Role In Patients Research Articles

Patient engagement in system redesign teams: a process of social identity

PurposeStudies demonstrate how patient roles in system redesign teams reflect a continuum of involvement and influence. This research shows the process by which patients move through this continuum and effectively engage within redesign projects.Design/methodology/approachThe authors studied members of redesign teams, consisting of 5–10 members: clinicians, systems engineers, health system staff and patient(s), from three health systems working on separate projects in a patient safety learning lab. Weekly team meetings were observed, January 2016–April 2018, 17 semi-structured interviews were conducted and findings through a patient focus group were refined. Grounded theory was used to analyze field notes and transcripts.FindingsResults show how the social identity process enables patients to move through stages in a patient engagement continuum (informant, partner and active change agent). Initially, patient and team member perceptions of the patient's role influence their respective behaviors (activating, directing, framing and sharing). Subsequently, patient and team member behaviors influence patient contributions on the team, which can redefine patient and team member perceptions of the patient's role.Originality/valueAs health systems grow increasingly complex and become more interested in responding to patient expectations, understanding how to effectively engage patients on redesign teams gains importance. This research investigates how and why patient engagement on redesign teams changes over time and what makes different types of patient roles valuable for team objectives. Findings have implications for how redesign teams can better prepare, anticipate and support the changing role of engaged patients.

Kidney failure, status passage, and the transitional nature of living with the disease: A qualitative study in Argentina.

The span of kidney failure (KF) has been extended by advances in treatment. To elucidate the lived experiences of people with KF, we draw on Glaser and Strauss's theory of status passage. Semi-structured interviews were conducted with 50 patients with KF and 14 health professionals, from two healthcare facilities in Buenos Aires, Argentina. The theory informed on the temporal dimensions of people's passages and dimensions related to what actors know of this passage. We described the status passage as a sequence of transitions (starting dialysis, receiving a transplant, returning to dialysis) that have devastating effects on patient's roles, and are accompanied with fear and experience of wasting time. Temporal aspects were crucial and planning was useless; indeed, timing of statuses was uncertain. With a transplant, certain roles and capacities could be regained. Some patients were not aware of the chronic nature of the disease and the ultimate reversibility of the transplant. Control over the passage was minimal because of the unpredictable prognosis of the disease but patients employed strategies to regain it. Control was even more limited for people who migrated to receive a treatment; whose lives were completely altered. Status passage theory signaled the overwhelming impact of the passage on all aspects of people's lives, the uncertainty of the transitions, lack of control and awareness of essential aspects, and unexpected aspects of desirability, adding to our understanding of how people experience this disease and its treatments.

OR5. Supportive Heart Failure Care Program: Reducing Hospital Re-admissions at a Visiting Nurse Agency

OR5. Supportive Heart Failure Care Program: Reducing Hospital Re-admissions at a Visiting Nurse Agency

The Significance of Blood Eosinophilia in Atopic Dermatitis

Background: Atopic dermatitis (AD) is chronic relapsing, pruritic, inflammatory skin disease. Itusually accompanies other atopic problems like asthma and allergic rhinitis. Eosinophil plays a rolein patients with AD.Objectives: To assess blood eosinophils in patients with AD and to evaluate the factors that areaffecting the blood eosinophilia.Materials and methods: This prospective study was conducted at Hit General Hospital in theperiod from October 2018-October 2019. The age, gender, and personal or family history of asthmaor allergic rhinitis of the patients with AD were recorded. The severity of the disease was assessedby the SCORAD score. The total number of eosinophil was measured for each subject. The datawere analyzed using SPSS version 22.Results: Out of 70 patients with AD, 38 (54.3%) were females, and 32 (45.7%) males. The age ofthe patients ranged from 8 months to 30 years (mean 7.59±7.40). The highest age group affectedwas 2-12 years 40 (57.1%). The SCORAD score ranged from 6-80 (mean 24.19±17.59). Themajority of our patients with mild course 50 (71.1%). The majority of the cases were without ahistory of asthma (n=53,75.7%), and around 50% without allergic rhinitis. The range of eosinophilcount was 42-3360 (mean 636.44±491.37). The majority of the subjects (n=53,75.7%) with mildeosinophilia (500-1500/ mm3). The age, gender, and patients with a history of allergic rhinitis orasthma had no significant effect on the number of eosinophils (P-Value >0.05). While, there wasa high statistically significant difference between the eosinophils count, and the severity of AD(P-Value=0.000).Conclusion: From these findings we concluded that blood eosinophilia is a relatively commonlaboratory finding of AD. Blood eosinophilia was influenced by the severity of AD.

Interactional practices in person-centred care: Conversation analysis of nurse-patient disagreement during self-management support.

BackgroundPerson‐centred care implies a change in interaction between care professionals and patients where patients are not passive recipients but co‐producers of care. The interactional practices of person‐centred care remain largely unexplored.ObjectiveThis study focuses on the analysis of disagreements, which are described as an important part in the co‐production of knowledge in interaction.DesignA qualitative exploratory study using conversation analysis.Setting and participantsData were collected from a nurse‐led person‐centred intervention in a hospital outpatient setting. Interactions between adult patients with irritable bowel syndrome (n = 17) and a registered nurse were audio‐recorded. COREQ guidelines were applied.ResultsDisagreements were found after demonstration of the nurse's or patients’ respective professional or personal knowledge. Disagreements were also evident when deciding on strategies for self‐management. Although negotiations between opposing views of the nurse and patient were seen as important, the patient generally claimed final authority both in knowing how IBS is perceived and in the right to choose self‐management strategies. The nurse generally oriented towards patient authority, but instances of demonstration of nurse authority despite patient resistance were also found.Discussion and conclusionsThis study provides information on how co‐production of knowledge and decisions occur in the context of a person‐centred care intervention. Negotiations between nurse and patient views require a flexible approach to communication, adapting interaction to each context while bearing in mind the patients having the final authority. To facilitate co‐production, the patient's role and responsibilities in interaction should be explicitly stated.

Can we learn on Psychotherapeutic Process Dimensions with Single Case Study?

Relational psychoanalysis states that an adequate management of the intersubjective processes displayed in psychotherapy are essential to promote effective change. The analysis about some variables of the therapist and patient and the complex and co-determined interaction between them, give us new perspectives on the therapeutic process. This analysis leads us to question some topics and consider from a new view the therapist's functions and the patient's roles within the therapeutic process. A group of researchers in Spain, Argentine, Mexico and Germany have worked along a decade (1997-2008) in the Salamanca-Barcelona-Madrid Project on Psychotherapy Process Research. This project, an study conducting single case research (´The Publicist´ case), along the main phases of complete treatment (up to 200 recorded sessions), have given us the opportunity to adquire a better knowledge on therapeutic process, through the content analysis of sessions and with qualitative data using a wide variety of procedures. In this paper we are presenting relevant results concerning some inferences on therapeutic process along the whole treatment and their phases. Crossing all the studied dimensions, we propose a comprehensive model of change observed in the case object of study, considering all the approaches, both from quantitative and qualitative methods and process dimensions, both the contributions of the therapist and the patient to psychotherapeutic process. Results are discussed in the light of recent perspectives on active use of counter-transference as a therapist’s tool to improve the psychoanalytic psychotherapy process, controlling negative aspects of countertransference collusions.

ОСОБЕННОСТИ МОТИВАЦИОННО-ПОТРЕБНОСТНОЙ СФЕРЫ БОЛЬНЫХ ЭПИЛЕПСИЕЙ: КЛИНИКО-ПСИХОЛОГИЧЕСКИЙ АСПЕКТ

Epilepsy is a common neuropsychiatric disease in which a number of personality characteristics change. Motivation takes one of the main places in the structure of the patient's personality. Motivation largely determines human behavior, is an important component, since it helps to understand the features and directions of human activity. A motive is an impulse to activity, which is associated with the goal of satisfying the arisen desires. Only by understanding how the patient's motivational-need sphere is arranged, it is possible to determine the patient's role, the degree of his participation in treatment-and-prophylactic measures, as well as influence the formation of motivation, motivate the sick person for educational activities, labor, production activities, etc. The study of the characteristics of the patient's motivational-need sphere is necessary in order to understand how the patient's motivation is formed in the treatment process, how important it is in his life and whether the patient will be able to effectively manage life, enjoy reality, successfully look and plan the future, precisely based on his own motive. That is why the problem of motivation is very relevant at the present time. This work analyzes the features of the motivational-need-related sphere of patients with epilepsy. The study included 317 patients aged 18 to 65 years with focal forms of epilepsy, whose structure was dominated by simple, complex partial seizures. Verification of the diagnosis in the examined patients was carried out on the basis of the results of clinical neurological, psychopathological, pathopsychological, electroencephalographic examination and computed tomography of the brain. The study used a methodology for assessing the level of claims: V. Gerbachevsky's questionnaire. Clinical and psychological research of patients with epilepsy made it possible to substantiate the choice of 2 clusters: the first cluster included able-bodied working patients – n=131 (41.3%), the second cluster - non-working patients – n=186 (58.7%). In the 1st cluster, indicators on the scales "Level of mobilization of efforts", "Regularity of results", "Cognitive motive" prevail, in the 2nd cluster indicators on the scale "Avoidance" prevail. Taking into account the motivational-need-oriented orientation of the patient is an important component in the construction of therapeutic programs aimed at improving the quality of medical care.

Effects of self-management programs on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension: Meta-analysis of randomized controlled trials.

To assess the effects of self-management interventions on systolic blood pressure, diastolic blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension. Effective treatment of hypertension may require the practice of self-management behaviours. However, evidence on effects of self-management interventions on blood pressure, self-efficacy, medication adherence and body mass index in older adults with hypertension is lacking. A systematic review and meta-analysis. CINAHL, Cochrane Library, Embase, Ovid-Medline, PubMed, Scopus, Web of Science and other sources were searched to October 2020. Data were analysed using Comprehensive Meta-Analysis 2.0 and quality assessment was done using ROB 2.0. The pooled effect sizes were reported as Hedges' g values with corresponding 95% confidence intervals using a random-effects model. Twelve randomized controlled trials met our inclusion criteria. The results revealed that self-management interventions significantly decreased blood pressure and increased self-efficacy and medication adherence in older adult patients with hypertension, with no significant effect on body mass index. Self-management interventions have considerable beneficial effects in older adults with hypertension. Health care providers should implement self-management interventions to strengthen the patient's role in managing their health.

Relationship Of Patient Characteristics With Compliance With Lifestyle Modifications In Recovery Post Diabetes Mellitus Patients

Diabetes mellitus is a group of metabolic diseases with hyperglycemic characteristics that occur due to abnormal insulin secretion, insulin action or both. In managing the disease, the patient's role is very important, especially in terms of increasing adherence in establishing therapy in order to achieve optimal blood glucose levels to prevent more severe complications. Objective The relationship between patient characteristics and the level of adherence to lifestyle modification in the recovery of patients after DM Method This research is analytical research with cross sectional approach. This research was conducted in the Pelni Hospital Room in Jakarta in May 2017. The population was all patients with diabetes mellitus who came to the Pelni Hospital room. Sampling using a consecutive sampling technique with a total sample of 65 people. Primary data collection instruments using DM risk factor questionnaire. Results of the study In this study respondents who were the subject of the study were Diabetes Mellitus sufferers who visited the Pelni Hospital Inpatient Room Jakarta. Differences in characteristics possessed by each patient, can indirectly affect patient compliance in taking drugs. In table 1 it can be seen that in the age group below 45 years have a higher compliance that is equal to 70.0% compared to the age group above 45 years which is 25.5%. This shows the tendency between patient compliance in taking diabetes medications, where the younger the patient's age, the more likely it is to be obedient in consuming diabetes medications. Conclusion Based on the results of the study it can be concluded that there is a significant relationship between the age and level of education of patients with the level of adherence in undergoing treatment. However, there is no significant relationship between the sex of the patient and the level of adherence in undergoing treatment.

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years. According to the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing. Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020). For the purpose of this special issue, we use the NCCIH's definition of CIH as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients' preference is possibly due to providers' lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017). Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients' nondisclosure of the use of these therapies. Patients' fear of disclosure due to perceived skepticism or disapproval from their provider was frequently attributed as a cause of patients' nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012). The arrival of patient-centered care models is beginning to shift the ways we understand the patient's role in treatment engagement. Patient-centered approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019). The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient's cultural beliefs, or what Kleinman called the "explanatory belief model" (Kleinman, 1978)- for example, by "aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice" (APA, 2019, p. 24). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Communication skills training using virtual reality: A descriptive qualitative study

BackgroundModern medical pedagogical strategies are shifting toward the use of virtual patient simulations. ObjectiveThis study aims to examine students' users' attitudes and experiences and clinical facilitators' perspectives on student performances in the clinical setting post-virtual patient training. DesignA descriptive qualitative study design was used. SettingNursing faculty at a local university in Singapore. Participants24 nursing undergraduates and six clinical facilitators. MethodsThis study is a follow-up of an experimental study on the Virtual Counseling Application Using Artificial Intelligence (VCAAI). The study took place from the academic year 2017/2018 ended in November 2019. Focus group discussions and individual interviews were conducted. All interviews and focus group discussions were audiotaped, transcribed verbatim, and analyzed using thematic analysis. ResultsTwo overarching themes (students' virtual patient user experience and clinical facilitators' evaluations of students' clinical communication skills) comprising six themes were generated. Themes under students' user experience included: 1) attitudes toward virtual patient training, 2) virtual patient's role in student development, and 3) enhanced features and implementation suggestions. Themes under clinical facilitators' evaluations included: 1) insights on students' communication skills and 2) approaches to improve communication skills. An overlapping theme titled ‘value of technology in teaching communication’ comprised of mutual feedback from both students and clinical facilitators. Early implementation, continued accessibility, enhancing realism and technological improvements to the VCAAI were listed as key areas for program improvement, while increased situational sensitivity and language training are recommended to further enhance students' communication skills. ConclusionThe mixed attitudes toward virtual patient interactions and recognitions of the benefits of virtual patient simulations suggest the potential effectiveness of the use of virtual patients in teaching effective nursing communication skills. However, the lack of authenticity and other limitations need to be addressed before official implementations of such trainings with virtual patients to undergraduate nursing curricula.

Living with chronic obstructive pulmonary disease: A story conditioned by the symptoms.

To determine the meaning of the experience of people with chronic obstructive pulmonary disease. A qualitative approach study rooted in hermeneutic phenomenology. In-depth interviews were conducted with 10 people with critical and severe chronic obstructive pulmonary disease. The findings obtained are described in three emerging topics and their consequent subtopics, which describe the process of the disease focusing on five subtopics related to awareness of the disease, the choking characteristic of the disease and tiredness as daily unpleasant symptoms, as well as choking as a death threat, rejection of oxygen dependency and coping systems to control the disease. In the second topic, family support with two subtopics are described: the loss of the patient's role, the burden of care; and the third topic concerns the support of health system on two subtopics: medical care and nursing care. The symptoms and functional changes in general, denote a different meaning not only in everyday life, but also in times of exacerbation of the condition. Likewise, changes in lifestyle due to the loss of roles and health care processes are revealed, as experiences that do not allow effective coping and adaptation.

Proper Counseling and Dispensing of Isotretinoin Capsule Products by Community Pharmacists in UAE: A Simulated Patient Study.

PurposeTo evaluate the pharmacist’s assessment of patient eligibility for safe use of isotretinoin and the quality of pharmacist’s counseling.Patients and MethodsA covert simulated patient (SP) methodology was used in which a trained female researcher, who was 25 years old, played the patient’s role through this cross-sectional study by visiting community pharmacies and requesting isotretinoin capsules through a controlled prescription. A data form was used to collect the information following each pharmacy visit by asking about medical/family history and providing comprehensive counseling about the most common adverse effects, proper use instructions, and the importance of adherence to medication. The pharmacists, who did not initiate counseling, were prompted by the SP.ResultsThe pharmacists in 400 pharmacies who agreed to participate were visited by the SP. Only 7 (2%) pharmacists provided a complete assessment of patient eligibility for using isotretinoin with comprehensive counseling. Most of the pharmacists (84%) provided incomplete assessment as indicated by the overall score. Only 11 (3%) pharmacists asked the six crucial questions for the assessment of patient eligibility. On prompting, only 6 (2%) pharmacists provided complete counseling about the expected adverse effects. The most frequently provided adverse effect was dry skin, specifically dry lips (71.8%). A minority of 108 (27%) pharmacists provided education about the importance of using contraception during isotretinoin therapy. A complete level of counseling was provided by 125 (31.3%) pharmacists regarding the lab tests that the SP needs to undergo during therapy. Female pharmacists were more likely to provide counseling about the pregnancy test (mean=134, p=0.001).ConclusionSuboptimal level of the patient’s assessment was revealed with poor educational counseling by the community pharmacists. New strategies are needed to improve pharmaceutical care services in the UAE.

Patient participation in gastrointestinal endoscopy - From patients' perspectives.

BackgroundPatient participation is associated with satisfaction and improved health‐related outcomes. In gastrointestinal endoscopy, patient participation is an underexplored area.ObjectiveTo gain understanding on patients' experiences, attitudes and preferences concerning patient participation in the endoscopy pathway.MethodsSemi‐structured interviews with endoscopy patients (n = 17, female n = 8, male n = 9, ages 19‐80 years) were performed. Interview transcripts were analysed using qualitative content analysis. Participants were recruited by purposive sampling from an endoscopy unit in a Swedish university hospital. Inclusion:≥ 18 years, fluency in Swedish and recent experience of endoscopy at the unit.ResultsFive generic categories emerged, two within the area of the patient's role, which was described as active or passive/included or excluded. Another three generic categories related to factors, critical to active participation, including organizational aspects, impressions of staff and individual circumstances were identified. In this context, patient participation described in the interviews was on a low to basic level, although sometimes reaching a higher level when staff ‘invited’ patients in decision making.DiscussionThis study contributes to the understanding of patient participation in endoscopy. Patients are in an inferior position and need support from the staff for an active role in their care. Although there were variations on the perceived importance of different factors, a heavy responsibility lies on the endoscopy staff to acknowledge the patients' individual needs and to facilitate patient participation.ConclusionsEndoscopy staff has a key role in supporting patient participation. In endoscopy settings, patient participation is vulnerable to multiple factors.

MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION Ethan Matz*, Rahul Dutta, William Anderson, Kyle Scarberry, and Ryan Terlecki Ethan Matz*Ethan Matz* More articles by this author , Rahul DuttaRahul Dutta More articles by this author , William AndersonWilliam Anderson More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Refractory ischemic priapism (IP) often requires shunting. We hypothesize cases due to sickle cell (SC) disease or prescribed intracavernosal injection (ICI) may present earlier. We sought to characterize etiology and management for IP to determine likelihood of shunting based on patient parameters. METHODS: An IRB approved database of men seen for IP at our emergency department (ED) since January of 2011 was reviewed. Case data through December 2018 was evaluated for demographics and event details. For patients with recurrent IP, the most recent event was considered. Statistical associations were assessed with chi square and 2-sided t-test, and ROC analysis performed. RESULTS: In total, 110 men were included. Median overall time to presentation (TTP) to ED for IPP was 10 hours (1.5-196). Etiologies included: ICI (24%), idiopathic (16%), trazodone use (16%), SC trait or disease (15%), use of other psychotropic medications (15%). Other etiologies comprised an insignificant number of cases. Median TTP for SC and ICI were not significantly different with median of 6.5 (1.5-22) and 6 (3-120) hours, respectively (p = 0.42).Likelihood of undergoing shunt surgery was highest among cases due to psychotropic medication (59%), followed by trazodone (44%), idiopathic (38%), and ICI (8%). No SC patients required shunting.When compared directly to ICI, the odds of shunting were significantly higher for idiopathic (OR 7.6 CI 1.35, 42.89 p=0.02) or trazodone-related cases (OR 9.6 CI 1.72, 53.4 p=0.0098). ROC analysis yielded a sensitivity of 1 and specificity of 0.9231 for requiring distal shunt using 20 hours to presentation as a cutoff (AUC=0.9904, p<0.0001). No men presenting sooner had distal shunting, while 84% of those seen after were shunted.Grouping SC and ICI cases together (42 men, 38% of cohort), rate of shunting was 4.8% vs 44.1% in others combined (p < 0.001). Median TTP for SC and ICI combined was 6 (1.5-120) hours vs 17 (2-196) hours for others combined (p = 0.001) CONCLUSIONS: Cases of IP presenting to the ED are most commonly due to ICI, and these cases typically present earlier and have a lower incidence of shunting. IP secondary to trazodone or other oral medications presents later with a significantly higher chance of surgery. TTP beyond 20 hours is unlikely to avoid shunting. Analysis for SC and ICI cases suggest lower likelihood of surgery is due to earlier TTP, possibly secondary to better education regarding risk of IP. Prescribers offering trazodone or psychotropic medications associated with IP may need to better educate patients on risk. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1179-e1179 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz* More articles by this author Rahul Dutta More articles by this author William Anderson More articles by this author Kyle Scarberry More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...

Communication and Respect for Patient Value as Significant Factors in Patient-Centered Infertility Care: A Survey of Patients' Experiences in Two Infertility Centers.

Context:The patient-centered infertility care (PCIC) approach emphasizes the patient's role in choosing the most appropriate clinical approach in infertility care. The concept can improve the patient satisfaction with care performed as well as the efficacy of the treatment. In addition, this concept can also lead to improve collaboration between patient and care provider, ultimately supporting a more cost-effective health-care scheme.Aims:This study was developed in order to determine patients' experience in their PCIC.Settings and Design:This is a descriptive study. We conducted the study in two fertility care clinics, Clinic A and Clinic B.Subjects and Methods:The Patient-Centeredness Questionnaire-Infertility (PCQ-I) was used, consisting of 7 essential themes. The questionnaire was completed by consenting patients in two infertility clinics.Statistical Analysis Used:The questionnaire was analyzed using the Statistical Package for the Social Sciences 21 version statistical software.Results:Eighty-eight Clinic A patients who completed the questionnaire responded that the best element of their treatment received was communication (correlation with global score [CGS]: 0.747), whereas the least acceptable aspect was the low accessibility (CGS: 0.211). A total of 20 Clinic B patients responded that the best element of their treatment received was respect for the patient's value (CGS: 0.866), whereas the least acceptable aspect was also the low level of accessibility (CGS: 0.193).Conclusions:The PCQ-I can be used to evaluate patients' experience during treatment and may help the health-care provider to improve their performance.

Nurses' articulations of the patients' role when the vision is partnership: A qualitative study.

Although principles such as 'patient participation' and 'patient involvement' have become ideals in health-care, they have proven to be difficult to apply in practice. In 2014, one Danish region issued an official document that included the vision of 'the patient as partner'. However, little is known about how such a vision affects clinical practice. The purpose of this study was to investigate nurses' views on how partnerships between them and patients are established considering this vision. We conducted semi-structured interviews with eight nurses working in Danish hospitals. Then, we analysed the interviews in a Norman Fairclough-inspired critical discourse analysis. During this three-dimensional analysis, we identified three discourses. We found that a liberalistic discourse wins hegemony based on the nurses' expectations of the patient's role. Nurses construct a picture of the patient's role, expecting the patient to be responsible and to participate. For the partnership to arise as envisioned, the patient is perceived as being dependent on the nurse's professional knowledge. Surprisingly, the nurses' articulations of the patient's role were identical to the vision's elements. Therefore, we suggest that the vision reflects prevailing societal norms for individuals, thereby reflecting society's attitude towards people's responsibility for their own lives.

The early diagnosis of cancer in primary care: A qualitative exploration of the patient's role and acceptable safety-netting strategies.

The study had two aims-to assess the components considered important for patient involvement in diagnosing cancer earlier in primary care and to assess the acceptability, feasibility, cost and burden of three safety-netting interventions in terms of their potential to become a sustainable component of standard care and improve diagnostic outcomes for cancer in a primary care setting. Fifteen interviews were conducted with patients and GPs/Nurse Practitioners. Findings were fed back at a workshop with 18 stakeholders who helped to conceptualise an intervention. Interviews were analysed using thematic analysis. Stakeholder discussions were captured through group feedback sessions. Three key themes around stakeholders' views on patient involvement emerged from the interviews. These were keeping the door open, roles and responsibilities and fear of cancer. Interview findings and workshop feedback identified the intervention should include a verbal discussion and plan, written information and a patient prompt option. Patient involvement in diagnosing cancer in primary care is considered acceptable to patients and HCPs. Factors that facilitate or hinder involvement have been identified. Components deemed important in a safety-netting intervention, and potential costs and benefits were established. This knowledge can direct future research and the development of safety-netting interventions.

Perspectives and Practice: Physical Therapist Students' Clinical Reasoning

Introduction. Entry-level physical therapist (PT) educational programs need to prepare practitioners who engage in patient-centered clinical reasoning. Many factors, including health care practitioners' beliefs and values, influence how clinicians engage in clinical reasoning. Variations in students' characterizations of physical therapy practice may explain some of the differences observed in previous studies of clinical reasoning. This paper examines the relationship between PT students' characterizations of practice and their clinical reasoning during an encounter with a patient. Methods. This paper used a qualitative, descriptive case study method with thematic analysis. Eight entry-level doctor of physical therapy students from 2 programs participated in semistructured conceptual interviews and standardized patient encounters with retrospective think-aloud for this paper. Qualitative thematic analysis was used to examine the students' perspectives on practice and clinical reasoning strategies. The students' perspectives on the purpose and the patient's role in the physical therapy encounter were then analyzed for their relationship with the students' clinical decision-making processes during a standardized patient encounter. Results. The students demonstrated a spectrum of qualitative differences in both their perspectives and their reasoning. The students' clinical decision-making processes paralleled their views on practice. A negative case example illustrates the complexity of the relationship between perspective and practice. Discussion and Conclusion. Physical therapist students' approaches to a patient encounter parallel their perspectives on practice; however, students must also have the appropriate clinical skills to enact their characterization of practice. Entry-level PT educational programs should include learning opportunities that support students in developing patient-centered perspectives as well as the skills to carry out that practice.

299Survival after heart transplantation: the role of psychosocial variables and patients' expectations toward themselves and others

Abstract Introduction Among various forms of heart failure treatment, heart transplantation (HTx) gives a chance to return to full well-being. Proper adaptation to life with the new organ allows reducing the risk of treatment failure and graft rejection. Previous studies suggest a significant impact of individual personality traits on both general health and lifestyle, as well as adaptation to the patient's role, such as adherence to medical recommendations. They can also influence outcomes of the treatment. Purpose The major aim of the study was to estimate the relationship between health behaviours and psychosocial characteristics of HTx patients and the survival in a 3-year follow-up. The additional aim was to describe experiences of people with particularly long survival time after HTx (more than 15 years) in relation to their collaboration with medical staff and medical recommendations. Methods The study group consisted of 107 patients after HTx (19 to 75 y.o., M = 53.11, SD = 14.39), 11 women and 96 men (10.3% vs 89.7% of the group). The time from transplantation was 1 to 24 years (M = 6.75, SD = 4.76). In the study, an ex post facto model was used in the exploratory version using sequential mixed-method design (QUAN → qual). The collection and analysis of qualitative data were carried out using the autobiographical method. The study used self-assessment questionnaires related to individual psychological characteristics and general health status, and a survey on demographic variables. The semi-structured interviews have also been conducted with selected patients regarding their experiences of heart transplantation, adaptation to the treatment and expectations towards themselves and the medical team. Results The results of Cox proportional hazard regression analysis indicated 2 predictors of life expectancy in the 3-year follow-up: the level of somatic symptoms GHQ A (Exp(B) = 1.379) and the level of passive acceptance of illness AIS (Exp(B) = 1.240) (2LL = 43.683; Chi2= 13.385; p&lt;0.001). Patients have diverse experience with HTx, but they manifest consistent expectations toward themselves, which are present in 2 major domains: adaptation to everyday life (having a regular occupation, usefulness to others, avoiding thinking about the disease) and adaptation to treatment (taking care of health, building a constructive relationship and sharing knowledge with the treatment team and with other people after HTx). Survival curve after HTx (GHQ A/AIS) Conclusions There were two psychosocial factors that are significant for the prediction of life expectancy after HTx: the sense of disease burden and acceptance of their health situation. Patients with long survival after HTx express certain expectations regarding adaptation to everyday life and the role of the transplant patient. Taking into account the above conclusions it seems reasonable to include estimation of subjective characteristics and patients' expectations, as important resources, in the process of care after HTx.