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The Oncologist Jul 2016A medical student reflects on his experience as a patient with leukemia.
A medical student reflects on his experience as a patient with leukemia.
Topics: Humans; Leukemia; Patients; Students, Medical
PubMed: 27286789
DOI: 10.1634/theoncologist.2016-0002 -
Clinical Medicine (London, England) Jan 2022Clinicians are responsible for both commencing and stopping medications. This study evaluates the attitudes of older acute medical inpatients about deprescribing....
Clinicians are responsible for both commencing and stopping medications. This study evaluates the attitudes of older acute medical inpatients about deprescribing. Overall, patients are positive toward stopping medications, want to be involved and do not feel a clinician is giving up on them if a medication is stopped. Patients on fewer medications counterintuitively feel a greater medication burden, are more interested in being involved in decision making and consider deprescribing appropriate to a greater degree than patients who are taking more medications. Conversely, they also reported greater concerns about stopping medications. We discuss these findings in the context of the positive and negative effects of deprescribing, in the context of patient engagement and shared decision making, and how clinicians can work with inpatients to reduce potentially inappropriate medications.
Topics: Aged; Attitude to Health; Deprescriptions; Hospitals; Humans; Inpatients
PubMed: 35078795
DOI: 10.7861/clinmed.2021-0445 -
Annals of Palliative Medicine Jul 2023Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such... (Review)
Review
BACKGROUND AND OBJECTIVE
Geographic cohorting refers to localization of inpatients to designated hospital areas (typically a unit or a set of beds) based on specified criteria. One such criterion that has been commonly discussed and studied since the early days of the hospitalist movement in the US is a patient's assigned clinical care team. Because implementing cohorting of this type requires substantial operational investment, it is important to understand the benefits and the tradeoffs associated with bringing patients into closer spatial proximity with their full team of providers and allowing clinicians to work within a defined clinical space.
METHODS
We conducted a narrative review of the evidence around geographic cohorting of patients by clinical care team. We performed a comprehensive search of the PubMed, Embase, Cinahl and Scopus databases, identifying relevant English language articles. We used an inductive approach to developing thematic domains for categorization of article content.
KEY CONTENT AND FINDINGS
We reviewed eighteen articles published between 2008 and 2022, and identified four thematic outcomes domains: patient-centered outcomes, communication, efficiency, and satisfaction. The existing literature demonstrates associations with improved communication and staff satisfaction. The data regarding patient outcomes and overall work efficiency, on the other hand, are equivocal and, in general, limited by study methodology.
CONCLUSIONS
Geographic cohorting of inpatients according to clinical care team offers some promise for improved workplace culture. More rigorously designed studies are needed, however, to understand its impact on patient outcomes, and there should be added attention paid to throughput metrics and tradeoffs that often limit its implementation.
Topics: Humans; Inpatients; Communication; Databases, Factual; Hospitals; Patient Care Team
PubMed: 37081705
DOI: 10.21037/apm-22-1400 -
Medical Care Oct 2021Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse...
BACKGROUND
Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood.
OBJECTIVE
We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population.
RESEARCH DESIGN
This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital.
SUBJECTS
We include Veterans undergoing elective inpatient general, vascular, or thoracic surgery (August 1, 2015-June 30, 2017).
MEASURES
We assessed unplanned readmission to any medical facility within 30 days of hospital discharge.
RESULTS
A total of 736 patients completed the 30-day postoperative follow-up, and 16.3% experienced readmission. Lower patient-reported physical and mental health, inadequate health literacy, and discharge home with help after surgery or to a skilled nursing or rehabilitation facility were associated with an increased incidence of readmission. Classification regression identified the patient-reported Veterans Short Form 12 (SF12) Mental Component Score <31 as the most important psychosocial determinant of readmission after surgery.
CONCLUSIONS
Mental health concerns, inadequate health literacy, and lower social support after hospital discharge are significant predictors of increased unplanned readmissions after major general, vascular, or thoracic surgery. These elements should be incorporated into routinely collected electronic health record data. Also, discharge plans should accommodate varying levels of health literacy and consider how the patient's mental health and social support needs will affect recovery.
Topics: Aged; Female; General Surgery; Hospitals, Veterans; Humans; Interviews as Topic; Male; Middle Aged; Patient Readmission; Patients; Postoperative Period; Prospective Studies; Qualitative Research
PubMed: 34149017
DOI: 10.1097/MLR.0000000000001600 -
The Journal of Medical Humanities Mar 2015Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and...
Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank's proposal, noting why thinking about medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an 'ideal of wonder' noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder's gaze.
Topics: Humanities; Humans; Imagination; Patients; Personal Satisfaction
PubMed: 25483615
DOI: 10.1007/s10912-014-9320-6 -
Neurosurgical Review Feb 2022Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of...
Outpatient neurosurgery is rising popularity leading to patients' satisfaction and cost-savings. Although several North-American teams have shown the safety of outpatient stereotactic brain biopsies, few data from other countries with different health care systems are available. We therefore conducted a feasibility and safety study on the outpatient stereotactic brain biopsies. We prospectively examined all the consecutive stereotactic brain biopsies performed in an outpatient setting at our tertiary medical center, between June 2018 and September 2020. Among the 437 patients who underwent stereotactic brain biopsy during the study period, 40 (9.2%) patients were enrolled for an outpatient management. The sex ratio was 1 and the median age on biopsy day was 55 [41-66] years. The median distance from patients' home to hospital was 17 km [3-47]. 95% of patients had pre-biopsy ASA score of 1 or 2 and mRs equal to 2 or less. The rate of same-day discharge was 100%. No patient experienced post-biopsy symptomatic complication necessitating readmission within the month following the biopsy. One patient (2.5%) resorted to an unplanned consultation. Histological findings obtained from brain biopsy led to a diagnosis in all patients; the most frequently found were neoplastic lesions (77.5%). Stereotactic brain biopsies can therefore be safely achieved on an outpatient setting in carefully selected patients. This process could be more widely adopted in other neurosurgical centers, without affecting the quality of patient's health care and safety. In this article, we propose management guidelines and pre-biopsy checklist for performing ambulatory stereotactic brain biopsies.
Topics: Biopsy; Brain; Humans; Neurosurgical Procedures; Outpatients; Patient Discharge
PubMed: 34164746
DOI: 10.1007/s10143-021-01593-3 -
BMC Psychiatry Jun 2020Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.
METHOD
PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.
RESULTS
Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.
CONCLUSIONS
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
Topics: Depression; Humans; Patients; Psychotherapy, Psychodynamic; Qualitative Research
PubMed: 32552748
DOI: 10.1186/s12888-020-02682-1 -
Frontiers in Public Health 2022Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for...
BACKGROUND
Long waiting time for treatment in the outpatient department has long been a complaint and has influenced patient's experience. It is critical to schedule patients for doctors to reduce patient's waiting time. Nowadays, multi-channel appointment has been provided for patients to get medical services, especially for those with severe illnesses and remote distance. This study aims to explore the factors that influence patient appointment channel choice in the context of multi-channel appointments, and how channel choice affects the waiting time for offline visiting.
METHODS
We collected outpatient appointment records from both online and offline appointment channels to conduct our empirical research. The empirical analysis is conducted in two steps. We first analyze the relationship between appointment channel choice and patient's waiting time and then the relationships between three determinants and appointment channel choice. The ordinary least squares and the logistic regression model are used to obtain the empirical results.
RESULTS
Our results show that a patient with an online appointment decision has a shorter consultation waiting time compared with a patient with on-site appointment (β = -0.320, < 0.001). High-quality resource demand (β = 0.349, < 0.001), high-severity disease (β = 0.011, < 0.001), and high non-disease costs (β = 0.039, < 0.001) create an obvious incentive for patients to make appointments the Internet. Further, only the effect of non-disease cost on channel choice is lower for patients with multiple visit histories (β = -0.021, < 0.001).
CONCLUSIONS
Our study confirms the effect of Internet use on reducing patient's waiting time. Patients consider both health-related risk factors and cost-related risk factors to make decisions on appointment channels. Our study produces several insights, which have implications for channel choice and patient's behavior literature. More importantly, these insights contribute to the design of appointment systems in hospitals.
Topics: Appointments and Schedules; Empirical Research; Humans; Outpatients; Physicians; Referral and Consultation
PubMed: 35979451
DOI: 10.3389/fpubh.2022.923661 -
Best Practice & Research. Clinical... Dec 2021Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in... (Review)
Review
Patient-reported outcomes (PROs) have been increasingly recognized as valuable information for delivery of optimal perioperative care to high-risk surgical patients in recent years. However, progress from clinical research on PROs has not been widely adopted in routine patient care. This review discusses the current concepts and practice status regarding PROs and addresses the missing links from research to practice adoption to further improve patient's experiences and clinical outcomes in perioperative care. Insufficient empirical research on appropriate PROs and its methodologies, insufficient implementation research to solve the practical issues, and insufficient data collection methods and experiences on ePROs are also discussed. Future research agenda should focus on evidence-supported, PRO-based symptom monitoring systems for early diagnosis and management of impending compromised clinical outcomes.
Topics: Humans; Patient Reported Outcome Measures; Patient-Centered Care; Patients; Perioperative Care
PubMed: 34801218
DOI: 10.1016/j.bpa.2020.10.006 -
Journal of the American Board of Family... 2020In this narrative account, the author, a medical student, describes his encounters with several inpatients at a community hospital. He becomes acquainted with a...
In this narrative account, the author, a medical student, describes his encounters with several inpatients at a community hospital. He becomes acquainted with a patient's son, who, initially withdrawn, over the course of his mother's hospitalizations transforms into a compassionate volunteer. This change is made especially evident when the author meets another patient who recognizes the volunteer and reveals his very different past.
Topics: Empathy; Humans; Inpatients; Male; Students, Medical; Volunteers
PubMed: 32430384
DOI: 10.3122/jabfm.2020.03.190291