scholarly journals Regret and Therapeutic Decisions in Multiple Sclerosis Care: Literature Review and Research Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Gustavo Saposnik ◽  
Guillermo Bueno-Gil ◽  
Ángel P. Sempere ◽  
Alfredo Rodríguez-Antigüedad ◽  
Beatriz del Río ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Medical Errors ◽  
Healthcare Professionals ◽  
Expert Panel ◽  
Behavioral Characteristics ◽  
Limited Information ◽  
Occupational Burnout ◽  
Family Expectations ◽  
Standardized Protocol ◽  
Therapeutic Decisions

Background: Decisions based on erroneous assessments may result in unrealistic patient and family expectations, suboptimal advice, incorrect treatment, or costly medical errors. Regret is a common emotion in daily life that involves counterfactual thinking when considering alternative choices. Limited information is available on care-related regret affecting healthcare professionals managing patients with multiple sclerosis (MS).Methods: We reviewed identified gaps in the literature by searching for the combination of the following keywords in Pubmed: “regret and decision,” “regret and physicians,” and “regret and nurses.” An expert panel of neurologists, a nurse, a psychiatrist, a pharmacist, and a psychometrics specialist participated in the study design. Care-related regret will be assessed by a behavioral battery including the standardized questionnaire Regret Intensity Scale (RIS-10) and 15 new specific items. Six items will evaluate regret in the most common social domains affecting individuals (financial, driving, sports—recreation, work, own health, and confidence in people). Another nine items will explore past and recent regret experiences in common situations experienced by healthcare professionals caring for patients with MS. We will also assess concomitant behavioral characteristics of healthcare professionals that could be associated with regret: coping strategies, life satisfaction, mood, positive social behaviors, occupational burnout, and tolerance to uncertainty.Planned Outcomes: This is the first comprehensive and standardized protocol to assess care-related regret and associated behavioral factors among healthcare professionals managing MS. These results will allow to understand and ameliorate regret in healthcare professionals.Spanish National Register (SL42129-20/598-E).

scholarly journals Behavioral aspects of nurse practitioners associated with optimal multiple sclerosis care in Spain

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261050
Author(s):  
Gustavo Saposnik ◽  
Beatriz Del Río ◽  
Guillermo Bueno-Gil ◽  
Ángel P. Sempere ◽  
Alejandro Lendínez-Mesa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Nurse Practitioners ◽  
Critical Role ◽  
Behavioral Characteristics ◽  
Limited Information ◽  
Case Scenario ◽  
Occupational Burnout ◽  
Cross Sectional ◽  
Therapeutic Decisions ◽  
The Mean

Background Nurse practitioners (NPs) play a critical role in the multidisciplinary management of patients with multiple sclerosis (MS). Neurologists´ behavioral characteristics have been associated with suboptimal clinical decisions. However, limited information is available on their impact among NPs involved in MS care. The aim of this study was to assess nurses´ therapeutic choices to understand behavioral factors influencing their decision making process. Methods A non-interventional, cross-sectional, web-based study was conducted. NPs actively involved in the care of patients with MS were invited to participate in the study by the Spanish Society of Neurology Nursing. Participants answered questions regarding their standard practice and therapeutic management of seven simulated relapsing-remitting MS (RRMS) case scenarios. A behavioral battery was used to measure participants´ life satisfaction, mood, positive social behaviors, feeling of helpfulness, attitudes toward adoption of evidence-based innovations, occupational burnout, and healthcare-related regret. The outcome of interest was therapeutic inertia (TI), defined as the lack of treatment escalation when there is clinical and radiological evidence of disease activity. A score to quantify TI was created based on the number of simulated scenarios where treatment intensification was warranted. Results Overall, 331 NPs were invited to participate, 130 initiated the study, and 96 (29%) completed the study. The mean age (SD) was 44.6 (9.8) years and 91.7% were female. Seventy-three participants (76.0%) felt their opinions had a significant influence on neurologists´ therapeutic decisions. Sixteen NPs (16.5%) showed severe emotional exhaustion related to work and 13 (13.5%) had depressive symptoms. The mean (SD) TI score was 0.97 (1.1). Fifty-six of NPs showed TI in at least one case scenario. Higher years of nursing experience (p = 0.014), feeling of helpfulness (p = 0.014), positive attitudes toward innovations (p = 0.046), and a higher intensity of care-related regret (p = 0.021) were associated with a lower risk of TI (adjusted R2 = 0.28). Burnout was associated with higher risk of TI (p = 0.001). Conclusions Although NPs cannot prescribe MS treatments in Spain, their behavioral characteristics may influence the management of patients with RRMS. Continuing education and specific strategies for reducing occupational burnout may lead to better management skills and improve MS care.

scholarly journals Does attendance at the ECTRIMS congress impact on therapeutic decisions in multiple sclerosis care?

2019 ◽  
Vol 5 (1) ◽  
pp. 205521731983522
Author(s):  
Gustavo Saposnik ◽  
Jorge Maurino ◽  
Angel P Sempere ◽  
Maria A Terzaghi ◽  
Maria Pia Amato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Healthcare Professionals ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Clinical Progression ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Therapeutic Decisions ◽  
Therapeutic Decision Making ◽  
Treatment Escalation

Conferences traditionally play an important role in the ongoing medical education of healthcare professionals. We assessed the influence of attending the ECTRIMS congress on therapeutic decision-making in multiple sclerosis (MS) care. A non-interventional, cross-sectional study involving 96 neurologists was conducted. Treatment escalation when therapeutic goals were unmet and management errors related to tolerability and safety scenarios of MS therapies were tested using different case-scenarios. Attendance at ECTRIMS was associated with an increase likelihood of treatment escalation in the presence of clinical progression (cognitive decline) and radiological activity (OR 2.44; 95% CI 1.06–5.82) and lower number of management errors (OR 0.26; 95% CI 0.07–0.98). Attendance at ECTRIMS may facilitate therapeutic decisions and reduction in management errors in MS care.

scholarly journals Dementia looming!

Dementia ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. 263-265
Author(s):  
Lisette Oliemeulen
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Brain Atrophy ◽  
Healthcare Professionals ◽  
Personal View ◽  
The Sublime

Background I, the 45-year-old scientist, the PhD, the sublime researcher, now subject to dementia? I felt confused, very ashamed and told no one, until they found out. I suffer from brain atrophy, associated with multiple sclerosis I am suffering from for years. My cognitive impairment is the result of my shrinking brain! Objectives With my personal view ‘Dementia Looming!’, I hope to contribute to and support healthcare professionals and scientists in understanding the meaning of dementia. Although not scientific, my paper gives a unique behind-the-scenes view into what it means to experience dementia symptoms.

scholarly journals Creating a Framework for Medical Professionalism: An Initial Consensus Statement From an Arab Nation

2016 ◽  
Vol 8 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Sawsan Abdel-Razig ◽  
Halah Ibrahim ◽  
Hatem Alameri ◽  
Hossam Hamdy ◽  
Khaled Abu Haleeqa ◽  
...  
Keyword(s):  
United Arab Emirates ◽  
Cultural Context ◽  
Consensus Statement ◽  
Expert Panel ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Medical Professionalism ◽  
Limited Information ◽  
Social Construct ◽  
Consensus Definition

ABSTRACT  Medical professionalism has received increased worldwide attention, yet there is limited information on the applicability and utility of established Western professionalism frameworks in non-Western nations.Background  We developed a locally derived consensus definition of medical professionalism for the United Arab Emirates (UAE), which reflects the cultural and social constructs of the UAE and the Middle East.Objective  We used a purposive sample of 14 physicians working in the UAE as clinical and education leaders. This expert panel used qualitative methods, including the world café, nominal group technique, the Delphi method, and an interpretive thematic analysis to develop the consensus statement.Methods  The expert panel defined 9 attributes of medical professionalism. There was considerable overlap with accepted Western definitions, along with important differences in 3 aspects: (1) the primacy of social justice and societal rights; (2) the role of the physician's personal faith and spirituality in guiding professional practices; and (3) societal expectations for professional attributes of physicians that extend beyond the practice of medicine.Results  Professionalism is a social construct influenced by cultural and religious contexts. It is imperative that definitions of professionalism used in the education of physicians in training and in the assessment of practicing physicians be formulated locally and encompass specific competencies relevant to the local, social, and cultural context for medical practice. Our goal was to develop a secular consensus statement that encompasses culture and values relevant to professionalism for the UAE and the Arab region.Conclusions

scholarly journals Second life in healthcare education: Virtual environment's potential to improve patient safety

2011 ◽  
pp. 17-23
Keyword(s):  
Patient Safety ◽  
Virtual Environments ◽  
Virtual Environment ◽  
Medical Errors ◽  
Second Life ◽  
Healthcare Professionals ◽  
Improve Patient Safety ◽  
Healthcare Education ◽  
Healthcare Profession ◽  
Improve Patient

Research has shown that a large portion of healthcare cost is due to medical errors. There are many factors that cause medical errors but one major factor is linked to healthcare professionals who are not adequately trained with the appropriate skills. Virtual environments and simulations are being used to help improve training in many different areas, including the healthcare profession. This paper explores the usage of Second Life in healthcare education and its ability to improve patient safety. The conclusion is that much progress and development still needs to be made before Second Life will make a significant impact on improved patient safety through healthcare education. There is a need to make the virtual environment more realistic to adequately train healthcare professionals.

scholarly journals IMPLEMENTATION OF CHOOSING WISELY CAMPAIGN IN HEALTH COURSES IN BRAZIL – DESCRIPTION OF THE FIRST STEPS

2016 ◽  
Vol 4 (4) ◽  
Author(s):  
Marta Silva Menezes ◽  
Marilia Menezes Gusmão ◽  
Ana Marice Teixeira Ladeia ◽  
Carolina Vila Nova Aguiar ◽  
Cristiane Magali Freitas dos Santos ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Expert Panel ◽  
Group Formation ◽  
Role Modeling ◽  
Choosing Wisely ◽  
Research Activity ◽  
Medical Decisions ◽  
Modeling Behavior ◽  
Initial Process ◽  
Fast Evolution

Introduction. Popular medical decisions regarding testing or treatment are often ineffective or even harmful. Seeking an awareness of healthcare professionals and patients in this regard, it was created the international campaign "Choosing Wisely”, whose strategy is based on creating lists containing situations that are frequent but of low value to patients. Objective. To describe the initial process of implementing Choosing Wisely Campaign in EBMSP. Material and methods. Descriptive study based on observation reports. Results. It was made a presentation and invitation the healthcare courses coordinators of EBMSP, followed by research group formation. The medical course list was written using an expert panel and it was sent to students and medical teachers of the school. The partial results were presented in events of medical education and a Choosing Wisely meeting in Brazil. A student-aimed questionnaire to evaluate perceptions on cost-conscious attitudes and role-modeling behavior is being validated. Conclusion. It is noticeable the high interest of students and teachers about the campaign, the development of a research activity helped systematization and organization of the actions and fast evolution of the research team.

scholarly journals Compliance assessment of ambulatory Alzheimer patients to aid therapeutic decisions by healthcare professionals

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Oliver Schwalbe ◽  
Christian Scheerans ◽  
Ines Freiberg ◽  
Andrea Schmidt-Pokrzywniak ◽  
Andreas Stang ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Compliance Assessment ◽  
Therapeutic Decisions

Combining clinical and magnetic resonance imaging markers enhances prediction of 12-year disability in multiple sclerosis

2016 ◽  
Vol 23 (1) ◽  
pp. 51-61 ◽  
Author(s):  
Tomas Uher ◽  
Manuela Vaneckova ◽  
Lukas Sobisek ◽  
Michaela Tyblova ◽  
Zdenek Seidl ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Cumulative Risk ◽  
Resonance Imaging ◽  
Cox Models ◽  
T2 Lesions ◽  
Therapeutic Decisions ◽  
The Individual

Background: Disease progression and treatment efficacy vary among individuals with multiple sclerosis. Reliable predictors of individual disease outcomes are lacking. Objective: To examine the accuracy of the early prediction of 12-year disability outcomes using clinical and magnetic resonance imaging (MRI) parameters. Methods: A total of 177 patients from the original Avonex-Steroids-Azathioprine study were included. Participants underwent 3-month clinical follow-ups. Cox models were used to model the associations between clinical and MRI markers at baseline or after 12 months with sustained disability progression (SDP) over the 12-year observation period. Results: At baseline, T2 lesion number, T1 and T2 lesion volumes, corpus callosum (CC), and thalamic fraction were the best predictors of SDP (hazard ratio (HR) = 1.7–4.6; p ⩽ 0.001–0.012). At 12 months, Expanded Disability Status Scale (EDSS) and its change, number of new or enlarging T2 lesions, and CC volume % change were the best predictors of SDP over the follow-up (HR = 1.7–3.5; p ⩽  0.001–0.017). A composite score was generated from a subset of the best predictors of SDP. Scores of ⩾4 had greater specificity (90%–100%) and were associated with greater cumulative risk of SDP (HR = 3.2–21.6; p < 0.001) compared to the individual predictors. Conclusion: The combination of established MRI and clinical indices with MRI volumetric predictors improves the prediction of SDP over long-term follow-up and may provide valuable information for therapeutic decisions.

scholarly journals Multiple Sclerosis: Overview of Disease-Modifying Agents

2014 ◽  
Vol 6 ◽  
pp. PMC.S13213 ◽  
Author(s):  
Alessandro Finkelsztejn
Keyword(s):  
Multiple Sclerosis ◽  
Healthcare Professionals ◽  
Drug Class ◽  
Cognitive Disability ◽  
Oral Drugs ◽  
The Us ◽  
Disease Modifying Agents ◽  
Phase Ii And Iii ◽  
Chronic Autoimmune Disease

Multiple sclerosis (MS) is a chronic autoimmune disease that usually affects young adults, causing progressive physical and cognitive disability. Since the 1990s, its treatment has been based on parenteral medications known collectively as immunomodulators. This drug class is considered safe and usually prevents 30% of MS relapses. Drugs in this class exert almost the same efficacy and require an inconvenient administration route. New medications have recently been launched worldwide. Thus, new oral drugs are increasingly being administered to MS patients and contributing to a better quality of life, since these have better efficacy than the old immunomodulators. Today, 10 different drugs for MS are marketed worldwide, which requires deep knowledge among neurologists and other healthcare professionals. This paper summarizes all the drugs approved for MS in the US and Europe, emphasizing their mechanism of action, the results from phase II and III studies, and the product safety.

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