bluuebunny/crossref_metadata_2025 huggingface dataset:
The uptake of active surveillance for the management of prostate cancer: A population-based analysis
Authors: Richard Patrick O. , Alibhai Shabbir M.H. , Panzarella Tony , Klotz Laurence , Komisarenko Maria , Fleshner Neil E. , Urbach David , Finelli Antonio
Published: October 2016

Introduction: Active surveillance (AS) is a strategy for the management of low-risk prostate cancer (PCa). However, few studies have assessed the uptake of AS at a population level and none of thesewere based on a Canadian population. Therefore, our objectives were to estimate the proportion of men being managed by AS in Ontario and to assess the factors associated with its uptake.Methods: This was a retrospective, population-based study using administrative databases from the province of Ontario to identify men ≤75 years diagnosed with localized PCa between 2002 and 2010. Descriptive statistics were used to estimate the proportion of men managed by AS, whereas mixed models were used to assess the factors associated with the uptake of AS.Results: 45 691 men met our inclusion criteria. Of these, 18% were managed by AS. Over time, the rates of AS increased significantly from 11% to 21% (p<0.001). Older age, residing in an urban centre,being diagnosed in the later years of the study period, having a neighborhood income in the highest quintile, and being managed by urologists were all associated with greater odds of receiving AS.Conclusions: There has been a steady increase in the uptake of AS between 2002 and 2010. However, only 18% of men diagnosed with localized PCa were managed by AS during the study period. The decisions to adopt AS were influenced by several individual and physician characteristics. The data suggest that there is significant opportunity for more widespread adoption of AS.
Comparison of prostate MRI-3D transrectal ultrasound fusion biopsy for first-time and repeat biopsy patients with previous atypical small acinar proliferation
Authors: Cool Derek W. , Romagnoli Cesare , Izawa Jonathan I. , Chin Joseph , Gardi Lori , Tessier David , Mercado Ashley , Mandel Jonathan , Ward Aaron D. , Fenster Aaron
Published: October 2016

Introduction: This study evaluates the clinical benefit of magnetic resonance-transrectal ultrasound (MR-TRUS) fusion biopsy over systematic biopsy between first-time and repeat prostate biopsypatients with prior atypical small acinar proliferation (ASAP).Methods: 100 patients were enrolled in a single-centre prospective cohort study: 50 for first biopsy, 50 for repeat biopsy with prior ASAP. Multiparameteric magnetic resonance imaging (MP-MRI) and standard 12-core ultrasound biopsy (Std-Bx) were performed on all patients. Targeted biopsy using MRI-TRUS fusion (Fn-Bx) was performed f suspicious lesions were identified on the prebiopsyMP-MRI. Classification of clinically significant disease was assessed independently for the Std-Bx vs. Fn-Bx cores to compare the two approaches.Results: Adenocarcinoma was detected in 49/100 patients (26 first biopsy, 23 ASAP biopsy), with 25 having significant disease (17 first, 8 ASAP). Fn-Bx demonstrated significantly higher per-core cancer detection rates, cancer involvement, and Gleason scores for first-time and ASAP patients. However, Fn-Bx was significantly more likely to detect significant cancer missed on Std-Bx for ASAP patients than first-time biopsy patients. The addition of Fn-Bx to Std-Bx for ASAP patients had a 166.7% relative risk reduction for missing Gleason ≥ 3 + 4 disease (number needed to image with MP-MRI=10 patients) compared to 6.3% for first biopsy (number to image=50 patients). Negative predictive value of MP-MRI for negative biopsy was 79% for first-time and 100% for ASAP patients, with median followup of 32.1 ± 15.5 months.Conclusions: MR-TRUS Fn-Bx has a greater clinical impact for repeat biopsy patients with prior ASAP than biopsy-naïve patients by detecting more significant cancers that are missed on Std-Bx.
Moral and Social Values Embodied in the Books Content of National Interactive Curriculum for Kindergartens in Jordan—An Analytical Study
Authors: Al-Mohtadi Reham M , El-Subhieen Eid H , Al-khattab Ahmad A
Published: October 2016

The study aimed to discuss the moral and social values embodied in the books contents of national interactive curriculum for kindergartens in Jordan; through analyzing such books’ contents. For the purposes of this study, a list of proposed moral and social values was prepared, including twenty eight values. Word, phrase and image are considered herein as analysis tools. The Generated outputs referred to 360 values which are contained in the books of national interactive curriculum for kindergartens in Jordan. The National Social values field occupied the first rank of 256 repetitions, at 71.11%. On the other hand, family personal values field occupied the 2nd. rank; 104 repetitions at 28.89%. The outputs also displayed the availability of many suitable moral and social values stipulated for in the study tool. In turn, it was noticed the unavailability of many suitable moral and social values.
Food Quality Induces a Miscible Disease with Relevance to Alzheimer’s Disease and Neurological Diseases
Authors: Martins Ian J.
Published: October 2016

Food and nutrition guidelines for the handling and processing of fresh fruit, bread, and vegetables are essential and fresh produce may require cold preservation procedures to prevent minimal bacterial and fungi contamination of food. Bacterial lipopolysaccharides (LPS) corrupt lipoprotein and amyloid beta (Aβ) metabolism in diabetes, Alzheimer’s disease (AD) and various neurological diseases. In the developing world the increased plasma LPS levels induce non-alcoholic fatty liver diseases and interfere with albumin and Aβ interactions with spontaneous Aβ oligomer formation in the cerebrospinal fluid and brain that leads to neuron apoptosis by inactivation of Starling’s equation that is responsible for the maintenance of hydrostatic and oncotic pressure with relevance to fluid balance. In the developing world increased levels of LPS, mycotoxin and xenobiotics lead to irreversible neurological diseases by inhibition of Starling’s equation for maintenance of oncotic/osmotic pressure that lead to neuron senescence or apoptosis. In the developed world nutrigenomic diets are required that prevent Sirtuin 1 gene repression and maintain neuron survival that links the brain and peripheral hepatic monomer Aβ metabolism. The maintenance of blood-cerebrospinal fluid capillary transport of albumin and monomer Aβ is relevant to stabilization of neurons not only in Alzheimer’s disease but also in Type 3 diabetes and various neurological diseases. Healthy diets reverse the inhibition of brain to peripheral Aβ transport that is sensitive to Starling’s equation for regulation of central nervous system hydrostatic and oncotic pressure with the prevention of diabetes, various neurological diseases and Alzheimer’s disease.
Child-Centric Intervention Research: The Devil is in the Detail
Authors: Campbell Catherine , Collins Marjorie , Reid Corinne
Published: October 2016

This paper discusses conceptual, ethical, pragmatic and paradigmatic constraints encountered in a T2 ‘bench to bedside’ translational research endeavour piloting an early intervention program for young children who have experienced sexual abuse. The resultant child-centric intervention research framework emerged from the challenges associated with trauma-related clinical work, the absence of an evidence-base and the difficulties of adopting traditional positivistic methodologies when evaluating practice in this complex field. Critically, the resultant framework was person-centred and, hence, individually responsive. More specifically, it was child-centred and so developmental and systemic issues were privileged.
Valuing the Flourishing Life
Authors: Pickles Charles
Published: October 2016

In this paper it will be argued that the naturalist metaphysical assumptions of scientific attention to psychological, physical and behavioural aspects of the person, with particular attention to the explanatory normative promise of evolutionary psychology, might be necessary, but are not sufficient to establish any final picture of the flourishing person. How and what we are shaped to be, is amongst these factors, a consequence of our capacity to escape the causal determinants of biology and be responsive to matters of value as embodied in our social institutions. Because we are self-reflective, imaginative and critical, we construct varying cultures which sometimes embody very different pictures of what is to be valued and what is to count as identity and flourishing with respect to those values. If this is the case, then it is also necessarily the case that any visions of healthcare incorporating a broad scope directed towards flourishing and wellbeing will incorporate a picture of the healthy person governed by some ethical, socio-political or religious framework. Values so derived might sometimes be unwittingly implicit in a putatively neutral ‘scientific’ account of wellbeing.
Communication about life-sustaining therapy: insights from the Adaptive Leadership Framework
Authors: Neglia Elizabeth , Anderson Ruth , Brandon Debra , Docherty Sharron
Published: October 2016

Objective: Effective provider and caregiver communication is central to quality care during treatment for life-threatening illnesses. The study aim was to analyze communication patterns between providers and a parent of an infant with a life-threatening disease using the Adaptive Leadership Framework, which is an activity that involves mobilizing others to adapt to a difficult situation.Method: A secondary analysis was conducted using 23 interviews of providers and mother with an infant diagnosed with Hurler’s syndrome. The interviews focused on decision-making challenges in regard to the infant’s treatment and were conducted over a 1-year period (pre-transplant, study entry, monthly, after a life-threatening event or substantial change in treatment and at 1-year post enrollment). Content analysis was used to identify and categorize communication patterns using concepts from the Adaptive Leadership Framework.Results:  Infant illness events and parent-provider caregiving were chronicled across a 1-year trajectory.  Despite the life-threatening nature of Hurler’s disease, the parent and providers did not discuss palliative care or end-of-life. The parent sought direction and answers from the providers. The Adaptive Leadership Framework suggested how communication approaches were often mismatched with the apparent needs of the parent. Discussion:  The results of the study accentuate the need to improve communication between provider and parents about end-of-life for their child. Adaptive Leadership illuminates how providers can influence a parent’s behavior when facing a challenging situation. This study suggests that Adaptive Leadership is a useful framework to guide research about healthcare communication in dealing with challenging issues.
Logos, ethos and pathos in balance - the care of the patient and the soul of the clinic: person-centered medicine as an emergent model of modern clinical practice.
Authors: Fuller Jonathan , Upshur Ross
Published: October 2016

In a recent discussion paper, Miles and Mezzich described person-centered medicine (PCM) as a model of modern medical practice that has emerged from the intellectual currents of the past century. In this commentary, we consider what PCM has to offer as a model for the clinical encounter and for clinical judgement. The doctor-patient relationship is an important thread in a person-centered medicine that visualizes the clinical encounter as a dialogue between 2 persons. Person-centered clinical judgement is concerned with the individual clinical case and as such is integrative, context-sensitive, interpretive and circumstantial. A care model incorporating these elements of dialogue and individualized judgement is ideal for older patients, for whom population-level guidelines are often inapplicable, who are often dependent on other persons and who are heterogeneous in their needs. As such a model, PCM is the dialectic synthesis arising out of decades of conflict between patient-centered medicine, and its antithesis, evidence-based medicine. If PCM is to progress from a prescriptive model to a descriptive model of modern medicine, its proponents must claim its philosophical commitments, keeping in mind that a model is fundamentally instrumental and not necessarily always literal. Medicine should look to a care model that is person-centered in the ways described here and that keeps the rational, virtuous and humane elements of practice in balance.
Shared decision-making: merging evidence into patient- centered care
Authors: Elwyn Glyn
Published: October 2016

Miles and Mezzich  argue for the coalescence of evidence-based medicine (EBM) and patient-centered care, citing many of the key protagonists that have argued for the central place of 'the patient' in the clinical process of care for almost a hundred years. Peabody, Engel, Levenstein and many more have put cogent cases forward, but very little seems to change. They see clinical practice as being too technical, too mechanistic, driven by impersonal protocols and guidelines. The person and his/her family become lost and confused among fragmented systems of care that fail to develop any semblance of relationship or continuity and where personal preferences get short shrift. The trend shows no sign of abating, as technological advances increase levels of specialisation.
Can person-free medical knowledge inform person-centered medical practice?
Authors: Kirkengen Anna Luise , Mjolstad Bente Prytz , Getz Linn , Ulvestad Elling , Hetlevik Irene
Published: October 2016

We have taken great pleasure in reading the comprehensive and detailed review of the latest development in biomedical clinical practice presented by Miles & Mezzich [1]. We hereby respond to the invitation implicit in the authors’ categorization of their paper as “for discussion”. We feel an urge to add some reflections regarding a core topic not addressed in the paper. But initially, we present our condensed interpretation of Miles & Mezzich’ s text, prior to setting out the ground for our subsequent reflections.
Clinical Decision-Making for a Person Centered Medicine: the necessity of casuistic reasoning
Authors: Tonelli Mark
Published: October 2016

In their call to develop a consistent, coherent and comprehensive notion of person-centered medicine, Miles and Mezzich have elucidated several specific challenges that need to be urgently addressed. One of these foundational tasks is the development of a more complete understanding of person-centered clinical decision-making. Miles and Mezzich note that while the emphasis on clinical research in evidence-based medicine has served to de-emphasize the importance of the individual patient, the alternative of patient-centered medicine has the potential to de-emphasize the judgment of the clinician by making unfettered patient choice paramount. A practice of medicine that reduces professional healers to an informational role only, one where they lay out potential interventions devoid of context and allow patients to choose from amongst them, undervalues clinical expertise and will clearly not lead to better outcomes. Person-centered medicine (PCM), then, must be able to develop and defend a model of clinical judgment and practice that strikes the correct balance between the science of medicine and the personal experience of the individual in search of care.
Response to Miles and Mezzich
Authors: Turner Andrew , Blakey John , Kerry Roger
Published: October 2016

Miles and Mezzich offer a welcome and comprehensive account of historical recent developments in healthcare and the role of its practice models. They identify a ‘crisis’ in medicine, which seems to have occurred in part because the science of medicine has been over-emphasised and the importance of compassion and care de-emphasised.  As they point out, this crisis has been perceived to have evolved over the past one hundred years. Evidence Based Medicine (EBM) is suggested to be inadequate to solve the crisis and it may be the case that EBM, in fact, has precipitated it because it ignores patients qua persons. It is also suggested that Patient Centred Care (PCC) seeks to address the imbalance, but that this is inadequate, too. Between these existing views it is claimed that Person Centred Medicine (PCM) solves the crisis by giving persons and evidence their proper roles and relative importances
Values as ‘modest foundations’ for medicine
Authors: Little Miles , Gordon Jill , Lipworth Wendy , Markham Pippa , Kerridge Ian
Published: October 2016

Medicine and healthcare have been around for thousands of years, but we seldom ask why they are so important. It seems self-evident that we should seek relief of suffering from some institution in the society in which we live and equally self-evident that each society should provide healthcare for its people at some level. Yet when we inquire further, we are driven to seek foundational answers to iterative questions, seeking answers at deeper and deeper levels. Ultimately, it seems best to accept the Humean refuge [1] and finish with some such statement as “Humans are like that” or “Societies can’t function in any other way”.These Humean questions suggest that survival, security and flourishing are endpoints for such an inquiry and that medical (and many other) systems are built on these implicit foundations. The ways in which societies build relevant systems (such as medicine, welfare, law, transport, housing and so on) will differ strikingly, but common ground will still exist at the foundational level.Acknowledging a commonality of foundations does not commit one either to a conservative normativity, nor to a loose relativism. Increasing activity at the level of the International Court of Justice makes clear that there is a possibility of consensus for judging the validity of the interpretations and enactments of foundational values in any society. The ideals of the American Declaration of Independence – life, liberty and the pursuit of happiness – are principles very similar to the foundational values of survival, security and flourishing. Person-centered medicine is inescapably based on theories of the person and must therefore be able to offer an account of what personhood is. Values underpin the philosophy and practice of medicine, including person-centered medicine, because they are foundations of personhood, as well as foundations of the societies in which each person lives.
Can An 8-weeks Mindfulness-Based Medical Practice Training Program for Medical Students Promote Person-Centred Medicine in their Practice? A Commentary.
Authors: Gafni Amiram , Charles Cathy
Published: October 2016

Can An 8-weeks Mindfulness-Based Medical Practice Training Program for Medical Students Promote Person-Centred Medicine in their Practice? A Commentary.
Measuring family-centred care: working with children and their parents in two second level hospitals in Australia
Authors: Shields Linda , Mamun Abdulla A , Flood Kirsty , Combs Shane
Published: October 2016

Rationale and aim: As a model of care, family-centred care (FCC) is ubiquitous in paediatrics. In a previous study we demonstrated the attitudes of health professionals in a tertiary children’s hospital towards when working with children and with their parents. This present study replicates that project in two second-level hospitals.Method: We used a validated questionnaire with two scores, one for working with children and one for working with parents. We examined demographic characteristics and compared responses from a randomized sample of nurses, doctors, allied health staff and ancillary workers. We compared means and medians of scores given to working with children and working with parents, using a Wilcoxon signed rank test p<0.0001. Mean differences by categories of demographics were estimated using ANOVA and median test compared the median scores.Results: Participants gave significantly more positive scores for working with children than parents. These were influenced by level of education, whether respondents were parents themselves, the time they had worked in their respective occupations, if they had worked with children for a long time and held a paediatric qualification.Conclusions: Staff in two similar second level hospitals experienced working with children in a more positive light than working with their parents. We argue that if FCC was being implemented effectively, there would be no observable difference between working with children or their parents.
Social capital and care in the community: a methodological study
Authors: Papastavrou Evridiki , Andreou Panayiota , Middleton Nicos
Published: October 2016

Rationale, aims and objectives: Healthcare reform systems require that individuals with long term and complex health problems to be cared at home by their families making informal caregivers a critical national healthcare resource. Caregiver support may be better understood in the context of the social capital framework that has the capacity to support health and wellbeing for the patient and caregiver through a combination of connections, informal exchange, informal non-family relations and resource acquisition.The aim of the study was to assess the validity and reliability of the Social Capital Questionnaire (SCQ-Greek) amongst Greek-speaking community dwellers in Cyprus.Methods: The SCQ was administered to a total sample of 225 Greek Cypriot community dwellers consisting of 2groups - a group of family caregivers of patients with dementia (n=76) and a neighborhood-matched control group (n= 149). Exploratory factor analysis using Varimax rotation was performed and items with factor loadings greater than 0.4 were retained. Cronbach’s coefficient of internal consistency was calculated for the overall scale and sub-scales. The association of Social Capital and its components (factors) with the socio-demographic characteristics of the participants were investigated in regression analyses.Results: A 6-factor solution with 28 items accounted for 48.3% of the variance. The item-total correlation ranged from 0.20 to 0.49 indicating that each of them contributed to the total score. For the overall instrument, Cronbach’s alpha was 0.83 and ranged between 0.55 and 0.82 for the individual factors. Generally, younger individuals, those with higher educational attainment and higher income tended to report higher levels of social capital.Conclusions: Findings demonstrate that a 28-item version of the SCQ is a reliable and valid tool for the assessment of perceptions of social capital among Greek-Cypriot community residents which included a sample of caregivers of the chronically ill. A tool to measure the perceptions of social capital is important for the understanding and utilizing the broader resources required for the care of the chronically ill in the community.
Use of Complementary and Alternative Medicine Among Pediatric Ophthalmology Patients in San Diego, California
Authors: Hilkert Sarah M , Askari Naz , Hirsch Jan D , Robbins Shira L
Published: October 2016

Objectives:   Complementary and Alternative Medicine (CAM) has become increasingly common in pediatrics.  While previous studies have evaluated pediatric CAM use across various subspecialties, estimates regarding pediatric CAM use in ophthalmology are lacking. This study explores CAM use among pediatric ophthalmology patients in a pediatric ophthalmology practice.Methods:  609 self-report questionnaires were distributed to parents whose children were seen at the University of California, San Diego / Ratner Children’s Eye Center between July 2009 and January 2010.  The survey included questions regarding demographic information of the parent, eye condition of the child, and CAM use by the child. The two main outcomes were CAM use in the past and preference for CAM use in the future. Results:  126 surveys were included in the final analysis.  Overall, 11% of parents reported previous CAM use for their child’s eye condition, and 44% of parents indicated a preference for CAM use for their child’s eye condition, depending on the side effects.  Logistic regression revealed that past CAM use was not associated with the parent’s race, gender, or level of education.  However, CAM preference was negatively associated with the parent’s level of education (p = 0.045). Discussion:   As with other pediatric subspecialties, treatment of children with CAM is common in pediatric ophthalmology.  Given the significant number of parents who reported using CAM and/or a preference for CAM, our results emphasize the need for all pharmacists, ophthalmologists, and pediatricians to discuss CAM use with patients and their families.
Involving stroke patients and carers in the planning and conduct of a research study exploring the use of art therapy in stroke rehabilitation
Authors: Ali Khalid , Parekh Nikesh , Roffe Christine , Waller Diane
Published: October 2016

Background Demonstrating meaningful Patient and public involvement (PPI) in research is a core requirement by research funders and ethics committees. However PPI amongst older people is relatively neglected. This paper describes the involvement of older people in planning and conducting a research study exploring Art Therapy (AT) in stroke rehabilitation. Methods The research team discussed the proposed study in a semi-structured focus group meeting with four stroke survivors (and 2 carers) recently discharged from hospital, and separately with another two stroke survivors.  Following input from PPI in the planning stage; the actual AT study was conducted involving six male stroke patients over six weeks. Weekly on-going input from the study participants themselves informed conduct of subsequent AT sessions. After completing the AT study, another meeting was held with the study participants to inform a future larger study. Results The stroke survivors and carers confirmed the relevance and need of a creative research intervention such as AT in stroke rehabilitation. PPI informed the methodology as group interactive AT rather than one-to-one sessions, recommended including a qualitative narrative of the study, and informed practical aspects of the study such as timing, location, facilitation, assessment and evaluation. Post study feedback with the research participants helped identify positive and negative aspects of the conducted study, and shaped a current grant application. Conclusions We have demonstrated the value of engaging older people in planning research.  It is feasible, enhances the quality of the research and ensures that the study design meets the participant needs.
New Zealand health professional and patient perceptions of chronic illness care
Authors: Doolan-Noble Fiona , Gauld Robin , Waters Debra L , De la Barra Sophia Leon
Published: October 2016

Background: In 2004 the New Zealand Ministry of Health announced additional funding, called Care Plus, for primary care to enhance provision of chronic illness care. There has, however, been no national evaluation of the impact of this additional funding.Objective: The main purpose of this study was to assess patient and primary health care provider (PHCPs) perceptions of chronic illness care in the Southern region of New Zealand.Design and Setting: Cross-sectional survey of patients with multiple chronic conditions in conjunction with a survey of all PHCPs in the Southern Region of New Zealand.Method: The Modified Patient Assessment of Chronic Illness Care (M-PACIC) survey was mailed to a random sample of 500 patients enrolled in Care Plus and all PHCPs in the region. M-PACIC assesses care across six domains: patient activation; delivery system; goal setting; problem solving; follow up and care coordination; and cultural sensitivity.Results: Thirty-one percent (n=198) of PHCPs responded compared to fifty-two percent (n= 259) of patients. At least one response was received from 77% of general practices in the region. The difference in perceptions of care between patients and PHCPs was statistically significant (p=<0.001) across five of the six domains, with the delivery system domain also reaching statistical significance (p=0.018).Conclusion: Overall, patients reported lower chronic care competency scores than health professionals. This suggests that additional funding provided to primary care via the Care Plus programme has not improved the health care experiences of patients living with chronic illness in the region.
Knowledge and Awareness about Osteoporosis among Jordanian Women
Authors: Alefishat Eman , Hammad Hana , Shehadeh Mayada , Ramadan Sana , Mukattash Tariq
Published: October 2016

Objectives: Although osteoporosis is now recognized as a major health problem in Jordan, there is limited information on public perceptions, awareness and knowledge of osteoporosis. The aim of this study was therefore to assess awareness, perception and factors affecting osteoporosis knowledge in female patients in Jordan. Methods and study design: The study was a cross-sectional correlation study. A total of 309 Jordanian women were recruited through this study. Main outcome measures: Participant knowledge was largely assessed using the Osteoporosis Questionnaire (OPQ). Results: The mean total score was 9.26 (SD ± 3.67; range 0 to 18; maximum possible score 20). Eighty five percent of the sample had heard of osteoporosis and 49.2% knew the correct definition of osteoporosis. Bivariate and multivariate regression analysis showed that women with a higher level of education, or who were single had significantly higher osteoporosis knowledge score. The majority of the participants were unaware of the beneficial effects that hormone replacement therapy (HRT) has on preventing the progression of osteoporosis. Conclusions: Our results highlight the importance of involving health authorities and physicians in public education efforts in order to improve knowledge as well as maintain the quality and reliability of information provided to patients on osteoporosis. The characterization of existing patient knowledge on osteoporosis and the consideration of efforts to increase it is an important contribution to patient education and empowerment and thus to person-centered healthcare.
Virtues: foundations for medical ethics?
Authors: Knaup Marcus
Published: October 2016

"The Terrorism of Virtue." This was the title of an article published 2012 in the German weekly Die Zeit. The article was about self-proclaimed guardians of virtue who are convinced they always know what is good for their neighbors. Their insights range from advising against smoking to demanding that everyone should follow certain trends. And this brings us directly to our central topic: we follow Aristotle in exploring what is really meant by virtue and whether the virtuous person is in fact a "moralistic terrorist". Our understanding of virtue will then allow us to take a brief look at current issues in medical ethics, in this article and how they relate to the growing movement of person-centered healthcare.
Students’ lack of knowledge regarding healthcare providers’ duties, and their preferences for information when selecting new providers
Authors: Perrault Evan
Published: October 2016

Rationale, aims and objectives: When USA college students need medical care, their first destinations are usually campus health centers. Normally, staffed by a variety of care providers (e.g., nurse practitioners, physician assistants, physicians), students may be confused about who they may need to see and possibly hesitant to receive care. The present study sought to determine students’ knowledge about primary care providers and the qualities they would like to know about them prior to consultations. The goal of this paper is to improve the information campus health centers in terms of their ability to provide students health solutions when and where they need them. Methods: 534 USA college students from a large Midwestern USA university completed a web-based survey about their knowledge, attitudes and information preferences regarding their various care providers. They also viewed 3 experimentally manipulated biographies of providers and chose the provider they would want to visit. Results: The majority of students did not know the differences between physicians, physician assistants and nurse practitioners and the types of care that they could provide. About 9% stated they would not seek care and 16% would delay seeking care if unable to see a physician immediately. The most important pieces of information desired were providers’ philosophies of care, certifications, areas of specialization and length of time practising medicine. As students perceived greater similarities due to more personal information provided in the biographies, they viewed, uncertainty was reduced leading to higher levels of anticipated patient satisfaction and quality of care. Conclusions: USA college students need greater levels of education regarding the care that can be received from a variety of healthcare professionals. Information provided should also include more personal information about the providers to help reduce students’ uncertainty and to enable students to access services that are person-centered in their nature.
NHS at the hustings: four quality indicators for a person centred medicine.
Authors: Cox John , Gray Alison
Published: October 2016

No abstract
PSYCHOGENIC VOICE DISORDER: A VIEW THROUGH THE LENS OF SELF
Authors: Jacobs Margaret , Van Biene Leo
Published: October 2016

Patients with psychogenic voice disorder (PVD), a disorder of voice in the absence of identifiable pathology, present a particular challenge to clinicians. Although the voice can usually be restored by the use of speech therapy, recurrences can only be prevented by psychotherapeutic intervention. Psychological factors have been long recognized as playing a role in these disorders, but the nature of this contribution has been unclear. Various conceptual frameworks have been used to understand this disorder. While for much of the last century, “conversion” has been seen as the primary process that underpins this disorder, little attention has been paid to the role of dissociation in this regard. This paper explores the utility of viewing PVD through a lens of Self. In so doing, PVD can be considered as a symptomatic expression of a compromised sense of Self which has its genesis in relational trauma and maladaptative defensive maneuvers. These are underpinned by complex dissociative processes which operate largely outside of conscious awareness. A clinical vignette demonstrates the utility of treating this disorder with both speech therapy techniques and a specific mode of psychotherapy, the Conversational Model, which is focused on the fostering of a sense of Self.  It will be shown that this perspective not only provides a clear view of the genesis of thisdisorder, but also describes a pathway for effective treatment.
Visit Entropy: comparing a novel method to existing continuity of care measures
Authors: Garrison Gregory M , Bania Buck
Published: October 2016

Introduction: Continuity of care is a key characteristic of primary care yet there is little agreement on an accepted measure of continuity.  Density (Usual Provider Continuity, Primary Provider Continuity), dispersion (Continuity of Care Index), and sequence (Sequence of Care Index) are often used measures, but they each have specific drawbacks when applied to patients with multi-comorbidity who are cared for within a patient-centered medical home practice.Methods: A new measure of continuity called Visit Entropy was developed using mathematical constructs from information theory and physics.  This was compared to four existing measures of continuity in a dataset of 811 hospitalized primary care patients.Results: Visit Entropy is inversely related to other measures of continuity of care.  It has a less skewed distribution and it helps differentiate the substantial number of patients at the extremes of other measures of continuity of care.  Visit Entropy also eliminates the problem of undefined values caused by division by zero seen in other continuity measures.Conclusions: Visit Entropy solves many of the shortcomings of existing continuity measures when applied to a dataset of primary care patients cared for within a medical home practice.  Further study is indicated to determine if Visit Entropy is associated with the benefits commonly ascribed to continuity of care and if it matches patient and physician perceptions of continuity of care.
David Smyth. (2013). Person-Centered Therapy with Children and Young People. London: Sage Publications. ISBN 9 78057 027603
Authors: Lindsay Margot
Published: October 2016

No abstract
A participatory learning model and person-centered healthcare: moving away from “one hand clapping”
Authors: Stephens John
Published: October 2016

The level of complexity within healthcare practice makes close collaboration with ‘service users’ a necessity in the education of pre-registration healthcare professionals to promote the development of optimal clinical decision making skills in the delivery of safe, effective, and efficient person-centred care.  This article reports on the development of a series of facilitated workshops within two pre-registration physiotherapy programmes framed by an adapted participatory learning model, underpinned by the concepts of complexity science, in an attempt gain some understanding of the facilitation of learning that is person-centred and collaborative in nature.The participatory learning model offers a structure to organise a learning process in a manner that is not only conceptually appealing but also of practical use. The model would seem to have the potential for transfer to broader areas of professional education. In embracing participation and complexity ‘don’t be afraid to start’, and ‘learn from doing’ are key messages of encouragement. However, it is important to think about any training needs across organisations and individuals, to find and nurture relationships, and to be creative and also have clarity of purpose.
Assessing patient-centered care: Validation of the French Version of the Patient-Practitioner Orientation Scale (PPOS)
Authors: Paul-Savoie Emilie , Bourgault Patricia , Gosselin Emillie , Potvin Stephane , Lafrenaye Sylvie
Published: October 2016

Rationale, aims and objectives: Patient-centered care (PCC) is widely acknowledged as a central component of high-quality health care and it has been associated with many positive outcomes for patients. Although many studies support the benefits of PCC, the style of practice may vary from a caregiver to another. To measure PCC and investigate the factors that may be related to this concept, it is necessary to have rigorous instruments. Thus, the aim of this study was to adapt and validate a French version of the PPOS (F-PPOS) for the assessment of PCC in both nurses and physicians who work with chronic pain patients.Method: The PPOS was translated and validated in a French population of nurses and physicians according to the Hébert methodological recommendations for translation and validation. The final version of the F-PPOS was distributed to 21 nurses and 21 physicians working with chronic pain patients. The content validity and the internal consistency were assessed. Results: The expert panel was satisfied with the content validity of this instrument. The internal consistency was acceptable for the total score for all participants (Cronbach’s alpha = 0.60), for nurses (Cronbach’s alpha = 0.62) and for physicians (Cronbach’s alpha = 0.54). The F-PPOS showed good content validity and acceptable internal consistency.Conclusions: The F-PPOS could be used in future studies in French populations, in both nurses and physicians. This instrument can also be used to compare the type of approach between caregivers in worldwide since it is available in several languages.
Measuring family-centred care: working with children and their parents in a Turkish hospital
Authors: Shields Linda , Çavuşoğlu Hicran , Pars Hatice , Mamun Abdulla A.
Published: October 2016

Rationale, aims and objectives: Family-centred care is the model of care in most children’s hospitals, but is difficult to measure. This study examined health professionals’ attitudes to working with children and with parents in a Turkish hospital. It builds on previous studies, using the same questionnaire, to test a component of family-centred care. Method: The “Working with Families” questionnaire contains scores for working with children and parents and demographic questions. Nurses, doctors and allied health staff working with children in a Turkish paediatric hospital were asked to complete this anonymous questionnaire (response rate 91%). We used Wilcoxon signed rank test to compare the two scores; the influence of demographic characteristics was tested with ANOVA. Results: Participants (N=205) gave more positive mean scores for working with children (4.242, SD=0.53) than parents (2.26, SD=0.8) (p<0.05). Influencing factors were similar to other studies, except for participants having children of their own - those with children gave a less positive mean score for working with parents than working with children (p=0.003); holding a specialist paediatric qualification had a similar effect (p<0.001). Conclusion: Similarly to other studies in this series, health professionals were much more positive about working with children than parents, with much stronger differences. Questions about the applicability of family-centred care as a model of care in this Turkish hospital arise. Theoretically, if family-centred care was being implemented effectively, there would be no difference. Education about family-centred care is needed, as well as further research to investigate why these differences occur.
Consultant Pharmacist Case Management of Older People in Intermediate Care: a New Innovative Model
Authors: Miller Ruth , Darcy Carmel M , Friel Anne , Scott Michael G , Toner Stephen B
Published: October 2016

Rationale, Aims and Objectives: In 2011, ‘Transforming Your Care’ outlined the remodelling of Health and Social Care in Northern Ireland (HSCNI) UK, specifically recommending better integration of hospital and community services for older people. This work aimed to evaluate consultant pharmacist case management for older patients admitted from acute to intermediate care continuing back into the community setting, given the importance of such a transition to person-centered healthcare.  Method: On transfer to intermediate care, the consultant pharmacist determined the Medication Appropriateness Index (MAI) for each drug prescribed. Individualised pharmaceutical care plans were implemented with clinical interventions recorded and graded using Eadon criteria. Cost savings resulting from interventions which prevent medication errors/Adverse Drug Events (ADEs) have been estimated using the model as described by the University of Sheffield School of Health and Related Research (ScHARR); these were applied. Drugs stopped/started were costed using the NHS dictionary of medicines and devices (dm+d). Case management continued via communication with GPs and/or community pharmacists and post-discharge patient telephone calls/home visits.  Results: Three hundred and fifty-five patients had 3674 drugs assessed for medication appropriateness; both individual and total drug MAI scores on admission to and discharge from intermediate care, were significantly reduced (Wilcoxon signed rank test, p<0.001, n=355). An average of 2.5 clinical interventions per patient were made, with 84% being self-graded as Eadon ≥ Grade 4 (significant interventions resulting in improved care standards). Clinical interventions yielded potential savings of £63-144k pa whilst annual drug cost savings were £68k. Conclusion: This project demonstrated consultant pharmacist case management results in both cost savings and more appropriate prescribing with safer, seamless and more person-centered care.
Cross-Cultural Adaptation and Validation of the Comprehensive Needs Assessment Tool (CNAT) for Chinese Cancer Patients
Authors: Zhang Yin-Ping , Wei Huan-Huan , Zhao Xin-Shuang , Zhang Yao , Xu Ya-Qiong , Porr Caroline
Published: October 2016

Rationale, aims and objectives: The appropriate assessment of a cancer patient’s needs is critical for high quality care services. However, a systematic assessment of an individual patient’s needs fundamental to person-centered healthcare, is rarely practised in China. This study aimed to adapt the Comprehensive Needs Assessment Tool (CNAT) to Chinese cancer patients and to evaluate the psychometric properties of the newly adapted Chinese CNAT.Method: Cross-cultural adaptation of the original CNAT was performed according to published guidelines. A subsequent validation study was conducted with 300 cancer patients in Mainland China. Validity was determined through exploratory factor analysis and the known-group comparison. Reliability was determined using internal consistency and test-retest reliability.Results: The overall CNAT had acceptable internal consistency with Cronbach's alpha coefficient 0.967 for the scale and 0.811~0.958 for subscales. Test-retest reliability by intra-class correlations was 0.877 for the overall scale. Principal component analysis resulted in an 8-factor structure explaining 70.325% of the total variance indicating good construct validity. Known-group validity was supported by its ability to detect significant differences according to sociodemographic and medical characteristics of participants.Conclusions: The newly adapted Chinese CNAT scale possesses adequate validity, test-retest reliability and internal consistency in this population.
Improving patients experience in a neuro-rehabilitation unit using tablet computers
Authors: Suchak Pria , Ameer Khalid , Gaylard Jane , Newman Julie , Ali Khalid
Published: October 2016

Rationale, aims and objectives: Patients in stroke rehabilitation units spend considerable time unengaged in therapeutic or meaningful activity, feeling bored with suboptimal engagement in rehabilitation. Systematic reviews have shown that novel interventions such as interactive video gaming result in improved motor function and cognitive performance. The objective of this study was to evaluate the feasibility of introducing “tablet computers - iPads” in hospital rehabilitation programmes and their impact on patients’ boredom and overall satisfaction. In addition, acceptance and familiarity of the multidisciplinary members of the neuro-rehabilitation team with iPads were explored.Methods: A £10,000 fund was secured from Health Education England, UK to buy 10 iPads. A loan scheme was implemented to regulate iPad use. Information technology and governance issues were agreed with the hospital trust to ensure safety, accountability and confidentiality. Members of the multidisciplinary team offered training and education to patients on iPad use. Questionnaires were used before iPad use to assess patients and staff views on iPads. After iPad use patients and staff completed another questionnaire and were interviewed about which specific applications were used, boredom levels before and after use, and overall satisfaction.Results: Nine patients (7 males) used the iPads (8 strokes and 1 traumatic brain injury), with an average age of 59 (19-79) years. Staff used several applications in physiotherapy and speech therapy and found some applications such as memory games and puzzles particularly helpful. In addition to therapeutic uses, patients used iPads for internet searches, e-mail, Facebook, Skype and games. Eighty-nine percent of patients were satisfied with the iPad experience and 100% reported less boredom or between better and the same boredom compared to baseline.Conclusions: iPad use is feasible and beneficial to patients and welcomed by staff in neuro-rehabilitation units.