Shared decision making and specific informed consent in patients with aortic aneurysms

Introduction: Studies show that vascular surgery patients have the desire to participate more actively in their treatment, but that they find it difficult to express themselves. Patients prefer to know all the therapeutic options available, not just those that the surgeon considers appropriate. With this knowledge, patients can begin to choose the most appropriate therapeutic modality for themselves, also becoming responsible for the therapeutic decision. Therefore, the objective of this paper was to analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed IC form followed by a meeting where the patient and his or her family could analyze each item; Methods: Data from 49 patients who had aneurysms and were offered surgical treatment were retrospectively collected and analyzed. Results: After reading the IC and the described meeting, among the 49 patients, 13 (26.5%) refused surgery. We observed that patients who refused surgery had statistically smaller aneurysms than patients who accepted surgery (9% versus 26%). Conclusion: One-quarter of patients who were indicated for elective surgical correction of aortic aneurysms rejected surgery after SDM, which consisted of the presentation of an IC form followed by a clarification meeting for the patient and his or her family to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm, so patients who rejected surgery had smaller aneurysms than those who accepted surgery.

Effect of Installation of Alcohol Gel Dispensers and Behavioral Nudges on Behavioral Drivers for Hand Hygiene: A Quasi-Experimental Study at a Tertiary Hospital during the COVID-19 Pandemic

Objective: To compare the level of hand hygiene behavioral drivers before and after installation of alcohol gel dispensers and behavioral nudges among outpatients and visitors at a tertiary hospital in Thailand during the coronavirus disease 2019 (COVID-19) pandemic.Material and Methods: A quasi-experimental study was conducted among outpatients and visitors in June 2020. We installed 12 alcohol gel dispensers with signs serving as behavioral nudges at a tertiary hospital in the Internal Medicine Outpatient Department (OPD), Surgery OPD, and the Pharmacy. We trained enumerators to interview outpatients and visitors regarding their behavioral drivers (beliefs about COVID-19 and hand hygiene based on the health belief model, plus handwashing social norms). We analyzed data using descriptive statistics.Results: Enumerators recruited 206 participants in the pre-intervention phase (refusal rate = 37.6%) and 219 participants in the post-intervention phase (refusal rate = 32.2%). There were significant differences between the pre-intervention and post-intervention phases with regard to self-efficacy for hand hygiene (92.0% vs. 100%, respectively), perceived lack of barriers to hand hygiene with alcohol (93.2% vs. 98.2%, respectively), and the proportion of participants who reported that hand hygiene had become a habit (7.5 vs. 18.8%, respectively). Reports of other domains of health beliefs (perceived severity of COVID-19, perceived benefits of handwashing) were homogeneous in both periods.Conclusion: We found differences in perceived lack of barriers and reported habit of hand hygiene but while self-efficacy was homogeneous in both periods. Issues regarding selection bias, construct validity, and generalizability may limit the usefulness of the study data. Caveats should be considered in the interpretation of the study findings.

COVID-19 Vaccine: A Survey of Hesitancy in Patients with Celiac Disease

(1) Background: COVID-19 vaccination campaigns offer the best hope of controlling the pandemic. However, the fast production of COVID-19 vaccines has caused concern among the general public regarding their safety and efficacy. In particular, patients with chronic illnesses, such as celiac disease (CD), may be more fearful. Information on vaccine hesitancy plays a pivotal role in the development of an efficient vaccination campaign. In our study, we aimed to evaluate COVID-19 vaccine hesitancy among Italian CD patients. (2) Methods: an anonymous questionnaire was sent to CD patients followed at our tertiary referral center for CD in Milan, Italy. Patients were defined as willing, hesitant and refusing. We evaluated the reasons for hesitancy/refusal and the possible determinants, calculating crude and adjusted odds ratios [AdjORs] with 95% confidence intervals [CIs]. (3) Results: the questionnaire was sent to 346 patients with a response rate of 29.8%. Twenty-six (25.2%) of the 103 respondents were hesitant, with a total refusal rate of 4.8%. The main reason was fear of adverse events related to vaccination (68.2%). Among hesitant patients, 23% declared that their opinion was influenced by their CD. The determinants positively influencing willingness to be vaccinated against COVID-19 were adherence to a GFD, perception of good knowledge about COVID-19 and its vaccines, and a positive attitude to previous vaccines (AdjOR 12.71, 95% CI 1.82–88.58, AdjOR 6.50, 95% CI 1.44–29.22, AdjOR 0.70, 95% CI 0.11–4.34, respectively). (4) Conclusions: CD patients should be vaccinated against COVID-19 and a specific campaign to address the determinants of hesitancy should be developed.

Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use

Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterine malformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p = 0.002). The mean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p = 0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.

Evaluation of reasons for participation refusal among pregnant women in a perinatal outcome research

Background: The number of protocol-eligible patients, refusing to participate in a biomedical research is often not mentioned in the results of the studies. There are no studies that have looked at the data on willingness to participate in a research among pregnant women in India. The aim of this study is to report the number of pregnant women who refused to participate and to evaluate the reasons for not participating in a research that was concerned with swabbing of the genital tract for culture.Methods: A prospective research study was done among healthy pregnant women, that required collection of vaginal swabs for culture to study the vaginal flora. The women eligible to participate in the study were approached for their willingness to participate in the study. The details of women who refused to participate in the study and the various self-reported reasons for their refusal were documented and analysed.Results: A total 48.2% of the total protocol-eligible group refused to participate in the study and the refusal rate was alarmingly higher than expected. Some of the common responses for their refusal include reasons such as the study involved tests from their private parts, lack of interest to participate and the need to discuss with their partner or that their partner wound not allow them to participate in research.Conclusions: It is important for research studies to include data on the refusal to participate and also the reasons why people refuse to participate in research so as to formulate strategies to improve the acceptance rate for participation in research.

Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder: Quasi-Experimental Cluster Study

Background Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders. Objective This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention’s impact on patients with schizophrenia spectrum disorder. Methods A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants’ commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants’ commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients’ self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires. Results The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P=.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=.46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=.002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients’ self-esteem or other subscales in illness cognition. Conclusions The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.