scholarly journals Patient subjective experience of treatment with long-acting injectable antipsychotics: a systematic review of qualitative studies

2021 ◽  
Vol 70 (1) ◽  
pp. 68-77
Author(s):  
Gianluca Fiore ◽  
Davide Elia Bertani ◽  
Mattia Marchi ◽  
Graça Cardoso ◽  
Gian Maria Galeazzi
Keyword(s):  
Subjective Experience ◽  
Healthcare Providers ◽  
Qualitative Studies ◽  
Common Finding ◽  
Accurate Information ◽  
Shared Decision ◽  
Depot Therapy ◽  
Key Concepts ◽  
Long Acting ◽  
Lack Of Knowledge

ABSTRACT Objective: To gain a better understanding of how long-acting injectable antipsychotic (LAI) therapy is perceived by patients. Methods: A search for qualitative studies has been carried out on PubMed, Google Scholar, PsycINFO and PsycArticles, yielding 11 studies suitable for a review of qualitative studies. The reporting approach chosen was meta-ethnography, following the ENTREQ statement recommendations. Key concepts common to the different studies were extrapolated and then analysed in a systematic and comparative way. Results: Some recurrent issues were associated with LAIs, such as fear of coercion, fear of needles and lack of knowledge about depot therapy. These topics are linked to each other and the patients most concerned about the disadvantages of LAIs are those who are less informed about them, or who have experienced coercion and trauma during hospitalisation. On the other hand, patients who had already received LAIs, and those who had a good therapeutic relationship with their healthcare providers expressed satisfaction with this form of treatment and its continuation. Conclusion: Long-acting injectable antipsychotics are a tool in the management of mental disorders, and a viable alternative to oral medication. Patients show curiosity towards this method of administration, but lack of knowledge is a common finding. Shared decision making about the use of LAIs antipsychotics requires that patients receive accurate information and support for their decision regarding medication.

scholarly journals Neurological manifestations and neuroimaging findings in patients with SARS-CoV2—a systematic review

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Nikita Mohan ◽  
Muhammad Ali Fayyaz ◽  
Christopher del Rio ◽  
Navpreet Kaur Rajinder Singh Khurana ◽  
Sampada Sandip Vaidya ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Case Reports ◽  
Healthcare Providers ◽  
Case Series ◽  
Altered Mental Status ◽  
Common Finding ◽  
Cochrane Library ◽  
Neurological Manifestations ◽  
The Cochrane Library ◽  
Ct And Mri

Abstract Background The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. Objective To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2. To identify neuro-invasive pathways of COVID infection. Methods Relevant studies were identified through four databases—the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords—“COVID-19,” “SARS-CoV2,” “neurological manifestations,” “neuroimaging,” “CT,” and “MRI.” Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. Results Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. Conclusion The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.

Contraception in Adolescents

2021 ◽  
Author(s):  
Shandhini Raidoo ◽  
Marit Pearlman Shapiro ◽  
Bliss Kaneshiro
Keyword(s):  
Contraceptive Use ◽  
Unwanted Pregnancy ◽  
Healthcare Providers ◽  
The United States ◽  
Sexually Active ◽  
Contraceptive Methods ◽  
Contraceptive Counseling ◽  
Unscheduled Bleeding ◽  
Long Acting ◽  
Long Acting Reversible Contraceptive

AbstractAdolescents are at risk for unwanted pregnancy when they become sexually active, and contraception is an important part of mitigating this risk. Use of contraceptive methods, and long-acting reversible contraceptive methods such as implants and intrauterine devices in particular, has increased among adolescents. Although sexual activity has declined and contraceptive use has increased among adolescents in the United States in recent years, the unintended pregnancy rate remains high. All of the currently available contraceptive methods are safe and effective for adolescents to use; however, adolescents may have specific concerns about side effect profiles and unscheduled bleeding that should be addressed during contraceptive counseling. Healthcare providers should prioritize adolescents' needs and preferences when approaching contraceptive counseling, and also consider the unique access and confidentiality issues that adolescents face when accessing contraception.

Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies

2018 ◽  
Vol 20 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Marie Hamilton Larsen ◽  
Kåre Birger Hagen ◽  
Anne Lene Krogstad ◽  
Astrid Klopstad Wahl
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Shared Decision Making ◽  
Qualitative Studies ◽  
Shared Decision

scholarly journals Consenting to invasive contraceptives: an ethical analysis of adolescent decision-making authority for long-acting reversible contraception

2018 ◽  
Vol 44 (9) ◽  
pp. 585-588 ◽  
Author(s):  
Rosemary Talbot Behmer Hansen ◽  
Kavita Shah Arora
Keyword(s):  
Decision Making ◽  
Pregnancy Termination ◽  
Healthcare Providers ◽  
Parental Consent ◽  
Best Interest ◽  
Adolescent Autonomy ◽  
Long Acting ◽  
The Right ◽  
Satisfaction Rates ◽  
Analogous Reasoning

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception (LARC) methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted.

Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes

2021 ◽  
pp. bmjspcare-2020-002857
Author(s):  
Erin Denney-Koelsch ◽  
Denise Cote-Arsenault
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Parental Decision ◽  
Parental Decision Making ◽  
Case Comparison ◽  
Theme Identification ◽  
Iterative Coding

ObjectivesWhen parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby.MethodsThis study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents’ experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison.ResultsThirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents’ experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk–benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets.ConclusionFor shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents’ subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.

Clinical Communication in the Aspect of Development of New Technologies and E-Health in the Doctor-Patient Relationship

2016 ◽  
pp. 1465-1497
Author(s):  
Aleksandra Rosiek-Kryszewska ◽  
Łukasz Leksowski ◽  
Anna Rosiek ◽  
Krzysztof Leksowski ◽  
Aleksander Goch
Keyword(s):  
New Technologies ◽  
Healthcare Providers ◽  
Work Environments ◽  
Shared Decision ◽  
Clinical Communication ◽  
Professional Discourse ◽  
Medical Environment ◽  
Close Analysis ◽  
Communication Challenges ◽  
Clinician Communication

Patient-clinician communication presents the views of several national authorities on the principles and expectations of shared decision-making between patients and their healthcare providers, including doctors, and nurses and oncology nurses. In this chapter authors focus on the communication challenges facing doctors who trained in medical environment in Poland, in order to prepare communications training designed specifically for doctors and to illustrate how a close analysis of professional discourse can be transferred to work environments beyond the medical world. Authors draw attention to clinical roles performed by medical staff practicing locally and trained doctors.

Caring experiences of family caregivers of patients with heart failure: A meta-ethnographic review of the past 10 years

2020 ◽  
Vol 19 (6) ◽  
pp. 473-485 ◽  
Author(s):  
Eun Young Kim ◽  
Seieun Oh ◽  
Youn-Jung Son
Keyword(s):  
Heart Failure ◽  
Family Caregivers ◽  
Healthcare Providers ◽  
Qualitative Studies ◽  
Bibliographic Databases ◽  
Eligibility Criteria ◽  
Essential Information ◽  
Patients With Heart Failure ◽  
Caregiving Roles

Background: Living with heart failure, a debilitating disease with an unpredictable course, requires ongoing adaptation and management not only from patients but also from their families. Family caregivers have been known to be key facilitators of self-management of heart failure. An integrative understanding of the experiences of family caregivers will provide essential information for improving the quality of life of persons with heart failure and their families. Aims: This study aimed to integrate and synthesize the findings of qualitative studies on family members’ experiences of caring for patients with heart failure. Methods: We employed the meta-ethnography methodology. Five electronic bibliographic databases were used to retrieve studies published from April 2009–March 2019 that explored family caregivers’ experiences of caring for patients with heart failure. Twelve qualitative studies were finally included for the synthesis, based on the eligibility criteria. Results: Three themes were identified: “shouldering the entire burden,” “starting a new life,” and “balancing caregiving and everyday life.” These three themes illustrate how family caregivers fulfilled caregiving roles, what helped them juggle their multiple responsibilities, and how they struck a balance between life as caregivers and individuals in their own right. Conclusion: This review provides a deeper understanding of family caregivers’ experiences of caring for patients with heart failure. The findings can help healthcare providers in the development and implementation of tailored interventions for both patients and family caregivers.

scholarly journals T236. A PROGRAM TO INCREASE THE APPROPRIATE USE OF LONG-ACTING ANTIPSYCHOTIC MEDICATIONS IN COMMUNITY SETTINGS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S322-S323
Author(s):  
Dawn Velligan ◽  
Martha Sajatovic
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Antipsychotic Medication ◽  
Poor Adherence ◽  
Shared Decision ◽  
Appropriate Use ◽  
Antipsychotic Medications ◽  
Oral Antipsychotic ◽  
Long Acting ◽  
Over Time

Abstract Background Antipsychotic medications are evidence-based treatments for schizophrenia that improve health outcomes and reduce costs. However, rates of non-adherence to oral antipsychotic medications can exceed 60%. We examined whether a simple checklist to identify individuals not receiving optimum benefit from current oral antipsychotic treatment (NOB Checklist) and The Multi-level Facilitation of Long-acting Antipsychotic Medication Program (MAP) could increase the appropriate use of long-acting injectable antipsychotic medication (LAI) in community clinics. Methods Two clinics in Texas and two in Ohio changed clinical procedures in one of two ways 1) NOB only clinics--providers used a five-item checklist to identify individuals with schizophrenia on oral antipsychotics who were Not receiving Optimum Benefit from current treatment and may therefore benefit from a switch to LAI. 2) MAP- providers used the NOB checklist AND received MAP; MAP is a novel behavior change intervention designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer for whom peer specialists showed a video describing shared decision making and how to make a choice between tablets and injections, and provided a balanced shared-decision making tool to assist them in choosing medication route,2) the provider who received academic detailing describing various LAI options, how to make good offers as part of a shared decision making dialogue, and important benefits of LAI including the ability to disentangle efficacy versus poor adherence and to help individuals with cognitive and practical problems that lead to poor adherence, and 3) the administrators who received information on how LAI could improve outcomes for individuals and clinic processes, how to encourage the use of LAI among providers and how to provide regular feedback to providers about prescribing practices. The primary outcome was the percentage of LAI versus oral antipsychotic medication prescribed to individuals with schizophrenia. Results Higher NOB checklist scores were associated with an increased provider likelihood of LAI offers and increased consumer acceptance of LAI. All clinics increased use of LAI over time. In Texas, where MAP was fully implemented, the MAP clinic had greater use of LAI over time (eventually reaching about 50% of all antipsychotic use) vs. the NOB only clinic. In Cleveland, the patient stakeholder curriculum was not delivered and there was no significant difference in LAI use between MAP and NOB clinics. Discussion The NOB checklist appears to be a useful tool to help identify patients who might be appropriate candidates for LAI and the full MAP program may help clinicians and consumers to work together to optimize the appropriate use of LAI in outpatient settings. Implementation must be customized for clinics and workflows to determine which parts of the MAP program are practical and appropriate. Participation of consumer stakeholders may be essential to delivery of the MAP Program.

scholarly journals Nurses and guideline for interrupting or not initiating CPR: An exploratory survey

2019 ◽  
Vol 7 (4) ◽  
pp. 13
Author(s):  
Claudia Agnoletto ◽  
Fancesco Gastaldo ◽  
Simonetta Padrin
Keyword(s):  
Intensive Care ◽  
Work Experience ◽  
Healthcare Providers ◽  
P Value ◽  
Anonymous Questionnaire ◽  
Work Area ◽  
Significant Difference ◽  
Exploratory Survey ◽  
And Behaviors ◽  
Lack Of Knowledge

Objective: An area that still causes difficulties and a sense of inadequacy in healthcare providers is related to Do Not Attempt Resuscitation decision (DNAR). The aim of the study is to investigate knowledge, opinions and behaviors of nurses about DNAR in order to plan appropriate improvement interventions.Methods: An anonymous questionnaire was administered to 207 nurses belonging to four Medicine Departments and to four Intensive Care areas. The questionnaire, which consists of 29 items, collects some information related to work experience and investigates opinions and behaviors of nurses about DNAR decision.Results: 55% of the nurses in the sample say they do not know the meaning of the acronym DNAR. It was noted a statistically significant association both between training and knowledge of DNAR (p-value = .038) and between years of work and knowledge of the acronym (p-value = .004). There was also a statistically significant difference between knowledge of the acronym and some opinions and behaviors of nurses, including the importance of informing the patient about DNAR decision (p-value = .028).Conclusions: The study shows that the sample investigated, regardless of the work area of afference, does not know DNAR decision adequately. The lack of knowledge influences opinions and attitudes of nurses in relation to DNAR decision, constituting a barrier for an appropriate management of the patient. The need for more training on the topic and the formulation of clear protocols on DNAR decision emerges.

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