Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

What Do You Want Us to Know?: Learning From Life Stories to Improve Veterans’ Healthcare Experiences

My Life My Story (MLMS) is a national Veterans Health Administration (VA) life story interview program that aims to provide more humanistic care for veterans by focusing on the patient as a person. Our project took place at the Pittsburgh VA Healthcare System and had 3 main goals: (1) describe themes that emerge in MLMS interviews from the prompting question, what do you want your healthcare provider to know about you?; (2) identify topics of importance to veterans and suggest ways for healthcare providers to explore them; and (3) foster a culture at the Pittsburgh VA that places not only the health but also the personal triumphs, hardships, and aspirations of veterans at the center. Veterans provided verbal consent to have their previously recorded stories used in this study. Stories were coded and then analyzed for patterns and themes. A total of 17 veterans participated in our study. Themes that emerged from the stories include (1) Early Hardships; (2) Economic Disadvantage; (3) Polaroid Snapshots; (4) Around the World; (5) Haunted by Combat; (6) Life-altering Moments; (7) Homecoming; (8) Romantic Beginnings & Obstacles; (9) Inequity across Gender & Race; and (10) Facing Mortality. This study's findings underscore the need to address the traumas associated with military service, as well as the challenges faced with re-integration into civilian life, when working with veterans. The MLMS interviews explored in this study can help clinicians identify topics of importance to veterans, strengthen their relationships with their patients, and improve the care that veterans receive.

Using Shared Medical Appointments for Delivering Patient-Centered Care to Cancer Survivors: A Feist-Weiller Cancer Center Pilot Study

Background: Shared medical appointments (SMAs) have shown promise in the care of patients with conditions such as diabetes; however, the impact of lifestyle medicine-based SMAs on the overall health status of cancer survivors remains poorly understood. Materials and Methods: This cross-sectional survey of patients was conducted to study the impact of a unique lifestyle medicine-based survivorship program on cancer survivors. Results: A total of 64 patients were telephonically contacted for the survey, out of which 39 (60.9%) patients responded. All patients (39 of 39, 100%) found the program to be helpful in some way; 26 patients (66.7%) found SMAs to be significantly helpful, while 13 patients (33.3%) found SMAs as only somewhat helpful. The majority noted feeling a great sense of support (35 of 39, 89.7%), followed by improvement in appetite (21 of 39, 54%) and improvement in pain (14 of 39, 35.9%). All patients reported at least some improvement in subjective well-being (SWB); patients who attended >3 appointments reported significant/very significant improvement in SWB ( P = .03). Conclusion: SMAs offer promise in the effective delivery of lifestyle medicine-focused care to cancer survivors. Further prospective studies are needed to validate these findings.

What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life?

This qualitative study sought to answer three questions: What is it like to live with rotator cuff tendinopathy? What are the barriers and facilitators of a healthy lifestyle with an aging shoulder? And, what are the outcomes that matter most to people seeking care for rotator cuff tendinopathy? Patients diagnosed with rotator cuff tendinopathy participated in group discussions using semi-structured guides that focus on diagnosis, daily experiences living with rotator cuff tendinopathy, goals, concerns, and clinical care experiences. A hybrid of initial inductive coding of themes and subsequent deductive consideration of these themes within the capability, comfort, and calm framework was utilized. Themes associated with rotator cuff tendinopathy were less restful sleep, difficulty with work and life transitions, loss of baseline abilities, and limitation in social roles in the capability realm; physical pain, despair, and loneliness in the comfort realm; and lack of direction or progress and feeling uncared for in the calm realm. Barriers identified included: the sense that rotator cuff tendinopathy is something correctable rather than age-associated and the sense that painful activities will make the tendinopathy worse (common misconceptions); tenuous relationships and limited trust with clinicians; loss of hope; and a sense that care is directionless. What matters most to a person seeking specialty care for shoulder pain are feeling that they are getting effective care and not being dismissed; maintaining meaningful activity and life roles; and replacing despair and frustration with hope and progress. Anticipating these needs may facilitate the design of more effective care models. Level of Evidence: N/A.

Supporting Individuals and Families Impacted by Dementia in Counseling: Case Report

As more than 6 million people in the United States are living with dementia, it is important to foster and train counselors who are specialized in dementia. This case report explores the process and benefits of counseling when individuals and families are impacted by dementia. By understanding multiple changes in the individual and the family system, a counselor can provide guidance and resources to navigate and adapt changes during the disease process. Based on family systems therapy, a counselor can assist the family by facilitating family involvement and communication. It is critical for a counselor to help the family members in understanding how each one may be in a differing stage of acceptance regarding the diagnosis and loss. In addition, dementia-specific counseling should entail psychoeducation of the disease as well as existing community-based resources that are designed to support community-dwelling people living with dementia.

Rural Patients’ Perceptions of Their Potentially Preventable Hospitalisation: A Qualitative Study

Potentially preventable hospitalisations (PPHs) occur when patients receive hospital care for a condition that could have been more appropriately managed in the primary healthcare setting. It is anticipated that the causes of PPHs in rural populations may differ from those in urban populations; however, this is understudied. Semi-structured interviews with 10 rural Australian patients enabled them to describe their recent PPH experience. Reflexive thematic analysis was used to identify the common factors that may have led to their PPH. The analysis revealed that most participants had challenges associated with their health and its optimal self-management. Self-referral to hospital with the belief that this was the only treatment option available was also common. Most participants had limited social networks to call on in times of need or ill health. Finally, difficulty in accessing primary healthcare, especially urgently or after-hours, was described as a frequent cause of PPH. These qualitative accounts revealed that patients describe nonclinical risk factors as contributing to their recent PPH and reinforces that the views of patients should be included when designing interventions to reduce PPHs.

Impact of Patient Communication Preferences on the Patient Trust in Physicians: A Cross-Sectional Study in Iranian Outpatient's Clinics

There are widely emerging concerns that patient confidence in physicians is diminishing as physician–patient communication is threatened globally. This study aimed to assess patient communication preferences and their impact on patient trust in physicians. A cross-sectional study was conducted among outpatient clinics of 2 public and private hospitals in Tabriz, Iran. A total of 704 patients were selected conveniently. Of the 704 patients, 6.39% had low trust, 36.79% moderate trust, 35.37% had a high trust, and 21.45% had blind trust in physicians. Overall patient communication preference score was more in a private clinic rather than a public one ( P = .008). Patients of private hospitals and those who were living in rural areas have been shown to have more trust in physicians. Patients’ trust in physicians showed a significant association with patient communication preference ( B = 0.58; 95% CI: 0.53-0.63, P < .001).

Estimation of Prevalence and Comparing the Levels of Stress, Anxiety, Depression, and Psychological Impact Before and After COVID-19 Lockdown Among Front Line Health Care Workers

The main objective of the study is to estimate the prevalence and compare the levels of psychological impact, anxiety, depression, and stress experienced by the frontline health care workers (HCWs) during the lockdown and post lockdown periods at Apollo Institute of Medical Sciences and Research, Hyderabad, India. All participants involved in the study were evaluated by using depression, anxiety and stress scale 21, the impact of event scale revised scale for post-traumatic stress disorder (PTSD), and a standardized questionnaire. During the lockdown period, the score for depression was observed mean scores to be more in front desk people (2.70) followed by pharmacists and technicians (2.60) and security (2.28) in the lockdown period. During the lockdown, the highest levels of anxiety were seen in security staff (4.72) and housekeeping (4.8), with a considerable increase after the lockdown situation. During the lockdown period, the mean score of pharmacists and technicians (10.33) were more stressed than other HCWs, and the second-highest levels of stress were observed in security (10.11) and front desk workers (10.09), respectively. Our results show that there was a worsening of the psychological impact of the pandemic and an increase in PTSD, stress, anxiety, and depression among HCWs. Female gender, pharmacists, and technicians were the most vulnerable group to develop psychiatric comorbidities.

Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma

Rotationplasty is an established technique that is indicated as part of the surgical reconstruction for certain patients with primary bone tumors around the knee who undergo tumor resection. There is considerable variation in the application of rotationplasty by surgeons as well as acceptance of the procedure by patients who may be candidates for this procedure. We qualitatively studied the decision-making process of families of patients who had undergone rotationplasty by interviewing 4 patients and their families using semi-structured interviews. Thematic analysis identified the following themes that were important in the decision-making process: (1) the desire for good information sources, (2) finding value in meeting with other patients who had been faced with a similar decision, (3) prioritizing function over cosmesis, (4) a desire to limit the need for revision surgeries, and (5) accepting that a return to normalcy is not an option with a surgery. Physicians and patients faced with a similar decision can benefit from a better understanding of the process, and by the normalization of anxieties and concerns that they may experience.