Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study

Background Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood. Methods For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs. Results Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation. Conclusion Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.

Coping with COVID-19 pandemic lockdown – The lady doctors perspective

Objectives: This study is about the challenges faced by the women doctors in India during the first wave of the COVID-19 pandemic. Material and Methods: We conducted an online survey in 2020 for women doctors who were professionally engaged in active patient management in India before the onset of the current pandemic. Results: A total of 260 valid responses were received. Only 28% (73/260) were able to provide at least 50% of professional services as compared to the pre COVID-19 lockdown period. Statistically significant differences related to emotional health (feelings), physical activity, changes in how family sees the lady professional, personal free time availability, and family bonding. Conclusion: COVID-19 has led to the following important concerns for professional women - academic productivity; work-life balance; missed opportunities for collaborating; mental health, the need for equity-minded academic leadership, and decision-making. Our study showed that majority were stressed during the COVID-19 lockdown – with the impact being highest among those giving more than 50% of their time to professional medical services outside their homes.

Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.

Kajian Literatur: Faktor-Faktor yang Mempengaruhi Partisipasi Pasien dalam Keselamatan Pasien

Introduction: Patient participation is globally recognized as one of the main factors for promoting quality and safety of health services. Active patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. Literature review related to determinants of patient participation last five years is limited. The aim of this study was to determine the factors that influence patients to participate in patient safety. Methods: This study used a literature review method by searching online data. Literature was searched through electronic database such as EBSCOhost, Science Direct, and Scopus. The inclusion criteria of article were respondent to the article found are inpatient and nurse, full text articles and publication years from 2015 to 2019.Results: Search results found four articles were eligible to be reviewed. This review indicates that there are two factors that influence patient participation in patient safety, including factors from the patient's side and factors from the nurse's side.Conclusion: These results reinforce that creating patient safety requires the collaboration of all parties, not only from the nurse but also from the patient. Patient involvement needs to be further investigated regarding the extent of patient participation in patient safety.

A REVIEW ON THE CHALLENGES FACED ON REGULAR BLOOD SUPPLY POST COVID - 19 VACCINATION AND THE NECESSITY TO IMPLEMENT AN ACTIVE PATIENT BLOOD MANAGEMENT PROGRAMME

As Covid-19 vaccines are being distributed throughout the nation, there has been increased concern regarding the deferral period for blood donation. There are no uniform deferral criteria across the globe till date and the deferral period in some countries depend upon the type of Covid-19 vaccine being administered. Deferral period post-vaccination has impacted on the number of eligible blood donors available to donate blood which can eventually result in shortage of blood and blood components. An imbalance between the availability and demand of blood supplies can ultimately lead to adverse outcomes in the health care system. Hence, it is imperative to promote autologous blood donation programmes to attain an active patient blood management strategy nationwide so as to reduce the impact of allogenic blood shortage and risks of allogenic blood transfusion.

A qualitative study of patients’ and caregivers’ perspectives on educating healthcare providers

Background: Patients/caregivers can be actively involved in the education of healthcare providers (HCPs). The purpose of this study was to explore patients'/caregivers' perspectives on their involvement and roles in the education of HCPs. Methods: We invited patients/caregivers to participate in one-on-one semi-structured interviews. We analyzed the interview data using conventional content analysis to identify themes. Results: In terms of patient/caregiver involvement in the education of HCPs, we identified that patients/caregivers perceive that it: (a) is challenging because of power-differentials between themselves and HCPs; (b) requires patient training; (c) needs to start early in HCPs’ education processes; (d) can improve patient-HCP partnerships, and (e) requires compensation for patients. With regards to the roles that patients can play in educating HCPs, we found that patients/caregivers want to: (a) teach HCPs about patients’ expectations, experiences and perspectives through case studies, storytelling, and educational research; (b) provide direct feedback to HCPs, and (c) advise on curricula development and admission boards for HCPs. Conclusions: Understanding patients’/caregivers’ perspectives on this topic can help educational leaders and HCPs improve active patient/caregiver involvement in the education of HCPs. We need to listen to patients’/caregivers’ voices in order to make effective changes in current and future health professions education.

The practice of active patient involvement in rare disease research using ICT: experiences and lessons from the RUDY JAPAN project

Background The role of patients in medical research is changing, as more emphasis is being placed on patient involvement, and patient reported outcomes are increasingly contributing to clinical decision-making. Information and communication technology provides new opportunities for patients to actively become involved in research. These trends are particularly noticeable in Europe and the US, but less obvious in Japan. The aim of this study was to investigate the practice of active involvement of patients in medical research in Japan by utilizing a digital platform, and to analyze the outcomes to clarify what specific approaches could be put into practice. Methods We developed the RUDY JAPAN system, an ongoing rare disease medical research platform, in collaboration with the Rare and Undiagnosed Diseases Study (RUDY) project in the UK. After 2 years of preparation, RUDY JAPAN was launched in December 2017. Skeletal muscle channelopathies were initially selected as target diseases, and hereditary angioedema was subsequently added. Several approaches for active patient involvement were designed through patient-researcher collaboration, namely the Steering Committee, questionnaire development, dynamic consent, and other communication strategies. We analyzed our practices and experiences focusing on how each approach affected and contributed to the research project. Results RUDY JAPAN has successfully involved patients in this research project in various ways. While not a part of the initial decision-making phase to launch the project, patients have increasingly been involved since then. A high level of patient involvement was achieved through the Steering Committee, a governance body that has made a major contribution to RUDY JAPAN, and the process of the questionnaire development. The creation of the Patient Network Forum, website and newsletter cultivated dialogue between patients and researchers. The registry itself allowed patient participation through data input and control of data usage through dynamic consent. Conclusions We believe the initial outcomes demonstrate the feasibility and utility of active patient involvement in Japan. The collaboration realized through RUDY JAPAN was enabled by digital technologies. It allowed busy patients and researchers to find the space to meet and work together for the Steering Committee, questionnaire development and various communication activities. While the practice of active patient involvement in Japan is still in its early stages, this research confirms its viability if the right conditions are in place. (331 words).

Traumatic Rupture of the Posterior Deltoid Tendon During Weightlifting: A Case Report and Review of Literature

Deltoid tendon rupture is an infrequent injury. We report on a young active white male who sustained a humeral sided deltoid avulsion tendon rupture while attempting a 450-pound barbell shoulder shrug. Early surgical fixation and a progressive rehabilitation program provided successful short and long-term outcomes in our young active patient.