Patient-centered Care Research Articles

Effectiveness of Digital Technology in Enhancing Blue Tourism Sustainability in Tanzania

The study examined the effectiveness of digital technology in enhancing blue tourism sustainability in Tanzania. Specifically, the study examined the use of solar panel technology, use of artificial intelligence and use of health technologies. The study employed a desk research method which involves the collection of data from various literature sources such as documents, scripts, previous research findings, journals, and related books. Qualitative content analysis was utilized as the method for analyzing the data. The findings revealed that solar panel technology is one of the most renewable and green energy sources in reducing greenhouse gas emissions and mitigating climate change. The findings also revealed that Artificial Intelligence has released up new tourism opportunities with positive effects on the economy, society, and environment. The study concludes that integration of solar power reduces Carbon footprints and increased appeal to budget conscious travelers. Artificial Intelligent enhances visitor’s management, safety, and eco-friendly experiences. Online platforms improve access to information about overseas care and empower patients to make informed decisions. The study recommends that the development and integration of renewable energy sources, like solar, wind, and hydropower, into the energy mix should be given top priority by government and tourism companies. Programs supporting sustainable agriculture and forestry conservation/reforestation should be put into place. Strategies to economic development and environmental sustainability should also be put into place such as encouraging eco-tourism, efficient manufacturing, and sustainable urban planning. The Ministry of Tourism of Tanzania should promote the use of AI technologies in the creation, use, and manufacturing of tourism products.

Assessing the safety and effectiveness of endoscopic ultrasound for pediatric hepato-pancreatico-biliary disorders: a systematic review.

Endoscopic ultrasound (US) has been established as a safe diagnostic tool for adults, but its use in children remains underexplored. The rising prevalence of pediatric hepato-pancreato-biliary disorders requires a closer examination of its utility. In this systematic review, we aimed to evaluate the efficacy, safety, and clinical impact of endoscopic US in the pediatric population, concentrating on its diagnostic accuracy and therapeutic applications. All related clinical studies were identified by searching the Web of Science databases, PubMed (MEDLINE), Scopus, Cochrane, and Embase. Data were extracted from relevant studies using a pre-planned Excel sheet. Twenty-eight studies demonstrated that endoscopic US in children is safe, technically successful, and clinically impactful, offering valuable diagnostic and interventional competencies. Endoscopic US was frequently used for microlithiasis, choledocholithiasis, and pancreaticobiliary anomalies. It reliably outperformed other imaging modalities, effectively reducing the need for more invasive procedures. Endoscopic US had a remarkable clinical impact, with diverse diagnostic yields, highlighting its role in diagnosing and treating children with hepato-pancreato-biliary disorders. The safety profile of endoscopic US in children was excellent, with nominal reported complications. Our comprehensive review underlines the promising application of endoscopic US in pediatric hepato-pancreato-biliary diseases. The endoscopic US demonstrates its diagnostic accuracy and therapeutic potential in children, offering a non-invasive, safe, and efficient approach. As we move forward, addressing the identified limitations and expanding the pediatric-specific research on endoscopic US will enhance our ability to provide precise and patient-centered care in managing pediatric hepato-pancreato-biliary disorders.

The promise of AI in healthcare: transforming communication and decision-making for patients.

By addressing communication gaps, the integration of AI tools in healthcare has a greater ability to improve decision-making and to empower patients with more control over their health. Current systems for navigating healthcare - such as finding providers or understanding costs - are fragmented and cumbersome, often leaving patients frustrated and uninformed. An AI Healthcare Assistant App, leveraging advances in health IT interoperability, price transparency, and user-centred design, could simplify these processes. By integrating medical records, provider directories, cost data, and user preferences, the app could deliver tailored recommendations, schedule appointments, and even suggest alternatives based on patient feedback. However, widespread adoption of such tools faces challenges, particularly around data privacy and inclusivity. Effective communication strategies - emphasizing transparency, data ownership, and cultural tailoring - are crucial to building trust. Equitable design principles, such as low-literacy interfaces and device compatibility, ensure broader access. While the AI Healthcare Assistant App remains hypothetical, recent technological advances make it much more possible and its potential to revolutionize patient empowerment and healthcare communication is undeniable.

Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023).

The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks. This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age. Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication. From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks. This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication.

Factors affecting utilization of male sexual and reproductive health services: a qualitative description of males in Anambra State, Southeast Nigeria

IntroductionThe utilization of sexual and reproductive health (SRH) services by males globally is significantly low despite their considerable sexual and reproductive health needs. This study aimed to understand the factors that influence the utilization of male sexual and reproductive health SRH services.MethodsWe used an explanatory sequential mixed methods research design, with qualitative description to explore the perceptions of males (15-49years) on the utilization of male SRH services in Anambra State, Nigeria. In October 2021, 56 males participated in seven focus group discussions conducted across seven communities. The data were analysed by thematic analysis. A composite narrative was used to report the results.ResultsMales in both urban and rural areas of Anambra State preferred informal health facilities; male-focused health facilities and male health workers. The participants perceived services as costly; and criticized healthcare workers’ attitudes. Some rural areas had inadequate SRH facilities, staff and commodities. The participants exhibited varying levels of SRH awareness.ConclusionTo improve male SRH service utilization, clinics should be more male-centric and cost-effective. Healthcare providers require retraining to offer patient-centered care. Additionally, ward development committees should advocate for better staffing and the availability of SRH commodities.

A Brief Web-Based Person-Centered Care Group Training Program for the Management of Generalized Anxiety Disorder: Feasibility Randomized Controlled Trial in Spain.

Shared decision-making (SDM) is a crucial aspect of patient-centered care. While several SDM training programs for health care professionals have been developed, evaluation of their effectiveness is scarce, especially in mental health disorders such as generalized anxiety disorder. This study aims to assess the feasibility and impact of a brief training program on the attitudes toward SDM among primary care professionals who attend to patients with generalized anxiety disorder. A feasibility randomized controlled trial was conducted. Health care professionals recruited in primary care centers were randomized to an intervention group (training program) or a control group (waiting list). The intervention consisted of 2 web-based sessions applied by 2 psychologists (VR and YA), based on the integrated elements of the patient-centered care model and including group dynamics and video viewing. The outcome variable was the Leeds Attitudes Towards Concordance scale, second version (LATCon II), assessed at baseline and after the second session (3 months). After the randomized controlled trial phase, the control group also received the intervention and was assessed again. Among 28 randomized participants, 5 withdrew before the baseline assessment. The intervention significantly increased their scores compared with the control group in the total scale (b=0.57; P=.018) and 2 subscales: communication or empathy (b=0.74; P=.036) and shared control (ie, patient participation in decisions: b=0.68; P=.040). The control group also showed significant pre-post changes after receiving the intervention. For a future effectiveness trial, it is necessary to improve the recruitment and retention strategies. The program produced a significant improvement in participants' attitude toward the SDM model, but due to this study's limitations, mainly the small sample size, more research is warranted.

Longitudinal qualitative assessment of meaningful symptoms and relevance of WATCH-PD digital measures for people with early Parkinson’s

BackgroundLongitudinal qualitative data on what matters to people with Parkinson’s disease are lacking and needed to guide patient-centered clinical care and development of outcome measures.ObjectiveTo evaluate change over time in symptoms, impacts, and relevance of digital measures to monitor disease progression in early Parkinson’s.MethodsIn-depth, online symptom mapping interviews were conducted with 33 people with early Parkinson’s at baseline and 1 year later to evaluate (A) symptoms, (B) impacts, and (C) relevance of digital measures to monitor personally relevant symptoms. Maps and transcripts were coded for frequencies, Likert scale rankings (0 = not present to 4 = most bothersome), and thematic findings. Wilcoxon Signed Rank test was used to evaluate change over time.ResultsOther than walking and balance, most motor symptoms did not change significantly from baseline to 1 year later. Multiple significant changes were observed in non-motor areas (cognition, speech, sleep, mood, fatigue, pain; p < 0.05) and functional impacts (mobility, effort to do usual activities, personal comfort; p < 0.05). Thematic analysis revealed ability to cope with and compensate for actual or anticipated symptoms reduced disruptions to well-being and changed how bothersome symptoms were. All digital measures targeted symptoms that were personally important to most participants (> 80%).ConclusionNon-motor and walking/balance symptoms changed sooner than other motor symptoms during the course of 1 year. Evaluation of coping and compensatory mechanisms may be essential to understanding symptom bothersomeness at a given point in time. Smartphone and smartwatch digital measures were relevant to personally meaningful symptoms of early PD.

DOCTORS DIFFER: A PHILOSOPHICAL PERSPECTIVE

The phrase "Drs differ" acknowledges the inherent uncertainty and variability in medical practice. This paper explores the complexities of medical decision-making through two case studies, highlighting the importance of patient-centered care and the need for nuanced understanding of medical knowledge.

Closing the Gap: Digital Innovations to Address Hypertension Disparities.

Significant inequities persist in hypertension detection and control, with minoritized populations disproportionately experiencing organ damage and premature death due to uncontrolled hypertension. Remote blood pressure monitoring combined with telehealth visits (RBPM) is proving to be an effective strategy for controlling hypertension. Yet there are challenges related to technology adoption, patient engagement and social determinants of health (SDoH), contributing to disparities in patient outcomes. This review summarizes the evidence to date for RBPM, focusing on the potential to advance health equity in blood pressure control and the existing levers for largescale implementation. Several studies demonstrate the promise of RBPM programs to address health disparities through: (1) the use of cellular-enabled blood pressure machines that do not require internet access or smart devices to connect readings into the medical record; (2) emphasis on home blood pressure monitoring to illuminate the daily factors that influence blood pressure control, thereby increasing patient empowerment; (3) adoption of standardized algorithms for hypertension management; and (4) integration of services to address SDoH. Multidisciplinary, non-physician care teams that include nurses, pharmacists, and community health workers are integral to this model. However, most studies have not embraced all aspects of RBPM, and implementation is challenging as current payment models do not support the digital components of RBPM or a diverse workforce of hypertension providers. To address hypertension disparities, RBPM programs need to integrate digital technology that is accessible to all users as well as multidisciplinary care teams that attend to the medical and social needs of populations experiencing health inequities.

Patient centered medication treatment for opioid use disorder in rural Vermont: a qualitative study

BackgroundOpioid-related fatal overdoses are occurring at historically high levels and increasing each year. Accessible social and financial support are imperative to the initiation and success of treatment for Opioid Use Disorder (OUD). Medications for Opioid Use Disorder (MOUD) offer effective treatment but there are many more people with untreated OUD than receiving evidence-based medication. Patient-centered care is associated with increased care utilization for substance use disorders. This qualitative study explored the patient perspective of OUD care through a Patient-Centered Care (PCC) framework to illuminate patients’ sense of engagement in care.MethodsFifteen semi-structured telephone interviews were conducted from August through November of 2021 regarding patient experiences receiving MOUD in 13 Vermont Hub and Spoke clinics. Emergent themes were deductively mapped to PCC domains of Therapeutic Alliance, Individualized Care, Shared Decision-Making, and Holistic Care.ResultsParticipants indicated that PCC fostered engagement and often characterized MOUD clinics they no longer attended as lacking in PCC. Themes related to Therapeutic Alliance were the most prevalent and suggest pathways to retention. Individualizing care through flexible appointment scheduling was strongly valued, while inflexible scheduling fostered fear of not getting medication. Some participants indicated they were less likely to remain in care when providers did not include them in decisions about medication type, dose, or formulation. Participants also appreciated holistic biopsychosocial care and care referrals.ConclusionsPatient-centered MOUD care was important to participants and encouraged engagement in care. Prioritizing alliance with patients, adapting care to patient needs and preferences particularly when scheduling, including patients in medication decisions, and biopsychosocial attention to patients are congruent with patient perception of desirable MOUD care. Having this understanding of an established, leading MOUD treatment system may serve to benefit states looking to implement this model, or for states who are looking to improve the model they already have in place, potentially leading to higher treatment and retention rates.Trial registrationThis was not a clinical trial involving an intervention, and therefore registration was not required.

Editorial: Patient safety and patient-centred care in emergency medical services and adjoining care settings

Editorial: Patient safety and patient-centred care in emergency medical services and adjoining care settings

Exploring the contribution of integrated healthcare practices to malaria control in Ghana: perspectives of medical herbalists

BackgroundThe integration of herbal and orthodox medicines has gained momentum in global health, ensuring improved management of infectious diseases like malaria. This study explored the experiences of medical herbalists working in Ghana’s diverse ecological zones to understand the contributions of integrated healthcare to malaria control.MethodsA phenomenological design was employed to conduct in-depth interviews with 19 purposively sampled medical herbalists. Framework analytical approach and Donabedian’s conceptual framework for quality of care were utilised in analysing the data.ResultsFindings revealed high awareness of integrated healthcare practices among participants. Medical herbalists perceived integrated care as instrumental in enhancing malaria management through factors such as improved quality assurance, increased accessibility to integrated health facilities, patient-centred care, follow-up practices, and opportunities for continuous professional development. However, structural and process-related challenges were identified, including inadequate healthcare personnel, medicines, and equipment. Additionally, limited promotional activities, non-comprehensive National Health Insurance Scheme (NHIS), and ineffective referral systems were recognised as barriers hindering the effectiveness of the integrated system and its potential contribution to malaria control.ConclusionAlthough national and health system-based challenges have thwarted the importance of integration on malaria control, medical herbalists feel optimistic about the intervention. To optimise the effectiveness of integrated healthcare in controlling malaria in Ghana would require policy modification and implementation. Future research could focus on developing healthcare frameworks, particularly for malaria, that prioritise quality service delivery within an integrated system.

Patient Preferences or Provider Pressure? The Relationship Between Coercive Contraceptive Care and Preferred Contraceptive Use

Background/Objectives: Coercion in contraceptive care occurs when healthcare providers unduly influence patients to use or not use birth control. Contraceptive coercion is antithetical to quality patient-centered care. However, it is unclear how experiencing contraceptive coercion relates to patients’ lives and contraceptive outcomes. In this study, we examined associations between contraceptive coercion and a patient-centered outcome: preferred contraceptive use. Methods: In 2023, we used the Prolific panel to recruit reproductive-aged people in the USA who were assigned female at birth. Our analytic sample included surveyed participants who had ever talked to a healthcare provider about contraception (N = 1197). We conducted chi-square and regression analyses to investigate associations between contraceptive coercion and preferred contraceptive use. We added context by mapping the current and preferred contraceptive method(s) for participants who experienced coercion and were not using their preferred method(s). Results: After adjusting for potential confounders, participants who reported downward coercion (pressure to not use birth control) at their last contraceptive counseling were less likely to be using their preferred contraceptive method(s). The odds of using preferred contraception did not differ significantly based on whether participants experienced upward contraceptive coercion (pressure to use birth control). Patterns in unmet contraceptive preference for patients experiencing coercion include use of the pill when it is not the desired method and unmet desire for permanent contraception. Conclusions: In this study, patients who perceived pressure from a provider to not use birth control were less likely to be using their preferred contraceptive method(s). Promoting reproductive autonomy requires comprehensive, patient-centered, and unbiased contraceptive care.

Multicenter Validation of the Ocular Myasthenia Gravis Rating Scale Questionnaire.

Ocular myasthenia gravis (OMG) causes disabling ocular symptoms of ptosis and diplopia, but a validated disease-specific patient-reported outcome measure (PROM) has not been reported. We sought to validate a novel PROM for OMG, OMG Rating Scale Questionnaire (OMGRate-q), as a measure of visual functioning to support patient-centered care. This was a prospective study of patients aged 18 years and older with OMG receiving care at 3 medical centers (January 2022-October 2023). The 10-item OMGRate-q was administered, and response data were analyzed using exploratory factor analysis followed by Andrich rating scale model fitting. Poorly fitting items were eliminated, and the model was refit to produce the final items, item locations, and thresholds. Latent scores (theta) were estimated, test-retest reliability was established with repeat measures, and correlation with other myasthenia gravis PROMs was measured. Of the 134 patients included in the study, 45 (33.6%) were women, 99 (73.9%) were White, and the median age (interquartile range [IQR]) was 64.6 years (52.6-73.9 years). A ptosis-related item showed significant item-trait deviation (p < 0.001) and was kept as a separate factor from the remaining diplopia-related items. After excluding this item, there were no misfitting items. Theta estimation for the diplopia scale ranged from -3.47 to 5.51 with median = -0.53 (IQR -2.33, 0.72). Test-retest reliability of the OMGRate-q diplopia subscale was high (intraclass correlation coefficient = 0.95 [95% CI 0.90-0.98]) and of the ptosis item was good (weighted κ = 0.56). No significant differences were observed in OMGRate-q diplopia subscale scores or the ptosis item between the 3 sites (diplopia p = 0.44; ptosis p = 0.32). OMGRate-q scores were moderately to highly correlated with the Myasthenia Gravis Quality of Life 15 questionnaire (n = 122; diplopia: r = 0.68, p < 0.001; ptosis: r = 0.48, p < 0.001) and Myasthenia Gravis Impairment Index (n = 130; diplopia: r = 0.76, p < 0.001; ptosis: r = 0.77, p < 0.001). OMGRate-q length was acceptable to most participants (125/130 [96.2%]), and the questionnaire was completed in 80.7 (±45.2) seconds. The OMGRate-q is a valid and reliable disease-specific PROM for OMG that may be used to facilitate patient-centered research and care. However, the OMGRate-q emphasizes the impact of diplopia on visual functioning with a single separate item measuring ptosis. Future studies are needed to determine OMGRate-q responsiveness to disease-state changes and how to add measures of ptosis to this scale or whether a separate measure is needed.

&lt;b&gt;Machine Learning Enabled In-Home ECG: A Review&lt;/b&gt;

Machine learning (ML)-based in-home electrocardiogram (ECG) systems have emerged as transformative tools, advancing beyond traditional cardiology methods by offering innovative techniques for cardiac care. These systems enable sustained data collection, real-time monitoring of cardiac status, and individualized treatment plans, all while minimizing the need for frequent clinic visits. By leveraging advanced analytics and ML algorithms, in-home ECG systems analyze large-scale datasets to detect patterns and anomalies that might otherwise go unnoticed, providing early alerts and improving patient outcomes. This review examines the latest trends in ML-enhanced in-home ECG technology, emphasizing its functionality in anomaly detection, continuous monitoring, and decision-making processes. The integration of ML not only enhances diagnostic precision but also opens avenues for scalable, personalized, and remote healthcare solutions. Despite these advancements, significant challenges remain, including issues related to data privacy, algorithmic biases, and the reliability of real-world implementations. Addressing these challenges is essential for optimizing the performance and ethical use of these systems. This review also explores opportunities for future research, particularly in improving algorithm robustness and addressing biases to ensure equitable and accurate cardiac care for diverse populations. By integrating state-of-the-art ML techniques, in-home ECG systems are poised to revolutionize contemporary cardiology, reducing healthcare costs and enabling a progressive shift toward accessible, patient-centered care. This comprehensive exploration highlights the potential of ML-based in-home ECG systems to redefine cardiac monitoring and treatment, contributing to the broader transformation of modern healthcare. Received: 13 September 2024 | Revised: 11 December 2024 | Accepted: 31 December 2024 Conflicts of Interest The authors declare that they have no conflicts of interest to this work. Data Availability Statement Data sharing is not applicable to this article as no new data were created or analyzed in this study. Author Contribution Statement Aqsa Bibi: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review &amp; editing, Visualization, Project administration. Jawwad Sami Ur Rahman: Methodology, Validation, Investigation, Resources, Writing - review &amp; editing, Supervision, Project administration.

Mobile health in communication disorders: willingness to use, attitude, advantages, and challenges from the perspective of patients

IntroductionCommunication disorders are one of the most common disorders that, if not treated in childhood, can cause many social, educational, and psychological problems in adulthood. One of the technologies that can be helpful in these disorders is mobile health (m-Health) technology. This study aims to examine the attitude and willingness to use this technology and compare the advantages and challenges of this technology and face-to-face treatment from the perspective of patients.MethodsThis descriptive study was conducted with a researcher-made questionnaire and investigated the willingness and attitude of patients with communication disorders to use mobile health technology. The face and content validity of the questionnaire were examined with the help of experts in speech therapy, health information management, and medical informatics. Chi-square, Fisher's exact test, and the Kruskal–Wallis test were used to analyze the relationship between variables. Also, the challenges and advantages of mobile health technology and face-to-face treatment were extracted from the patient's answers and presented in the form of main themes and sub-themes.ResultsOne hundred seventy patients participated in this study. The results of this study showed that 57 (33.5%) participants preferred face-to-face visits, 11 (6.5%) preferred m-Health, and 102 (60.0%) preferred the combination of mobile applications and the face-to-face visits method. The results showed a statistically significant relationship between "Residence (rural or urban)", "Having trouble traveling to speech therapy centers", and "Delaying treatment due to lack of access to speech therapists" with treatment methods (face-to-face, mobile health, face to face and mobile health). Accessibility and convenience, treatment efficacy and variety, patient empowerment and confidence, family involvement and support, cost and time efficiency, treatment adherence and completion, and comfort and lifestyle compatibility were six categories related to the advantages of mobile health technology from the point of view of patients with communication disorders. Also, technological challenges, effectiveness and quality concerns, patient experience and engagement, and trust and confidence issues were mobile health challenges from the patients' point of view.ConclusionThe results of this study showed that patients tend to use both face-to-face interactions and mobile health. Integrating both m-Health and traditional methods can optimize speech therapy outcomes. Addressing challenges such as inadequate technological infrastructure and data security is crucial for successful implementation.

Effect of depression and empowerment on medication adherence in patients with breast cancer: a descriptive survey

BackgroundGiven the global prevalence of breast cancer and its high mortality rate, adherence to long-term anti-hormonal therapy is crucial for preventing recurrence and improving survival outcomes. Previous research demonstrates how psychological factors including depression and empowerment impact medication adherence. However, comprehensive studies remain limited, especially in Korea. This study explores the effects of depression and empowerment on medication adherence among patients with breast cancer undergoing anti-hormonal therapy.MethodsThis descriptive survey involved 183 patients with breast cancer from one hospital in South Korea; participants were recruited using convenience sampling. Self-reported questionnaires were used to assess medication adherence, depression levels using the Korean version of the Beck Depression Inventory-II, and empowerment levels using a tool developed for women with breast cancer. Hierarchical regression explored relationships and influences between variables.ResultsParticipants demonstrated an average depression score of 19.67 ± 11.25, with medication adherence measured at 18.06 ± 5.15 and empowerment at 106.40 ± 18.15, revealing that, among patients with breast cancer, many experienced depression with varying levels: 16.9% mild, 27.3% moderate, and 21.9% severe. Medication adherence levels were distributed, with 58.5% of patients categorized as non-adherent and 41.5% categorized as adherent. The results indicated a significant negative correlation between depression and medication adherence and a positive correlation between empowerment and medication adherence. Higher empowerment levels were associated with improved adherence. Conversely, high depression levels were associated with low medication adherence.ConclusionsThis study enhances understandings of psychosocial factors influencing medication adherence in patients with breast cancer, highlighting patient empowerment as crucial for healthcare interventions. Thus, healthcare providers should implement targeted interventions including educational programs to inform patients about their treatment regimens, provide counseling services addressing mental health concerns such as depression, and establish support groups fostering a sense of community and shared experiences among patients. By integrating these strategies into patient care, healthcare professionals can significantly enhance patient empowerment and improve medication adherence toward better health outcomes for breast cancer patients. Future research could explore the long-term effects of these interventions on adherence and overall patient well-being.

Electronic Patient-Reported Outcome System Implementation in Outpatient Cardiovascular Care

The integration of patient-reported outcome (PRO) assessments in cardiovascular care has encountered considerable obstacles despite their established clinical relevance. To assess the impact of a physician- and patient-friendly electronic PRO (ePRO) monitoring system on the quality of cardiovascular care in clinical practice. This open-label, multicenter, pilot randomized clinical trial was phase 2 of a multiphase study that was conducted from October 2022 to October 2023 and focused on the implementation and evaluation of an ePRO monitoring system in outpatient clinics in Japan. During phase 1 (conducted from December 2021 to March 2022), this ePRO monitoring system was developed at a single outpatient center using feedback from patients and physicians. Eligible patients were older than 18 years with a clinical diagnosis of heart failure (HF), atrial fibrillation (AF), or coronary artery disease (CAD). Participants were randomly assigned 1:1 to either the ePRO or control group. Statistical analysis was based on the intention-to-treat approach. Patients in the ePRO group were asked to complete the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12), Atrial Fibrillation Effect on Quality-of-Life Questionnaire (AFEQT), or Seattle Angina Questionnaire (SAQ) on smart tablets before their clinical examination. Results were reviewed by physicians at each outpatient visit. The control group received usual care consisting of medication management, lifestyle modification, and invasive procedures in accordance with clinical guidelines. Both groups had 5 monthly outpatient visits. Patient satisfaction, quality of information (QOI) provided by physicians, and disease knowledge were assessed using questionnaires (eg, Patient Satisfaction Questionnaire [PSQ]; score range: 5-25, with higher scores indicating greater patient satisfaction) at baseline and the fifth visit, over approximately 4 months. Of the 50 patients included, 48 (median [SD] age, 71.0 [62.3-75.0] years; 28 males [58.3%]) completed follow-up. The prevalence was 56.2% (n = 27) for HF, 75.0% (n = 36) for AF, and 10.4% (n = 5) for CAD. The distribution of PRO measures used was 21 patients (43.8%) for KCCQ-12, 24 (50.0%) for AFEQT, and 3 (6.2%) for SAQ. Compared with the control group, the ePRO group showed significant improvements in mean (SD) PSQ score (0.16 [2.06] vs 1.61 [1.75]; P = .01) and QOI score regarding treatment (-0.12 [0.53] vs 0.35 [0.71]; P = .01). The ePRO group exhibited a greater increase in the PSQ score regarding communication (-0.12 [0.53] vs 0.43 [0.90]; P = .01). In this randomized clinical trial, implementation of the ePRO monitoring system significantly enhanced patient-physician communication and the clarity of physicians' explanations about treatment. These findings suggest that the ePRO monitoring system is capable of supporting patient-centered cardiovascular care. University Hospital Medical Information Network Identifier: UMIN000049251.

Characterization of Individuals Achieving Type 2 Diabetes Remission in Real-World Settings: Bridging Clinical Evidence and Patient Experiences.

The objectives of the study were to: 1) Describe characteristics and lifestyle factors of individuals who have achieved type 2 diabetes (T2D) remission (sub-diabetes glucose levels without glucose-lowering medications for ≥3 months) through changes to diet and exercise behaviour in real-world settings; 2) Investigate continuous glucose monitoring (CGM) profiles of these individuals and explore how dietary pattern may influence glucose regulation metrics. This cross-sectional study recruited individuals living with T2D who achieved remission via changes to diet or exercise behaviours. Various questionnaires were used to assess overall health and participants wore a blinded CGM for 14 days to assess glucose profiles and filled out three-day food records. A total of 21 adults (57 ± 8 years of age) who were recently diagnosed with T2D (4±3 years) with a A1c of 5.7±0.4% volunteered to participate. Participants achieved remission through various means (e.g., combination of diet and exercise/physical activity) and self-reported following different diets, including 52% following a low-carbohydrate or very low-carbohydrate diet, 14% following a "ketovore/carnivore" diet, 10% using a meal replacement diet, 5% following Weight Watcher's diet, and 19% no defined dietary pattern. The 24-hour average CGM glucose value was 5.0 [4.8-5.6] mmol/L (median [IQR]) with 92 [85-97]% of time spent in range (between 4.0-9.9 mmol/). 24-hour average CGM glucose (r=0.692; P=0.001), as well as A1c (r=0.470; P=0.049), were correlated with the daily percentage of energy intake from carbohydrate. Remission of T2D appears achievable through various means, including adoption of different dietary approaches and a more active lifestyle underpinning the importance of a patient-centred care.

Cardiovascular Science and Physical Therapy: Improving Heart Health Through Tailored Rehabilitation Programs

Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, necessitating innovative strategies for prevention, treatment, and recovery. Physical therapy has emerged as a cornerstone in cardiovascular rehabilitation, offering tailored programs that enhance heart health and overall quality of life. This paper explores the intersection of cardiovascular science and physical therapy, emphasizing the role of individualized rehabilitation programs in improving cardiac function, reducing risk factors, and promoting sustainable lifestyle changes. Key elements such as aerobic and resistance training, patient education, and psychological support are highlighted. Furthermore, advancements in technology, including wearable devices and telemedicine, are discussed as tools to enhance adherence and outcomes. The integration of evidence-based practices in physical therapy offers a pathway to reducing the burden of CVDs and optimizing patient-centered care.