Evaluating the Effects of Symptom Monitoring on Menopausal Health Outcomes: A Systematic Review and Meta-Analysis

Evidence suggests that monitoring and appraising symptoms can result in increased engagement in medical help-seeking, improved patient-doctor communication, and reductions in symptom prevalence and severity. To date, no systematic reviews have investigated whether symptom monitoring could be a useful intervention for menopausal women. This review explored whether symptom monitoring could improve menopausal symptoms and facilitate health-related behaviours. Results suggested that symptom monitoring was related to improvements in menopausal symptoms, patient-doctor communication and medical decision-making, heightened health awareness, and stronger engagement in setting treatment goals. Meta-analyses indicated large effects for the prolonged use of symptom diaries on hot flush frequencies. Between April 2019 and April 2021, PsychInfo, EMBASE, MEDLINE, CINAHL, Cochrane, ProQuest, PsychArticles, Scopus, and Web of Science were searched. Eighteen studies met the eligibility criteria and contributed data from 1,718 participants. Included studies quantitatively or qualitatively measured the impact of symptom monitoring on menopausal populations and symptoms. Research was narratively synthesised using thematic methods, 3 studies were examined via meta-analysis. Key themes suggest that symptom monitoring is related to improvements in menopausal symptoms, improved patient-doctor communication and medical decision-making, increased health awareness, and stronger engagement in goal-setting behaviours. Meta-analysis results indicated large effects for the prolonged use of symptom diaries on hot flush frequency: 0.73 [0.57, 0.90]. This review is limited due to the low number of studies eligible for inclusion, many of which lacked methodological quality. These results indicate that symptom monitoring has potential as an effective health intervention for women with menopausal symptoms. This intervention may be beneficial within healthcare settings, in order to improve patient-doctor relations and adherence to treatment regimes. However, findings are preliminary and quality assessments suggest high risk of bias. Thus, further research is needed to support these promising outcomes.Systematic Review Registration Number:https://www.crd.york.ac.uk/prospero/display_record.php?, PROSPERO, identifier: CRD42019146270.

The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

ABSTRACT Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis.

Vaginal Vibrator as an alternative to Dilator in vaginal stenosis post pelvic radiotherapy in cervical cancer

Sexuality, post cancer treatment is the most unattended aspect of patient doctor communication. Quality of life in a cancer survivor should be addressed without any inhibitions so that patient does not suffer from any kind of psychological distress. Vaginal stenosis is a well-known side effect of pelvic radiotherapy, which we have tried to address in our study. We have used vaginal vibrator as an alternative to vaginal dilator in two of our patients on experimental basis post vaginal dilator. Both the patients gave feedback that vibrator is comparatively easy to use and less painful. On follow up examination visits, their per vaginal examinations were easy to perform and visibly improved vaginal mucosal health. Psychosexual adjustment is an important domain for better quality of life. Vaginal vibrator is an unorthodox method which we have explored and found some promising results, in overcoming vaginal stenosis and adhesions post pelvic radiation. However, this aspect of treatment as well as method needs to explored.

Patients’ Satisfaction Regarding The Dental Treatment Provided by Educational Dental School in Majmaah University

Introduction: Patient satisfaction with health care is considered to be one of the main objectives of quality ‎care. The satisfaction of the patients has been investigated in different colleges of dentistry in ‎many countries. Assessment of the patients’ feedback could help in promoting best quality of ‎treatment. Aims & Objective. The objective of this study is to determine patients’ satisfaction regarding the quality ‎of treatment at dental clinics of the College of Dentistry at Majmaah University.‎ Material & Method: Self-administrated questionnaire was distributed to patients attending to dental clinics. It was ‎composed of twenty-four closed questions measuring patient satisfaction regarding the dental ‎care provided. This questionnaire had three main themes. First, was the reason why patients chose ‎the dental school and the purpose of the visit. Second, was based on the ease of getting an ‎appointment and staff behavior. Third was related to student/doctor communication and attitude. ‎ Results: A total of 442 questionnaires were collected. Response rate was 88.4% as 442 out of 500 ‎questionnaires were returned. The most of the patients were male (68.1%) whereas female were ‎‎(31.9%). A total of 424 (95.9%) of the participants agreed that it was easy to get an ‎appointment in the dental clinics and a total of 278 (62.9%) were very satisfied with the ‎performance of the reception. Regarding to the treatment Majority of the participant were ‎satisfied with the treatment provider, 295(66.7%) very satisfied.‎ Conclusions: The results of the study reported that dental clinics in the college of dentistry in ‎Majmaah university has been successful in achieving participant’s satisfaction regarding the ‎services, staff, treatment and patient–dentist interaction. Key words: Dental care, Education, patient satisfaction

Corpus Analysis of Interactional Response Words as Indicators of Shared Understanding in Medical Problem-Based Learning Tutorials

Background Shared understanding is essential to effective collaborative learning. Interactive processes occurring in problem-based learning (PBL) tutorials have been explored to determine their cognitive and social advantages, but shared understanding is a relatively under-researched social process of PBL. The objective of this study is to describe how medical students share understanding in medical problem-based learning tutorials. MethodsWe recruited participants from first-year medical students in a single institution’s problem-based learning graduate entry curriculum. Transcripts from full cycles of eight tutorial groups were compiled to form the study corpus. Small interactional response words as indicators of shared understanding were measured using the Wmatrix 3 programme, and concordance lineswere analysed manually to determine word functions. ResultsInteractional response words were most prevalent in session 1 and least prevalent in session 2 of the PBL cycle. Interactional response words were used to mark unexpanded and simple and complex content expansion functions. While affirmation content expansion functions and reactive content expansion functions were more prevalent in sessions 1 and 3, negation content expansion functions were more frequent in session2. The frequency of interactional response words and their functions seem to align with the focus of each PBL tutorial session. ConclusionsDemonstrating the feasibility of corpus linguistics methodology for PBL concept analysis, this study showed that students in PBL tutorials attained sophisticated levels of shared understanding. We discussed the implication of the results for interprofessional teamworking and patient-doctor communication.

978 Improving Satisfaction in Patients with Learning Disabilities

Aim Patients with learning disabilities (LD) are less satisfied because they do not fully understand their surgical management. Poor communication between doctors & LD patients leaves them unhappy & reluctant to seek further help. We aimed to improve satisfaction in 90% of patients. Method In one year in a midlands DGH 201 patients with an LD were admitted. Interviews were conducted which highlighted key problems. Multiple ideas were reviewed, and the simple but effective intervention was a brightly coloured prompt sheet with 4 questions placed in the patient notes: Have you explained: A simple scale tracked the patient & carer satisfaction over 8 weeks as the prompt sheets were introduced to patient notes by the learning disability nurses. Results A 90% increase in patient satisfaction was not achieved but considerable positive feedback was. Moreover, the LD nurses witnessed an increased use of hospital passports among doctors as well as improved patient-doctor communication. A small target population restricts the rapid collection of large amounts of data. The patient satisfaction measure was qualitative, and a 10-point scale would have detailed smaller changes. Lack of carer continuity also made it difficult to collect consistent data. Conclusions The role of learning disability nurses is key to improving patient understanding and satisfaction, but they can be assisted by channelling and maintaining initiatives to raise awareness of the needs of these patients.

Difficulties of general practitioners in (de)prescribing benzodiazepines

Background In Portugal, the consumption of psychotropic drugs, namely benzodiazepines, is almost double the average European consumption. Most of the prescriptions for benzodiazepines (BZD) are carried out by family doctors, since they are doctors more accessible to the general population. Therefore, it is essential to assess the difficulties of family doctors in prescribing and discontinuing BZD in order to understand how to optimize the consumption of these drugs in Portugal. Methods The data were collected through a survey sent to family doctors across the country by email and other digital platforms. The participants were interns and specialists in family medicine and a convenience sample was obtained of 274 physicians. The survey, previously structured, contained three open questions and twenty-five statements to be classified using a Likert scale. For the quantitative analysis, SPSS® program was used and the qualitative analysis was performed using the MAXQDA® data analysis facilitation software. Results Difficulties related to: patient's beliefs/attitudes and doctor-patient communication, means and strategies of prescription and discontinuation, dependence and tolerance, unwanted effects of BZDs, need for BZD and lack of alternatives/resources, doctor-doctor communication and role of the family doctor were identified. Conclusions The qualitative approach used in this study was essential, since the theme of the study is not widely explored in Portugal. An added value of the study is the inclusion of interns in General and Family Medicine. Studies are suggested that deepen these topics and allow the development of appropriate strategies to optimize the process of BZD (de)prescription.

What women want: the effect of health agency advertising on patient-doctor communication

Purpose The purpose of this study is to investigate the relationship between women’s sexual health agency and their intent to initiate communications with their doctors. The research questions examined the effect sexual health agency has on patient-doctor communication, women’s emotional responses to health advertisements encouraging patient communication with their doctors, attitude toward the message and behavioral intentions after exposure to the advertising message. Design/methodology/approach An experimental design was implemented via an online questionnaire instrument to test the differences between younger-aged women (25 to 45 years) and mature-aged women (46 to 70 years). It was observed that 188 women who reported their status as single and sexually active in the past 12 months were exposed to a health advertisement that encouraged patient-doctor communication. Analyses were conducted to compare between-group measures on sexual health agency, emotional response and attitude toward the ad and behavioral intention. Findings No statistical difference existed between younger and older women. In general, women expect their doctor to lead conversations about sexual health but are positively reinforced by health messages that encourage their assertiveness as patients. Research limitations/implications The small sample size also may have limited the study’s potential to evaluate differences between age segments. Future research should explore this further. Practical implications The study provides evidence that sexual health advertising can reinforce women’s intent to initiate conversations with doctors regardless of age. Social implications Health communications can bolster women’s sexual health agency and improve patient-initiated conversations with doctors. Originality/value The study is the first to explore advertising messaging’s potential for applying health agency as a communication strategy for encouraging sexual health communications between women and their doctors.