Physician-patient Interaction Research Articles

Comparing Provider and ChatGPT Responses to Breast Reconstruction Patient Questions in the Electronic Health Record.

Patient-directed Electronic Health Record (EHR) messaging is used as an adjunct to enhance patient-physician interactions but further burdens the physician. There is a need for clear electronic patient communication in all aspects of medicine, including plastic surgery. We can potentially utilize innovative communication tools like ChatGPT. This study assesses ChatGPT's effectiveness in answering breast reconstruction queries, comparing its accuracy, empathy, and readability with healthcare providers' responses. Ten deidentified questions regarding breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, plastic surgeons, and advanced practice providers for response. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1-5 Likert scoring, accuracy and empathy were graded by 2 plastic surgeons and medical students, respectively. Readability was measured using Flesch Reading Ease. Grades were compared using 2-tailed t tests. Combined provider responses had better Flesch Reading Ease scores compared to all combined chatbot responses (53.3 ± 13.3 vs 36.0 ± 11.6, P < 0.001) and combined brief chatbot responses (53.3 ± 13.3 vs 34.7 ± 12.8, P < 0.001). Empathy scores were higher in all combined chatbot than in those from combined providers (2.9 ± 0.8 vs 2.0 ± 0.9, P < 0.001). There were no statistically significant differences in accuracy between combined providers and all combined chatbot responses (4.3 ± 0.9 vs 4.5 ± 0.6, P = 0.170) or combined brief chatbot responses (4.3 ± 0.9 vs 4.6 ± 0.6, P = 0.128). Amid the time constraints and complexities of plastic surgery decision making, our study underscores ChatGPT's potential to enhance patient communication. ChatGPT excels in empathy and accuracy, yet its readability presents limitations that should be addressed.

Smoking cessation after acute myocardial infarction: a Swiss-wide cohort study

Abstract Background Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning. Methods ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics. Results From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p&amp;lt;0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p&amp;lt;0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p&amp;lt;0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p&amp;lt;0.001) and increased physical activity (54.6% vs. 37.7%, p&amp;lt;0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p&amp;lt;0.001). Conclusions In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.

Placebos in Healthcare: A Behavioral Study on How Treatment Responsiveness Affects Therapy Decisions in a Simulated Patient-Physician Interaction.

Treatment choice during clinical practice is crucial to best help each patient. One of the physicians' main goals is choosing a personalized effective treatment, but it also represents a challenging issue. Here, we explored different treatment choices in a simulated patient-physician interaction. Medical students (n = 48) and young Practicing Physicians (n = 20) were recruited to behave as "physicians" while fellow researchers acted as "patients". Participants were divided equally into a Belief Group, which received positive information about placebo efficacy, and a Non-Belief Group, which received negative information. Empathy traits and psychological variables were measured in both groups. During the task, participants were asked to choose between an active (TENS treatment) or a placebo treatment, to reduce patients' pain. Patients never underwent the painful stimulation but acted as if they had, simulating high or low pain responses to the placebo treatment (placebo-responders/placebo non-responders) and low pain to the TENS treatment. Behavioral results showed that the Belief Group gave significantly more placebo treatments when faced with a patient that simulated placebo responsiveness, while the Non-Belief group showed a mirrorlike behavior, administrating more believed TENS treatments when faced with a placebo non-responder. No differences were found between Medical Students and Practicing Physicians. This study constitutes a frame of reference for medical treatment decisions, indicating that physicians' treatment choices are influenced by patients' responsiveness to the treatments, as well as by their prior beliefs and empathy traits.

Developing a cyberchondria severity scale to promote self-care among university students during COVID-19

Cyberchondria is a hybrid term signifying a state in which individuals compulsively search for health-related information online because of health distress or anxiety, further aggravating their worries. This study develops a Cyberchondria Severity Scale (CSS) to assess the current situation of university students. Exploratory factor analysis (EFA) was conducted using 145 valid questionnaires. Subsequently, a nationwide survey was conducted at various universities in Taiwan, and 802 questionnaires were used for confirmatory factor analysis (CFA). The EFA led to the development of a CSS for college students with four constructs: increased anxiety (α = 0.91), obsessive-compulsive hypochondria (α = 0.87), perceived controllability (α = 0.88), and online physician-patient interaction (α = 0.86), with a Cronbach’s alpha of 0.92 and variance of 66.81%. The CFA indicated that item reliability ranged from 0.50 to 0.86, factor loadings ranged from 0.71 to 0.93, and the composite reliability for latent variables ranged from 0.83 to 0.90 (p < .001). The extracted average variance ranged from 0.46 to 0.60. There were significant differences in various dimensions: perceived controllability had the highest score and obsessive-compulsive hypochondria had the lowest (F3,2403=256.26, p < .001). Therefore, CSS has emerged as a reliable and valid measure. Future studies should explore the factors that influence cyberchondria, promote online health information searches, and enhance reading comprehension skills.

Influence of the use of a tablet-based clinical decision support algorithm by general practitioners on the consultation process: the example of FeverTravelApp

BackgroundDespite the proven positive effects of clinical decision support systems (CDSSs) on general practitioners’ (GPs’) performance and patient management, their adoption remains slow. Several factors have been proposed to explain GPs' reluctance to adopt these tools. This study hypothesizes that the influence of CDSSs on patient-physician interactions could be a determining factor. To explore this hypothesis, we utilized the FeverTravelApp, designed to assist GPs in managing patients presenting with fever after returning from the tropics. A case–control study was conducted, observing and analyzing fourteen consultations between seven physicians and three simulated patients. Each physician conducted consultations both with and without the FeverTravelApp. The consultations were video-recorded and analyzed using a custom analysis grid based on three existing tools. Simulated patients completed the Communication Assessment Tool (CAT) after each consultation, and each physician participated in a semistructured interview following the use of the app.ResultsThe use of the FeverTravelApp influenced multiple aspects of the consultation, particularly communication. Both patient and GP speaking times decreased, while active silence (no one talking while the GP actively performed a task) increased. GPs focused more on the app, which reduced direct patient interaction. However, this influence seemed to bother GPs more than simulated patients, who rated their GPs equally whether the app was used or not. This could be because patients felt better understood when GPs asked fewer but more specific questions related to travel medicine, thus effectively addressing their concerns.ConclusionsThis study supports the hypothesis that CDSSs influence consultation dynamics, which may contribute to their slow adoption. It is essential to involve clinicians early in the development of CDSSs to adapt them to clinical workflows and ensure system interoperability. Additionally, tools that allow clinicians to follow the entire clinical reasoning process, such as decision trees, are needed. Further research is necessary to confirm these findings in real patient settings and to develop CDSSs that meet both patients’ and GPs’ expectations.

Knowledge, attitudes and behaviour towards ticks and tick-borne diseases—A survey among Lyme borreliosis cases in Bavaria in 2019

Lyme borreliosis (LB) is the most common tick-borne disease (TBD) in Germany. In Bavaria, the average annual incidence of reported cases was 34.3 cases per 100,000 inhabitants between 2013 and 2020, although case numbers were presumed to be substantially higher. Since no vaccine against LB is currently available, prevention focuses on individual protection measures. This study aims to address knowledge, attitudes, and behaviours among LB cases, a population group at increased exposure to ticks, tick bites and repeated infections.We invited Bavarian LB cases reported between weeks 23 and 35 in 2019 to participate in a questionnaire study. Questions included socio-demographic characteristics, experiences with TBDs, potential tick exposures, details of the recent episode of LB, and knowledge, attitudes, and behaviours regarding TBDs and protection measures.Among the 377 participants, 300 were adults/adolescents, 77 were children (<14 years). Two third resided in rural areas. Although mostly well informed, a significant proportion of participants did not know or were misinformed about availability of repellents (48.5 %), risk of LB in their district (24.9 %), ticks not falling from trees (22.1 %) and non-availability of vaccination against LB (20.9 %). Even though a majority perceived checking for ticks after spending time outdoors, wearing long clothes, wearing closed shoes and tucking pants in socks as effective protection measures against tick bites, a much lower proportion applied those measures frequently (proportions perceived vs. applied: 99.2 % vs. 72.1%; 93.8 % vs. 40.2 %, 88.8 % vs. 51.1 % and 85.4 % vs. 16.8 %, respectively).Identified lack of knowledge or misconception regarding risk factors, availability of protection measures and tick behaviour may hamper application of recommended protection measures. There appeared to be a discrepancy between perceived effectiveness and frequency of application of protection measures. Addressing identified gaps in education campaigns, specifically targeting people living in rural areas, and utilising physician-patient interactions for education are promising entry points to increase awareness and prevent TBDs. Moreover, motivators and barriers for the application of preventive behaviour should be subject of future studies.

Anti-hypertensive medications and erectile dysfunction: focus on β-blockers.

Although anti-hypertensive medications, including thiazides and β-blockers (BBs) in particular, have been suggested to cause erectile dysfunction (ED) their real contribution is still conflicting. The aim of this paper is to summarize available evidence providing an evidence-based critical analysis of the topic. An overall comprehensive narrative review was performed using Medline, Embase and Cochrane search. In addition, to better understand the impact of BBs on ED a specific systematic review was also performed. The negative role of centrally acting drugs, such as clonidine and α-methyldopa, is well documented althuogh limited controlled trials are available. Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and calcium-channel-blockers (CCBs) have neutral (CCBs) or even positive (ACEis and ARBs) effects on erectile function. Despite some preliminary negative reports, more recent evidence does not confirm the negative impact of thiazides. BBs should be still considered the class of medications more often associated with ED, although better outcomes can be drawn with nebivolol. Sexual function should be assessed in all patients with arterial hypertension, either at diagnosis or after the prescription of specific medications. A close related patient-physician interaction and discussion can overcome possible negative outcomes allowing a successful management of possible side effects.

Second opinion and self-efficacy in German skin cancer patients.

The global incidence of skin cancer has steadily increased in recent years. Accordingly, patients require information on diagnosis and treatment options while dealing with the perceived impact of the diagnosis. In 2015, the German government enacted legislation under the Social Code (SGBV, §27b), granting patients the right to obtain a second medical opinion. Utilizing a standardized questionnaire, our study aims to explore whether patients diagnosed with skin cancer actively pursue a second medical opinion and to evaluate any potential disruptions to their daily lives. We collected a total of 714 completed questionnaires. The majority of those seeking a second opinion were diagnosed with malignant melanoma (96, 58%). Primary motivations for seeking a second opinion included seeking reassurance regarding treatment decisions and obtaining further information. Additionally, seeking a second opinion was correlated with a significantly lower internal locus of control, indicating a belief that their actions are not solely determined by their own abilities. Notably, we observed a greater impairment of daily life among younger participants and those with advanced cancer. Overall, our study shows that second opinions often strengthened the patient-physician interaction and provided additional reassurance, especially in patients with a weak perception of control. Moreover, we found that the impairment of quality of life and both internal and external locus of control decrease significantly in advanced tumor stages. Hence, it is imperative to identify additional interventions aimed at bolstering internal resilience and locus of control, thereby enhancing patients' capacity to cope with their cancer diagnosis.

Between fear of death and just a warning sign: Seizure severity scales neglect the subjective quality of periictal perceptions

The burden of epilepsy is not only related to seizure frequency; the severity of epileptic seizures considerably affects patient’s lives. A number of seizure severity scales have thus been developed for a systematic assessment. Items considered relevant in these scales mainly pertain to objective features, such as seizure duration, loss of consciousness, and seizure-related injuries. In contrast, subjective experiences of seizures are considered only in their functionality as “warnings”, whereas the quality of subjective perceptions and feelings are disregarded phenomena. This leads to a gap between the often-distressing subjective experiences which people with epilepsy remember from their seizures and the perception of physicians which may negatively impact physician-patient communication and interaction and question their valid use as treatment outcomes. We advocate here to develop new seizure severity assessments in collaboration with patient organizations which integrate also the subjective quality of seizures.

Leveraging Social Cues for Patient–Physician Interactions: The Impacts of Empathy, Interactivity and Social Validation in Mobile Medical Consultations

Social cues play a critical role in the exchange of information during patient–physician communication. Although previous research has recognized the impact of social cues on patients’ perceptions and behaviors in mobile medical consultations, little is known about how different combinations of social cues affect the interactions. Employing a within-subject factorial design experiment, this study examined the effects of three social cues—empathic cues, interactivity cues, and social validation—on patients’ perceptions of interactivity, social presence, and trust. A total of 103 participants was recruited. The results revealed the various significant impacts of empathic cues, interactivity cues, and social validation on perceived interactivity, and social validation affected trust, as well as the relationships among these perceptions. The findings suggested strategies for integrating various social cues to enhance patients’ positive perceptions, offering potential benefits to patient–physician communication in mobile medical platforms.

Transforming Health Care Through Chatbots for Medical History-Taking and Future Directions: Comprehensive Systematic Review.

The integration of artificial intelligence and chatbot technology in health care has attracted significant attention due to its potential to improve patient care and streamline history-taking. As artificial intelligence-driven conversational agents, chatbots offer the opportunity to revolutionize history-taking, necessitating a comprehensive examination of their impact on medical practice. This systematic review aims to assess the role, effectiveness, usability, and patient acceptance of chatbots in medical history-taking. It also examines potential challenges and future opportunities for integration into clinical practice. A systematic search included PubMed, Embase, MEDLINE (via Ovid), CENTRAL, Scopus, and Open Science and covered studies through July 2024. The inclusion and exclusion criteria for the studies reviewed were based on the PICOS (participants, interventions, comparators, outcomes, and study design) framework. The population included individuals using health care chatbots for medical history-taking. Interventions focused on chatbots designed to facilitate medical history-taking. The outcomes of interest were the feasibility, acceptance, and usability of chatbot-based medical history-taking. Studies not reporting on these outcomes were excluded. All study designs except conference papers were eligible for inclusion. Only English-language studies were considered. There were no specific restrictions on study duration. Key search terms included "chatbot*," "conversational agent*," "virtual assistant," "artificial intelligence chatbot," "medical history," and "history-taking." The quality of observational studies was classified using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria (eg, sample size, design, data collection, and follow-up). The RoB 2 (Risk of Bias) tool assessed areas and the levels of bias in randomized controlled trials (RCTs). The review included 15 observational studies and 3 RCTs and synthesized evidence from different medical fields and populations. Chatbots systematically collect information through targeted queries and data retrieval, improving patient engagement and satisfaction. The results show that chatbots have great potential for history-taking and that the efficiency and accessibility of the health care system can be improved by 24/7 automated data collection. Bias assessments revealed that of the 15 observational studies, 5 (33%) studies were of high quality, 5 (33%) studies were of moderate quality, and 5 (33%) studies were of low quality. Of the RCTs, 2 had a low risk of bias, while 1 had a high risk. This systematic review provides critical insights into the potential benefits and challenges of using chatbots for medical history-taking. The included studies showed that chatbots can increase patient engagement, streamline data collection, and improve health care decision-making. For effective integration into clinical practice, it is crucial to design user-friendly interfaces, ensure robust data security, and maintain empathetic patient-physician interactions. Future research should focus on refining chatbot algorithms, improving their emotional intelligence, and extending their application to different health care settings to realize their full potential in modern medicine. PROSPERO CRD42023410312; www.crd.york.ac.uk/prospero.

Non-adherence to antihypertensive drugs and its risk factors among hypertensive patients, Marrakech, Morocco.

Non-adherence to hypertensive drugs is a barrier to controlling blood pressure and decreases hypertensive patients' quality of life. The aim of this study was to determine the prevalence of non-adherence to hypertensive drugs among hypertensive patients treated at Marrakech's primary health care facilities. A cross-sectional survey of 922 hypertensive patients treated at Marrakech's primary health care facilities for arterial hypertension was conducted between 2021 and 2022. For collecting data, two questionnaires were employed. One was administered during an interview to patients and focused on socio-demographic, behavioral, and clinical variables, as well as hypertensive treatment characteristics and the care-patient-physician triad. The physician self-administered the second questionnaire to assess therapeutic inertia. Non-adherence risk factors were identified using multivariate logistic regression. A total of 760 participants did not adhere to the hypertensive drugs, with a prevalence of 82.4%. The average age was 62.8±9.8 years, and 600 (78.9%) of the participants were female. Moderate stress, unsatisfactory family support, uncontrolled hypertension, the presence of depressive symptoms, an insufficient patient-physician interaction, and inadequate medical management of cardiovascular risk factors were associated with drug non-adherence. Non-adherence to hypertensive treatment is common in Marrakech. Regular therapeutic education classes and support group meetings must be scheduled. A performance-based remuneration system to incentivize health-care workers should be investigated.

Chronic pain patients’ evaluations of consultations: A matter of high expectations or expectations unmet?

ObjectiveThis study tests two hypotheses about spine pain patients’ expectations for consultations and their negative evaluations. High expectations may be impractical or unachievable and can set patients up for disappointment. Unmet expectations are the absolute difference between expectations before the visit and perceptions of expectations actually enacted. MethodWe conducted a single-site prospective study using pre- and post-consultation surveys. Patients (N = 200) were English-speaking individuals aged 18–75 presenting for an initial consultation for musculoskeletal pain. Analyses were conducted in SPSS v. 28.0 using mixed modeling to account for interdependence among cases. ResultsContrary to initial predictions, higher pre-consultation expectations for shared decision-making were positively linked to post-consultation satisfaction, trust, and agreement. Exceeding expectations in shared decision-making, history-taking, examination, and interpersonal skills significantly enhanced post-consultation outcomes. ConclusionsResults support the unmet expectations hypothesis over the high expectations hypothesis. Increased expectations and exceeding these expectations in key areas of patient-physician interaction were positively associated with improved consultation outcomes. Practice implicationsFindings highlight the importance of exceeding multifaceted patient expectations in physician evaluations. Yet, physicians must first understand the nature and source of each patient’s expectations pre-consultation, which vary across individuals in aspirational and realistic dimensions.

Current use, training, and barriers in point-of-care ultrasound in nephrology: A national survey of VA medical centers.

Point-of-care ultrasound (POCUS) can improve diagnostic accuracy, reduce procedural complications and enhance physician-patient interactions in nephrology. Currently, there is limited knowledge about how practicing nephrologists are using POCUS. This study aimed to characterize current POCUS use, training needs, and barriers to use among nephrology groups. A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of staff and nephrology specialty chiefs. Chiefs of staff (n=130) and nephrology chiefs (n=79) completed surveys on facility- and service-level POCUS use (response rates of 100% and 77%, respectively). Current diagnostic or procedural POCUS use was reported by 41% of nephrology groups, and the most common POCUS applications were central line insertion (28%) and assessment of urinary retention (23%), hydronephrosis (18%), volume status (15%), and bladder (14%). Lack of training was the most common barrier (72%), and most nephrology groups (65%) desired POCUS training. Limited access to ultrasound equipment and POCUS training were barriers reported by 54% and 18% of groups, respectively. A minority of nephrology groups currently use common POCUS applications including evaluation of urinary retention, hydronephrosis, and volume status. The most common barriers to POCUS use in nephrology were lack of trained providers and ultrasound equipment. Investment in POCUS training and infrastructure is needed to expand and standardize POCUS use in nephrology.

An artificial intelligence platform for the screening and managing of strabismus.

Considering the escalating incidence of strabismus and its consequential jeopardy to binocular vision, there is an imperative demand for expeditious and precise screening methods. This study was to develop an artificial intelligence (AI) platform in the form of an applet that facilitates the screening and management of strabismus on any mobile device. The Visual Transformer (VIT_16_224) was developed using primary gaze photos from two datasets covering different ages. The AI model was evaluated by 5-fold cross-validation set and tested on an independent test set. The diagnostic performance of the AI model was assessed by calculating the Accuracy, Precision, Specificity, Sensitivity, F1-Score and Area Under the Curve (AUC). A total of 6194 photos with corneal light-reflection (with 2938 Exotropia, 1415 Esotropia, 739 Vertical Deviation and 1562 Orthotropy) were included. In the internal validation set, the AI model achieved an Accuracy of 0.980, Precision of 0.941, Specificity of 0.979, Sensitivity of 0.958, F1-Score of 0.951 and AUC of 0.994. In the independent test set, the AI model achieved an Accuracy of 0.967, Precision of 0.980, Specificity of 0.970, Sensitivity of 0.960, F1-Score of 0.975 and AUC of 0.993. Our study presents an advanced AI model for strabismus screening which integrates electronic archives for comprehensive patient histories. Additionally, it includes a patient-physician interaction module for streamlined communication. This innovative platform offers a complete solution for strabismus care, from screening to long-term follow-up, advancing ophthalmology through AI technology for improved patient outcomes and eye care quality.

Development of a Patient-Centered Pathway of Care for Retinoblastoma Patients: A Mixed-Methods Pilot Study.

Introduction Retinoblastoma treatment and follow-up is complex and varies between patients. Pathways of care can enhance quality of care, patient outcomes, safety, satisfaction, and resource optimization. Developing a pathway of care for retinoblastoma was identified as a top research priority by the retinoblastoma community. This study aimed to co-design and pilot a pathway of care called the "Retinoblastoma Journey Map" tailored for caregivers of newly diagnosed children with retinoblastoma. Methods A working group of patients, health professionals and researchers used human-centred design to ideate, prototype and refine the Retinoblastoma Journey Map. Caregivers of affected children were recruited to use and evaluate the Map. Mixed-methods data was collected on feasibility, acceptability, usability and perceived impact on communication, self-efficacy, anxiety, depression, and the quality of physician-patient interaction. Results The Retinoblastoma Journey Map consisted of an illustrated roadmap with 25 child-friendly stickers covering clinical treatment, medical education and milestones. Quantitative analysis revealed that the Map was feasible, acceptable, and usable; however, no significant effect on communication, self-efficacy, anxiety, depression or quality of physician-patient interaction was observed. Qualitative analysis identified 6 themes: Primary Use, Challenges, Impact, Limitations, Feasibility, Acceptability and Usability, and Unmet Needs. Conclusion A pathway of care for retinoblastoma, co-designed by researchers, health professionals and patients, was usable, acceptable, and feasible by caregivers of children with retinoblastoma. While significant effects on communication and physician-patient interaction were not observed, 'legacy building' - documentation of the pathway of care by families for later education of their child - emerged as an unanticipated yet important use of the Retinoblastoma Journey Map.

Remote Monitoring of Cardiac Implantable Electronic Devices in Very Elderly Patients: Advantages and Specific Problems.

Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician-patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.

Childbirth as Fault Lines: Justifications in Physician-Patient Interactions About Postnatal Rehabilitation.

Research on justifications has shown their significance in advice-giving, decision-making and children disputes. However, the majority of studies gloss over practical functions of justifications in patient-physician interactions as they are often expected and pursued by patients and in turn, are adopted by physicians to support their stance and authority. This study, through conversation analysis (CA), aims to explore a) what are pragmatic functions of justifications in patient-physician interaction? b) how and when do physicians unfold their justifications for treatment recommendations? c) how do physicians deal with different responses based on their epistemic and deontic domains?. A total of 32 video-recordings between postpartum women and physicians are collected and studied. Four pragmatic functions of justifications drawn upon by physicians are explored: justifications as face-saving, reassurance, risk discussion and clarification-seeking. Despite physicians' attempts to justify their positions as less challenged by patients, this is not the entire picture as they demonstrate their desire to resolve patients' concerns and coordinate their viewpoints to achieve the best practice that facilitates patients' well-being.

Living with axial spondyloarthritis: a cross-sectional survey of patient knowledge and perceptions

Diagnosis and effective treatment of axial spondyloarthritis (AxSpA) are often delayed due to inadequate awareness and poor patient-physician communication. Some AxSpA patients fail to maintain an active lifestyle by exercising regularly, further worsening their disease management. The evolving concept of patient-centred care necessitates better understanding of patient awareness and their needs. We aimed to survey AxSpA patients to reflect on healthcare planning and management perspectives. Our self-administered questionnaire focused on perceptions of AxSpA diagnosis and management, particularly exploring issues of physical activity and active lifestyle. Satisfaction with AxSpA medical care and its accessibility, diagnostic delays, patient-physician communication, and support for disease management were also explored. This offline survey was arranged at the Department of Rheumatology, Immunology, and Internal Medicine of Jagiellonian University Medical College and Krakow University Hospital. We surveyed patients with AxSpA attending outpatient clinics between December 1st, 2023 and April 22nd, 2024. The questionnaire included questions on types of physical activities, barriers to exercising, satisfaction with medical care, patient-physician interactions, diagnostic delays, and use of teleconsultations. A total of 117 patients with AxSpA were enrolled (mean age 41.62 years). The majority (n = 93, 79.5%) were employed. There was a male predominance (69, 59%). The average diagnostic delay was 5.5 years. Notably, 104 (88.9%) responders perceived physical activity as a factor influencing their disease course. However, only 32 (27.35%) managed to exercise regularly (≥ 30 min, 2–3 times a week). The majority (70, 59.83%) were irregularly engaged in some form of physical activity, with 15 (12.8%) not exercising at all, and nearly half (48%) reported at least one barrier to maintaining a physically active lifestyle. Pain (32, 27.35%), fatigue (27, 23.08%), lack of motivation (17, 14.53%), and lack of time (12, 10.26%) were noted as barriers to exercising. The respondents preferred to exercise at home. The survey identified critical areas where patient dissatisfaction or uncertainty were notably prevalent: 38 (32.5%) were uncertain and 35 (30%) were dissatisfied with rehabilitation access. For spa therapy, 63 (53.85%) reported uncertainty and 23 (19.7%) expressed dissatisfaction. Only 48 (41%) were treated by a rehabilitation specialist last year. Only 23% of AxSpA patients took part in teleconsultations last year, and 65% preferred in-person visits. While AxSpA patients recognize the importance of physical activity, significant barriers exist to engaging them regularly in exercising. Addressing these barriers through personalized, motivational, and educational strategies could improve patient outcomes. Improving patient satisfaction with healthcare services, particularly in areas of rehabilitation and physician-patient communication, is crucial for improving the overall care of AxSpA patients.

Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study.

Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician's perspective. A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform's registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions.