Abstract
Introduction
To reduce inappropriate polypharmacy, deprescribing should be part of patients’ regular care. Yet deprescribing is difficult to implement, as shown in several studies. ...Understanding patients’ attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults’ perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients’ willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions.
Methods and analysis
This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (
n
= 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients’ medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements.
Discussion
The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients’ preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs’ and patients’ views and preferences on stopping or reducing specific medications. Our findings will help to understand patients’ attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients’ preferences.
Who's behind an HCAHPS score? Wild, Dorothea M G; Kwon, Nancy; Dutta, Suparna ...
Joint Commission journal on quality and patient safety,
10/2011, Letnik:
37, Številka:
10
Journal Article
Recenzirano
The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey asks patients how frequently their physicians treated them with courtesy and respect, listened carefully, and ...explained things in a way they could understand. Such summary reports may obscure differences among the types of physicians involved. A study was conducted to examine the association between ratings for different physician types and the overall HCAHPS rating of physicians.
A mixed-methods study included closed-ended surveys and in-depth interviews of patients on a hospitalist teaching service. The three HCAHPS physician communication items were used to interview patients about their communication experiences with emergency medicine (EM) physicians, hospitalists, and specialists. The association between the overall score and the scores of each physician type was examined using Spearman correlation coefficients and linear regression. Qualitative data from additional in-depth interviews were analyzed using the constant comparative method to identify recurrent themes.
Ninety-six patients were recruited for the survey, and additional in-depth interviews were conducted with the first 30 patients. Hospitalist and specialist scores were significantly associated (p values < .05) with overall scores. Recurrent themes regarding determinants of patients' ratings were categorized in three broad domains: individual physician behavior, team communication, and system issues. The influence of each domain differed across physician types.
Physician communication scores may be most strongly influenced by patient experiences with hospitalists and specialists rather than with EM physicians. Several team communication and system issues represent opportunities for improving physician communication.
Humoral hypercalcemia of malignancy is frequently observed in patients with solid tumors. However, few instances have been described involving patients with gynecological malignancies. We report a ...case of endometrioid carcinoma of the uterine corpus in a patient who initially presented with hypercalcemia. The elevated calcium levels were found to be the result of an increased serum concentration of parathyroid hormone-related peptide (PTHrP). PTHrP is commonly secreted by malignant cells and suppresses PTH. This case demonstrates that endometrial cancer should be considered in the differential diagnosis of patients presenting with symptomatic or asymptomatic hypercalcemia.
Background The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin Hospital ...in Derby CT has offered a 4-year integrated internal medicine and preventive medicine residency program since 1997. This article reports the outcomes of that program. Methods Data were collected from surveys of program graduates and the American Boards of Internal and Preventive Medicine in 2005–2007, and analyzed in 2007–2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, and the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. Results Since 1997, the program has enrolled 22 residents. Residents and graduates contribute significantly toward quality of care at the hospital. Graduates take and pass at high rates the boards for both for internal and preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine and public health (28%). Conclusions Integrating preventive medicine training into clinical residency programs may be an efficient, viable, and cost-effective way of creating more medical specialists with population-medicine skills.
End-of-life decisions are frequently necessary in intensive care units. These decisions are made more difficult through rapidly changing disease dynamics, lack of continuity of care, differing ...expectations, as well as a lack of support. In these situations, structured communication concepts can help families and staff, e. g. through structured family conferences, the concept of family as the expert for the patient's preferences, and empathetic reactions to emotions. The article discusses concrete strategies how to communicate about end-of-life care.
Background: The importance of integrating preventive medicine training into other residency programs was reinforced recently by the residency review committee for preventive medicine. Griffin ...Hospital in Derby CT has offered a 4-year integrated internal medicine & preventive medicine residency program since 1997. This article reports the outcomes of that program. Methods: Data were collected from surveys of program graduates & the American Boards of Internal & Preventive Medicine in 2005-2007, & analyzed in 2007-2008. Graduates rated the program in regard to job preparation, the ease of transition to employment, the value of skills learned, the perceived quality of board preparation, & the quality of the program overall. Graduates rated themselves on core competencies set by the Accreditation Committee for Graduate Medical Education. Results: Since 1997, the program has enrolled 22 residents. Residents & graduates contribute significantly toward quality of care at the hospital. Graduates take & pass at high rates the boards for both for internal & preventive medicine: 100% took internal medicine boards, 90% of them passed; 63% took preventive medicine boards, 100% of them passed). The program has recruited residents mainly through the match. Graduates rated most elements of the program highly. They felt well-prepared for their postgraduation jobs; most respondents reported routinely using preventive medicine skills learned during residency. Graduates either have gone into academic medicine (31%); public health (14%); clinical fellowships (18%); or primary care (9%); or they combine elements of clinical medicine & public health (28%). Conclusions: Integrating preventive medicine training into clinical residency programs may be an efficient, viable, & cost-effective way of creating more medical specialists with population-medicine skills. Copyright 2008 American Journal of Preventive Medicine; published by Elsevier Inc.
The antineoplastic compound paclitaxel (Taxol) causes an increased assembly of extraordinarily stable microtubules. The present study was designed to characterize the effects of paclitaxel on ...proliferation and migration of human arterial smooth muscle cells (haSMCs) in vitro and on neointima formation in an in vivo experimental rabbit model.
Both monocultures of haSMCs and cocultures with human arterial endothelial cells (haECs) were used. Cell growth after 4, 8, and 14 days was determined in the absence or presence of platelet-derived growth factor-AB (PDGF-AB), basic fibroblast growth factor (bFGF), or thrombin. Nonstop paclitaxel exposure, as well as single-dose applications of paclitaxel for 24 hours or even 20 minutes (0.1 to 10.0 micromol/L), caused a complete and prolonged inhibition of haSMC growth up to day 14, with an IC50 of 2.0 nmol/L. Mitogens or cocultures with stimulating haECs did not significantly attenuate paclitaxel-induced effects. Immunohistochemistry showed characteristic cytoskeletal changes predominantly in the microtubule network. Additionally, in 20 male New Zealand White rabbits, intimal plaques were produced by electrical stimulation. In 10 animals, paclitaxel was locally applied by use of microporous balloons. Histologically, the intima wall area, wall thickness, and degree of stenosis were reduced significantly in paclitaxel-treated animals compared with controls.
Our data show that paclitaxel inhibits haSMC proliferation and migration in a dose-dependent manner in monocultures and cocultures even in the presence of mitogens. Furthermore, paclitaxel prevents neointima formation in rabbits after balloon angioplasty. The long-lasting effect after just several minutes' exposure time makes this lipophilic substance a promising candidate for local antiproliferative therapy of restenosis.
We describe a novel type of human thrombocytopenia characterized by the appearance of giant platelets and variable neutropenia. Searching for the molecular defect, we found that neutrophils had ...strongly reduced sialyl-Lewis X and increased Lewis X surface expression, pointing to a deficiency in sialylation. We show that the glycosylation defect is restricted to α2,3-sialylation and can be detected in platelets, neutrophils, and monocytes. Platelets exhibited a distorted structure of the open canalicular system, indicating defective platelet generation. Importantly, patient platelets, but not normal platelets, bound to the asialoglycoprotein receptor (ASGP-R), a liver cell-surface protein that removes desialylated thrombocytes from the circulation in mice. Taken together, this is the first type of human thrombocytopenia in which a specific defect of α2,3-sialylation and an induction of platelet binding to the liver ASGP-R could be detected.
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