Racial Disparities in Patient Activation: The Role of Economic Diversity

The Patient Activation Measure (PAM) assesses a person’s level of knowledge, skills, and confidence to self-manage their day-to-day health. We conducted a mediation analysis to examine potential direct effects of race on significantly lower baseline PAM scores in Black than in White participants (p<0.001) who were a subset of 184 adults who participated in a randomized controlled trial. In the mediation analysis, using natural indirect effects, the continuous outcome was the PAM score. The mediators were income, education, ability to pay bills, and health literacy; race (Black or White) was the “exposure.” The results indicate that income (p=0.025) and difficulty paying monthly bills (p=0.04) mediated the relationship between race and baseline PAM score, whereas health literacy (p=0.301) and education (p=0.436) did not. Researchers must further investigate the role of economic diversity as an underlying mechanism of patient activation and differences in outcomes. Clinical Trial Registration: Avoiding Health Disparities When Collecting Patient Contextual Data for Clinical Care and Pragmatic Research: NCT03766841 https://clinicaltrials.gov/ct2/show/NCT03766841?term=crotty&draw=2&rank=1

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The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care

Journal of Affective Disorders ◽

10.1016/j.jad.2021.05.084 ◽

2021 ◽

Author(s):

Arela Agako ◽

Eleanor Donegan ◽

Randi E. McCabe ◽

Benicio N. Frey ◽

David Streiner ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Group Therapy ◽

Emotion Dysregulation ◽

Controlled Trial ◽

Clinical Care ◽

Routine Clinical Care ◽

Randomized Controlled ◽

Perinatal Anxiety ◽

Cognitive Behavioural

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The Treatment of Brain AVMs Study (TOBAS): an all-inclusive framework to integrate clinical care and research

Journal of Neurosurgery ◽

10.3171/2017.2.jns162751 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1823-1829 ◽

Cited By ~ 13

Author(s):

Elsa Magro ◽

Jean-Christophe Gentric ◽

André Lima Batista ◽

Marc Kotowski ◽

Chiraz Chaalala ◽

...

Keyword(s):

Clinical Research ◽

Clinical Judgment ◽

Clinical Care ◽

Clinical Trial Registration ◽

Treatment Allocation ◽

Patient Allocation ◽

Test Study ◽

Brain Avms ◽

Management Groups

OBJECTIVEThe management of brain arteriovenous malformations (bAVMs) remains controversial. The Treatment of Brain AVMs Study (TOBAS) was designed to manage patients with bAVMs within a clinical research framework. The objective of this study was to study trial feasibility, recruitment rates, patient allocation to the various management groups, and compliance with treatment allocation.METHODSTOBAS combines two randomized care trials (RCTs) and a registry. Designed to be all-inclusive, the study offers randomized allocation of interventional versus conservative management to patients eligible for both options (first RCT), a second RCT testing the role of preembolization as an adjunct to surgery or radiotherapy, and a registry of patients managed using clinical judgment alone. The primary outcome of the first RCT is death from any cause or disabling stroke (modified Rankin Scale score > 2) at 10 years. A pilot phase was initiated at one center to test study feasibility, record the number and characteristics of patients enrolled in the RCTs, and estimate the frequency of crossovers.RESULTSAll patients discussed at the multidisciplinary bAVM committee between June 2014 and June 2016 (n = 107) were recruited into the study; 46 in the randomized trials (23 in the first RCT with 21 unruptured bAVMs, 40 in the second RCT with 17 unruptured bAVMs, and 17 in both RCTs), and 61 patients in the registry. Three patients crossed over from surgery to observation (first RCT).CONCLUSIONSClinical research was successfully integrated with normal practice using TOBAS. Recruitment rates in a single center are encouraging. Whether the trial will provide meaningful results depends on the recruitment of a sufficient number of participating centers.Clinical trial registration no.: NCT02098252 (clinicaltrials.gov)

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Self-esteem, job insecurity and psychological distress among Chinese nurses

10.21203/rs.3.rs-221598/v1 ◽

2021 ◽

Author(s):

yun liu ◽

chunyan yang ◽

guiyuan zou

Keyword(s):

Regression Analysis ◽

Psychological Distress ◽

Mediation Analysis ◽

Job Insecurity ◽

Underlying Mechanism ◽

Self Esteem ◽

Cooperative Work ◽

Two Dimensions ◽

Class A

Abstract Background Many studies have investigated the related variables of nurses’ psychological distress, but little is known about the underlying mechanism between job insecurity, self-esteem and psychological distress. Aims The purpose of this study examined the role of self-esteem as a mediator between job insecurity and psychological distress among Chinese nurses. Methods Questionnaires, assessing job insecurity, self-esteem and psychological distress, were collected from 462 nurses at a third-grade class-A hospital in Shandong Province, China. Results Results showed that the prevalence of psychological distress among nurses was 83.8%. Regression analysis showed that job insecurity was positively associated with psychological distress, explaining 17.5% of variance in psychological distress. Mediation analysis showed that self-esteem partially mediated the effect of the two dimensions of job insecurity on psychological distress. Conclusions Nurses with low self-esteem and high job insecurity deserved attention. Programs that reduce uncertainty and increase predictability and cultivate a supportive, cooperative work climate may promote nurse overall health and foster self-esteem.

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Demystifying the Benefits and Harms of Anticoagulation for Atrial Fibrillation in Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06430518 ◽

2018 ◽

Vol 14 (1) ◽

pp. 125-136 ◽

Cited By ~ 5

Author(s):

Katherine G. Garlo ◽

David J.R. Steele ◽

Sagar U. Nigwekar ◽

Kevin E. Chan

Keyword(s):

Atrial Fibrillation ◽

Controlled Trial ◽

Clinical Care ◽

Oral Anticoagulants ◽

Contemporary Literature ◽

Clinical Equipoise ◽

Pharmacokinetic Studies ◽

Randomized Controlled ◽

Direct Acting

Patients with CKD represent a vulnerable population where the risks of atrial fibrillation, ischemic stroke, and bleeding are all heightened. Although large randomized, controlled trials in the general population clearly demonstrate that the benefits of warfarin and direct-acting oral anticoagulants outweigh the risks of bleeding, no such studies have been conducted in patients when their creatinine clearance falls below 25–30 ml/min. Without randomized, controlled trial data, the role of anticoagulation in patients with CKD with atrial fibrillation remains unclear and our practice is informed by a growing body of imperfect literature such as observational and pharmacokinetic studies. This article aims to present a contemporary literature review of the benefits versus harms of anticoagulation in atrial fibrillation for patients with CKD stages 3, 4, 5, and 5 on dialysis. Although unanswered questions and areas of clinical equipoise remain, this piece serves to assist physicians in interpreting the complex body of literature and applying it to their clinical care.

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Fan therapy for cough: case report and literature review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002363 ◽

2020 ◽

pp. bmjspcare-2020-002363

Author(s):

Anna Elizabeth Sutherland ◽

Matthew Carey ◽

Mary Miller

Keyword(s):

Case Report ◽

Literature Review ◽

Controlled Trial ◽

Underlying Mechanism ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Patient Reported ◽

Infectious Pathogen ◽

Randomised Controlled

This case report describes the care of a 59-year-old woman with metastatic small cell lung cancer and chronic obstructive pulmonary disease who was highly symptomatic with an intractable cough. The patient reported a subjective benefit from a table fan. The authors observed an objective improvement with a marked reduction in cough frequency when the fan was in use. A literature review was undertaken and identified one randomised controlled trial assessing the use of fan for cough. The proposed underlying mechanism of cough relief is stimulation of the trigeminal nerve, possibly by cooling. This mechanism is well described in breathlessness. It presents the possibility of a novel therapeutic approach to managing cough. Further studies of both the role of nasal receptors in cough pathophysiology and the role of fan therapy in cough, where there is no concern of an airborne infectious pathogen such as COVID-19, are warranted.

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1076 Optimizing engagement in health behavior interventions: the role of patient activation and health literacy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.1101 ◽

2021 ◽

Vol 224 (2) ◽

pp. S665

Author(s):

Jenise Jackson ◽

Chen Yen ◽

Charlotte M. Niznik ◽

Karolina Leziak ◽

Rana Saber ◽

...

Keyword(s):

Health Literacy ◽

Health Behavior ◽

Patient Activation ◽

Behavior Interventions ◽

Health Behavior Interventions

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Characteristics of Older Adults who Receive Assistance with Management of Multidrug Regimens

Innovation in Aging ◽

10.1093/geroni/igab046.2777 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 754-755

Author(s):

Rachel O'Conor ◽

Julia Yoshino Benavente ◽

Mogan Eifler ◽

Lauren Opsasnick ◽

Laura Curtis ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Health Literacy ◽

Cognitive Aging ◽

Chronic Conditions ◽

Clinical Care ◽

Medication Management ◽

Patient Activation ◽

Community Dwelling ◽

Multiple Chronic Conditions

Abstract Many older adults manage multiple chronic conditions requiring adherence to multidrug regimens, yet half are non-adherent, increasing their risk of hospitalization for poorly controlled chronic conditions. Few studies have investigated whether caregivers support medication-related behaviors of community-dwelling older adults. We interviewed 97 patient-caregiver dyads participating in a cognitive aging cohort study to identify factors associated with caregiver assistance in managing multidrug regimens. Patients completed a neuropsychological battery covering five cognitive domains. Health literacy and patient activation were measured using the Newest Vital Sign and Consumer Health Activation Index, respectively. Caregivers reported their medication-related involvement. Predictors of involvement in medication-related tasks were examined using logistic regression models. Patients were on average 71 years old, managing 4 comorbidities and prescribed 5 medications. The majority were female (73%) and identified as Black (46%) or White (47%). Caregivers’ mean age was 65 years; half were female (53%), were predominantly spouses (57%) or children (26%), and lived with the patient (61%). 31% of caregivers ordered patients’ prescribed medications, 40% helped manage their medications, and 50% spoke with the patient’s clinician about their clinical care. Cognitive impairment (OR 2.60, 95% CI 1.08-6.25), limited health literacy (OR 2.97, 95% CI 1.26-6.97), and ≥3 comorbidities (OR 2.14, 95% CI 1.06-9.30) were associated with medication management assistance. Patient activation, gender, cohabitation, or relationship were not associated. These findings suggest that caregivers are assisting with older adults’ medication management and should be included in clinical discussions about medication management, especially among patients with cognitive impairment, low health literacy or multimorbidities.

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