, leads to the improvement of the entire healthcare system. This article traces the history of the progressive construction of the concept of therapeutic education of the patient at the pharmacy, in France, during the twentieth century. This study is based on a corpus of brochures for patients (almanachs, booklets) distributed initially by some pharmacies concerned with their advertising ; but also over twenty years of the newsletter Info Santé (1977-1997) produced by the CESSPF. This article presents also three iconic pharmaceutical figures in health education : Dr Pierre Rolland, Pr André Quevauviller et the chemist Janine Dufouil.

The influence of patient engagement on the design and implementation of a clinical trial to improve cancer care delivery.

223 Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.

Knowledge Against Cancer: The Second Step

Background and context: The Institute of Oncology and Radiology of Serbia (IORS), supported by the Ministry of Health, launched the project Knowledge Against Cancer in 2015, whose aim was to prepare educational material for cancer patients. Thirteen brochures were presented on WCC in Paris in 2016. The IORS conducted a survey among oncology patients in January 2017 for them to evaluate the distributed brochures and suggest the topics for new educational material. Aim: This paper aims at evaluation of brochures for cancer patients which were created during the project and its primary goal is to define new topics for future educational material. Strategy/Tactics: The study includes 348 respondents (92% women, 8% men) with average age of 54.77 ± 13.26 and predominantly highly educated (45.4%). 90% of the respondents has evaluated this kind of educational material as significant. The study has also examined the choice and relevance of topics and the quantity and usage potential of new data. The analysis has shown that most patients are interested in including psychological aspects of cancer treatment as a new topic (76%) and in including topics concerning healthy lifestyles (69%). As the majority of the respondents are women, the significant interest has been shown for topics concerning lifedem and tumor radiation of female genital organs (over 85% of female respondents). Based on the results obtained through survey and consultations and interviews with patient support group and patients associations the educational brochures were created. Program/Policy process: In 2017, nine new topics were prepared by multidisciplinary teams from IORS: Brochure: psychological support for oncology patients, the manual for family and friends, the manuals for patients on radiation of tumors on female genital organs, for head and neck tumors, lymphoedema - prevention and treatment, treatment of thyroid gland cancer with radioactive iodine, tumor markers and laboratory diagnostic, prevention of malign illnesses and quitting smoking. Outcomes: Brochures are currently available both in paper and on the Web site free of charge. The design of mobile phone application is planned for the future. The educational material is not only presented and distributed to cancer families and the public but also to health professionals and medical workers. What was learned: The research has shown that this educational material is very important for cancer patients and that with adequate information and data such patients can improve life quality predominantly through the reduction of fears and anxiety, development of coping mechanisms to deal with the cancer diagnosis and treatment and encouraging them to take active part in cancer treatment.

Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands

BackgroundPatient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with their patients, and if there is a need for improvement.MethodsWe developed a survey to assess whether topics pertaining to sexual function were discussed during plastic surgical consultations. In 2016, all 385 members of the Dutch Association for Plastic Surgery were invited via post mail to participate.ResultsWe received 106 completed surveys (27.5%). The median age of the respondents was 45 (29–66) years. Most participants (78.3%) indicated that they rarely to never discuss sexuality with their patients. Surgeons in the subspecialization gender and genital surgery discussed sexual function most frequently. Two thirds of all respondents indicated that their current knowledge on this topic was insufficient, yet there was generally no interest expressed in receiving additional training (78.6%). However, there was a need for proper patient brochures (43.4%) and an organized referral network (36.5%) regarding sexuality.ConclusionsIn plastic surgery practice, sexuality appears to be a rarely discussed subject, with the gender and genital surgery subspecialties as the exception. Although professionals and patients emphasize the importance of sexuality, plastic surgeons express limited urge to be trained and prefer written patient information and referring patients to other healthcare professionals. The authors stimulate more education on sexuality during (continued) plastic surgery training.Level of Evidence: Not ratable

Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections.

Few studies have evaluated the long-term effects of educational interventions on antibiotic prescription and the results are controversial. This study was aimed at assessing the effect of a multifaceted practice-based intervention carried out 6 years earlier on current antibiotic prescription for respiratory tract infections (RTIs). The 210 general practitioners (GPs) who completed the first two registrations in 2008 and 2009 were invited to participate in a third registration. The intervention held before the second registration consisted of discussion about the first registration of results, appropriate use of antibiotics for RTIs, patient brochures, a workshop and the provision of rapid tests. As in the previous registrations, GPs were instructed to complete a template for all the patients with RTIs during 15 working days in 2015. A new group of GPs from the same areas was also invited to participate and acted as controls. A multilevel logistic regression analysis was performed considering the prescription of antibiotics as the dependent variable. A total of 121 GPs included in the 2009 intervention (57.6%) and 117 control GPs registered 22 247 RTIs. On adjustment for covariables, compared with the antibiotic prescription observed just after the intervention, GPs assigned to intervention prescribed slightly more antibiotics 6 years later albeit without statistically significant differences (OR 1.08, 95% CI 0.89-1.31, P = 0.46), while GPs in the control group prescribed significantly more antibiotics (OR 2.74, 95% CI 2.09-3.59, P < 0.001). This study shows that a single multifaceted intervention continues to reduce antibiotic prescribing 6 years later.

Readability assessment of American Shoulder and Elbow Surgeons patient brochures with suggestions for improvement

BackgroundMany Americans have limited literacy skills, and the National Institutes of Health (NIH) suggests patient educational material be written below the 8th grade level. Many orthopedic organizations provide print material for patients, but whether these documents are written at an appropriate reading level is not clear. This study assessed the readability of patient education brochures provided by the American Shoulder and Elbow Surgeons (ASES).Materials and MethodsIn May 2017, 6 ASES patient education brochures were analyzed using readability software. The reading level was calculated for each brochure using 9 different tests. The mean reading level for each article was compared with the NIH-recommended 8th grade level using 2-tailed, 1-sample t tests assuming unequal variances.ResultsFor each of the 9 tests, the mean reading level was higher than the NIH-recommended 8th grade (test, grade level): Automated Readability Index, 14.1 (P < .05); Coleman-Liau, 14.2 (P < .05); New Dale-Chall, 13.2 (P < .05); Flesch-Kincaid, 13.7 (P < .05); FORCAST, 11.8 (P < .05); Fry, 15.8 (P < .05); Gunning Fog, 16.5 (P < .05); Raygor Estimate, 15.4 (P < .05); and Simple Measure of Gobbledygook (SMOG), 15.1 (P < .05).ConclusionsThe ASES patient education brochures are written well above the NIH-recommended 8th grade reading level. These findings are similar to other investigations concerning orthopedic patient education material. Supplementary brochures and websites could be a useful source of information, particularly for patients who are deterred from asking questions in the office. Printed material designed for patient education should be edited to a more reasonable reading level. Further review of patient education materials is warranted.

Acceptability of intervention materials to decrease risk for alcohol and medication interactions among older adults

BackgroundThe majority of older adults take prescription or over-the-counter medications and about half consume alcohol regularly. Despite high risk for alcohol medication interactions (AMI), few community-level interventions exist to prevent AMI. The current study assessed the acceptability of educational materials created for use in a brief intervention to prevent AMI among older adults. MethodsOlder adults from two senior centers reviewed intervention materials (poster, patient and pharmacist brochures, and public service announcement) and participated in a pre and post-test to provide feedback and to assess changes in AMI-related awareness and intentions. ResultsPost-test data showed positive feedback and an increase in participant understanding of AMI prevention, with statistically significant changes in perceived importance of messaging surrounding risky alcohol use and potential consequences of AMI. DiscussionThe intervention materials were positively received, and participant feedback indicated that the collective presentation of all the materials was the most preferred tool for educating the community. With positive trends in awareness and knowledge, intervention effectiveness needs to be further evaluated in future large-scale studies. Lessons LearnedThis study provides health education specialists with tools to prevent alcohol and medication interactions among older adults.

Parental opinion regarding the pediatric outpatient organizations’ functioning as an important criterion of pediatric medical care quality

A survey was carried out to identify the factors influencing parent satisfaction with care provided in a pediatric clinical setting for children younger than 15 years. We distributed questionnaires to 300 parents to measure the quality of medical care provided in pediatric outpatient settings in Volgograd. The questionnaires included 26 closed questions, most of which were subjective and straightforward. The questions concerned availability of information about pediatric clinical settings, scheduling an appointment with a pediatrician or a pediatric specialist, patient waiting time for medical care, meeting the requirement to obtain voluntary informed consent from patients and availability and suitability for pediatric patients of most laboratory and diagnostic facilities. Parents reported that they obtained information from different sources, including registration staff in a clinical setting, the website of a clinical setting as well as from posters and patient brochures in the clinical setting. 68% of the respondents stated that the information provided was sufficient and comprehensible. Most respondents regarded registration staff working in pediatric clinical settings as the most authoritative source of information available. Registration stations in clinical settings were reported as the easiest and most affordable system for scheduling medical visits. 80% of the respondents stated that they always gave their informed consent to therapy or related issues, while 16% - rarely, and 4% of the respondents never provided informed consent. The majority of the respondents in the survey indicated that the information about their children’s health provided by the pediatrician was sufficient and accurate. The respondents reported being satisfied with the work hours of a pediatrician and waiting time for medical care. Out of 300 respondents, 79% said that their children received consultations with pediatric specialists as indicated.

The Use of a Brochure to Enable CAM-with-Chemotherapy Patient Education.

The majority of cancer patients receiving chemotherapy will consider taking complementary and alternative medicine (CAM) during their treatment. As biologically-active CAM may detrimentally interfere with chemotherapy treatment, cancer patients require evidence-based information on chemotherapy-CAM integration consequences. This study aimed to assess if the availability of a purpose-designed brochure within a cancer service aided doctors' discussions with their patients on CAM use and helped patients understand the effects of CAM during their chemotherapy treatment. Cancer care doctors consulting in an adult day unit completed a structured post-intervention feedback survey form (n = 17), and cancer patients receiving chemotherapy treatment were provided the brochure and completed the local health service consumer testing feedback form (n = 30). All cancer care doctors perceived a need for the brochure and recommended the brochure to their patients. All doctors thought the brochure made it easier for them to discuss CAM with their patients, and 59% believed that it saved them time during patient consultations. Ninety percent of cancer patients reported the brochure had enough information to answer their CAM questions, and all patients thought the information was easy to read and understand. An evidence-based CAM-with-chemotherapy patient brochure was perceived to have enabled cancer care doctors to discuss CAM with their patients and to have answered patients' CAM questions.

Facilitating the implementation of pharmacokinetic-guided dosing of prophylaxis in haemophilia care by discrete choice experiment.

Patients', parents' and providers' preferences with regard to medical innovations may have a major impact on their implementation. To evaluate barriers and facilitators for individualized pharmacokinetic (PK)-guided dosing of prophylaxis in haemophilia patients, parents of young patients, and treating professionals by discrete choice experiment (DCE) questionnaire. The study population consisted of patients with haemophilia currently or previously on prophylactic treatment with factor concentrate (n = 114), parents of patients aged 12-18 years (n = 19) and haemophilia professionals (n = 91). DCE data analysis was performed, taking preference heterogeneity into account. Overall, patients and parents, and especially professionals were inclined to opt for PK-guided dosing of prophylaxis. In addition, if bleeding was consequently reduced, more frequent infusions were acceptable. However, daily dosing remained an important barrier for all involved. 'Reduction of costs for society' was a facilitator for implementation in all groups. To achieve implementation of individualized PK-guided dosing of prophylaxis in haemophilia, reduction of bleeding risk and reduction of costs for society should be actively discussed as they are motivating for implementation; daily dosing is still reported to be a barrier for all groups. The knowledge of these preferences will enlarge support for this innovation, and aid in the drafting of implementable guidelines and information brochures for patients, parents and professionals.

Normalising advance care planning in a general medicine service of a tertiary hospital: an exploratory study.

Objective The aim of the present study was to develop, implement and explore the effects of a program in advance care planning (ACP) within a tertiary hospital general medicine service. Methods Before-after exploratory mixed-methods analysis was conducted of an ACP program comprising seven components designed to overcome well-documented barriers to ACP in clinical practice. The results of pre-ACP program audits performed in June 2014 were compared with those of post-ACP audits performed over 5 months from July to November 2014. The main outcome measure was the number of advance care plans completed in patients considered eligible for ACP based on a life expectancy of 12 months or less as assessed by two prognostication instruments. Questionnaire surveys ascertained staff perceptions of ACP and the usefulness of training and resources in ACP. Results Pre-ACP program analysis of 166 consecutive patients deemed eligible for ACP revealed that only 1% had a documented advance care plan. Following ACP implementation, 115 of 215 (53%) potentially eligible patients were considered able to participate in ACP discussions and were approached to do so before discharge, of whom 89 (77.4%) completed an advance care plan, whereas 26 (23.6%) declined. This equated to an overall completion rate for all potentially eligible patients of 41% compared to 1% pre-ACP (P<0.001). Major barriers to ACP perceived by at least 30% of questionnaire respondents included the reluctance of patients and family to discuss ACP, insufficient time to initiate or complete ACP, patient and/or family factors that rendered ACP impractical, inadequate communication skills around end-of-life issues, confusion about who was primarily responsible for conducting ACP and difficulty using ACP documentation forms. Enabling factors included dedicated ACP workshops, facilitator and resource packages for staff, and ACP brochures for patients and family. Conclusion A multifaceted ACP program in a general medicine service led to completion of an advance care plan in more than three of four patients considered eligible for, and who participated in, ACP. However, although program components were tailored to overcome known barriers to ACP, staff indicated ongoing difficulties, with less than half of ACP-eligible patients completing advance care plans. What is known about this topic? Advance care planning is increasingly recognised as an important part of hospital care for older patients with advanced chronic disease. However, research indicates that ACP discussions are rare in hospital settings because of various barriers that are not adequately addressed in the design of ACP programs. What does this paper add? The present exploratory study of the development, implementation and evaluation of an ACP program in a tertiary hospital general medicine service shows that program components designed to overcome specific barriers to ACP discussions was associated with a >75% completion rate of advance care plans among ACP-eligible patients who participated in ACP discussions. Dedicated staff training and resources in ACP, employment of an ACP facilitator and ready access to ACP documentation forms were important enabling strategies. What are the implications for practitioners? Hospital units caring for significant numbers of older patients with limited life expectancy can implement ACP programs that help normalise ACP discussions within routine clinical care.

Improving recognition and referral of patients with an increased familial risk of colorectal cancer: results from a randomized controlled trial.

Only 12-49% of colorectal cancer (CRC) patients and their first-degree relatives with an increased familial CRC risk are referred for cancer prevention measures (surveillance colonoscopies or genetic counselling). The study was performed to evaluate the effectiveness and feasibility of a novel strategy to improve the uptake of genetic counselling for high risk individuals and surveillance colonoscopy for moderate risk groups. Eighteen hospitals participated in a clustered randomized controlled trial. Patients in nine hospitals received usual care (group A). Nine other hospitals received the novel strategy (group B) including access to a website for patients and clinicians, patient-targeted brochures and clinician-targeted education and pocket referral cards. Data before and after dissemination of the strategy were collected from questionnaires and medical records. Data were complete for 358 (44%) of 820 CRC patients and 50 (36%) of 137 clinicians before dissemination of the strategy and 392/862 patients (45%) and 47/137 clinicians (34%) after. Referral for cancer prevention measures was assessed at a median of 8 (2-12) months after CRC diagnosis in groups A and B before the dissemination of the strategy and in group A after. In group B referral was assessed at a median of 9 (4-11) months after the dissemination of the strategy. Uptake of genetic counselling by high risk patients was equal in groups A and B, being 33% before and 15% after (P=0.003). Uptake of surveillance colonoscopy by moderate risk relatives did not change significantly (group A, 36% before vs 41% after; group B, 33% before vs 19% after). In group B 94/140 patients (67%) and 25/72 clinicians (35%) visited the website and 34/140 (24%) patients read the brochure. Patients valued clinicians' information as most useful, followed by the patient brochure. Clinicians preferred pocket cards and education. Our strategy did not improve referral for cancer prevention measures. Although the newly offered strategy elements were appreciated, patients preferred clinicians' advice regarding referral for cancer prevention measures. It may be useful to aim future interventions at healthcare professionals rather than patients to improve the prevention of familial cancer.

Hip arthroscopy: a patient education and clinical research tool.

Many mobile medical applications are available for the practicing surgeon, but few offer simultaneous clinical utility and hip specificity for the hip preservationist. The application, Hip Arthroscopy (Free on the AppStore for iPAD iOS), was developed by Alberto Sanchez, MD, PhD to meet the need for mobile software that comprises patient education and outcomes tools. This application provides point of care learning and clinical outcomes resources- primarily on femoroacetabular impingement (FAI). The application is available in English and Spanish, and may be downloaded by both patients and practitioners. The diagnosis of FAI is explained in a detailed patient brochure accessible from the application’s home screen. The brochure contains simple but informative diagrams of hip anatomy and the pathomechanics of FAI. The language is concise and accessible to the lay audience. A basic description of the pathology is followed by expectations for the clinical exam and possible treatment options. Treatment options include both non-operative and operative management plans. A video demonstrating the mechanics FAI aids in patient understanding. The application may be accessed by patients from home or recommended for review after a clinic appointment. Clinical utility of the application is enhanced by the pre-loaded outcomes questionnaires. These include the following: iHOT-12 (International Hip Outcome Tool, short version) and iHOT-33 (long version), HOS (Hip Outcome Score), HOSS (Hip Outcome Score Sports), NAHS (Non Arthritic Hip Score), mHHS (Modified Harris Hip Score) and WOMAC (Western Ontario and McMaster Universities Arthritis Index). The Visual Analog Score for pain is also available. The user interface is simple and rapid; e.g. the iHOT-33 can be completed in <3 min. These outcomes questionnaires can be emailed from the device to print, transfer into a database, or upload into an electronic medical record. The application has the capacity to reduce research costs and increase outcomes reporting by permitting data collection in the clinic or from any iOS device running the software. Although the application has great potential for a hip preservation practice, there are several limitations. First, integration across the clinical and research data entry points is limited. Second, the user interface for surgical documentation is not immediately intuitive and does not flow to other aspects of the program. Next, the utility of special functions such as radiographic measurement is unique, but requires several steps beyond a typical digital radiology interface. Finally, there is no security or encryption function that restricts transfer of private health information across unsecure networks. In summary, practitioners and researchers will find value in this application for recording both subjective outcome scores and objective clinical data. Further, the educational component of the program offers patients a simple and responsive interface on hip arthroscopy and FAI. Despite certain limitations, Hip Arthroscopy has the advantage of efficiency in data collection and mobility.

Clinic-wide intervention lowers financial risk and improves revenue to HIV clinics through fewer missed primary care visits.

: We calculated the financial impact in 6 HIV clinics of a low-effort retention in care intervention involving brief motivational messages from providers, patient brochures, and posters. We used a linear regression model to calculate absolute changes in kept primary care visits from the preintervention year (2008-2009) to the intervention year (2009-2010). Revenue from patients' insurance was also assessed by clinic. Kept visits improved significantly in the intervention year versus the preintervention year (P < 0.0001). We found a net-positive effect on clinic revenue of +$24,000/year for an average-size clinic (7400 scheduled visits/year). We encourage HIV clinic administrators to consider implementing this low-effort intervention.

Evaluation of a Patient CAM-with-Chemotherapy Educational Brochure.

Biologically active CAM may detrimentally interfere with chemotherapy treatment, so cancer patients require targeted, evidence-based information on chemotherapy-CAM integration consequences. The object of this study was to investigate the potential for medical doctor recommendation and patient acceptance of a purpose-designed patient educational brochure on the safe use of CAM with chemotherapy. Cancer care doctors (n = 17) were provided a draft version of a patient educational brochure developed by the authors and completed a structured feedback form. Cancer patients receiving treatment (n = 12) were provided with the brochure and completed the local health service consumer testing feedback form. All 17 doctors perceived a need for the brochure and all would recommend the brochure to their patients. Approximately 59% of the doctors indicated they would recommend the brochure to all patients receiving chemotherapy and 41% preferred that only patients using CAM or who enquired about CAM be given the brochure. Cancer patients receiving chemotherapy reported that the brochure information answered their questions and was easy to understand. This evidence-based CAM-chemotherapy patient brochure may be a useful adjunct for use by cancer care health professionals to educate patients on the potential dangers of biologically active CAM use with chemotherapy and to provide patients with safe CAM alternatives.

Unnecessary bleeding, unnecessary suffering: normalcy and necessity of menstruation in promoting NovaSure®

NovaSure® is an endometrial ablation procedure that destroys the inner lining of uterus to stop heavy bleeding. It is performed mostly on women entering menopause who are experiencing irregular and heavy bleeding. In this article, this biotechnology, promoted for women approaching the end of their reproductive life, is analyzed. The analysis is informed by a feminist science studies and medical anthropology background. The discourse of ‘normal’ menstruation and representations of menstruation in the promotional materials for NovaSure® are explored through a textual analysis of the NovaSure® website and patient brochure. The themes in the materials analyzed include the idea of getting back to life, ‘normal’ bleeding, and having a choice among different medical procedures and interventions. The possibility of getting rid of embarrassment that accompanies heavy bleeding is also emphasized. It will be argued that NovaSure® contributes to the redefinition of what is ‘natural’ and ‘necessary’ by combining the ‘unnecessary period’ idea of pills such as Seasonale®, which is aimed toward women in their reproductive years, with the ‘unnecessary suffering’ idea related to menopausal complaints. While advertising the procedure, NovaSure® promotional materials co-construct the ideal user for the technology and reproduce the taboos and embarrassment that accompany menstruation.

Information needs and information-seeking preferences of ALS patients and their carers

Our objective was to investigate information-seeking behaviour in patients with ALS and their caregivers and their rating of the usefulness of different information sources in Germany. Surveys were made on 106 patients and 100 caregivers in two university ALS outpatient clinics. Before seeing a doctor, 28% of patients and 23% of caregivers had used other sources to find symptom related information, mostly the internet. Although two-thirds were satisfied with the means of diagnosis disclosure, 88% of patients and 85% of caregivers searched for additional information, most often the internet (patients 72%, caregivers 85%), followed by patient brochures (patients 58%, caregivers 66%). Internet, patient brochures and the ‘German Neuromuscular Disease Society’ were rated most frequently as useful/very useful. Traditional print media and interpersonal contacts were also frequently used and most respondents relied on more than one source for information. Only few respondents used the internet for exchange with other patients. Two-thirds wanted to discuss web contents with their physician.In conclusion, patients with ALS and their caregivers clearly have additional information needs. Besides traditional information sources, the internet is frequently used. Therefore, reliable and useful websites should be provided. Patients’ and caregivers’ need to discuss their findings with the physician should be acknowledged.