Patient-centered Context Research Articles

Novel use of structural equation modeling to examine the development of a framework of patient-centered two-way referral systems for building digital subjective well-being healthcare: A cross-sectional survey in Central China.

Digital health technologies are progressively assuming significant roles in aspects encompassing in-hospital management, patient-centered design, and tiered referral systems. Nevertheless, current studies do not involve exploration into the potential value and mechanisms of digital health in a patient-centered context. This study aimed to explore the development of a framework of comprehensive, evidence-based digital health technologies for the construction of welfare-oriented healthcare. From March to June 2023, a cross-sectional online study was performed, involving 335 respondents with prior referral experiences hailing from the Central China region. Data on welfare-oriented healthcare factors (clinical pathway management, medical structure configuration, healthcare service accessibility, two-way referrals) underwent factor analysis in advance, and correlation between these factors and their association with two-way referrals was evaluated by testing for direct and indirect (mediating) effects. Firstly, there existed a significant positive correlation between integrative medical indicators and welfare-centered healthcare (β = 0.02-0.16, p < 0.05). Furthermore, two-way referral had an direct association with integrative medical parameters and the welfare healthcare service system (β = 0.15-0.31, p < 0.05), but exerted a partial mediatory function in the welfare healthcare service system (β = 0.005-0.021, α < 0.05). Two-way referrals partially mediate the integrated medical indicators, mainly through direct effects, while also providing complementary support. Clinical pathways, medical structure, and accessibility are closely linked to welfare healthcare and significantly influence healthcare quality. Thus, improving these factors should be prioritized. This study proposes a method combining integrated evaluation indicators with pathway mechanism design. This pathway mechanism design includes key steps such as patient registration, information extraction, hospital allocation or referral, diagnosis and treatment, rehabilitation plan monitoring, service feedback, and demand resolution. This design aims to change patients' intentions in seeking healthcare, thereby increasing their acceptance of bidirectional referrals, and ultimately enhancing the effectiveness and realization of welfare healthcare.

Metacommunication process during a 3-day digital storytelling workshop for patients recovering from hematopoietic cell transplantation

Abstract Purpose: The purpose of this study was to qualitatively analyze metacommunication during the digital storytelling (DST) workshop process for patients undergoing hematopoietic cell transplantation (HCT). Methods: HCT survivors who had undergone transplant within the past 2 years were recruited at a cancer center in the Phoenix Metropolitan area. Participants (M age = 51.5 years) attended a 3-day DST workshop telling and creating digital stories around their HCT experiences. Using a constructivist grounded theory approach, line by line coding and content analysis were conducted with four research team members. Results: Four themes emerged from the data: (1) communal connection; (2) expressing and processing emotions; (3) self-empowerment; and (4) multi-dimensional coping. Participants described telling and sharing their story with other HCT patients as therapeutic. Conclusion: DST shows promise as a potential coping tool and offers multiple dimensions of the role of narrative as a coping technique, in community building, and in patient-centered contexts within HCT.

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters

Background: Physicians have long had patients whom they have labeled “difficult”, but little is known about how medical students perceive difficult encounters with patients.Methods: In this study, we analyzed 134 third year medical students’ reflective essays written over an 18-month period about difficult student–patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students’ observations and reflections.Results: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in “standard” behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions.Conclusions: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

Circles of care: A novel tool for interprofessional health education

The health care landscape has seen a dramatic change over the last 15 years, with an emphasis on an interprofessional model of health care delivery in a patient-centered context (Thistlethwaite, Mo...

The Microbiology Bench Companion

Diagnostic testing for infectious diseases is an increasingly complex area of laboratory medicine. The microbial community continues to evolve and adapt to changing environmental influences, and the distribution of human pathogens has become more global. Our recognition of the spectrum of microorganisms that cause invasive human disease has exploded with the use of culture-independent methods to detect and characterize pathogens. Clinicians, epidemiologists, and public health officials can benefit from consultative interactions with laboratory professionals to assist with optimizing diagnostic test options and interpretation of test results. For technologists without access to board-certified laboratory professionals who can guide the work-up of infectious agents in a microbiology laboratory, a concise guide can be extremely beneficial. In this handbook, J. Michael Miller, a highly experienced clinical microbiologist, distills a great deal of information into 120 pages, largely formatted as tables and flowcharts. Molecular methods for detecting or identifying microorganisms are notably absent, which may reflect the author’s intent to address readers who perform conventional diagnostic tests only. The handbook is divided into 3 sections. Section 1 focuses on routine laboratory bench algorithms for identifying bacteria, fungi, and parasites. Although most of this information can be found in clinical microbiology textbooks, the flowcharts are an easy reference, especially for medical technologists. Section 2 is entirely formatted with tables listing clinical syndromes (e.g., cellulitis, pneumonia, gastroenteritis) and their possible infectious causes. The lists of etiologic agents are extensive, yet practical, and would be of most benefit to infection control practitioners, nurses, and laboratory technologists. Section 3 is devoted to therapeutic choices for various microorganisms and is intended to inform laboratorians of treatment options; it is not a guide for therapeutic decision-making by clinicians. Although certain taxonomic classifications and susceptibility guidelines do not reflect the current standard, most information, such as annotated remarks for pathogens classified as select agents, is timely. The author valiantly furnishes us with pearls and nuances of clinical microbiology in this clear and concisely written handbook. The task was Herculean. As the author aptly notes in the introduction, no handbook can capture every parameter or indication for identification of all clinically relevant microorganisms and describe these microorganisms in public health or patient-centered contexts. Overall, the author delivers a wealth of information that can benefit technologists and healthcare practitioners in regions with limited access to professionals who specialize in clinical microbiology or infectious diseases.

Body image change in pregnancy: a comparison of normal weight and overweight primigravidas.

Body image in pregnancy has been linked to maternal and neonatal health. This study examined the relationship between prepregnancy body weight and body image change in primigravid women. Through a self-administered, free-response questionnaire, 76 primigravidas of at least 30 weeks' gestation described their feelings about current appearance and body shape and compared these to prepregnancy feelings. Respondents also completed the Body Shape Questionnaire to measure current concern with body shape. Women who were overweight before pregnancy were more likely to have had a positive change in body image when they were at more than 30 weeks' gestation. Women who were normal weight before pregnancy were more likely to have had a negative change. Despite overweight women's positive changes, their body shape concerns were more negative than those of normal weight women. Our study highlights the relationship between social values, prepregnancy body weight, and body image change during pregnancy. Some women may benefit from discussing their experiences in a patient-centered context.