Personalized Versus Generic Patient Handouts: Tools to Improve Patient Knowledge on Treatment Options and Perioperative Care

Vaccine-induced immune thrombotic thrombocytopenia (VITT) has already been described after vaccination with ChAdOx2 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson & Johnson/Janssen). However, less knowledge so far has been gained about optimal therapeutic regimens in VITT-suspected patients. Here, we report the case of a 26-year-old female patient, who developed bilateral deep vein thrombosis in the lower legs and severe thrombocytopenia after ChAdOx2 nCov-19 vaccination. After initial anticoagulation therapy regimens including fondaparinux, apixaban, and danaparoid failed, the patient was successfully treated with high-dose intravenous immunoglobulins in combination with parental anticoagulation therapy with argatroban. As vaccination against severe acute respiratory syndrome coronavirus 2 affects billions of people worldwide, medical facilities and hospitals have to be prepared and provide effective treatment options in VITT-suspected patients, including rapid application of high-dose intravenous immunoglobulins, to improve patient outcomes.

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PP20 UK Ambulance Service resuscitation management of pulseless electrical activity: a systematic review of text and opinion

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.20 ◽

2021 ◽

Vol 38 (9) ◽

pp. A9.2-A9

Author(s):

Ali Coppola ◽

Michael A Smyth ◽

Sasha Johnston ◽

Sarah Black ◽

Ruth Endacott

Keyword(s):

Electrical Activity ◽

Early Identification ◽

Discharge Rate ◽

Treatment Options ◽

Pulseless Electrical Activity ◽

Ambulance Service ◽

National Guidelines ◽

Improve Patient Survival ◽

The United Kingdom ◽

Improve Patient

BackgroundIn the United Kingdom, out of hospital cardiac arrest patients with pulseless electrical activity (PEA) have a poor survival to discharge rate of 5.3%.1 PEA is managed according to national guidelines.2 These guidelines are imperfect due to limited research resulting in ambulance services locally amending guidelines to support resuscitation decisions.3 This review aimed to examine the local guidelines of UK ambulance services for the management of PEA.MethodsA three-step search strategy was applied from August 2020 to October 2020. 1) A search of UK ambulance service websites was conducted to identify published local guidelines. Where guidelines were not available a written request was made for the guideline, associated guideline or a narrative summary in the absence of a guideline. 2) Documents referenced within the local guidelines specific to pulseless electrical activity were identified and extracted as supporting literature. 3) Documents referenced in the supporting literature identified as having pulseless electrical activity in the title were extracted.ResultsTwenty-two documents of textual data met the inclusion criteria. Twenty-nine conclusions were extracted and analysed to generate ten categories, forming three synthesised themes relating to the variability in the clinical management of PEA between UK ambulance services, the early identification of reversible causes and appropriate treatment options to increase survivability and the consensus for further research.ConclusionComprehensive national guidelines are lacking due to limited research. The local clinical guidelines and practices of UK ambulance services which aim to address the gaps in research, introduce variability in the management of pulseless electrical activity. Early identification and treatment to reverse the cause of pulseless electrical activity was highlighted to improve patient survival, however, this was complex and challenging to achieve during pre-hospital resuscitation. There was a consensus in the paucity of evidence and the potential for future prognostic research to improve patient outcomes.

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Embedding neuroscience in psychiatry training

BJPsych Advances ◽

10.1192/bja.2020.27 ◽

2020 ◽

Vol 26 (6) ◽

pp. 379-380

Author(s):

Christopher O'Loughlin

Keyword(s):

Patient Care ◽

Royal College ◽

Treatment Options ◽

Improve Patient Care ◽

Medical Specialty ◽

Psychiatry Training ◽

Clinical Assessments ◽

The Uk ◽

Improve Patient ◽

Scientific Fields

SUMMARYTraining in neuroscience is vital to the future of psychiatry as a medical specialty. Trainees and trainers alike demonstrate a desire to keep up to date with developments in the associated scientific fields. Neuroscience increasingly underpins clinical assessments, treatment options and patients’ expectations. Psychiatry training in the UK can embrace neuroscience at many levels, from discussing patient presentations with supervisors, to teaching programmes supported by the Royal College of Psychiatrists’ activities. Although challenges remain, neuroscience literacy enhances the specialty and will improve patient care.

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Immunotherapy in gastroesophageal cancers: Current state and future directions

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220963538 ◽

2020 ◽

pp. 107815522096353

Author(s):

Hira Shaikh ◽

Amir Kamran ◽

Dulabh K Monga

Keyword(s):

Patient Outcomes ◽

Molecular Targeted Therapy ◽

Treatment Options ◽

Cell Cycle Checkpoints ◽

Future Directions ◽

Alternative Strategies ◽

Current State ◽

Dismal Prognosis ◽

The World ◽

Improve Patient

While gastroesophageal (GE) cancers are one of the most common cancers worldwide, unfortunately, the mortality remains high. Commonly used treatment options include surgical resection, chemotherapy, radiotherapy, and molecular targeted therapy, which improve survival only minimally; thus, affirming the dire need for exploring alternative strategies to improve patient outcomes. Immunotherapy, which has revolutionized the world of oncology, has somewhat lagged behind in GE malignancies. Tumor-associated microenvironment and regulatory T cells, alongside cell cycle checkpoints, have been proposed by various studies as the mediators of carcinogenesis in GE cancers. Thus, inhibition of each of these could serve as a possible target of treatment. While the approval of pembrolizumab has provided some hope, it is not enough to override the dismal prognosis that this disease confers. Herein, we discuss the prospects of immunotherapy in this variety of cancer.

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Vascular access cannulation and haemostasis: a national observational study of French practices

Clinical Kidney Journal ◽

10.1093/ckj/sfaa098 ◽

2020 ◽

Author(s):

Marion Sallée ◽

Lucile Mercadal ◽

Guillaume Jean ◽

Bruno Guery ◽

Didier Borniche ◽

...

Keyword(s):

Observational Study ◽

Arteriovenous Fistula ◽

Skin Reaction ◽

Local Anaesthetic ◽

Calcium Alginate ◽

Patient Knowledge ◽

Know How ◽

Allergic Skin ◽

Improve Patient ◽

Allergic Skin Reaction

Abstract Background We report the results of an observational study of arteriovenous fistula (AVF) cannulation and haemostasis practices in France. Methods The study (sponsored by Brothier Pharmaceutical Inc.) was conducted in 150 dialysis units. Data obtained from 150 supervisory nurses, 1538 nurses and 3588 patients with an AVF were analysed. Results The nurses reported using rope-ladder, area or buttonhole cannulation techniques in 68, 26 and 6% of cases, respectively. Metal needles were used most frequently (64%), with mainly a diameter of 15 G or 16 G. The needle was introduced with the bevel up in 56% of cases. Compression applied using dressings (in particular, pure calcium alginate dressings) was the method of choice for haemostasis of the puncture sites and was assessed as being strong by most of the nurses and very strong in cases of prolonged bleeding. Most (82%) of the patients reported the use of local anaesthetic before cannulation and 23% reported an allergic skin reaction to the anaesthetic. Bleeding of the puncture sites lasted for >10 min for 48% of the patients and it reappeared between two sessions for 29% of the patients. Whereas the nurses appeared to have a good understanding of AVF, more than half of the patients did not know how to care for it, with 55% requiring more information. Conclusions This study underlines the lack of national consensus concerning AVF cannulation practices. It suggests that haemostasis methods of the puncture sites can be improved and it highlights the need to improve patient knowledge.

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Improving patient safety in perioperative care for major surgeries

Orvosi Hetilap ◽

10.1556/oh.2012.29446 ◽

2012 ◽

Vol 153 (37) ◽

pp. 1447-1455 ◽

Cited By ~ 1

Author(s):

Alexandra Horváth ◽

Géza Reusz ◽

János Gál ◽

Ákos Csomós

Keyword(s):

Patient Safety ◽

Perioperative Care ◽

Improve Patient Safety ◽

Medical Practices ◽

European Consensus ◽

Perioperative Nutrition ◽

Goal Directed Fluid Therapy ◽

Helsinki Declaration ◽

Improve Patient ◽

European Board

The Helsinki Declaration was created and signed by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was initiated in June 2010, and it implies a European consensus on those medical practices which improve patient safety and provide higher quality perioperative care. Authors focus on four elements of this initiative, which can be easily implemented, and provide almost instant benefit: use of preoperative checklist, prevention of perioperative infections, goal-directed fluid therapy and perioperative nutrition. The literature review emphasizes that well organized perioperative care plays the most important role in improving patient safety. Orv. Hetil., 2012, 153, 1447–1455.

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Expectations for Tinnitus Treatment and Outcomes: A Survey Study of Audiologists and Patients

Journal of the American Academy of Audiology ◽

10.3766/jaaa.16154 ◽

2018 ◽

Vol 29 (04) ◽

pp. 313-336 ◽

Cited By ~ 3

Author(s):

Fatima T. Husain ◽

Phillip E. Gander ◽

Jaclyn N. Jansen ◽

Sa Shen

Keyword(s):

Patient Satisfaction ◽

Treatment Options ◽

Treatment Success ◽

Survey Study ◽

Hierarchical Regression ◽

Current State ◽

Tinnitus Treatment ◽

Definition Of ◽

Improve Patient ◽

Scale Format

AbstractRoughly 10–15% of the general population is affected by tinnitus and this percentage is estimated to rise in future. Because there is currently no cure for tinnitus, treatment is limited and is primarily achieved through management of symptoms and counseling.This study compared audiologists’ and patients’ responses to related survey questions about their expectations regarding tinnitus treatment. Two separate surveys were created, one for patients with tinnitus, and one for practicing audiologists who may treat such patients. The surveys included several related questions, such that comparison of the two could reveal where patients’ and audiologists’ expectations for tinnitus care were in agreement and areas in which they differed.The surveys for audiologists and adults with tinnitus were 31- and 38-item questionnaires, respectively. Both surveys comprised demographic questions followed by several tinnitus-related questions in either multiple-choice or Likert-scale format.We received 230 completed Patient Surveys and 68 completed Audiologist Surveys.All survey recruitment was completed online. Responses were collected via the Survey Monkey web tool (http://www.surveymonkey.com/). Responses were analyzed within and between surveys and grouped into topical categories (assessment, counseling, current available tinnitus information, satisfaction and expectations, improving tinnitus management). For data within each survey, descriptive statistics and correlation analyses were used. For selected comparisons between surveys, cross-tabulations were used. Hierarchical regression modeling was conducted to further explore (1) the perceived effectiveness of treatment received, and (2) how each group defined treatment success.Differences were noted between the two groups’ responses to the question on the definition of treatment success; audiologists reported decreased awareness (77%), stress/anxiety relief (63%), and increased knowledge of tinnitus (63%) most commonly, whereas patients reported reduction of tinnitus loudness (63%) and complete elimination of tinnitus (57%) most often. The topic of greatest agreement was the desire for more information on tinnitus; 62% of patients felt more information from their healthcare provider would be the most important factor for improved tinnitus management, and 67% of audiologists reported currently having “some access” or less to appropriate resources for tinnitus treatment. Modeling results for effective tinnitus management and definitions of treatment success highlighted the importance of resource access and information sharing for both audiologists and patients.Patients and audiologists differed in terms of their expectations for successful treatment, with the patients focusing on perceptual factors and the audiologists on the reaction to the sound. Patient satisfaction with tinnitus treatment may be improved through access to more information, specifically, more information about current tinnitus treatment options and how these focus on the patient’s reaction to the tinnitus rather than the percept itself. Providing credible tinnitus information resources to audiologists, and focusing resources on training a small number of tinnitus specialist audiologists could greatly improve patient satisfaction with the current state of tinnitus palliative care.

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Impact of Pharmacist Counselling on Clozapine Knowledge

Schizophrenia Research and Treatment ◽

10.1155/2017/6120970 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Ciara Ní Dhubhlaing ◽

Ailish Young ◽

Laura J. Sahm

Keyword(s):

Side Effects ◽

Patient Information ◽

Side Effect ◽

Information Sources ◽

Knowledge Score ◽

University Hospital ◽

Patient Knowledge ◽

Specific Knowledge ◽

The Impact ◽

Improve Patient

Clozapine is the only antipsychotic with evidence for efficacy in treatment of resistant schizophrenia but it carries a high side effect burden. Patient information is provided but may be poorly retained. This study aims to examine the impact of pharmacist counselling upon patient knowledge of clozapine. Outpatients, aged 18 years and over, attending St. Patrick’s University Hospital, Dublin, participated in this study between June and August 2015. The intervention consisted of pharmacist counselling on two occasions one month apart. Knowledge was assessed using a 28-point checklist devised from the currently available clozapine patient information sources, at baseline and after each counselling session. Ethics approval was obtained. Twenty-five participants (40% female; mean age 45.1 years, SD 9.82; 64% unemployed, 28% smokers) showed an improvement in knowledge scores of clozapine from baseline to postcounselling on each occasion with an overall improvement in knowledge score, from baseline to postcounselling at one month, of 39.43%; p<0.001. This study adds to the evidence that interventions involving pharmacist counselling can improve patient knowledge, whilst the specific knowledge gained relating to recognition of side effects may help patients towards more empowerment regarding their treatment.

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