Consumption of psychiatric drugs by patients of medical and surgical clinics in a general hospital

PURPOSES: to identify the prevalence of the use of psychiatric drugs among patients admitted to medical and surgical clinics of a general hospital, and also the factors related to the consumption of this type of medication. METHOD: this is a transversal, descriptive, correlational study with quantitative analysis. For the collection of data, there was use of structured interviews and also reference to medical files. RESULTS: there was confirmation of a high prevalence of users of psychiatric drugs, which was associated to the female sex, to people who do not practice Roman Catholicism, and admittance to the clinic not covered by the Single Health System (Sistema Único de Saúde - SUS), as well as the presence of common mental disorders. Benzodiazepine drugs were the most commonly used psychiatric drugs. Among the total number of users, there has been the identification of patients who were not aware that they were receiving such medication. Doctors who are not psychiatrists were responsible for most prescriptions of psychiatric drugs. CONCLUSIONS: this signals the need to prepare health professionals to deal with psychological and social problems commonly found in clinical practice, in order to promote the rational use of psychiatric drugs.

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Expertise, advocacy and activism: A qualitative study on the activities of prostate cancer peer support workers

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/1363459318785711 ◽

2018 ◽

Vol 24 (1) ◽

pp. 21-37 ◽

Cited By ~ 2

Author(s):

Marjaana Jones ◽

Ilkka Pietilä

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Health Policy ◽

Clinical Practice ◽

Peer Support ◽

Health Professionals ◽

Close Contact ◽

Structured Interviews ◽

Work Activities ◽

Individual Level

Peer support workers are now working with patients in a variety of settings, coming into close contact and even work alongside health professionals. Despite the potentially influential position peer support workers hold in relation to those engaged in support activities, their role, duties and their relationship to peers and health professionals lack clarity and is often defined by other actors. This study explores how peer support workers interpret and define the activities, responsibilities and knowledge associated with their work. Using methods of membership categorisation analysis, we analysed interview materials generated by conducting individual semi-structured interviews during the autumn of 2016 with prostate cancer peer support workers ( n = 11) who currently volunteer as support workers in Finland. Although the peer support workers acknowledged the psychosocial aspects of the work, we argue that their interpretations extend far beyond this and encompass expertise, advocacy and activism as central features of their work. These can be used to strengthen their position as credible commentators and educators on issues relating to cancer and men’s health; raise awareness and represent the ‘patient’s voice’ and attempt to influence both policy and clinical practice. These findings suggest that by categorising their work activities in different ways, voluntary sector actors such as peer support workers can attempt to portray themselves as legitimate authorities on a range of issues and influence decision-making ranging from individual level treatment decisions all the way to health policy.

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Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176248 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6248

Author(s):

Antonio Jesús Ramos-Morcillo ◽

David Harillo-Acevedo ◽

David Armero-Barranco ◽

César Leal-Costa ◽

José Enrique Moral-García ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Health Professionals ◽

Best Practice ◽

Research Study ◽

Structured Interviews ◽

Qualitative Research Study ◽

Implementation Program

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

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Clinical Judgment and the Influence of Screening on Decision Making

Screening for Depression in Clinical Practice ◽

10.1093/oso/9780195380194.003.0009 ◽

2009 ◽

Author(s):

Howard N. Garb

Keyword(s):

Mental Health ◽

Primary Care ◽

Clinical Practice ◽

Mental Health Professionals ◽

Health Professionals ◽

Clinical Judgment ◽

Structured Interviews ◽

Primary Care Settings ◽

Broad Array ◽

Clinically Depressed

How do clinicians arrive at diagnostic decisions? In most cases the decision is not made following formal criteria, but by intuition. In addition, routine interviews are often narrow and the feedback gleaned from patients is inadequate. Yet it is not clear if screening helps or hinders clinical judgment. It might be that only clinicians who have low confidence and interviewing and diagnostic skills are open to the use of and actually helped by diagnostic tools. To provide a theoretical framework for understanding why it is difficult for physicians to detect depression in primary care settings, a broad array of research in the mental health fields can be described. For example, more than 1,000 studies have been conducted on clinical judgment in the area of mental health practice, and the results from these studies can be used to illuminate the challenges physicians face in judging whether a patient is clinically depressed and can benefit from treatment. In this chapter, results on clinical judgment will be described. A second topic will also be briefly discussed. Results from research on clinical judgment would seem to indicate that screening should be of value. Yet, as noted in Chapter 7, stand-alone screening programs have added little or nothing to outcomes. Reasons for this unexpected result will be explored. Three topics will be discussed: (1) narrowness of interviews, (2) nature of patient feedback, and (3) the cognitive processes of clinicians. Depression goes undetected because in many cases physicians do not ask patients if they have symptoms of a depressive mood disorder.3 To place this in context, it can be noted that mental health professionals also often do not ask patients about important symptoms and behaviors. Failure to inquire about depression in primary care settings can be viewed in the broader context of failure to inquire about important symptoms and events in mental health settings. Research on clinical judgment has demonstrated that lack of comprehensiveness is often a problem for interviews made in clinical practice. For example, in one study,4 mental health professionals saw patients in routine clinical practice, and afterwards research investigators conducted semi-structured interviews with the patients. Remarkably, the mental health professionals had evaluated only about 50% of the symptoms that were recorded using the semi-structured interviews.

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Common Mental Disorders: socio-demographic and pharmacotherapy profile

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.2990.2355 ◽

2013 ◽

Vol 21 (6) ◽

pp. 1203-1211 ◽

Cited By ~ 12

Author(s):

Viviane Ferrari Gomes ◽

Tatiana Longo Borges Miguel ◽

Adriana Inocenti Miasso

Keyword(s):

Health Care ◽

Mental Disorders ◽

Health Professionals ◽

Exploratory Study ◽

Family Income ◽

Common Mental Disorders ◽

Structured Interviews ◽

Cross Sectional ◽

Primary Health ◽

Health Care Unit

OBJECTIVE: this study reports an association between Common Mental Disorders and the socio-demographic and pharmacotherapy profiles of 106 patients cared for by a Primary Health Care unit in the interior of São Paulo, Brazil. METHOD: this is a cross-sectional descriptive exploratory study with a quantitative approach. Structured interviews and validated instruments were used to collect data. The Statistical Package for Social Science was used for analysis. RESULTS: The prevalence of Common Mental Disorders was 50%. An association was found between Common Mental Disorders and the variables occupation, family income, number of prescribed medications and number of pills taken a day. Greater therapy non-adherence was observed among those who tested positive for Common Mental Disorders. CONCLUSION: this study's results show the importance of health professionals working in PHC to be able to detect needs of a psychological nature among their patients and to support the implementation of actions to prevent the worsening of Common Mental Disorders.

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Understanding non-vaccinating parents’ views to inform and improve clinical encounters: a qualitative study in an Australian community

BMJ Open ◽

10.1136/bmjopen-2018-026299 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026299 ◽

Cited By ~ 8

Author(s):

Catherine Helps ◽

Julie Leask ◽

Lesley Barclay ◽

Stacy Carter

Keyword(s):

Health Professionals ◽

Personal Experience ◽

Vaccine Safety ◽

Structured Interviews ◽

Purposive Sampling ◽

Clinical Encounters ◽

High Prevalence ◽

Australian Community ◽

Real Truth ◽

Regional Australia

ObjectivesTo explain vaccination refusal in a sample of Australian parents.DesignQualitative design, purposive sampling in a defined population.SettingA geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal.ParticipantsSemi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing.ResultsThematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents’ accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for ‘the real truth’; reactance to system inflexibilities and ongoing risk assessment.ConclusionsWe suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.

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Implementing the Maternal Postnatal Attachment Scale (MPAS) in universal services: Qualitative interviews with health visitors

10.1101/2021.11.30.21267065 ◽

2021 ◽

Author(s):

Philippa K Bird ◽

Zoe Hindson ◽

Abigail Dunn ◽

Anna Cronin de Chavez ◽

Josie Dickerson ◽

...

Keyword(s):

Clinical Practice ◽

Psychometric Properties ◽

Thematic Analysis ◽

Health Professionals ◽

Clinical Utility ◽

Qualitative Interviews ◽

Structured Interviews ◽

Health Visitors ◽

Measurement Tools ◽

Routine Assessment

A secure parent-infant relationship lays the foundations for childrens development, however there are currently no measurement tools recommended for clinical practice. We evaluate the clinical utility of a structured assessment of the parent-infant relationship (the Maternal Postnatal Attachment Scale, MPAS) in a deprived, multi-ethnic urban community in England. This paper answers the question: what are health visitors views on the parent-infant relationship, and experiences of piloting the MPAS? It explores the barriers and facilitators to implementation, and complements the paper on psychometric properties and representativeness reported in Dunn et al (submitted). Semi-structured interviews were conducted with 11 health visitors and data were analysed using thematic analysis. Health visitors stressed the importance of the parent-infant relationship and reported benefits of the MPAS, including opening conversation, and identifying and reporting concerns. Challenges included timing, workload, the appropriateness and understanding of the questions and the length of the tool. Suggestions for improvements to the tool were identified. Our findings help to explain results in Dunn et al, and challenges identified would hinder routine assessment of the parent-infant relationship. Further work with health professionals and parents has been undertaken to co-produce an acceptable, feasible and reliable tool for clinical practice.

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A qualitative study to investigate Swiss hospital personnel’s perceived importance of and experiences with patient’s mental–somatic multimorbidities

BMC Psychiatry ◽

10.1186/s12888-021-03353-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nicola Julia Aebi ◽

Seraina Caviezel ◽

Rainer Schaefert ◽

Gunther Meinlschmidt ◽

Matthias Schwenkglenks ◽

...

Keyword(s):

Mental Health ◽

General Hospital ◽

Health Professionals ◽

Interprofessional Collaboration ◽

Structured Interviews ◽

Framework Analysis ◽

Negative Stereotypes ◽

General Hospitals ◽

Perceived Importance ◽

Hospital Patients

Abstract Background Mental–somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel’s perceived importance of and experiences with mental–somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. Methods Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. Results Four themes emerged from the data analysis: 1) the relevance of mental–somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental–somatic multimorbidity, and 4) interprofessional collaboration for handling mental–somatic multimorbidity in hospital settings.The mental–somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental–somatic multimorbidity in general hospitals. Conclusion To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental–somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.

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“Fear of stopping” vs “wanting to get off the medication”: exploring women’s experiences of using domperidone as a galactagogue - a qualitative study

International Breastfeeding Journal ◽

10.1186/s13006-021-00438-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Gabriella Zizzo ◽

Alice R. Rumbold ◽

Luke E. Grzeskowiak

Keyword(s):

Clinical Practice ◽

Health Professionals ◽

Structured Interviews ◽

High Expectations ◽

Women’S Experiences ◽

Women's Experiences ◽

Considerable Controversy ◽

Prophylactic Use ◽

Timing Of Initiation ◽

Anecdotal Information

Abstract Background Domperidone is the most frequently prescribed medicine used to increase breast milk supply. There is considerable controversy surrounding the use of domperidone in lactation, due to limited evidence about efficacy and concerns about rare but life-threatening side-effects. Despite this, in many high-income settings such as Australia, use of domperidone among breastfeeding mothers appears to be increasing. The aim of this paper was to explore women’s experiences of using domperidone during breastfeeding. Methods Semi-structured interviews were conducted in 2019 with 15 women in Australia who reported using domperidone as a galactagogue during breastfeeding. Interviews were recorded, transcribed and analysed thematically. Results Women reported a wide variety of practices concerning the timing of initiation of domperidone use, including prophylactic use, as well as the dose and duration of use. Prolonged periods of use and unsupervised dosing were commonly reported, these practices were sometimes associated with a fear of the consequences of stopping, insufficient provision of information about the drug or feeling dismissed by health professionals. Some women indicated that when doctors refused to prescribe domperidone they responded by doctor shopping and seeking anecdotal information about benefits and risks online, leading to unsupervised practices. Women often reported high expectations surrounding the effectiveness of domperidone, and most used the medication in conjunction with food/herbal galactagogues and non-galactagogue support. Positive outcomes following domperidone use included having greater confidence in breastfeeding and pride at achieving breastfeeding goals. Conclusions This study identified a variety of practices concerning domperidone use, including potentially unsafe practices, linked in some cases to inconsistent advice from health professionals and a reliance on online, anecdotal information sources. These findings emphasise the urgent need for development of clinical practice guidelines and a greater focus on translating existing evidence concerning domperidone into clinical practice, including clinical support that is tailored to women’s needs.

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Epidemiology of Plasma Cell Disorders in a General Hospital: A Retrospective Study of 102 Patients.

Blood ◽

10.1182/blood.v110.11.4754.4754 ◽

2007 ◽

Vol 110 (11) ◽

pp. 4754-4754

Author(s):

Irene Ricca ◽

Giacomo Tamponi ◽

Celeste Arnò ◽

Angelo Bosio ◽

Flavio Cerrato ◽

...

Keyword(s):

Clinical Practice ◽

General Hospital ◽

Median Time ◽

Plasma Cell ◽

Cell Clone ◽

M Protein ◽

Cumulative Probability ◽

High Prevalence ◽

Plasma Cell Disorders

Abstract INTRODUCTION Plasma cell disorders are a group of diseases characterized by the proliferation of a plasma cell clone which produces a monoclonal protein (M protein). The most common type is Monoclonal Gammopathies of Undetermined Significance (MGUS), followed by multiple myeloma (MM) and Waldenstrom’s Macroglobulinemia (WM). In particular, the frequency of MGUS increases with age and its rate of progression is approximately 1% per year. Because of the high prevalence and the different fields of clinical practice in which these patients are followed, it could be of great interest to know the epidemiology of these diseases out of the Hematology Units. AIM OF THE STUDY to describe the frequency and the progression risk of plasma cell disorders in a General Hospital during more than a twenty-year period. METHODS We retrospectively reviewed the medical records of patients with diagnosis of MGUS, MM or WM seen at our center from 1984 through 2006. Statistical analysis were performed using GraphPad Prism 4 (GraphPad Software, Inc.). RESULTS The study included 102 patients: 78 affected by MGUS (76%), 14 by MM (14%) and 10 by WM (10%). Patients’ clinical features are summarized in the Table. Median follow-up was 48 months (range:12–280). Among the 89 patients with a first diagnosis of MGUS, malignant transformation occurred in 11 patients (7 MM and 4 WM). The median time from diagnosis of MGUS to diagnosis of a lymphoplasma cell proliferative disorder was 60 months (range 12–196). Median time to progression (TTP) was 167 months, as shown in Figure. The cumulative probability of progression was 13.5% at 5 years and 29.2% at 10 years. The amount of serum M protein at diagnosis was a significant predictor of progression. CONCLUSIONS MGUS are very common in clinical practice, accounting in our study for more than 75% of plasma cell disorders. The premalignant nature of this condition is comfirmed by the rate of transformation in lymphoplasma cell proliferative disorders (50% of MM and 40% of WM, in this study). Even if our results may be biased by the short follow-up period, the only significant predictor of progression was the size of serum M protein at presentation. Table: Patients’ characteristics Characteristics MGUS MM WM Gender male/female 41/37 4/10 7/3 Age at diagnosis median (range) 69 yrs (30–91) 72 yrs (51–90) 75 yrs (67–85) Serum M protein median (range) 1.26 g/dl (0.17–2.92) 3.85 g/dl (0.62–8.10) 3.20 g/dl (2.22–4.9) Isotype IgG 46 8 - IgA 14 6 - IgM 15 - 10 biclonal 3 - - Immunoparesis yes/no 20/58 14/0 10/0 BJ proteinuria pos/neg 11/67 11/3 1/9 Figure Figure

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The rise and fall of PET and PET/CT

Nuklearmedizin ◽

10.1055/s-0038-1625217 ◽

2005 ◽

Vol 44 (S 01) ◽

pp. S58-S60 ◽

Cited By ~ 8

Author(s):

W. Mohnike

Keyword(s):

Clinical Practice ◽

General Hospital ◽

Private Practice ◽

Ct Imaging ◽

Hospital Environment ◽

Governmental Organizations ◽

Pet Ct

Summary:PET is being considered a diagnostic commodity in clinical practice worldwide and thus receives increasing attention by health insurances and governmental organizations. In Germany, however, neither PET nor PET/CT are subject to reimbursement. This renders clinical PET and PET/CT imaging a challenge both in a general hospital environment and in private practice. This article describes briefly these challenges, which are not solely related to turf battles and associated costs.

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