Patient Perceptions Research Articles

A Comparative Study of Nurses' and Patients' Perceptions of Caring Behaviors in Oncology Departments

Background: Patients undergoing chemotherapy experience a wide range of physical and psychological symptoms due to the treatment they receive. The quality of care for these patients is primarily influenced by the caring behaviors of nurses. Objectives: Given that differences in the perception of caring behaviors between patients undergoing chemotherapy and nurses may leave patients' needs unmet, this study was conducted to compare the perceptions of oncology nurses and patients undergoing chemotherapy regarding nurses' caring behaviors. Methods: In this descriptive-comparative study, 97 patients undergoing chemotherapy in the Oncology Departments of Imam Hossein (AS) and Taleghani Hospitals in Tehran were selected through convenience sampling. Sampling was conducted daily from 8 a.m. to 6 p.m. until the required sample size was achieved. A census was performed on 39 nurses working in these hospitals. Data were collected using a demographic information form and the Caring Behavior Inventory. The collected data were analyzed using SPSS 24 and statistical tests, including t-tests, one-way ANOVA, and Spearman's correlation coefficient. Results: Nurses had significantly higher perceptions of the assurance of human presence, respectful deference to others, and positive connectedness subscales than patients (P = 0.007). However, there was no significant difference in the perception level for the knowledge and skill subscale between nurses and patients (P = 0.72). Overall, nurses assigned higher scores to caring behaviors than patients (P = 0.011). The experience of previous hospitalization among patients was significantly associated with their perception of overall caring behaviors (P < 0.001) and all subscales. Among nurses, gender had a positive correlation with their perception of assurance of human presence (P = 0.02) and overall caring behaviors (P = 0.04). Conclusions: Given the differences in how oncology nurses and patients undergoing chemotherapy perceive caring behaviors, it is essential for oncology nurses to incorporate patients' perceptions when prioritizing their caring behaviors and to strive to provide patient-centered care at all times.

Psychometric Properties and Meaningful Change Thresholds of the Vitiligo Area Scoring Index

Defining meaningful improvement using the Total Vitiligo Area Scoring Index (T-VASI) and the Facial VASI (F-VASI) aids interpretation of findings from clinical trials evaluating vitiligo treatments; however, clear and clinically meaningful thresholds have not yet been established. To assess concept validity and measurement performance of the T-VASI and F-VASI in patients with nonsegmental vitiligo and to identify meaningful change thresholds. This mixed-methods study consisted of a secondary analysis of a phase 2 multicenter double-blind dose-ranging randomized clinical trial and embedded qualitative interviews conducted at 35 sites in Canada, France, Japan, and the US. The secondary analysis included the trial's adult patients with nonsegmental vitiligo (T-VASI ≥5 and F-VASI ≥0.5 at baseline). Psychometric performance of the T-VASI and F-VASI and thresholds for meaningful change were evaluated using clinician- and patient-reported information. The trial's embedded interviews were used to qualitatively assess content validity and patient perceptions of meaningful repigmentation. Data analyses were performed from March to July 2023. Participants were randomized to 6-, 11-, or 22-mg/day upadacitinib or placebo for 24 weeks. Psychometric performance of the T-VASI and F-VASI and thresholds for meaningful changed plus content validity and patient perceptions of meaningful repigmentation. Measurement instruments included the T-VASI, F-VASI, Vitiligo Noticeability Scale, Total-Patient Global Vitiligo Assessment, Face-Patient Global Vitiligo Assessment, Total-Physician Global Vitiligo Assessment (PhGVA-T), Face-Physician Global Vitiligo Assessment (PhGVA-F), Patient's Global Impression of Change-Vitiligo, Physician's Global Impression of Change-Vitiligo (PhGIC-V), Vitiligo Quality-of-Life Instrument, Dermatology Life Quality Index, the Hospital Anxiety and Depression Scale, and transcribed verbatim interviews with patients. The psychometric analysis included 164 participants (mean [SD] age, 46 years; 103 [63%] females) and the qualitative analysis included 14 participants (mean [SD] age, 48.8 [12.2] years; 9 females [64%] and 5 males [36%]). Intraclass correlation coefficients were 0.98 for T-VASI and 0.99 for F-VASI in patients with clinically stable vitiligo between baseline and week 4, supporting test-retest reliability. At baseline and week 24, correlations were moderate to strong between T-VASI and PhGVA-T (r = 0.63-0.65) and between F-VASI and PhGVA-F (r = 0.65-0.71). Average baseline and week-24 VASI scores decreased with repigmentation (ie, increasing PhGVA scores). Least-square mean VASI scores increased with greater repigmentation as measured by the PhGIC-V. Least-square mean VASI scores also differed between patients with improved PhGIC-V and those with no change or worsened V-PhGIC scores. Using a multiple anchor approach, improvements of 30% in T-VASI and 50% in F-VASI scores reflected meaningful repigmentation between baseline and week 24. This mixed-methods study found that the T-VASI and F-VASI are reliable, valid, able to differentiate between clinically distinct groups, and responsive in patients with nonsegmental vitiligo. The thresholds for meaningful change were lower than those historically used in clinical trials, suggesting that T-VASI 50 and F-VASI 75 are conservative estimates and reflect improvements that would be meaningful in patients with nonsegmental vitiligo. ClinicalTrials.gov Identifier: NCT04927975.

Patient Perception of Prolapse Condition Questionnaire: A Validated Patient-Reported Outcome Measure.

Identifying patient-reported outcome measures allows management of urogenital prolapse to be tailored to reflect symptom bother and expectations of treatment. We devised a new single-item questionnaire, the Patient Perception of Prolapse Condition (PPPC), based on the Patient Perception of Bladder Condition (PPBC). The aim was to evaluate the criterion validity, test/re-test reliability and responsiveness of the PPPC. Women attending a tertiary urogynaecology clinic were recruited. At visit 1, patients completed the Prolapse Quality of Life (P-QOL) and PPPC questionnaires, and underwent a Pelvic Organ Prolapse Quantification (POP-Q) examination. This allowed assessment of criterion validity using Spearman's rank correlation (rho) of the PPPC against validated subjective and objective outcomes. At visit 2, within the next 6weeks, PPPC was repeated to assess test/re-test reliability using Cronbach's alpha (α). In those undergoing pelvic floor surgery, responsiveness of the PPPC was assessed at visit 3 by correlating PPPC and P-QOL scores 6weeks post-operatively. A total of 178 patients attended visit 1, 60 attended visit 2 and 58 attended visit 3. At visit 1, there were moderate correlations between the PPPC and both objective (POP-Q: rho = 0.385, p < 0.01, CI 0.192-0.549) and subjective (P-QOL: rho = 0.635, p < 0.01, CI 0.493-0.744) measures confirming criterion validity. Test/re-test reliability was high (α = 0.89). Correlation with post-operative PPPC and P-QOL confirmed moderate responsiveness (rho = 0.54, p < 0.01). The PPPC, a novel single-item patient-reported measure of prolapse condition, demonstrated good criterion validity, test/re-test reliability and responsiveness. These findings support the use of the PPPC as a global assessment of prolapse condition.

Navigating Burnout: Exploring Pharmacists’ Attitudes toward Patient Care

Abstract Background The study aimed to investigate the link between pharmacists’ burnout levels and their attitudes toward patient care, crucial for addressing burnout’s impact on service quality and fostering positive patient interactions. Methods The study utilized the Shirom-Melamed Burnout Questionnaire (SMBQ) to assess burnout levels among 442 community pharmacists. Additionally, the five-point Likert Scale of General Attitudes and Beliefs of Pharmacists about their Work with Patients (SOSUF), developed by the authors, was employed to measure pharmacists’ cognitive, affective, and behavioral attitudes toward patient care. Statistical analyses involved correlation and regression procedures. Results Moderate burnout levels among pharmacists observed (mean SMBQ score: 4.18 ± 0.96, range: 1.45 to 6.55), alongside generally positive attitudes toward patient care (mean SOSUF score: 3.44 ± 0.37). Regression analysis revealed a moderate positive correlation between burnout and attitudes toward patient care (R = 0.336, R Square = 0.113, Adjusted R Square = 0.111, p &amp;lt; .001). Burnout impacted pharmacists’ attitudes, notably in perceptions of patients not appreciating their efforts (r = -0.317, p &amp;lt; 0.001), finding patient interactions challenging (r = -0.409, p &amp;lt; 0.001), and disregarding their advice (r = -0.333, p &amp;lt; 0.001). Conclusions Despite generally positive attitudes toward patient care, burnout moderately correlates with negativity, notably impacting perceptions of patient appreciation, interaction challenges, and adherence to advice. Addressing burnout is crucial for maintaining positive patient care attitudes and ensuring quality service delivery. Key messages • Burnout impacts pharmacists’ patient care attitudes, emphasizing the need for intervention to enhance healthcare delivery. • Implementing strategies to reduce burnout among pharmacists can improve patient care outcomes.

Changes in mental health and illness perception in patients with hypertrophic cardiomyopathy referred to hybrid cardiac telerehabilitation in comparison to usual care - a randomised-control trial

Abstract Purpose Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, that influences patients' physical capacity and quality of life, as well as the risk of sudden cardiac death (SCD). Patients with HCM often experience emotional distress due to the uncertainty of their condition and have a threatening illness perception (the way individuals make sense of their illness, which can have a significant impact on adherence to treatment). Current studies suggest that some HCM patients could benefit from hybrid cardiac telerehabilitation (HCTR) in terms of somatic and psychological status. This study is part of a research project investigating the safety and effectiveness of hybrid cardiac telerehabilitation for HCM patients. The specific focus of this part is to evaluate the changes in mental health status and illness perception of HCM patients who have been referred for cardiac telerehabilitation compared to those receiving usual care. Methods An RCT study was conducted, with the inclusion criteria for the study of being above 18 y.o., HCM without LVOT obstruction, NYHA Class II or III, LVEF ≥ 50%, and having CIED. The study involved telerehabilitation (HCTR) and control (CG) groups. Both groups were completing questionnaires assessing illness perception (Brief IPQ) and overall psychosocial distress (GHQ-28) with its 4 domains: somatic symptoms, anxiety, social impairment, and depression. Psychological assessment was performed at the beginning and at the end of telerehabilitation/outpatient care, and at 3, 6 and 12 months after the end of care (T1/T2/T3/T4/T5). Results There was a significant improvement in the overall distress level in the HCTR group (p=0.003) but not in the CG (p=0.559). It remained significant in the HCTR group for the T2 (p&amp;lt;0.001), T3 (p=0.008), and T4 (p&amp;lt;0.001). The positive change was observed in somatic symptoms only in the HCTR group: for T2 (p=0.025) and T3 (p=0.032) compared to the T1. The gradual decrease in anxiety level was observed in the HCTR group, but not in the CG, with a significant difference for T4 (p=0.013) compared to T1. Although there was an improvement in social impairment in both groups (p=0.049 for the CG, and p=0&amp;lt;0.001 for the HCTR group), only in the HCTR group it held a stable pattern after the intervention (p&amp;lt;0.001 for T2; p=0.013 for T3; p=0.032 for T4). There were no changes in the level of depressive symptoms in either of the compared groups. There were also no significant differences in the illness perception (p=0.200 for the HCTR group and p=0.090 for the CG), although the HCTR group showed short-term improvement after three months of HCTR (T2) (p=0.032). Conclusions There are significant benefits of hybrid cardiac telerehabilitation for mental health, level of distress, and illness perception in HCM patients. It is worth noticing that this improvement is short-term, and prolonged effects might require providing additional support during extended care.overall distress in HCTR vs CGsubscales of GHQ_28 in HCTR vs CG

Addressing deficits in malnutrition care in northern Sierra Leone; an educational intervention

Abstract The 2017 Sierra Leone National Nutrition Survey reported poor practice regarding the medical management of severe acute malnutrition and the provision of emergency food to patients, particularly in the northern city of Makeni. We developed a training package for paediatric nurses, aiming to design an easily reproducible format which could be utilised nationally. Our aims were to empower and educate staff to provide more consistent care by challenging the negative cultural perception of malnourished patients and increasing knowledge of key guidelines. A two-day course based around UNICEF guidance on malnutrition was developed with the financial support of the Sierra Leonean office of the World Health Organisation. We sought the advice of local staff on issues impacting the quality of malnutrition care, including cultural barriers, educational limitations and supply issues. Lectures and practical sessions were devised covering recognition, assessment and management. Communication skills were taught using role play, focussing on the key role of nurses in parental education, and nursing skills were reinforced using practical tasks. Local staff identified for their strong teaching and leadership were recruited as instructors and to provide feedback on session design and content. 21 candidates attended from across the region, with the majority based in inpatient feeding units. Candidates completed a pre- and post-course written examination and a qualitative feedback form. Pre-course exam results ranged from 35%-85% with an average of 65%; post-course results showed improvement with a range of 55%-100% and an average of 88%. Candidates rated the course on average 9.7 out of 10 and the written feedback was positive. We subsequently observed positive changes in clinical practice in the inpatient feeding units across the region. Based on these assessments the course achieved its aims. Further study is needed to know if noted clinical improvements were sustained. Key messages • Challenging local cultural perceptions of malnourished patients is crucial to establishing improvement in medical care for this group. • Sustainable educational intervention requires local instructors who can independently deliver teaching, and establishing this cohort at the course inception is critical to its ongoing success.

Evaluation of Covid-19 risk perception and psychological status of transplant patients

Abstract Background Liver transplant patients are in the more at-risk group in terms of COVID-19 infection and mortality due to both immunosuppressive treatment and underlying chronic diseases. The aim of this study was to evaluate the COVID-19 risk perception, compliance with preventive measures, and psychosocial status of liver transplant patients. Methods This descriptive cross-sectional survey study included 311 patients who underwent liver transplantation between 2002 -2021 and presented to the outpatient clinic for routine controls. Data were collected via a questionnaire administered through face-to-face interviews. The questionnaire form used to collect the data of the study included a demographic and clinical characteristics form, the Short Depression-Happiness Scale, the COVID-19 Prevention Guidelines Compliance Scale, and the COVID-19 Risk Perception Scale. The Mann-Whitney U, the Kruskal-Wallis test and Spearman’s Rho correlation analysis were used in statistical analyses. Results The median age of the transplant patients who participated in the study was 56 (18-76) years. Of the transplant patients, 84.9% stated that they had COVID-19 vaccination. There was a statistically significant, very weak relationship between the scores of the Brief Depression-Happiness Scale and the COVID-19 Compliance with Preventive Measures Scale (r = 0.132; p = 0.02), and a weak, significant relationship in the same direction between the scores of the COVID-19 Compliance with Preventive Measures Scale and the COVID-19 Risk Perception Scale (r = 0.344; p = 0.001). Conclusions The vaccination rates of the patients were high. As the depression status of the patients decreases, their compliance with preventive measures increases, and as their compliance with preventive measures increases, their risk perception increases. Key messages • Since transplant patients are a vulnerable group, their vaccination status is important in terms of mortality risk. • Psychological factors such as depression-happiness scores influence adherence to COVID-19 preventive measures among transplant patients.

Utilization patterns and preferences of telemedicine services in the post-Covid-19 era in Israel

Abstract Background While telemedicine can streamline healthcare delivery, suboptimal use may compromise care quality and access. Given the increased adoption of these services during and after the Covid-19 pandemic, understanding best practices through examination of utilization patterns and patient preferences is crucial. This study estimated utilization rates, patient preferences and perceptions of response received for different physician-encounter channels for common clinical and administrative scenarios. Methods Cross-sectional telephone survey in Hebrew or Arabic of 519 Israelis who contacted a doctor in the past year for clinical or administrative needs. Data collected during April-June 2023, focused on chosen contact channel, reasons for choice, perceived response adequacy, and hypothetical future preferences. Findings 78% of encounters with family physician for clinical need were in-person, with lower rates for phone (16%) or messaging (6%); in-person dominated with encounters with specialists (94%). Conversely, for administrative needs, more used phone (15%) or messaging (48%), though 37% still preferred in-person encounter. Video usage was negligible (&amp;lt;1%). Main reasons for in-person choice were perceived need for physical exam, habit, or negative perception of remote service quality. Convenience/exam-free needs drove phone/messaging use. While most patients were satisfied with their chosen channels, phone consultations had lower future preference rates. Conclusions Matching channel to need is crucial. Physical exams require in-person visits, though they are not always required and many stick with in-person out of habit; remote options like messaging can streamline administrative tasks. Patient education could address habits and help familiarize patients with new options. Optimizing phone visits and promoting video options could enhance adoption due to their benefits. Key messages • In-person visits are preferred for clinical needs, while messaging/phone are underutilized for administrative tasks, highlighting missed opportunities for convenient telemedicine options. • Addressing patient habits and perceptions around remote healthcare channels is crucial for optimizing telemedicine adoption and streamlining care delivery.

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

Insights from an international clinic survey on CIED patient management practices and perceptions

Abstract Background Remote monitoring (RM) is recommended as standard of care to manage patients with cardiac implantable electronic devices (CIEDs). However, implementation within overall follow-up (FU) practice is challenging with many organizational aspects to consider. While the 2023 HRS/EHRA/APHRS/LAHRS consensus on management of remote device clinics provided guidance, data on current patient management practice is lacking to understand existing gaps. Purpose This survey of device clinic staff characterized the state and perceptions of CIED patient management. Methods A Delphi panel of US and EU clinical experts guided the research objectives, structure, and content of the survey. Once consensus was reached, the online survey (Qualtrics) was deployed in partnership with HRS. An available case analysis was performed to handle missing data. Results A total of 471 responses were received between September 2023-January 2024 (66% US, 19% Europe, 15% other). Overall, performing a combination of in-office visits and RM was the most frequent FU practice for all devices. Remote-only management was only commonly reported for insertable cardiac monitors (ICM). Adoption of RM was lower in EU compared to US for therapeutic devices, especially pacemakers for which in-person only FU remained high (Figure 1). Frequency of routine visits and transmissions is reported in Figure 2. While the majority of respondents (48-67%, depending on device type) expressed that less than 20% routine visits are actionable, adopting a practice of FU visits scheduled every 2 years as suggested in the 2023 consensus was rarely reported for therapeutic devices. However, alert-based RM seems to emerge for ICM without routine FU. In the US, frequency of scheduled transmissions appeared aligned with reimbursement rules (monthly for ICMs; quarterly for therapeutic devices), whereas there was more variability in EU where RM often lacks clear funding. Divided opinion was observed regarding staff sufficiency as 43% found staffing levels somewhat/very sufficient, while 42% rated it as somewhat/very insufficient. Managing disconnected patients, initial transmission review, and patient phone calls were identified as most burdensome tasks and were the ones for which there was most willingness to outsource. Although 60% respondents rated their practice as somewhat/very efficient, the majority (45%) did not report monitoring performance. The minority (29%) assessing patient management performance primarily tracked workload volume rather than quality-related metrics. Conclusion This large international survey characterized contemporary CIED patient management practices. While the 2023 HRS/EHRA/APHRS/LAHRS consensus highlighted the potential for alert-based RM, reducing in-person visits, and third-party resources to streamline patient FU, these practices have yet to be fully implemented. As such, there is opportunity to standardize and optimize workflows to drive efficiency and quality of care.Follow-up paradigm by regionFrequency of routine follow-up

Feasibiliy, safety and patient perceptions of an exercise-based cardiac telerehabilitation programme

Abstract Background Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) complete these programs and there is a need to develop more flexible and evidence-based options. Purpose The aim of this study was to evaluate feasibility, safety, and patient perceptions of remotely delivered EBCR. Methods This study was conducted at 23 cardiac rehabilitation centres during the Covid-19 pandemic (March 2020-September 2022), when access to centre-based EBCR was restricted. A total of 231 patients with MI &amp;lt;80 years were included 2-4 weeks after discharge to participate in a remote EBCR programme 2 times/week for 3-4 months. Exercise was delivered through a real-time group-based video meeting, connecting the physiotherapist to patients exercising at home. Safety monitoring in terms of adverse events (AE) and serious adverse events (SAE) were recorded. Outcomes were assessed before and after remote EBCR completion and comprised tests of physical fitness and questionnaires: self-reported physical activity and exercise (Haskell questionnaire), physical capacity (VAS), kinesiophobia (TSK-Heart), health-related quality of life (EQ5D-VAS), self-efficacy for exercise, and patient acceptance of the program. Results Patients performed in median 19 (Q1 9 - Q3 23) remote EBCR sessions. A total of 16 AEs were registered during exercise (e.g chest pain, syncope, dizziness, musculoskeletal symptoms) which were all resolved. Two SAEs that required hospitalization were reported (chest pain, in-stent restenosis), both unrelated to exercise. At end of remote EBCR, significant improvements in physical fitness, self-reported exercise and physical capacity, kinesiophobia, and health-related quality of life were observed (Table 1). Delta values were similar to previous centre-based EBCR studies. Patients agreed that remote EBCR improved health care access (83%), was easy to use (94%), and 95% found exercise performance and interaction acceptable. Conclusions This study supports that remote EBCR is feasible and safe with a high patient acceptance post-MI. The clinical effectiveness needs to be confirmed in a randomized controlled design.

Asia-Pacific Real-World Evolocumab Use, LDL-C Reduction, Physician Goals, and Patient Perceptions: HALES Observational Study.

Real-world data are needed to understand the effectiveness of new therapeutic options for low-density lipoprotein cholesterol (LDL-C) reduction in Asia-Pacific clinical practice. Description of evolocumab use among adults with establisHed Atherosclerotic cardiovascuLar diseasE or hypercholesterolemia in ASia-Pacific region (HALES) was performed to better understand characteristics of and clinical decision-making for adults with established atherosclerotic cardiovascular disease/hypercholesterolemia after local evolocumab approval. The HALES observational study, conducted at 33 sites (Hong Kong, Thailand, South Korea, Singapore, Taiwan, and Australia) comprised (1) chart review of patients who received evolocumab, a proprotein convertase subtilisin/kexin type9 inhibitor (PCSK9i), and (2) physician/patient survey and one-time data collection of patients with high cardiovascular risk initiating evolocumab or initiating/continuing non-PCSK9i lipid-lowering therapy. Patients could only enroll in (1) or (2). Chart review included 724 very high-risk patients initiating evolocumab from regulatory approval to 2021. From median baseline LDL-C of 3.2mmol/L (123.7mg/dL), patients had a median percent change in LDL-C of - 60.8% at 1-6months. Goal achievement increased from 7.9% to 69.8% for < 1.8mmol/L (< 70mg/dL) and 4.4% to 57.8% for < 1.4mmol/L (< 55mg/dL) from baseline to 12months. In the one-time data collection, more patients had ≥ 1.8mmol/L (≥ 70mg/dL) baseline LDL-C in the evolocumab vs non-PCSK9i group (95.2% and 48.5%, respectively). Surveys found that physicians applied guideline-recommended treatment targets, and patients demonstrated gaps in understanding cardiovascular risk. Real-world, Asia-Pacific data showed that LDL-C reduction after initiating evolocumab was consistent with that observed in other clinical trials and patient populations. Graphical abstract available for this article.·.

Participation in medication safety of older-adult patients with chronic disease during the transition from hospital to home: a descriptive qualitative study

BackgroundMedication safety issues occur frequently among older-adult patients with chronic diseases during the transition from the hospital to their homes. Patient participation in medication safety has been found to be an effective measure for improving patient safety. However, few studies have been conducted on the safety of older-adult patients with chronic disease during the hospital to family transition period. This study aimed to understand the experiences and perceptions of such patients regarding participation in medication safety during the hospital to family transition period and to explore the actual situation and obstacles during this period in the Chinese context.MethodsA descriptive, qualitative research approach was adopted using purposive sampling. Eighteen patients with chronic disease (aged 61–84 years) participated, all of whom were in the period of transition from hospital to home. Data were collected through semi-structured face-to-face interviews and analysed using directed qualitative content analysis.ResultsFour themes and 12 sub-themes were identified in this study. The four themes were participation in medication decision-making, participation in medication self-management, participation support, and barriers to patient participation.ConclusionsPatient participation is important in ensuring medication safety during the hospital to family transition period. This study highlights that older-adult patients’ participation in medication safety includes three aspects: participation in medication decision-making, participation in medication self-management, and participation support. Health literacy, medical communication, and family care support are the key factors affecting patient participation in medication safety. Effective intervention strategies for this patient group during the transition period would target improving patients’ cognition, health literacy, doctor-prescription communication, and family care support to encourage patients to be more actively involved in the process of drug treatment.

Beyond Empathy: Examining the Complexities of Outpatient Satisfaction in a Resource-Constrained Setting

Patient satisfaction is a critical indicator of healthcare quality, particularly in resource-constrained settings where efficient and effective care is paramount. This study aimed to explore the multifaceted nature of outpatient satisfaction at a private Indonesian hospital, moving beyond the traditional focus on empathy to understand the interplay of various service quality dimensions. A mixed-methods sequential explanatory design was employed. The quantitative phase involved a survey of 400 outpatients, measuring their satisfaction with five service quality dimensions: tangibles, reliability, responsiveness, empathy, and assurance. Data were analyzed using descriptive statistics, Importance-Performance Analysis (IPA), and gap analysis (suitability index). The qualitative phase utilized in-depth interviews and focus group discussions with patients, staff, and management to provide context and depth to the quantitative findings. While overall patient satisfaction was 82.9%, a gap analysis revealed substantial discrepancies between patient expectations and perceptions across several service quality dimensions. Tangibles, reliability, and responsiveness emerged as key areas requiring improvement. Qualitative findings highlighted extended wait times, inconsistent staff communication, and concerns about the physical environment as significant contributors to patient dissatisfaction. Achieving high levels of patient satisfaction in resource-constrained environments necessitates a comprehensive approach that addresses systemic inefficiencies and communication gaps alongside interpersonal factors like empathy. These findings underscore the need for targeted interventions to optimize resource allocation, streamline processes, and enhance staff communication skills to improve the patient experience.

Average volume-assured pressure support versus fixed pressure support in chronic hypercapnic respiratory failure: a systematic review and meta-analysis

Rationale: Chronic hypercapnic respiratory failure occurs due to alveolar hypoventilation resulting in carbon dioxide retention. This is commonly managed with noninvasive ventilation (NIV) with modalities including fixed pressure support and average volume-assured pressure support (AVAPS). However, there is limited information comparing outcomes with these two modes of ventilator support in the management of chronic hypercapnic respiratory failure. Objective: This review and meta-analysis analyze the outcomes with fixed pressure NIV versus average volume-assured pressure support NIV in managing chronic obstructive pulmonary disease (COPD) with chronic hypercapnic respiratory failure, focusing on patients’ perception of symptom burden and gas exchange based on arterial blood gases. Search methods: PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched; the latest search date was December 1, 2023. Inclusion criteria: randomized control trials and crossover studies in English in adults over the age of 19 with the diagnosis of COPD and chronic hypercapnic respiratory failure. Exclusion criteria: patients less than 19 years old, patients with acute exacerbations, and patients with central respiratory failure or neuromuscular disease. Outcomes included blood gas analysis after use of NIV measured in mmHg and patient perception of mental health, symptom burden, and comfort. Results for each outcome were analyzed in RevMan using an inverse variance statistical method with a fixed effect analysis. The final analysis included 7 studies with 252 participants. Results: The patients were 64 ± 9 years old. Baseline pulmonary function testing showed a forced expiratory volume in the first second (FEV1) of 34.6 ± 14.2 % predicted, consistent with severe COPD per GOLD criteria, and a baseline PaCO2 of 55.2 ± 9.2 mmHg. Primary outcomes for ventilation showed no statistical difference between AVAPS and fixed pressure support groups in PaCO2 (Odds Ratio [OR] -1.51; 95% Confidence Interval [CI]: -3.18, 0.16; p=0.08). Patient perceived outcomes were evaluated using several questionnaires, including St. George Respiratory Questionnaire (SGRQ), Short Form 36 Health Survey Questionnaire (SF-36), and Visual Analogue Scale (VAS). Comparable results were not available for all studies, but no statistically significant differences were found when comparing study results. Conclusions: There was little or no clinically significant difference between fixed pressure support and AVAPS in gas exchange. There are inadequate data to draw conclusions about the effect of fixed pressure support compared to AVAPS on patient perceived outcomes, such as comfort and symptom burden. No studies evaluated mortality benefit, cost effectiveness, or hospitalizations. Key words: COPD, chronic hypercapnic respiratory failure, non-invasive ventilation, average volume-assured pressure support ventilation

Perceptions of patients and caregivers toward the management of rare disease in Malaysia: a qualitative research study.

The management of rare diseases is rarely addressed among policymakers and public communities. It is hindered by the lack of information on its epidemiology and burden, especially from the perspective of patients and families with rare diseases. This study aims to understand the perceptions of rare disease patients and their families in the management of rare diseases in Malaysia. A qualitative interview was used to explore the perceptions of patients and families regarding the management of rare diseases in Malaysia. In-depth interviews were conducted with the rare disease patients or their parents/guardians provided by three major rare disease advocacy groups, between 1 July and 15 September 2016. The interviews focused on two key areas: the challenges associated with rare disease and the issues related to accessing medication. Out of the nineteen recruited participants, seventeen (89.5 percent) completed the interview sessions. The significance of awareness, knowledge, and support from others emerged as crucial for families and patients living with rare diseases. Despite facing delayed diagnosis and treatment, a majority of patients and parents expressed satisfaction with the advancements in rare disease management. Nevertheless, a prominent challenge revolves around access to enzyme replacement therapy for eligible patients. This study emphasizes the importance of healthcare professionals understanding patient with rare diseases perceptions to tailor communication strategies, provide accurate information, and address concerns effectively. The message underscores the significance of collaboration between healthcare providers and patient support groups to deliver adequate health information, potentially enhancing patients' understanding and their illness perceptions.

The First Surgery Experienced Through Virtual Reality: A Knee Surgery Case Report

The decision to undergo surgery and the significance of the operating theater environment are influenced by several factors, which vary from person to person. Negative perceptions of the operating room environment can influence the decision to undergo surgery and the process of treatment. Virtual reality (VR) technology offers the potential to alter individuals' environmental encounters through the provision of diverse environmental perceptions. This case study evaluates the results of a VR simulation applied during surgery to an individual with no previous surgical experience. A male patient scheduled for arthroscopic meniscus surgery was the subject of a VR simulation. The patient's perception of the simulated environment was transmitted through VR goggles from the time he entered the operating room until he left. However, the VR application was terminated during the administration of anesthesia, and no premedication was administered to the patient. The VR application included nature walks in various regions, including forests, lakeshores, and meadows, accompanied by the sound of birds. Data were collected using a visual analog scale to assess pain levels and a walking test form. The patient, a 35-year-old male, is a high school graduate and is undergoing his first surgical procedure. The patient expressed concerns and fears regarding the decision to undergo surgery. The patient's preoperative anxiety was rated at 9 out of 10 but subsequently decreased to 1 out of 10 following the surgical procedure. The patient rated his satisfaction with the surgical experience as 9 out of 10. The patient did not require sedatives or analgesics during the intraoperative period or for the first 10 hours following the operation. The patient was successfully mobilized at the 15-hour mark following surgery. The patient was highly satisfied with the application. The utilization of VR during surgical procedures has the potential to reduce the necessity for premedication and enhance postoperative compliance among patients.

A survey of smoking habits and perspectives in patients with hidradenitis suppurativa.

Patients attending the hidradenitis suppurativa (HS) clinic at our centre were surveyed about their smoking habits and their perspectives on the relationship between smoking and HS. We identified 27 patients with a smoking history, and age of onset of smoking preceded age of onset of HS in 81.5%, with an average time interval of 5 years. There were mixed patient perceptions on the role of smoking in HS, highlighting the need for more research in this area, and the importance of engaging and educating patients on the results of epidemiological studies in HS.

The influence religiosity as a moderating patient satisfaction and positive word of mouth in Indonesian hospitals

The aim of this study was to fill a gap that is critical to developing strategies to increase positive word of mouth in health settings. Understanding the mediating role of patient satisfaction can provide insight into the areas of hospital service quality that most directly influence patient perception and subsequent recommendations. By forming clearer connections between these variables, healthcare providers can tailor their services to improve patient satisfaction and in turn stimulate positive word of mouth. The moderate role of religiosity can provide insight into whether and how religious beliefs influence patients' likelihood of spreading positive information by word of mouth based on their satisfaction with the healthcare experience. The research method used Causal Explanatory Research with a sample of 297 respondents in hospitals with religious ideology in Indonesia. Data management is done using SEM. Religiosity as a moderator of the relationship between patient satisfaction and positive women shows a C.R value of 6.075 and a significant probability (ρ) of 0.000 is obtained which is smaller than the required significance level of 0.05. Religiosity is able to significantly moderate the influence of Patient Satisfaction on Positive WOM.

Survey on Patient Perception of At-Home Bacterial Biofilm Control in Relation to Peri-Implant Soft Tissue Health.

Bacterial biofilm control around dental implants is critical for the health of the peri-implant soft tissue and longevity of dental implants. The patient's role in regular biofilm removal around dental implants is just as important as that of the dental hygienist. The purpose of this study is to identify the relationship between at-home dental implant care and patients' perceptions of peri-implant soft tissue health. A 15-item paper survey was distributed to adult patients undergoing professional dental hygiene maintenance at a specialty dental practice within a 3-month period and had at least one dental implant. Survey items included participant demographics, patient-reported adjunctive aids for dental implants and patient perceptions of dental implant oral hygiene practices and peri-implant soft tissue health. There was a statistical difference between time spent cleaning dental implants and peri-implant soft tissue health. An association was found between patients who reported spending more time cleaning their dental implants and less bleeding (p = 0.046/54%), gingival inflammation (p = 0.026/58%) and gingival tissue redness (p = 0.036/53%). Additionally, patients who more frequently underwent professional dental hygiene maintenance perceived less gingival inflammation (p = 0.001/66%). To promote peri-implant soft tissue health and reduce oral biological complications, best practice guidelines should be implemented, including optimal at-home dental implant care and regular professional dental hygiene maintenance.