Points In Patients Research Articles

What is it like to take antipsychotic medication? A qualitative study of patients with first-episode psychosis.

What is known on the subject? Antipsychotic drugs are an important part of treatment for most patients with first episode psychosis. We do not know much about what it is like to take these drugs from the patient's point of view. What this paper adds to existing knowledge? We talked to 20 young people with psychosis about their experiences of taking antipsychotic drugs. Patients relationship with medication was complex, young people found medication often to be both good and bad at the same time. We were interested in how seemingly trivial issues--colour, taste, size, name--could be very important to young people and could result in them stopping. What are the implications for practice? We think our study highlights the complicated internal struggles that people with first episode psychosis have with medication. Our study highlights how Nurses and Doctors need to try and better understand what it is like to take these drugs and work collaboratively with patients to support them to make informed choices about treatment. Low-dose antipsychotic medication is an important part of treatment for people experiencing a first episode of psychosis. Little is known about this group of patients' experiences of taking medication. A qualitative study of purposively sampled young people experiencing a first episode of psychosis was carried out. A mental health nurse working in the early psychosis team interviewed participants using a structured topic guide. Interviews were subjected to thematic analysis. Interviews were completed with 20 young people. Thematic analysis generated six themes: (1) the drugs do work, (2) the drugs don't work (as well as I'd like), (3) side effects, (4) the indirect effects of medication, (5) rage against the machine and (6) the not trivial issues about medication. Our overarching meta-theme was that young people's experience of taking antipsychotics was complex; medication was often considered good and bad at the same time. Our observations underpin the importance of helping patients think through the use of antipsychotic medication in supporting their personal recovery.

Art as Healing, By Edward Adamson and John Timlin, Coventure, 2014, £25.00 (by cheque incl. P&P) pb, 68 pp. ISBN: 9780904575248 The book can be ordered from Mr Richard Morley at SLAM (richard.morley@slam.nhs.uk)

Art as Healing, By Edward Adamson and John Timlin, Coventure, 2014, £25.00 (by cheque incl. P&P) pb, 68 pp. ISBN: 9780904575248 The book can be ordered from Mr Richard Morley at SLAM (richard.morley@slam.nhs.uk) - Volume 40 Issue 1

Editorial: Biology of Cognitive Aging: Model Systems, Technologies, and Beyond.

Age-related memory impairment (AMI), also called age-associated memory impairment (AAMI), describes the normal emergence and progression of memory problems associated with aging. It is one of diverse age-associated phenotypes found across a variety of organisms, including bees, fruit flies, nematodes, snails, rodents, and humans. The goal of this editorial is to provide an overview of our current understanding of AMI and its progression to more severe deficits related to advanced age and dementia. This research issue focuses on model systems and technologies relevant to cognitive aging and Alzheimer's disease, and the study of AMI using invertebrate disease models. AMI can be viewed as a reduction in neuroplasticity, wherein the retention of existing memories is relatively well-preserved, compared with the ability to acquire new information. Aging specifically compromises mental processes underlying learning and some types of long-term memory, while leaving other types of long-term and procedural memories intact. AMI, however, may also include loss of existing memory, a condition termed age-related memory loss. In a simplified model, cognitive aging can be described to occur in the following sequence: AMI (normal state), mild cognitive impairment (MCI [transition state]), and then lastly, dementia (disease state). The neural mechanisms underlying the development of AMI into more advanced age-related disease remain unclear. A wide variety of model systems and comparative analysis techniques show promise in guiding therapeutic strategies for elderly patients with memory impairments. Despite their potential, the use of disease models in this field of medicine has been discouraged. As stated by the Alzheimer's Association1, “a limitation of these models is that they do not capture the full complexity of the human condition, which is problematic if one wants to use them to predict the success of specific therapeutic interventions in individuals with Alzheimer's disease (Accessed on Dec 2015).” This research issue thoroughly discusses both the advantages and limitations of disease models of cognitive aging. A major aim of this editorial is to compile information about and identify connections between patients with dementia and other organisms, such as bees (Farooqui), fruit flies (Mukherjee et al.), nematodes (Alexander et al.; Gkikas et al.; Machino et al.; Scerbak et al.; Therrien and Parker), snails (Hermann et al.), fish (Newman et al.), and rodents (Webster et al.; Way et al.); a manuscript co-authored by an early-stage patient with Alzheimer's disease (Murakami and Halperin) is also discussed. The work described herein includes rigorous reviews and original research articles on models of Alzheimer's disease, Parkinson's disease, Huntington's disease, Amyotrophic lateral sclerosis, and other neurodegenerative conditions. Alexander et al. comprehensively review neurodegenerative disease in the nematode, Caenorhabditis elegans (C. elegans), while Webster et al. address the significance of mouse models to our understanding of human Alzheimer's disease. Gkikas et al. discuss pathways of longevity that potentially restore memory function during aging in C. elegans. Machino et al. propose the use of a semi-automated motion-tracking system as a platform for genetic and pharmacological screening, which was inspired by feedback from an early-stage patient with Alzheimer's disease (Murakami and Halperin). The study of AMI and dementia also utilizes other non-mammalian models, such as the freshwater snail (Hermann et al.) and a zebra fish model of Alzheimer's disease (Newman et al.), among others. Animal models enable functional analysis of AMI and dementia and provide useful information for minimizing the risks for humans. Thus, it would not be beneficial to underestimate the role of model systems in medicine. Additionally, research using such systems would be better positioned to advance future therapies if patient feedback is incorporated. To this end, Murakami and Halperin have proposed soliciting feedback from patients in an effort to align basic research with clinical practice, patient care, and the patient experience. Such feedback emphasizes the importance of existing comorbidities and potential interaction/association between co-occurring diseases. This approach is consistent with the “mid-life crisis theory,” in which earlier deleterious events are associated with aging and later age-related diseases (Murakami et al., 2011; Murakami, 2013). I thank all of the authors for their contributions. I would especially like to thank my friend and collaborator, Dr. Alexander “Sandy” Halperin, who, despite difficult personal circumstances, continues to provide valuable insight from a patient's point of view.

Evaluation of quality of life in individuals with severe chronic motor disability: A major challenge.

Diverse conditions causing a very heavy and chronic motor disability, such as an advanced amyotrophic lateral, advanced form of multiple sclerosis, high spinal cord injury or a locked-in syndrom, are now getting better medical care and benefit of life support technology with consequent prolonged survival. Quality of life (QoL) assessment is being considered increasingly important to globally apprehend their general well-being. However, the motor disability that affects them appears as a substantial limitation for the assessment of their QoL and consequently a major challenge for all the community that carries an interest for them. This review discussed several avenues to provide to patients and caregivers, clinicians and researchers, and health decision making authority: i) elements to determine the most appropriate QoL measure with regard to the interest of patient's point of view, the QoL instruments suitable for this category of patients and their acceptability, ii) some arguments of the clinical relevance and accuracy of QoL assessment: interpretations of the questionnaires, QoL determinants, particularity of QoL evaluation for individuals with cognitive impairment and the caregivers perceptions of patients QoL. In conclusion, evaluation of QoL in patients with severe chronic motor handicap is a challenge of major interest, with major ethical issues. It needs to use adapted QoL scales and longitudinal following because of adaptive phenomena to the degree of handicap.

An overview of nuclear medicine imaging procedures.

Nuclear medicine imaging is not generally well understood by nurses who work outside this area. Consequently, nurses can find themselves unable to answer patients' questions about nuclear medicine imaging procedures or give them proper information before they attend for a test. This article aims to explain what is involved in some common diagnostic nuclear medicine imaging procedures so that nurses are able to discuss this with patients. It also addresses some common issues about radiation protection that nurses might encounter in their usual working routine. The article includes links to videos showing some typical nuclear medicine imaging procedures from a patient's point of view and links to an e-Learning for Healthcare online resource that provides detailed information for nurses.

Requirements for organ-specific oncology centers

The interdisciplinary, interprofessional, and transsectoral cooperation of partners in a network is prerequisite for the certification of a prostate cancer center. The network reflects all phases and aspects of the disease from the patient's point of view. On the basis of quality indicators that are audited annually, the qualified partners of the network ensure quality of care. Quality indicators reflect the quality of the cooperation in the network, the treatment according to the evidence-based guideline, and the specific expertise of the partners. The results of the quality indicators are evaluated annually and summarized in individual and general reports. The system of the quality indicators is an important tool for quality management and to improve daily oncological care. In the future, this system will be extended to include patient-reported outcomes in combination with the OncoBox. The ongoing quantitative and qualitative improvement makes the certification system a relevant instrument for health policy institutions and is useful in political discussions regarding quality assurance and improvement.

Influence du médecin généraliste dans la promotion du primo-don du sang selon les patients

BackgroundNeeds for labile blood products are continuously increasing in France. National self-sufficiency is currently achieved because important promotional efforts for blood donation have resulted in more than three million donations per year. Despite the peculiar relationship general practitioners (GPs) have with every patient and with public health actions, GPs are not included in the blood donation promotion chain. In this study, the main goal was to determine, from a non-donor patient's point of view, whether a discussion with their GP could be an efficient tool in blood donation promotion. The study was also designed to identify barriers to donation and information patients would expect from their GPs in such a discussion. MethodsThis was an epidemiological analytical cross-sectional and multicenter study. All patients aged 18 to 70years attending a GP's clinic in Nord-Pas-de-Calais was asked to complete a seven-item closed-question survey. The primary endpoint was the percentage of patients who stated that the discussion with their GP could be an efficient tool for promoting blood donation. ResultsOne thousand and forty-eight surveys were included in the analysis. Four hundred and fifty of the 660 non-donors interviewed (68.2 %) declared that a discussion with their GP could encourage them in the blood donation process. Non-donors declared that lack of time was the main barrier (33.5 %) and that they expected information from their GP about when and where they could donate blood (40.3 %). ConclusionMany non-donor patients attending primary care clinics declare that a discussion with their GP could encourage them to make a blood donation and therefore significantly increase the number of potential donors.

Patients' preferences for attributes related to health care services at hospitals in Amhara Region, northern Ethiopia: a discrete choice experiment.

BackgroundInformation from the patient’s point of view is essential in policy and clinical decisions. Prioritizing what patients value, need, and prefer in various aspects of a health program can be helpful in evaluating and designing hospital health care services.ObjectiveTo examine patients’ preference for attributes related to health care services and to ascertain the relative impact of attributes at hospitals in Amhara Region, northern Ethiopia.MethodsA stated-preference discrete choice experiment survey was performed in multistage, stratified, and systematic sampling of patients who visited the hospitals. Attributes were selected based on a literature review of the most important characteristics of hospital health care service and reviewed and validated with inputs from patients and researchers in the field. Attributes included in the study were waiting time, physician communication, nursing communication, drug availability, continuity of care, and diagnostic facilities. A random-effects probit model was used to perform the analysis.ResultsOne thousand and five respondents who received care in the outpatient and inpatient departments participated in the study. All attributes included in the study affected the choice of hospital. Patients were willing to wait up to 3.3 hours and 2.7 hours to get full drugs in the hospital and good nursing communication, respectively. The interaction terms indicate that preferences differ with the variables sex, occupation, and type of hospital. Patients expressed clear preferences in a decreasing order of all the significant attribute levels: a lot of diagnostic facilities, full drug availability, continuity of care, good nursing communication, partial drug availability, good physician communication, and shorter waiting time for the consultation.ConclusionDifferent hospital care attributes had a significant and different influence on patients’ choice of hospital. The study informs about patients’ preferences and the trade-offs among different possible process-related attributes. Decision makers should focus on patient preferences and consider selected attributes when designating hospital services, and hence to maximize patient satisfaction.

Behavior of long-period measurements using a small-sized photoacoustic cell for aqueous glucose monitoring.

Reliable, noninvasive glucose-monitoring devices are not currently available. From the patient's point of view, it is necessary that glucose-monitoring devices are portable as well as noninvasive. In photoacoustic spectroscopy (PAS), the PA signal induced by the irradiation of the sample with modulated light depends on the optical absorption coefficient of the sample. Unlike the sensitivity of conventional absorption spectroscopy, the sensitivity of PAS scales inversely with the dimensions. An external laser (wavelength of 1550 nm) and a PA cell with a volume of only 4.0 mm(3) were used for monitoring a glucose solution contained in a special sample reservoir. We present PA measurements of glucose in aqueous solutions using a sample reservoir that is suitable for investigations of liquid samples, such as native capillary blood, by performing a long-period measurement.

Difference between patients' and clinicians' perception of pouch dysfunction and its impact on quality of life following restorative proctocolectomy.

The Pouch Dysfunction Score (PDS) is a five-item instrument that evaluates bowel function and quality of life following restorative proctocolectomy for ulcerative colitis. The PDS includes items that have a significantly negative impact on quality of life from the patient's point of view. The study aimed to establish how pouch dysfunction is perceived by clinicians in relation to patients experience. Fifty-eight leading clinicians in the field of inflammatory bowel disease were invited to complete two PDS-based exercises. In part 1, they received a list of the 12 bowel symptoms from which the PDS had been developed and were asked to identify and rank (in order of severity) the five they thought had the most significantly negative impact on quality of life. In part 2, they were given the list of symptoms perceived by patients to be most troublesome and were then required to enter a score that they thought was appropriate for each item according to the impact on quality of life. Forty-three clinicians responded, and each correctly identified one to three items selected by patients and included in the PDS. Severity of urgency was selected by 29 (67%) clinicians, and four (9%) rated it to be the most important. Incomplete emptying after defaecation was selected by 10 (23%). Frequency of defaecation and the use of anti-diarrhoeal medication were selected by 14 (33%) and three (7%) clinicians, respectively. Twenty-six (60%) did not include incomplete emptying and 25 (58%) did not include uncontrolled loss of stool in their selection. This study demonstrates that clinicians do not have a great understanding of the symptoms of pouch dysfunction that really matter to the patient.

Development of a pan-serotype reverse transcription loop-mediated isothermal amplification assay for the detection of dengue virus

During dengue outbreaks, acute diagnosis at the patient's point of need followed by appropriate supportive therapy reduces morbidity and mortality. To facilitate needed diagnosis, we developed and optimized a reverse transcription loop-mediated isothermal amplification (RT-LAMP) assay that detects all 4 serotypes of dengue virus (DENV). We used a quencher to reduce nonspecific amplification. The assay does not require expensive thermocyclers, utilizing a simple water bath to maintain the reaction at 63°C. Results can be visualized using UV fluorescence, handheld readers, or lateral flow immunochromatographic tests. We report a sensitivity of 86.3% (95% confidence interval [CI], 72.7–94.8%) and specificity of 93.0% (95% CI, 83.0–98.1%) using a panel of clinical specimens characterized by DENV quantitative reverse transcription–polymerase chain reaction. This pan-serotype DENV RT-LAMP can be adapted to field-expedient formats where it can provide actionable diagnosis near the patient's point of need.

SP-0218: Psycho social aspects of breast cancer from a patient's point of view

SP-0218: Psycho social aspects of breast cancer from a patient's point of view

Proud2Bme: Exploratory research on care and control in young women's online eating disorder narratives.

Illness narratives have been studied to understand the patient's point of view. These narratives are becoming more prolific, accessible, and specialized, thanks to the improved Internet access and the growth of health-specific online communities. This article analyses illness narratives posted on a Dutch eating disorder website hosted by a treatment centre. Specifically, we look at 'care of the self' and 'control'. The young women wrote about controlling situations with disordered eating as a self-care tool, about being controlled by the disorder and about regaining control over the disorder. The website, with the opportunity for constant, unseen supervision, coercion through comments, and steering through edits and comments, revealed various modalities of control. While issues of control and eating disorders have been explored by others, little work has been done on how the control experienced by the young women (coercion on the individual, the body as the object of control, and the modality of pressure and supervision) interact, how control is presented in stories for a recovery-focused, monitored website, and how the website directs the content. As recovery-focused, therapist-led website is likely to continue growing, understanding how and why young women talk about care and control in the context of such websites is an important topic.

The ethics of an opt-out default in tobacco treatment.

In their paper 1, Richter & Ellenberg advance an argument that a key way to improve public health is to reduce the number of smokers by increasing the uptake of tobacco cessation (and, one might add, harm reduction) programmes by current smokers. They note that in many health systems the default position is that patients seeking clinical care are only offered tobacco treatment if, in the opinion of the clinician, they are either expressing a wish to quit smoking or otherwise give signs of ‘readiness to quit’. They argue further that this creates a barrier to treatment, which can be removed by mandating clinicians to offer tobacco treatment to all patients who smoke without assessing ‘readiness to quit’, leaving the decision to the patients as to whether or not they take up this offer of treatment. The theory here is that some patients who might otherwise not have been considered ‘ready to quit’ by their clinicians will accept the offer of treatment, and that some of those will complete treatment successfully. Moreover, it is assumed that no (or minimally few) patients who would accept treatment under the current default will reject it under the new default. While the authors mention the possibility that the simple offer of treatment, by communicating implicitly that the treatment will be beneficial to the patient, will actively influence some patients to agree, they do not rely on this influence as the mechanism of action underlying the intervention. They simply suggest that offering treatment to more people will probably lead to more people accepting the offer, with net beneficial consequences.

Tracking patient-reported outcomes in spinal disorders.

Background:Patient-reported outcome measures (PROMs) quantify health status from the patient's point of view. While the number of published outcomes studies grows each year, so too has the number of instruments being reported, leading to confusion on which instruments are appropriate to use for various spinal conditions.Methods:A broad search was conducted to identify commonly used PROMs in patients undergoing spinal surgery. We searched PubMed for combinations of terms related to anatomic location and a measure of patient-reported outcome in the title or text. We supplemented the search using the “related articles” feature of PubMed and by manually searching the bibliographies of selected articles.Results:Major categories of PROMs in spine surgery include health-related quality-of-life, pain, and disease-specific disability, for which several different instrument options were identified and detailed. The minimal clinically important difference varies between instruments and differentiates statistical significance from clinical significance. In addition, the accurate estimation of costs has become a challenging but intrinsically linked variable to outcomes as increased attention is paid to the relative value of surgical interventions.Conclusion:While a number of PROMs are available for tracking outcomes in spine surgery, only a handful appear to be widely used. At least one instrument from each category should be measured pre- and post-operatively to quantify treatment effect. In addition, while the primary goal is to select the most appropriate instruments for the patient's condition, one should keep in mind sustainability of efforts with regard to patient and administrative burden.

Economic and social factors that influence households not willing to undergo cataract surgery.

Purpose:Literature investigating barriers to cataract surgery is mostly done from the patient's point of view. However, many medical decisions are jointly taken by household members, especially in developing countries such as India. We investigated from the household head's (or representative's) perspective, households’ view on those not willing to undergo cataract surgery along with the economic and social factors associated with it.Materials and Methods:A cross-sectional survey of four randomly selected village clusters in rural areas of Theni district, Tamil Nadu, India, was conducted to elicit the willingness to pay for cataract surgery by presenting “scenarios” that included having or not having free surgery available. The presentation of scenarios allowed the identification of respondents who were unwilling to undergo surgery. Logistic regression was used to estimate relationships between economic and social factors and unwillingness to undergo cataract surgery.Results:Of the 1271 respondents, 49 (3.85%) were not willing to undergo surgery if they or their family members have cataract even if free surgery were available. In the regression results, those with good understanding of cataract and its treatment were less likely to be unwilling to undergo cataract surgery. Those not reporting household income were more likely to be unwilling to undergo cataract surgery.Conclusions:As a good understanding of cataract was an important predictor of willingness to undergo cataract surgery, health education on cataract and its intervention can improve uptake.

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire.

BackgroundThe aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22).MethodsThis cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels.ResultsTwo hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (β=0.15). Clinical improvement was moderately associated with higher global satisfaction (β=−0.15), higher satisfaction with quality of care (β=−0.19), and higher satisfaction with food (β=−0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (β, 0.20–0.43) except food, and for seclusion with global satisfaction (β=−0.33) and personal experience (β=−0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (β=−0.15).ConclusionThis study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient’s satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients’ management, and health outcomes in psychiatric hospitals.

Impact of interpersonal factors on insight in schizophrenia

Whereas clinical insight in schizophrenia has been consistently associated with personal factors (i.e. sociodemographic characteristics, symptoms or cognition), little is known about its relationships with interpersonal factors (i.e. close environment and personal characteristics involved in social interactions). Most of the few studies available have focused on one particular interpersonal factor, such as social cognition, contact frequencies or therapeutic alliance. To date, no study has explored the specificity of associations between clinical insight and different levels of interpersonal factors, neither if these associations are independent of personal factors.Associations between insight and interpersonal factors were explored through multiple regression in a sample of 80 outpatients with schizophrenia spectrum disorders. Lower insight was associated with lower interpersonal functioning, independently from personal factors such as age, gender, age at first hospitalization, executive functioning and symptoms. Our findings replicate previous studies with regard to the associations between clinician-rated insight and social cognition or social contact frequencies. They also provide new information about specific associations between clinician-rated insight and perceived social support as well as between patient-rated insight and therapeutic alliance. Finally, models of insight based on personal factors were significantly improved by the inclusion of interpersonal factors. These results strongly support the crucial role of interpersonal factors in insight, both from the clinician's and the patient's point of view. These exploratory data require further replication.

Knee arthroplasty and lawsuits: the experience in France.

Data regarding knee arthroplasty and lawsuit are scarce. With the expected increase in knee arthroplasty over the next 25 years, the number of claims might follow the same trend. Therefore, the most frequent causes of litigation after knee arthroplasty in France, and what is considered as malpractice by the expert, were determined. Over 8-year period, data gathered from a French private insurance company specializing in malpractice for private practitioners were analyzed. Demographics, type of knee arthroplasty, reason for claim, details of the legal procedure and the expert's decision were reviewed. One hundred and five claims were processed by four jurisdictions. Most of the cases concerned primary total knee arthroplasty. Surgeons and anesthesiologists were charged in 84 and 16 % of claims, respectively. The most frequent causes of litigation were infection, neurological deficit and unsatisfactory result, whereas the most common reasons for the surgeon's liability, as stated by the expert, were delay in diagnosis or treatment of a complication, infection and technical error. Our findings show that frequent complications are not those which raise most of the claims. Patients sue the surgeon when the outcome of the surgery is different from what they were expecting. An unsatisfactory result, according to the patient's point of view, is the second most frequent cause of claim. IV, Economic and Decision Analysis. See the Guidelines for Authors for a complete description of levels of evidence.

Lean production in healthcare: a simulation-based value stream mapping in the physical therapy and rehabilitation department of a public hospital

Assessing the quality and efficiency levels of healthcare organisations is important for effective health service delivery. The purpose of this study is to show how a healthcare organisation evaluates itself by using a pre-lean method, value stream mapping (VSM), and uses lean to become more efficient. The healthcare sector in Turkey was selected due to the very low number of studies available in the sector. A simulation-based VSM method was applied to the physical therapy and rehabilitation department of a public hospital. The current and the future states of the department were mapped using VSM. Simulation was then used to render dynamic the current and the future state maps. The results show that from the patient's point of view, the value added was low and there were many steps that could be seen as a waste of time. Steps which add no value for the patient were eliminated and lean patient flow was shown with a future state map. In order to observe how the proposed improvements affect the system, the current state and two different scenarios of future states were modelled using simulation. Patient length of stay was reduced by the proposed models. A considerable amount of non-value added time is reduced when the first proposed model is applied and it is totally eliminated in the second model. Both proposed models for the future state appear to be more stable than the current state. Finally, the limitations of this study and the potential for future research are considered.