A qualitative study of Telehealth patient information leaflets (TILs) : are we giving patients enough information?

BACKGROUND: The provision of patient information leaflets regarding telehealth has been perceived by potential consumers as a strategy to promote awareness and adoption of telehealth services. However, such leaflets need to be designed carefully if adoption and awareness among potential users is to be promoted. Therefore, the aims of this study were: first, to see how telehealth was portrayed in some of the existing telehealth leaflets (THLs). Second, to explore patients' perceptions of the existing THLs and their engagement with the concept and how THLs can be optimised. METHODS: A two-step approach was employed to address the aims of this study. The first phase involved the use of discourse analysis to compare 12 electronically and publically available THLs, with the existing THL guidance "Involve Yorkshire and Humber". The second phase involved conducting 14 semi-structured interviews with potential telehealth users/patients to gauge their perception and engagement with the concept, using the two leaflets that were mostly matching with the guidance used. Six interviews were audio-recorded and eight had detailed jotted notes. The interviews were transcribed and thematically analysed to identify key themes. RESULTS: The discourse analysis showed certain gaps and variations within the screened leaflets when addressing the following aspects: cost of the telehealth service, confidentiality, patients' choices in addition to equipment use and technical support. Analysis of the interviews revealed patients' need for having clear and sufficient information about the telehealth service within the THLs; in addition to, patients' preference for the use of simpler terminologies for telehealth description and the provision of clear simple texts with pictorial presentations. The interviews also revealed certain limitations against adoption of telehealth by the participants, such as: lack of privacy and confidentiality of information, fear of technology breakdown and equipment failure, loss of face-to-face contact with healthcare professionals and being too dependent on the telehealth service. CONCLUSION: The current study showed a great variation among the screened THLs and highlighted certain gaps within the content and presentation of these leaflets. However, the study also highlighted certain key issues to be considered when designing THLs in the future to enhance telehealth uptake and use by patients

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Knowledge and awareness of the general public and perception of pharmacists about antibiotic resistance

Background Antibiotic resistance (AR) continues to be a serious problem. Many factors contribute to AR, including inappropriate use of antibiotics, in which both healthcare professionals and patients play a contributing role. This study aimed to assess the awareness and knowledge of antibiotic usage and AR among the general public (in affluent and deprived areas) and community pharmacists' (CPs') in Greater London. Methods A cross-sectional survey involving members of the public was conducted between July 2014 and February 2015. Stage one involved members of the public (N = 384) residing in affluent areas of London. The second stage targeted public (N = 384) in deprived areas of London. In addition, CPs (N = 240) across the same areas were also surveyed. Data analysis was performed using Microsoft Excel and SPSS Software packages. Results Response rate: 36% (n = 139/384) and 57% (n = 220/384) and 25% (n = 60/240) of public residing in affluent areas, deprived areas and of CPs respectively was achieved. Definitive trends in knowledge of how antibiotics work could not be drawn to distinguish between affluent and deprived areas. However, public respondents residing in affluent areas possessed better understanding of AR and prudent use of antibiotics, and this was statistically significant in both cases (p < 0.05). Exposure to an antibiotic campaign (32% in affluent areas, 17% in deprived areas) did not raise public respondents' knowledge on AR and only partially raised their general knowledge on antibiotics usage. Only 20% of public residing in deprived areas received counselling from a CP, among them 74% had an antibiotic prescribed on at least one previous occasion. Those who received counselling displayed better knowledge about concordance/adherence with respect to antibiotic usage (p < 0.05) whereas exposure to an antibiotic campaign made no significant impact on knowledge about concordance/adherence. Conclusion The study highlights that there has been no change in the status quo with respect to awareness of antibiotic usage and AR even after the implementation of several awareness campaigns in England. Those who benefited from CP counselling showed a significant better knowledge towards prudent antibiotic usage which stresses the importance of CPs' counselling on antibiotic prescription

Suicide risk in schizophrenia: learning from the past to change the future

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the results of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophenia patients

Магнітно-резонансна томографія в оцінюванні морфологічних і структурних змін тіл хребців поперекового відділу хребта під час зниження мінеральної щільності кісткової тканини

The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI.Materials and methods. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance.Results. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *).ConclusionIt was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance.Обследовали 81 пациента с различной минеральной плотностью костной ткани тел позвонков поясничного отдела позвоночника. При остеопении статистически значимо коррелируют с показателями минеральной плотности костной ткани тел позвонков задняя высота тела L1, индекс Барнетта-Нордина в теле L4. При остеопорозе данные МРТ морфометрии характеризовались тем, что передняя и средняя высота тел позвонков существенно не изменились при слегка увеличенной задней высоте и соответствующем индексом Барнетта-Нордина (0,81). При остеопорозе статистически значимо с показателями минеральной плотности костной ткани коррелируют задние высоты тел позвонков при слабой коррелятивной связи индекса Барнетта-Нордина в телах L1, L2 и L3. Установлено, что визуализация вены Бреше на МРТ – признак, свидетельствующий о нарушении минеральной плотности костной ткани.  Обстежили 81 пацієнта з різною мінеральною щільністю кісткової тканини тіл хребців поперекового відділу хребта. При остеопенії статистично значущо корелюють з показниками мінеральної щільності кісткової тканини тіл хребців задня висота тіла L1, індекс Барнета-Нордіна в тілі L4. При остеопорозі дані МРТ морфометрії характеризувались тим, що передня і середня висота тіл хребців істотно не змінились при дещо збільшеній задній висоті і відповідному індексом Барнета-Нордіна (0,81). При остеопорозі статистично значущо з показниками мінеральної щільності кісткової тканини корелюють задні висоти тіл хребців при слабкому корелятивному зв’язку індексу Барнета-Нордіна в тілах L1, L2 і L3. Встановили, що візуалізація вени Бреше на МРТ є ознакою, що свідчить про порушення мінеральної щільності кісткової тканини

MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF MORPHOLOGICAL AND STRUCTURAL CHANGES OF THE VERTEBRAL BODIES OF THE LUMBAR SPINE WITH BONE MINERAL DENSITY REDUCTION

The aim of the study was to study the morphological and structural changes of the vertebral bodies in patients with different bone mineral density by MRI. Materials and methods. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance. Results. 81 patients with different bone mineral density (BMD) of the vertebral bodies of the lumbar spine (LS) had taken part in the study. Osteopenia was diagnosed in 33 patients, 28 have osteoporosis and 20 patients without evidence of osteoporosis (according to the DXA, which was made all the investigated) were in the control group. 69 of them were women and 12 men with a mean age 49,6 ± 7,6 years (control group), 56,5 ± 9,8 years (patients with osteopenia), 66,0 ± 9,4 years (with osteoporosis). All patients underwent dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI). DXA has been made on the unit «Lunar PRODIGY Primo DHA» (analysis version: 11.40) manufacture GE Healthcare, according to the standard protocol with the definition of osteoporosis by WHO (1994). In this case, average bone mineral density BMD (g/cm2) in the bodies of L1-L4 were: in healthy ones -1,232 ± 0,06; when osteopenia - 1,032 ± 0,07; osteoporosis - 0,757 ± 0,08. The average T -test was consistent, respectively: T - 1,27 ± 0,71; T - 1,40 ± 011 , T - 3,09 ± 1,73. The difference in BMD between I and II groups was 16,2 % , between I and III groups - 25%. MRI morphometry in patients with osteopenia changes of the vertebral bodies were accompanied by POP: marked reduction in the average height of the vertebral bodies, more pronounced than in osteoporosis, a slight drop height of the front body, reducing of the Barnett-Nordin index (B/N) - 0,84. Osteopenia significantly correlated with BMD of vertebral body height rear L1, the index of B/N in the body of L4. In osteoporosis MRI morphometry data were characterized by the fact that the front and the average height of the vertebral bodies were not changed significantly. In patients with osteoporosis BMD was significantly correlated with rear height of the vertebral bodies - L1 (r - 0,49, p = 0,02), L2 (r - 0,46, p = 0,04), L3 (r - 0,45 p = 0,04). B/N index in the bodies of L1, L2 and L3 had weak connection correlation (respectively, r + 0,31 *, r + 0,25 *, r - 0,27 *). Conclusion It was found that Veins Brescia visualization with MRI along with morphological changes are indicators of the bone mineral density disturbance

The effect of a physical activity programme on improving mood profile of patients with schizophrenia

Objectives: Physical activity in persons with schizophrenia is associated with improvement of physical health parameters, reductions in depression and anxiety and an increased social interaction and psychological well-being. The aim of this study was to examine the effect of an exercise programme on improving mood profile of 30 patients with schizophrenia, separated in three groups (control group, experiment group A and experiment group B) of 10 individuals. Methods: Data from patients with schizophrenia collected using the instrument Profile of Mood States which was selected and administered prior, during and after application of the exercise programme. Repeated measures ANOVA and post hoc paired t-test were used to examine the short-term effect of the exercise programme prior and after the 1st, the 12th and the 24th training session between and within groups, respectively. The eight weeks duration of the exercise programme was conducted combining physical activity with behavioural treatment so as to promote exercise behaviour and minimise drop out risk.Results: Experiment group B participants as compared to those of the experiment group A and control group reported at the end of the exercise programme as felling more vigorous, less depressed and less confused leading to an improved total mood score. Conclusions: Physical activity interventions referring to schizophrenia patients that also incorporate behaviour strategies lead to an improved mood profile of patients with psychosis. © 2014 © 2014 International Society of Sport Psychology