What Do Clinicians Who Deliver Maternity Services Think Patient-Centered Care Is and How Is That Different for Vulnerable Women? A Qualitative Study

Background. Patient-centered care is said to have a myriad of benefits; however, there is a lack of agreement on what exactly it consists of and how clinicians should deliver it for the benefit of their patients. In the context of maternity services and in particular for vulnerable women, we explored how clinicians describe patient-centered care and how the concept is understood in their practice. Methods. We undertook a qualitative study using interviews and a focus group, based on an interview guide developed from various patient surveys focused around the following questions: (i) How do clinicians describe patient-centered care? (ii) How does being patient-centered affect how care is delivered? (iii) Is this different for vulnerable populations? And if so, how? We sampled obstetricians and gynecologists, midwives, primary care physicians, and physician assistants from a health management organization and fee for service clinician providers from two states in the US covering insured and Medicaid populations. Results. Building a relationship between clinician and patient is central to what clinicians believe patient-centered care is. Providing individually appropriate care, engaging family members, transferring information from clinician to patient and from patient to clinician, and actively engaging with patients are also key concepts. However, vulnerable women did not benefit from patient-centered care without first having some of their nonmedical needs met by their clinician. Discussion. Most providers did not cite the core concepts of patient-centered care as defined by the Institute of Medicine and others

Snoring and sleep-related symptoms: A novel non-invasive 808 nm wavelength diode laser non-ablative outpatient treatment. a prospective pilot-study on 45 patients

Background: Surgical treatments for snoring and sleep-related symptoms are invasive, may have complications, have inconstant success rates, and may have a significant relapse rate. Methods: We evaluated the effectiveness of a non-surgical, non-invasive outpatient 808 nm diode laser treatment. Forty-five patients with snoring and sleep disorders were treated with an Elexxion-Claros\uae 50W Diode Laser 808-nm using the specific SNORE3 application. The possible presence of obstructive sleep apnea syndrome in patients was diagnosed with Polysomnography. The Epworth sleepiness scale was reported pre-and post-laser treatments. Patients were classified according to both Friedman tongue position and Mallampati classification. During treatment, the pain reported by patients was measured on a visual analogue scale. Results: The following data improved significantly: visual analogue scale for the loudness of snoring, Epworth sleepiness scale, waking up during sleep because of snoring, dreaming during the night, dry mouth on awakening, daytime sleepiness, tiredness on awakening, Mallampati score, Friedman tongue position and degree of oropharynx at nose, oropharynx, hypopharynx, and larynx classification (p < 0.001). A cessation of choking in 89% of the patients and of restless legs syndrome in 83% of the patients (p 64 0.005 and p 64 0.025) was also noted after the laser treatments. All of the patients who reported suffering from headaches upon waking (10 subjects) reported the complete cessation of this phenomenon after laser therapy. Conclusions: diode laser treatment is a promising procedure not only in reducing the loudness of snoring, but also in raising the global quality of sleep, a statistically significant reduction of AHI, and a cessation of bothersome phenomenon related to apnea. Results were sustainable at one year post-treatment