Positive Patient Perceptions Research Articles

Door de ogen van de patiënt: tele- en zelfmonitoring voor zwangere vrouwen met een verhoogd risico op hypertensie

Through the patient’s eyes: remote monitoring and patient self-measurement for women at risk of gestational hypertensive disorders Remote monitoring (RM) and patient self-measurement (PSM) are new technologies that enable blood pressure monitoring at home for pregnant women at risk of gestational hypertensive disorders (GHD). As patient satisfaction is increasingly considered as an indicator of the quality of care, this study aimed to compare patients’ perceptions on RM and PSM with those on conventional care for women at risk of GHD. The data collection was part of a multicentric RCT with 2 intervention groups (RM and PSM) and 1 control group. 254 participants completed the survey, determining the patients’ perceptions regarding the care they received at 4 measurement points. Linear probability models were used to assess the impact of RM and PSM on patients’ perceptions. Women at risk of GHD were significantly more likely to be satisfied with the care outcomes, to feel confident about their role as a mother and to be satisfied with their delivery after a follow-up by RM than after a follow-up by conventional care. In addition, they were significantly less likely to be concerned about their general health. The perceptions of women in the PSM group were not significantly better than those of the control group. The positive perceptions of patients regarding RM may be partly explained by the reduction in complications and the role of the study midwife as ‘advanced midwifery practitioner’.

A qualitative exploration of patients' perception regarding the comprehensive dental services availed at a primary health center.

Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients' future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients' perception of comprehensive dental services availed at a Primary Health Center (PHC). This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows. A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement. The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

Team climate and patients’ perception of primary healthcare attributes in Brazil: a cross-sectional study

ABSTRACT Team climate and attributes of primary healthcare (PHC) are key elements for collaborative practice. Few researchers have explored the relationship between team climate and patients’ perceptions of PHC. This study aimed to assess the association between team climate and patients’ perceptions of primary healthcare attributes. A quantitative approach was adopted. In Stage 1, Team climate was assessed using Team Climate Inventory in 118 Family Health Strategy (FHS) teams at a PHC setting. In Stage 2, Patients’ perceptions of PHC attributes were assessed using the Primary Care Assessment Tool (PCATool) in a sample of 844 patients enrolled in teams studied in Stage 1. Cluster analysis was used to identify team climate groups. The analysis used multilevel linear regression models. Patients assigned to teams with the highest team climate scores had the highest PHC attributes scores. Patients who reported affiliation at the team level had the highest PCATool scores overall. They also scored higher on the attributes of comprehensiveness and coordinated care compared to patients with affiliation to the health unit. In conclusion, patients under the care of FHS teams exhibiting a more favorable team climate had more positive patient perceptions of PHC attributes.

A qualitative exploration of patients’ perception regarding the comprehensive dental services availed at a primary health center

Introduction Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients’ future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients’ perception of comprehensive dental services availed at a Primary Health Center (PHC). Methods This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows. Results A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement. Conclusions The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

Patient perception and satisfaction in awake burr hole trepanation under local anesthesia for evacuation of chronic subdural hematoma

Evacuation of chronic subdural hematoma (CSDH) will be one of the most common neurosurgical procedures in the future in the increasingly aging societies. Performing cranial surgery on awake patients may place a psychological burden on them. Aim of this study was to evaluate the psychological distress of patients during awake CSDH relief. Patients with awake evacuation of CSDH via burr hole trepanation were included in our monocentric prospective study. Patient perception and satisfaction were measured using standardized surveys 3–5 days and 6 months after surgery. Among other questionnaires, the Hospital Anxiety and Depression and the Impact of Event Scale, were used to quantify patients' stress. A total of 50 patients (mean age 72.9 years (range 51 – 92)) were included. During surgery, 28 patients reported pain (mean 4.1 (SD 3.3)). Postoperatively, 26 patients experienced pain (mean 2.7 (SD 2.6)). Patients’ satisfaction with intraoperative communication was reported with a mean of 8.3 (SD 2.1). There was a significant negative correlation between intraoperatively perceived pain and satisfaction with intraoperative communication (p = 0.023). Good intraoperative communication during evacuation of CSDH in awake patients is associated with positive patient perception and correlates with pain reduction.

The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients (TROPHIES): Final patient-reported outcomes at 24 months.

To report health-related patient-reported outcomes (PROs) in people with type 2 diabetes (T2D) initiating their first injectable glucose-lowering medication (GLM) with two commonly prescribed glucagon-like peptide-1 receptor agonists (GLP-1RAs) from the prospective, observational TROPHIES study (The Real-World Observational Prospective Study of Health Outcomes with Dulaglutide and Liraglutide in Type 2 Diabetes Patients). TROPHIES was a two-cohort, 24-month study conducted in France, Germany and Italy. Adults with a T2D diagnosis, naïve to injectable treatment for T2D and prescribed dulaglutide or liraglutide as their first injectable GLM, were eligible for inclusion. Study objectives included describing the following PROs associated with the treatment of T2D with GLP-1RAs: health-related quality of life; impact of weight on self-perception; life and work productivity; and patient satisfaction with treatment and injection device. Additional analyses formally compared PRO measures between the treatment cohorts. Overall, improvements from baseline in PRO scores were observed among people who started dulaglutide or liraglutide. A more pronounced trend of improvement was observed in the dulaglutide cohort for changes from baseline in treatment satisfaction and impact of weight on self-perception, supported by statistically significant differences between treatment cohorts in additional comparative analyses at 12, 18 and 24 months. More positive patient perceptions of the injection device were observed with dulaglutide than with liraglutide. Improvements in PROs observed in TROPHIES, which were more evident with dulaglutide than liraglutide, reflect a relevant clinical benefit. From the patients' perspective, satisfaction, and confidence in continuing treatment with GLP-1RAs is likely to contribute to long-term treatment persistence.

Evaluation of Experiences and Attitudes of Patients Towards Patient Portal-Enabled Access to Their Health Information or Medical Records: A Qualitative Grounded Theory Study.

The demand for patient-centred care and patient engagement in their healthcare has driven patient portal introduction. The widespread adoption and use of patient portals, however, has been a rather slow process in the United Kingdom. Hence, a limited number of studies have explored patient perceptions and experiences of general portal use, which forms a foundation for successful implementation of a portal. This study, therefore, focuses on the experiences and attitudes of patients regarding use of patient portals and access to their health information. It further explores various factors perceived by patients that may influence portal use and uptake. The overall findings from this study highlight positive patient perceptions of portal use. Nevertheless, it demonstrates various areas of improvement essential to ensure future success of portal implementation and acceptance.

Understanding a New Age of Physician Ratings via Sentiment Analysis: How are Patients Reviewing Shoulder and Elbow Surgeons Online?

Background Physician review websites have a significant influence on patients with regard to provider selection. The goal of this study was to utilize machine learning to understand what influences patient ratings for shoulder and elbow surgeons online. Methods All reviews and ratings were obtained from Healthgrades.com. The “Valence Aware Dictionary and sEntiment Reasoner” (VADER) software was used to score the ratings on a scale between -1 and +1. Word frequency analysis was also performed to provide context to the words used to describe surgeons; both positive and negative word frequencies were analyzed. A multiple logistic regression identified the odds these words/phrases were associated with a sentiment score >0.50. Both star ratings (out of 5 points) and sentiment scores were collected. Results 493 surgeons (6,381 reviews) were included. There was no difference in ratings based on gender or geography. Age analysis indicated that star ratings and sentiment scores were lower for older providers (p<0.01). “Pain” was the most commonly used phrase in both the best and worst reviewed surgeon reports. When a comment included the phrases “knowledgeable”, “confident”, “listen[s]”, “recommend”, or “comfortable”, surgeons’ online ratings were 1.6x, 2.7x, 3.2x, 2.6x, and 3.8x more likely to be positive (p<0.01). Approximately 1 out of 5 reviews included mention of ancillary characteristics (e.g., “wait”, “front desk”, “office”). Conclusion This unique code allows surgeons to analyze their field, from the individual to health system level, to see how they are being reviewed online. For shoulder and elbow surgeons, this study showed that more positive online reviews were seen for surgeons who are younger, have reduced office wait times, and have overall positive patient perceptions. Pain and pain management were the primary determinants of overall scores. As online ratings can influence a patient’s choice of provider, surgeons should consider implementing these findings to optimize their practice.

A Retrospective Analysis of WhatsApp as a Mode of Teledermatology: A Need of the Present Bringing in a Newer Consultation Mode in Future

Background: Telemedicine is usually considered a provision of health-care services, where distances are a critical factor. WhatsApp is a popular instant messaging app used worldwide, which incorporates encrypted text/voice/video-based communication making it ideal for dermatology consults in the current situation. Objectives: The aim of the study was to do a retrospective analysis of new and follow-up patients seen through teledermatology (TD) using WhatsApp and telemedicine platform as a communication tool during the lockdown due to COVID-19 pandemic. Materials and Methods: Retrospective analysis of new and follow-up patients seen through teledermatology during the lockdown was done. The teleconsultation was provided through WhatsApp and telemedicine platform. Consent was sought, and a detailed history was obtained through messaging and by call. Clinical pictures sent by WhatsApp were analyzed, and a diagnosis was made by correlating the history and image findings. Treatment was individualized for each patient, and a teleprescription was sent as per the guidelines provided by the health-care regulators. Results: This study retrospectively analyzed the usefulness of WhatsApp-based teleconsultations for 60 patients comprising 32 new and 28 follow-up cases during the lockdown. The conditions ranged from various forms of dermatitis, papulosquamous disorders, and autoimmune blistering disorders to cutaneous infections. Conclusion: Diagnosis could be made in all 60 patients. Positive patient perception and prognosis, with decreased financial liabilities were noticed. WhatsApp provides a way to move forward in these uncertain times. Specific guidelines on TD have to be inculcated in routine practice.

Patient’s perceptions of presbycusis and associated tinnitus counselling practices within the KwaZulu-Natal province

BackgroundCounselling manages the psychosocial effects of presbycusis and associated tinnitus, which is best conducted through patient-centred care (PCC). However, there is a paucity of research on implementing PCC within audiology and on patients’ perceptions of counselling practice, making the focus on patient benefit and satisfaction crucial. Furthermore, PCC has been documented to be suitable in addressing the psychosocial effects of hearing loss and associated tinnitus, as it focuses on the adult patient playing an integral part of the management processes, providing improved patient outcomes.ObjectivesThis study aimed to explore patients’ perceptions of presbycusis and associated tinnitus counselling practices by audiologists within KwaZulu-Natal (KZN).MethodQualitative phenomenological semi-structured telephonic interviews were conducted through purposive sampling, consisting of seven patients with presbycusis and associated tinnitus who were recruited from private and public facilities in KZN. Data were analysed through hybrid thematic analysis following Braun and Clark’s steps.ResultsSix categories were identified: perceptions on counselling methods, efficacy and tools, audiological rehabilitative training, multicultural sensitivity, patient satisfaction and recommendations on improving counselling practices as PCC adaptation. Themes were then extracted from these categories. The overall outcome of the study found that patients had positive perceptions of methods and tools, and audiologists were viewed as adequately trained. Furthermore, they were satisfied and benefitted from counselling practices and found clinicians to be culturally sensitive in their practice. However, recommendations were made towards linguistic sensitivity and satisfaction evaluations.ConclusionTherefore, implementing PCC into counselling practice may achieve positive patient perceptions, thus highlighting the need to identify barriers and improve the implementation of PCC into practice, especially in resource-constrained contexts.

Understanding Perceived Barriers to Colposcopy Follow-Up Among Underserved Women at an Urban Teaching Hospital: A Qualitative Study.

Loss to follow-up after abnormal cervical cancer screening disproportionately impacts underserved populations. Our objective was to identify perceived barriers to follow-up after abnormal Pap smear among underserved women. Women with abnormal Pap smear presenting for colposcopy at an urban teaching hospital were asked to participate in qualitative interviews. A topic guide was developed to assess knowledge about cervical cancer screening and perceived barriers to follow-up. A demographic survey was completed and interviews were recorded and transcribed. Responses were coded and placed into a framework: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified. Demographic data were reported descriptively. Of 24 women enrolled, 18 (75%) completed full interviews. Median age was 38 years (range = 21-64). Participants were racially diverse: 10 (56%) Hispanic, 7 (39%) non-Hispanic White, 1 (5.5%) non-Hispanic Black, and 1 (5.5%) Asian, and all had public insurance. Seven (39%) presented for their 1st colposcopy visit and 11 (61%) had previous visits. Seventeen (94%) had a positive human papillomavirus test and 7 (39%) had atypical squamous cells of undetermined significance. The most common themes identified were related to knowledge gaps, including lack of understanding of Pap smears/human papillomavirus and cervical cancer risk factors. Most participants were satisfied with provider communication but dissatisfied with communication with the office, like scheduling appointments. Despite positive patient perception of physician communication, knowledge was most commonly identified as a barrier to colposcopy follow-up. Implementing a web-based intervention addressing knowledge gaps may improve abnormal cervical cancer screening follow-up among this population.

Improvement of Vascular Patient-Centered Quality of Care Across a Healthcare System

The Centers for Medicare and Medicaid Services (CMS) assesses hospitals on their quality of the care. A significant portion of that assessment is attributed to patient experience. Consequently, positive patient perceptions are paramount, driving hospitals and physicians to focus on providing excellent, patient-centered care. Recently, the distribution of a patient-centered supplement to vascular surgery patients at a single hospital demonstrated an increase in patient satisfaction and understanding of their disease process.

Understanding knowledge gaps and perceived barriers to follow up after abnormal Pap smear among low-income women in NYC: a qualitative study

Objectives: Cervical cancer is a preventable disease with disproportionate morbidity and mortality among low-income, minority populations. Non-adherence to follow up and treatment after abnormal cervical cancer screening is a major contributor to these disparities and is an ideal time to intervene. The purpose of this study was to identify knowledge gaps and perceived barriers to follow up after abnormal pap smear among low-income women to inform development of a web-based intervention. Methods: Women with a history of abnormal pap smear were approached at a New York City (NYC) colposcopy clinic serving low-income patients (determined by government subsidized insurance) to participate in structured interviews. A topic guide was developed to assess knowledge about cervical cancer screening, treatment of abnormal pap smears, and perceived barriers surrounding appropriate follow up. Interviews were recorded and transcribed, consisting of an initial demographic survey followed by open-ended and probing questions. Responses were coded by 3 independent investigators and placed into a single framework with 3 overarching categories: intrapersonal, interpersonal, and community barriers. Major themes and subthemes were identified under this framework. After initial independent coding, all discrepancies were discussed, and coders reached perfect agreement. Results: 24 women were enrolled and 15 (62.5%) completed full interviews. The mean age of those who completed interviews was 38.3 years (range: 21-64). Self-identified race was Hispanic (66.7%), White (36.7%), and Black (6.7%), and 46.7% of patients had an annual income of Download : Download high-res image (295KB) Download : Download full-size image Conclusions: Despite positive patient perception of physician communication and education around abnormal pap smears, knowledge was the most common theme identified as a barrier to follow up. Consideration for alternative web-based interventions addressing health literacy and knowledge gaps focused on HPV, cervical cancer risk factors, and treatments may improve follow up among this patient population.

Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My-LIFE European Delphi survey.

BackgroundClinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice.MethodsOverall, 148 healthcare practitioners from five European countries completed a two‐wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of five factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach.ResultsConsensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient's perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR = 18.3, 95% CI 13.4–25.05).ConclusionsThis survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients.SignificanceIn clinical practice, criteria to define the effectiveness of migraine preventive treatment and factors that guide treatment stop or continuation are not clearly defined. In this simulated clinical setting study, a reduction in the use of acute migraine medications was the factor associated with preventive treatment effectiveness definition. This study also revealed that factors strongly associated with the decision of treatment continuation in real life are the acute migraine medications use and a positive patient's perception of treatment effectiveness.

COVID-19 and binge eating: Patient perceptions of eating disorder symptoms, tele-therapy, and treatment implications.

COVID-19 has been shown to detrimentally affect eating disorder symptoms, including increased dietary restriction and increased binge eating. However, research in this area is thus far limited. Additionally, as a result of the pandemic, many eating disorder treatments have converted to tele-health platforms, however, little is known about patient perceptions of this modality. The aim of the present, exploratory study was to qualitatively examine: (1) The impact of COVID-19 on binge eating spectrum disorder symptoms (2) Patient perceptions of tele-therapy, and (3) Ways to address COVID-19 in eating disorder treatment. Data were collected through one-on-one, semi-structured interviews (N = 11), conducted as part of a mid-program assessment for those undergoing individual, outpatient therapy for binge eating spectrum disorders. After thematic analysis, it was identified that patients reported both symptom deterioration and improvement during COVID-19. Factors surrounding social distancing and stay-at-home measures were found to both improve and worsen symptoms for different patients. Further, patients reported positive perceptions of tele-therapy, particularly appreciating the convenience of this modality. Finally, patients provided variable feedback on the incorporation of COVID-related concerns into their eating disorder treatment, with some participants wishing for this inclusion, and others viewing COVID-19 and their eating disorder as separate issues. Findings from the present study preliminarily identify ways in which binge eating spectrum disorder symptoms may have improved due to COVID-19 and indicate positive patient perceptions of tele-therapy. Our results may be used to inform the adaptation of future eating disorder treatment during COVID-19.

Evaluation of a specialty pharmacy health coaching program

Background: Fairview Specialty Pharmacy provides comprehensive therapy management (TM) for patients, yet some patients require additional social, physical, and psychological support that may be unmet by a pharmacist or nurse. To address complex patient needs and remotely improve social determinants of health, a health coach is employed. The projected benefits of a health coaching program for patients include providing holistic support for health and mental well-being, identifying and overcoming barriers to healthy coping, and identifying additional resources for support. Aims: Goals of this study were to determine the impact of a health coach in patients who receive specialty pharmacy services as measured by number of referrals to this program, patient satisfaction and perceived impact on health, and impact on patient depression scores. Methods: Health coaching services were offered to patients during initial TM call or when a trigger was identified, such as emotional distress, new chronic illness diagnosis, life transition, coping issues, stress management, end of life, advanced care planning, or family concerns. Initial outreach health coach call to the patient provided program overview, confirmed interest, determined focus area (emotional/spiritual needs, loss/grief, lifestyle changes, or stress management), encouraged goal setting, and documented baseline depression score using the Patient Health Questionnaire (PHQ-9). Follow-up calls between the patient and health coach were focused on patient goals; referrals to additional services were documented. At the end of the third call, the PHQ-9 was given and a satisfaction survey was mailed to the patient. Program impact was determined based on satisfaction surveys, referrals, and the change in PHQ-9 after the third call. Results: 623 health coaching assessments were completed in 82 patients (April 2016-January 2019). The most common coaching focus (46% of patients) was combined emotional/spiritual and loss/grief. PHQ-9 was assessed in 54 patients at baseline and session 3; improvement occurred in 30 of the 54 patients (56%). In patients with baseline moderate to severe depression, 70% of patients experienced decreased depression. Anonymous patient experience survey (n = 21) revealed that 86% of patients in this program strongly agreed or agreed that their physical health and 95% strongly agreed or agreed that their mental health was positively impacted by working with the health coach. All patients (100%) strongly agreed or agreed that they were satisfied with the Fairview Specialty Pharmacy health coaching program. The health coach referred 37 patients to additional services, including support groups, social workers, case managers, physicians, psychiatrists, and hospice or advance care planning. Conclusions: The specialty pharmacy health coaching program was impactful, as measured by high patient satisfaction, positive patient perception of program impact on physical and mental health, improved patient depression scores, and referrals to other resources.

Usability Evaluation of a Mobile Phone-Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study.

BackgroundAs most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients with cancer, using patient-reported outcomes questionnaires and a clinician alerting system.ObjectiveThis study aims to evaluate the usability of the ASyMS, a mobile phone–based technology, from the perspective of Canadian patients with cancer receiving chemotherapy to identify existing design, functionality, and usability issues and elicit their views, experiences, and satisfaction with the ASyMS.MethodsWe used a mixed-method approach to data collection with user-based testing, a think-aloud technique, semistructured interviews, and short answer questionnaires with a purposive sample of 10 patients with cancer. Participants attended usability testing sessions at the Centre for Global eHealth Innovation, University Health Network, and performed specific tasks on the ASyMS device. The test was videorecorded and each task was timed during the test. After the usability sessions, participants completed a posttest questionnaire and participated in a semistructured qualitative interview. A thematic analysis was used to code and categorize the identified issues into themes that summarized the type and frequency of occurrence.ResultsThe thematic analysis generated 3 overarching themes as follows: ASyMS user-friendliness; usefulness of ASyMS (content quality and richness); and intention to use. Results from the posttest questionnaire indicated that 80% (8/10) of participants had great motivation to use the ASyMS, 70% (7/10) had positive perceptions of the successful use of the ASyMS, and all (10/10, 100%) had a positive attitude toward using the ASyMS in the future. Most identified design and functionality issues were related to the navigation of the ASyMS device and a desire for a more attractive design with advanced functionality and features. The main general design recommendations were as follows: enhance the readability of the screen; implement advance options (eg, search option); and support better navigation.ConclusionsThe ASyMS has shown positive perceptions of patients in usability testing and qualitative interviews. An evaluation of the effects of the ASyMS on symptom outcomes in a clinical trial is needed.

Remote monitoring and “Tele-orthodontics”: Concept, scope and applications

Tele-orthodontics is a broad term that encompasses remote provision of orthodontic care, advice, or treatment via information technology. The Purposes of the article were two-fold: (1) to review the rather new concept, applications and scope of teleorthodontics, and (2) to present preliminary results of a study with and without Dental Monitoring™ (DM) usage on appointment efficiency, patient perspectives and patient demographics. The sample was comprised of 74 consecutively treated Invisalign® patients using DM™ and 85 consecutively completed Invisalign® patients. An online questionnaire was given to the DM™ group to assess the patients’ perspective on the ease of use and benefit to treatment experience using a 5-point Likert scale. Also requested was a list of 5 benefits and problems while using DM™. Independent t-tests were used to determine any inter-group differences in, number of appointments and age; a chi-square test was used for differences between genders. Significance was set at P ≤ 0.05. Mean number of appointments was significantly lower by 1.68 appointments for DM compared to control (P < 0.001). Age averaged 3.2 years younger for the DM group (P < 0.05). More males used DM than the control group (31.6% vs 16.7%, P < 0.05, respectively). The mean Likert scale rating for “ease of use” was 4.31 out of 5.0, while benefit to treatment experience rating was 4.4. The most oft-mentioned perceived benefits were “better communication” (47 times), “increased convenience” (44 times), “reduced number of appointments” (40 times), and “ease of use” (38 times). The most oft-mentioned problems were related to the “difficulty of taking scans” (27 times) and “reduced communication” (12 times). Preliminary study results suggest the number of appointments may be reduced with Dental Monitoring. In addition, there was a positive patient perception on the use of DM.

Factors influencing the adoption of telemedicine for treatment of military veterans with post-traumatic stress disorder

Military veterans returning from a combat zone often face mental health challenges as a result of traumatic experiences. The veteran in the United States has been underdiagnosed and underserved. Since its advancement in the 1990s, telemedicine has become a more prevalent means of delivering services for post-traumatic stress disorder among veterans in the United States, but its adoption is not ubiquitous. To clarify the association of telemedicine and the treatment of veterans with post-traumatic stress disorder through identification of facilitators and barriers to the adoption of the modality. Reviewers analysed articles from CINAHL and PubMed databases, using relative key words, selecting the 28 most germane to the study objective. The most common adoption facilitators were: improving access to rural populations of veterans (22%), effective treatment outcomes (16%), and decreased costs related to care (13%). The most prevalent barriers were: veterans lacking access to necessary modalities (25%), availability of physicians competent in post-traumatic stress disorder treatment (20%), and complications with technology (20%). Five themes surfaced for facilitators: accessibility, effectiveness, cost reduction, positive patient perception, and supportive community; and 5 themes for barriers: access to technology, technical complications, physician availability, negative patient perception, and uninformed patients. This literature review identifies cost and outcomes-effectiveness. The association of telemedicine with the treatment of veterans with post-traumatic stress disorder is feasible, beneficial and effective.

Trending Longitudinal Agreement between Parent and Child Perceptions of Quality of Life for Pediatric Palliative Care Patients.

Pediatric palliative care studies often rely on proxy-reported instead of direct child-reported quality of life metrics. The purpose of this study was to longitudinally evaluate quality of life for pediatric patients receiving palliative care consultations and to compare patient-reported quality of life with parent perception of the child’s quality of life across wellness domains. The 23-item PedsQL™ V4.0 Measurement Model was utilized for ten child and parent dyads at time of initial palliative care consultation, Month 6, and Month 12 to assess for physical, emotional, social, and cognitive dimensions of quality of life as reported independently by the child and by the parent for the child. Findings were analyzed using Bland–Altman plots to compare observed differences to limits of agreement. This study revealed overall consistency between parent- and child-reported quality of life across domains. Physical health was noted to be in closest agreement. At the time of initial palliative care consult, children collectively scored their social quality of life higher than parental perception of the child’s social quality of life; whereas, emotional and cognitive quality of life domains were scored lower by children than by the parental report. At the one year survey time point, the physical, emotional, and social domains trended toward more positive patient perception than proxy perception with congruence between quality of life scores for the cognitive domain. Findings reveal the importance of eliciting a child report in addition to a parent report when measuring and longitudinally trending perceptions on quality of life.