bluuebunny/crossref_metadata_2025 huggingface dataset:
The STarT Back Tool: Physiotherapist Experience and Perceptions of its Clinical Utility
Authors: Woods Emma , Gaskell Lynne
Published: October 2016

i)             Rationale:The STarT Back Tool (SBT) has been recently validated for use as a prognostic screening tool with Lower Back Pain (LBP) patients in the primary care setting (1). A recent study by Hill et al (2) concluded that LBP outcomes and cost effectiveness could be improved from using the SBT to guide decision making and providing a stratified approach to care.  The SBT was introduced to musculoskeletal physiotherapists working in the community setting for Bolton NHS Foundation Trust.This study aims to explore the perceptions and experiences of physiotherapists using the SBT in clinical practice. No study has yet explored thisii)            Method:A qualitative study was conducted. A Nominal Group Technique (NGT) was undertaken to develop an appropriate set of questions for use in a single Focus Group (FG). The FG comprised of eight musculoskeletal physiotherapists. The FG was audio taped and the data obtained was analysed through Grounded Theory Methodology.iii)          Results:Physiotherapists felt the SBT acted in a confirmatory manner. Although deemed easy to use, a number of barriers led to only a small impact on decision making. These being, perceived oversimplification of the decision making process, impact on professional reputations and professional development, risks associated with single treatment sessions, patient satisfaction and threats to patient centred care.  iv) Conclusion:A number of barriers reduced Physiotherapist confidence in using the SBT to guide decision making and led to physiotherapists questioning whether a stratified approach to LBP management represented the ‘best care’ for their patients. The study highlighted the importance of a robust training prior to and during the implementation of the SBT and a stratified approach to care within physiotherapy departments.
Can a web-based tailored decision aid ‘stand alone’ for 65plus patients with localized prostate cancer?
Authors: Schrijvers Jessie
Published: October 2016

Objectives: A pilot study was designed to examine the feasibility of a web-based DA and its included technology features, considering treatment choice for patients between 65 and 75 with localized prostate cancer.  Patients and method: Twenty-nine patients, that had already been treated for localized prostate cancer, participated at an oral survey with close-ended questions about their internet use, the barriers and opportunities when accessing a web-based DA, their impression on the use of incorporated technology features and their preference for the booklet or the online DA version. Data were analyzed using non-parametrical statistics. Results: Participants with low internet use and without internet access at home preferred the booklet DA or a combination of both booklet as well as web-based format. Patient characterized as regular internet users with internet access at home preferred the web-based DA version and extensively used the tailoring component. The usage of other technology features such as value clarification tool and comparative tables was high while the use of the scientific information was limited. Conclusion: An online DA is a useful tool in a decision making process for patients characterized as frequent internet users with internet access at home, also in an older patient population.
Patient Satisfaction with the Health Services Provided by the Pharmacist at a General Hospital in Riyadh, Saudi Arabia
Authors: Al-Jumah Khalaf Ali , Hassali Mohamed Azmi , Alzaagi Ibrahim
Published: October 2016

Background: Patient satisfaction is one of the main indicators for determining the quality of the services provided to patients by pharmacists.Objective: The purpose of this study was to determine the patients’ satisfaction and various factors affecting satisfaction with pharmacists dispensing services atKingSaudMedicalCity inRiyadh,Saudi Arabia.Methods: A cross-sectional study was conducted to explore patient satisfaction with the pharmacy services from August through September2013. A self-administered, 10-item questionnaire was administered randomly to 500 participants to evaluate patient satisfaction. Twenty questionnaires were excluded because they were incomplete. Statistical Package for Social Sciences (SPSS) version 17.0 for Windows was used to analyze the data.Results: The response rate of this study was 96%. Most of the respondents were female (252, 52.4%), and 69.9% of the sample visited the pharmacy 3 or more times per year. The majority of the patients reported a high level of satisfaction, which was slightly variable among the groups, particularly with respect to the education level and employment status of the patients. Patients with a high school education or less were the most satisfied with the pharmacy services with a mean score of 3.50 (df= 2.969, F= 3.659, p=<0.006). Unemployed patients were the most satisfied with the pharmacy services, with a mean score of 3.52  (df= 2.580, F= 3.138, p=<0.044).Conclusion: The patients reported a high level of satisfaction with the pharmacy services atKingSaudMedicalCity inRiyadh.
Acknowledging the patient with back pain: A systematic review based on thematic synthesis'
Authors: Damsgaard Janne Brammer , Jorgensen Lene Bastrup , Norlyk Annelise , Thomas James , Birkelund Regner
Published: October 2016

Rationale and aims: Research shows that back patients’ illness experiences affect their interaction with the healthcare system. It is important to examine the exact nature of these experiences in order to shed valuable light on how back patients perceive their illness and hospitalisation. The aim of this literature review is to gain a better understanding of back patients’ illness experiences and to identify, systematise and integrate the findings of different qualitative studies that may elucidate barriers and the consequences or focal points in connection with care and treatment. Methods: The methodology for this literature review is based on the thematic synthesis used by James Thomas and Angela Harden. The literature review also draws on the sociological theories and arguments of Ulla Harriet Jensen and Trine Dalsgaard in which health professionals biological perception of the individual dominates the healthcare system and translates into a certain way of perceiving and explaining illnesses and symptoms.    Results: The thematic analysis shows that it is through experiences and memories that we create our identity and consciousness. Ignoring the illness experiences can therefore be seen as disregarding, the patient as a human being. With this in mind, it is easier to understand why back patients often feel marginalised and mistrusted in their interactions with the healthcare system. Respectfully including the patients’ experiences is fundamentally about acknowledging the back patient as a human being. Conclusions: A synthesis of the included studies demonstrates the need for healthcare professionals to pay attention to back patients’ narratives in order to acknowledge them as human beings. This acknowledgement involves an ethical dimension and a sense of responsibility, manifested as respectful inclusion of the patient’s experiences. The body can never be understood merely as a biological entity and therefore illness is far more than having symptoms, diagnoses and treatment. The synthesis thus proposes an acknowledgment of this and a more holistic approach.
The Impact of Text Messaging in Adherence Programs
Authors: Dolgin Kevin
Published: October 2016

Average adherence rates for chronic treatment average approximately 50%, leading the World Health Organisation (WHO) to state that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments and new drugs per se. In this environment, programs designed to increase adherence to medication and to treatment in general have multiplied over the past several years. These programs generally include communication with patients to inform and influence behavior. This communication can take place via a number of channels, ranging from face-to-face contact to physical mail to smart phone apps. Each channel has its own advantages and disadvantages and each entails costs of its own. Short Message Service (SMS) or text messaging has proven in numerous studies to represent an advantageous cost / benefit profile, particularly when the messages are customized to individual patients. This is the case across a wide variety of patient types, ages, pathologies and geographies. The present article provides an overview of the challenges of treatment adherence and how these can be successfully addressed using text messaging interventions across a variety of chronic illness and within different geographical and cultural settings.
Care planning for long term conditions in primary care: indicators of embeddedness
Authors: Lhussier Monique , Forster Natalie , Eaton Simon , Carr Susan M
Published: October 2016

Rationale, aims and objectives: Healthcare systems are continuously challenged to develop new ways of working to meet the demands of an increasing prevalence of multi-morbid long term illness. Care planning has been proposed as one solution. This analysis used the Normalisation Process Theory as a framework to identify precursors of embeddedness of care planning in 10 primary care practices. Methods: GPs, Nurses and Practice Managers from the selected practices took part in a series of collaborative learning workshops and a training programme. The data informing this article derive from 15 semi-structured interviews and from observational data collected during 4 collaborative meetings. Results: A key step in the meetings was collaboratively to differentiate the care planning function from previous practice. Later interviews showed a clear movement towards the generation and implementation of pragmatic solutions. These included the adaptation of pre-existing tools, IT systems, call and re-call procedures and documentation and communication procedures in order to implement care planning for diverse patient needs. Implementing the care planning function entailed a renegotiation of roles between clinicians as well as with patients, the explicit inclusion of practice managers and a consideration of relationships with secondary care and other local services. Participants provided anecdotal evidence of the benefits of care planning and reported having received positive feedback from patients. Conclusions: The learning collaborative enabled participants to shape care planning to fit their individual practice contexts, in terms of resources, structures and systems as well as in terms of the patient population. It emphasised the need for differentiation from prior practice, individual and communal specification and internalisation and fostered a sense of ownership.
Patients’ attitudes and perceptions regarding person centered care: results of a survey from an urban city of Pakistan
Authors: Qidwai Waris , Kazmi Zehra , Nanji Kashmira Sher Ali
Published: October 2016

Background: Doctor-Patient consultation models have evolved over time, but there is a need for a paradigm shift from a directive consultation style towards a non-directive, person-centered consultation style. The aim of this study was to identify patients’ attitudes and perceptions to a person-centered model of care. Methods: A pilot cross-sectional study was conducted at a general outpatients department of a tertiary care hospital in Karachi, Pakistan, from September to November 2011. A total of 460 adult patients (>18 years and visiting the same doctor for more than one year) were consecutively approached. A pre-tested structured questionnaire was used to collect patient information. Data were analyzed using SPSS version 19 and multivariable logistic regression analysis. Results: In total 424 participants were included in the final analysis. The majority of the patients were males (57.3%). Females preferred the person-centered care (PCC) model more (52.7 vs. 42.7%). The regression analysis showed that those participants who had 6 to 12 years of education preferred the PCC model more as compared to those with low educational status (AOR:0.08, 95% C.I: 0.06-3.0, p=<0.01). Other variables, such as being female, being less than 25 years old and being a student/housewife or being retired were statistically insignificant in the regression model. Conclusion: The results of the current study indicate that females prefer the PCC model more. There is a need for more intensive research that can assist in improving access to person-centered care. To improve PCC in all patient-physician encounters, it is important to identify contextual factors that underlie differences in communication as a function of gender.
Maternal non-compliance in a well-baby nursery: family characteristics and other reasons
Authors: Nadir Erez , Nir Vered , Foldi Sylvia , Hochberg Amit , Feldman Michael
Published: October 2016

Objective: Neonatal recommendations include medical follow-up, metabolic screening, vitamin K, eye drops/ointment and vaccinations. Most but not all parents follow these recommendations. This study aimed to characterize the non-adherent mothers in order to understand the reasons behind that non-adherence. Study design: All mothers who refused any routine treatment of their infant or who asked for early discharge of their infant were included. They completed a questionnaire on socio-economic items, previous births and those children’s health status, current pregnancy and delivery and their beliefs. Results: Three non-adherent subgroups emerged according to the responses: Muslim mothers requesting early discharge to care for children at home, Jewish mothers requesting early discharge because they disliked the hospital environment, Sabbath/holiday and children at home and Jewish mothers who rejected guidelines because they believed the treatments were unnecessary or possibly harmful to their infants. Conclusion: Socio-economic factors could influence maternal adherence to care guidelines in a well-baby nursery. Several interventions to enhance maternal adherence to medical recommendations are proposed in order to increase the child and family centeredness of clinical and social care.
Preliminary evaluation of phase-oriented and women-focused group therapy in partial inpatients with complex trauma histories
Authors: Carlier Ingrid , DeRee Marceline , VanRijn Sanne , Van der Spek Wilhelmina , Callewaert Ineke , Van Veen Tineke , Van Rood Yanda
Published: October 2016

Rationale, aims and objectives: Despite the broad acceptance of the phase-oriented therapy for Type II chronic trauma in clinical practice, there remains very little empirical evidence to support its validity. Moreover, evaluative studies of group psychotherapy for Post-traumatic Stress Disorder (PTSD) after chronic trauma remain scarce, especially within the partial inpatient setting. The present study reports the evaluation of phase-oriented group therapy for Type II traumatized female partial inpatients with chronic PTSD. The treatment involved 3 phases: (a) symptom reduction/stabilisation, (b) trauma processing, (c) life integration/rehabilitation. Special attention to women’s mental healthcare needs (e.g., training of skills to increase sense of security, self-esteem, autonomy) was also given. Methods: In a pilot study with 31 female partial inpatients, pre- and post-treatment measures were compared in our study of PTSD (Self-Rating Inventory for PTSD, SRIP), General Psychopathology (Symptom Checklist 90, SCL-90), coping (Utrecht Coping List, UCL). Results: At post-treatment, there was a reduction of all PTSD symptom clusters and some general psychopathology (medium to high effect sizes) and an increase of some adaptive coping strategies (low to medium effect sizes). Linear regression analyses showed that the pre-treatment scores of re-experiencing, hyperarousal, total PTSD, agoraphobia and somatic complaints, had a significant predictive influence on outcome. Conclusions: The positive results of this pilot study support the validity of phase-oriented and women-focused group therapy for Type II traumatized partial inpatients with chronic PTSD. These findings warrant further investigation, using a randomized design with larger sample size and assessments in between the phases and during follow-up. We advance our pilot study as a significant contribution to the person-centered management of complex trauma history
Helen Sanderson and Gill Bailey, Personalisation and Dementia; A Guide for person-Centred Practice, London: Jessica Kingsley Publishers, 2014. ISBN 978-1-84905-379-2
Authors: Lindsay Margot
Published: October 2016

No abstract
VIGNETTE-BASED DECISION POINT ANALYSIS (VDPA): A NOVEL METHOD OF EXPLORING PERSON-CENTERED CONTEXTUAL INFLUENCES ON CLINICAL DECISION-MAKING
Authors: Dharmaratne Sisira , Razee Husna , Ponnamperuma Gominda , Marambe Kosala , Dawson Andrew , Balasooriya Chinthaka
Published: October 2016

Rationale and aims: Contextual factors are increasingly recognized as having a significant influence on clinical-decision-making. Contextual influences however, are considered ‘less scientific’ or ‘non-clinical’ in the eyes of practicing clinicians, making it a sensitive issue for discussion.  Therefore, exploring these contextual influences can be challenging. Methods which can circumvent this challenge are required to evaluate clinical decision making at natural settings. This paper reports on the development of an innovative research method to address this challenge of exploring contextual influences and similar sensitive and complex clinical practice issues.  Method: The researchers conducted a field research to test an interview based method which was termed as ‘Clinician Recalled Vignette (CRV) Method’. Based on reflections on the field research experience this preliminary method was refined to develop an innovative method which is potentially capable of eliciting sensitive and complex clinical practice issues. Results: Reflections on field test data provided preliminary evidence on the usefulness of the CRV method and limitations. The method that was refined, in response to limitations, focused on key decision points relevant to the clinical vignettes recalled by clinicians, and included a mechanism to identify how contextual factors influence these key decision points. This innovative method was termed ‘Vignette-based Decision Point Analysis’. Conclusions: The innovative method discussed in this paper will assist other researchers in conceptualising and conducting research projects to explore sensitive and complex clinical practice issues in natural settings.
IF YOU WANT HEALTH, HAVE A HEALTH SYSTEM: CHANGING THE AGENDUM
Authors: Sturmberg Joachim
Published: October 2016

As previously described health is an experiential state resulting from the dynamic interactions between the somatic, psychological, social and semiotic or cognitive domains that characterize a person’s integrity. Contrast that with the prevailing discrete disease and economic rationalist approaches to managing the healthcare, or should one better say disease management, system. The epidemiology of health in the community indicates that 96% of the community does require something other than those highly specific and successful discrete disease interventions offered in the secondary and tertiary care environment. A healthcare system build around the experience of health of the community will organise care in a much broader though highly sophisticated way. It will in particular include a focus on health promoting/destroying local community circumstances. Such a systemic approach is illustrated by the healthcare vortex model.
MEDICAL IDENTITY: A SOCIO-CULTURAL ANALYSIS
Authors: Musaeus Peter
Published: October 2016

Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice, and culture.Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity is the study of the sociocultural paragons that conceptually underlie the phenomenology of physician’s coming to take themselves as autonomous social agents. The paper relies on Hegel’s Phenomenology of Spirit and investigates dilemmas pertaining to first objectivist versus subjectivist views and second hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with her being taken to be an autonomous professional.Conclusion: Medical identity should be analyzed with reference to literature, philosophy, and medical practice in order for the physician to a reflective position, which is both scientifically rational and subjectively meaningful.
THE ECONOMIC BURDEN OF CHRONIC ILL HEALTH
Authors: Garcea Giuseppe , Dennison Ashley
Published: October 2016

Background: Chronic diseases are the leading cause of mortality and morbidity in Europe and research suggests that complex conditions such as diabetes, obesity and depression will impose an even larger burden on health services in the future. The accurate profiling of immediate costs of these conditions is essential in planning healthcare.Methods: A literature search incorporating peer-reviewed papers, electronic resources and consensus documents was undertaken.Results: Modelling the costs of chronic disease is a complex process. Various mathematical formulae and software exists to make this as accurate as possible.Conclusion:Assessing the burden of disease, its direct costs and also the indirect impact which chronic disease has on subsequent GDP, is a difficult task. However, such benchmarking is essential to formulate effective future health strategies, including ones advocating more person-centered approaches in clinical practice.
Exploring changes in health visitors knowledge, confidence and decision making for women with perinatal mental health difficulties following a brief training package
Authors: Jones Catriona , Jomeen Julie , Glover Lesley , Gardiner Eric , Garg Deepak , Marchall Clare
Published: October 2016

Rationale and objective: Perinatal Mental Health (PMH) is an issue that spans the spectrum of pregnancy and childbirth and is now acknowledged to be significant on a global level. Health visitors (HVs) are increasingly expected to extend their knowledge and to understand and identify PMH in the antenatal period and across the spectrum from mild/moderate to severe. While training has been shown to enable HVs to identify post-natal depression (PND) effectively and reduce the proportion of women at risk, the mechanisms underpinning this success are unclear. This paper reports on the findings of a mixed methods study aimed at examining the impact of a single half day training session on perinatal mental health problems (PMHP) on HVs knowledge, confidence and empowerment in relation to managing PMH.Methods: Findings from data gathered by Likert Scales and focus group discussions are presented.Results: Training can empower HVs to identify PMHP beyond PND and plays a vital role in promoting confidence.Conclusions: This research highlights the potential that training of this type has on service provision and delivery. In a resource-limited service, the feasibility of a brief training package has demonstrated positive results for health visitors, childbearing women and their families.
Towards person-centered healthcare via realistic evidence-based medicine – informing the debate historically
Authors: Bolt Timo , Huisman Frank
Published: October 2016

There is a widespread feeling that, despite the many successes of evidence based medicine (EBM), the movement is now facing a serious crisis. The current debate on this ‘crisis’ may be understood as resulting from four interrelated evolutions which EBM went through. Our historical analysis of these evolutions leads us to two conclusions. First, it looks like the spirit of anti-authoritarianism, (self-)criticism, independence of thought and empowerment of individual physicians of the early days has gone. Second, the often-invoked image of the ‘golden past’ of ‘real EBM’ is distorted, as it reflects contemporary nuanced ideas rather than the initial program of the movement. Thus, history teaches us that we should forget about the idealized image of ‘real EBM’ and embrace realistic EBM instead.
Sanderson, H. & Lepkowsky, M.B. (2014). Person-Centered Teams: A Practical Guide to Delivering Personalisation Through Effective Teamwork. London: Jessica Kingsley. ISBN 978-1-84905-455-3
Authors: Lindsay Margot
Published: October 2016

No abstract
The relationship between self-efficacy and health-related quality of life in Multiple Sclerosis patients
Authors: Testa Silvia , Molinengo Giorgia , Oggero Alessandra , Bertolotto Antonio , Rosato Rosalba
Published: October 2016

Background and Objectives Multiple sclerosis (MS) has a broad spectrum of physical, social, psychological effects and significant impact on quality of life (QoL). Several studies has showed the importance of self-efficacy as a predictor of QoL in patients with MS.This study aims at evaluating the robustness of the relationship between self-efficacy and QoL. Specifically it aims to test whether such relation will vanish under the following conditions: using a general measure of self-efficacy and controlling for level of impairment defined as a broad construct dealing with physical, social and working changes due to the illness condition. Methods One hundred-fifty five participants responded to a questionnaire, including QoL and general self-efficacy measures, socio demographic and clinical variables. Two nested structural equation models that differ for the presence or absence of the path connecting self-efficacy and QoL was estimated.Results and Conclusions The hypothesis of the vanishing of the relationship between self-efficacy and QoL had to be rejected. These results support the genuineness of this relation and emphasize the importance of interventions promoting self-efficacy to improve QoL in chronic diseases such as MS. From a methodological perspective this study is an example of the usefulness of formative indicators in QoL studies.
Prevalence and associations of gender concordance in general practice consultations: a cross-sectional analysis.
Authors: Thomson Allison , Morgan Simon , Tapley Amanda , Van Driel Mike , Henderson Kim , Oldmeadow Chris , Ball Jean , Spike Neil , McArthur Lawrie , O'Mara Peter , Scott John , Magin Parker
Published: October 2016

Rationale, aims and objectives: Gender effects on physician-patient interactions are well-established and gender concordance of the physician-patient dyad influences consultation dynamics, person-centeredness and outcomes. We aimed to establish the prevalence and associations of gender-concordant and gender-discordant consultations of general practice (family medicine) trainees and to compare outcomes of gender-concordant and gender-discordant consultations.Method: A cross-sectional analysis from an ongoing cohort study. The outcome measure was whether a consultation included a gender concordant (female-female, male-male) or discordant (male-female, female-male) physician-patient dyad. Independent variables related to patient, physician (registrar), practice, consultation content and consultation outcome.Results: Five hundred and ninety-two general practice (GP) registrars (trainees) in 4 of Australia’s 17 regional training programs provided data on 56,234 individual consultations. Sixty-two point nine percent of consultations were gender-concordant (73.5% female-female, 26.5% male-male) and 37.1% were gender-discordant (47.0% male physician-female patient, 53% female physician-male patient). Associations of having a gender-concordant consultation were patient female gender and younger age (<55), the patient not being new to the registrar and the registrar being part-time, younger and having worked at the practice previously. Addressing a reproductive/contraceptive/ genital problem was associated with gender concordance. Gender-concordant consultations were  ‘complex’: significantly longer than gender-discordant consultations, addressed a greater number of problems, resulted in more pathology ordered, more follow-up organised and more learning goals generated.Conclusions: Gender-concordant consultations may be more complex and gender-concordance is ‘sought’ by patients rather than being random.  Thus, efforts could be made in general practice to provide access to both male and female GPs, especially for female patients or groups or patients with particular needs.
Renewing the expertise of health and social care professionals to provide integrated care: Evaluation of an intervention in a deprived Dutch neighbourhood
Authors: Van den Broeke Jennifer , Van der Aa Maartje , Busschers Wim , Stronks Karien , Plochg Thomas
Published: October 2016

Rationale, aims and objectives: Multimorbidity in deprived populations is associated with longer hospital stays, more avoidable admissions and complications, higher costs, and lower satisfaction with available services. While integrated care has been proposed as a solution, the expertise of professionals to deliver this type of care has received little attention. Our case study evaluates an intensive intervention in a deprived neighbourhood in the Netherlands, launched in 2008, to tackle multimorbidity and the expertise of health and social care professionals to cater to the population’s health needs.Methods: Mixed-methods evaluation. Between 2009-2012 semi-structured interviews (n= 11), field observations, conversations, dialogue sessions and documentary review. In 2012 and 2013 quantitative before-and-after study with web-based questionnaire in the intervention and two control neighbourhoods (n= 86 at t0 and n=117 at t1).Results: The intervention sought to develop professional expertise in population health orientation, generalism, and coaching. Activities were supported by management that emphasized learning by doing, working bottom-up with direct application in practice, and professionals enjoying discretion to experiment. The intervention’s widely supported mission brought cohesion to its activities. In the interviews, professionals reported becoming more adept at understanding the common causes behind patients’ complaints, unravelling their multiple problems, and encouraging them to be more active in addressing their own health and well-being. But this was not supported by the quantitative data measuring professionals’ attitudes.Conclusion and practice implications: Neighbourhood interventions can strengthen professionals’ expertise in population health orientation, generalism and coaching, and the communication and collaboration skills necessary to employ them. Whether they can lead to more adequate responses to multimorbidity and more effective integrated care arrangements needs to be further researched.
The Diverse Journeys of Rural Older Adults with Atrial Fibrillation
Authors: Rush Kathy L , Oelke Nelly D , Shay Matt , Reid Robert C
Published: October 2016

Rationale, aims and objectives: Atrial fibrillation (AF) is a serious chronic heart condition characterized by an irregular, rapid heartbeat and unpredictable course. Patients with AF often struggle with managing the impact of the disease on daily activities.  Afflicted rural dwelling patients face added challenges including inequities in health services and a lack of cardiac specialty services. AF patient journeys through the healthcare system have not been well documented, but offer a valuable tool for improving patient management and outcomes. The purpose of this study was to document individual AF patient journeys of rural living older adults. Method: This study used a 6-month longitudinal design to examine the rural healthcare experiences of 10 AF patients. AF patient journeys were mapped using information gathered through interviews, written logs, photographs and an electronic health record review. Thematic analysis was used in clustering common features of the healthcare journeys of older adult patients with AF and a typology developed to describe them.  Results: Each patient’s journey with AF was unique. Symptom and disease severity, health service utilization and needs emerged as differentiating features in the identification of 3 journey types: (1) Stable, (2) Chronically Unstable and (3) Acute Crisis. Conclusions: These journey types provide a valuable person-centered tool to assess patient needs at any point in the AF trajectory and to address salient risks that accompany each type to improve management of the increasing number of persons suffering from AF.
Strengthening positive parenting through a 2-month intervention in a local city in Japan: evaluating parental efficacy, family adjustment, and family empowerment
Authors: Wakimizu Rie , Fujioka Hiroshi
Published: October 2016

Aims: Childmaltreatmentisahigh-prioritypublichealthissueinJapan.Evenafter enactmentoftheChildAbuseProtectionLaw,thenumberofcasesreportedhasincreaseddramatically.Regardless,asignificantnumberofJapanesemothersaredistressedabouttheirparentingskills. Toaddressthissituation,itisnecessarytoadoptpreventionstrategiesknown as the Positive Parenting Program (Triple P) and strengthen positive parenting through intervention, especially in areas with limited healthcare resources. The purpose of this study was toinvestigatetheeffectivenessofGroupTriplePby evaluating parental efficacy, family adjustment and family empowermentina local city in Japan, as a direct contribution to child and family-centered care.Methods: Participantsinboththe intervention (N=15)andcontrol(N=9) groupswererecruitedfrommothersraising children aged 1-12 years and livingin a local City in Japan. We assessedchildadjustment and parent efficacyby Child Adjustment and Parent Efficacy Scale (CAPES),parenting and family adjustmentby Parenting and Family Adjustment Scales (PAFAS) andParentingExperienceSurvey (PES) and family empowerment by Family Empowerment Scale (FES) in both groups.An analysisof covariancewasusedtodeterminetheintervention’seffects.Results: Child Adjustment subscalesofthe CAPES and Parenting Adjustment subscalesofthe PAFAS indicatedasignificantinterventioneffect.Inaddition,post-interventionscoresfor mostPAFAS subscales,aswellasratingsforthe perceivedrewardsofparenting and agreement with partner regarding child discipline inthePES,weresignificantlyreducedintheinterventiongroupalone.The FES scorefor the Familysubscale and total score alsorevealed significantincreasesonlyintheinterventiongroup.Conclusion: GroupTriplePwas suggested to beeffectiveinimprovingthe adjustment of the child, parent and family and family empowerment amongJapanesefamilies.
Do higher levels of uncertainty in illness reduce the perceived health related quality of life of Multiple Sclerosis (MS) patients?
Authors: Gitto Lara , Giammanco Maria Daniela
Published: October 2016

Background: Multiple Sclerosis (MS) represents one of the most common causes of neurological disability and the unpredictability and severity of its manifestations determine uncertainty in illness. While MS patients’ Health Related Quality of Life (HRQoL) has been frequently assessed, the impact of uncertainty on HRQoL has not been adequately considered to date. The objective of the study was to reduce this gap in the literature.Design: One hundred and twenty patients with relapsing-remittingMS were interviewed in order to gather information about their assessment of HRQoL, measured with the Visual Analogue Scale (VAS) and their perceptions of uncertainty in illness assessed through the Mishel Uncertainty in Illness Scale (MUIS). The relationship between HRQoL and two dimensions of uncertainty, namely “ambiguity” and “inconsistency”, have been tested with diverse Tobit and Probit specifications.Results: Inconsistency exhibited a negative and significant correlation in all the specifications of the model. Marginal effects suggested how a unit change in the total score of the inconsistency scale determined an increase of 6.2% in the probability to report a VAS score higher than 60 (median score in the sample). Ambiguity and inconsistency, jointly considered, had a marginal effect of 2.1%.Conclusions: This study contributes to the assessment of the patient’s general status over the standard parameters for quality of life. It  may represent the starting point for further analyses on the impact of separate facets of the Uncertainty in Illness on HRQoL, experienced not only by MS patients, but also by other patients suffering from chronic conditions.
Psychopathology: Theory, Perspectives and Future Approaches. (2013) Stoyanov, D. (Ed.). New York: Nova Science Publishers. ISBN 978-1-62618-470-1
Authors: Broome Matthew
Published: October 2016

No abstract
A qualitative study of community pharmacists’ awareness of and involvement with intermediate care facilities.
Authors: Millar Anna N , Hughes Carmel M , Ryan Cristan
Published: October 2016

Rationale, aims and objectives: Intermediate care (IC) describes a range of services targeted at older people, aimed at preventing unnecessary hospitalisation, promoting faster recovery and maximising independence. The introduction of IC has created a new interface between primary and secondary care. Older people are known to be at an increased risk of medication-related problems when transferring between healthcare settings and pharmacists are often not included as part of IC multidisciplinary teams. This study aimed to explore community pharmacists’ (CPs) awareness of IC services and to investigate their views of and attitudes towards the medicines management aspects of such services, including the transfer of medication information. Method: Semi-structured interviews were conducted, recorded, transcribed verbatim and analysed using a constant comparative approach with CPs practising in the vicinity of IC facilities in Northern Ireland, UK. Results: Interviews were conducted with 16 CPs. Three themes were identified and named ‘left out of the loop’, ‘chasing things up’ and ‘closing the loop’. CPs felt that they were often ‘left out of the loop’ with regards to both their involvement with local IC services and communication across the healthcare interfaces. As a result, CPs resorted to ‘chasing things up’ as they had to proactively try to obtain information relating to patients’ medications. CPs viewed themselves as ideally placed to facilitate medicines management across the healthcare interfaces (i.e., ‘closing the loop’), but several barriers to potential services were identified. Conclusion: CPs have limited involvement with IC services. There is a need for improvement of effective communication of patients’ medication information between secondary care, IC and community pharmacy. Increasing CP involvement may contribute to improving continuity of care across such healthcare interfaces, thereby increasing the person-centeredness of service provision.
Patients’ views on using decision support tools: a systematic review
Authors: Engelen Annelies , Vanderhaegen Joke , Van Poppel Hendrik , Van Audenhove Chantal
Published: October 2016

Background, aims and scope: Decision support tools assist patients in medical decision-making. However, implementing these tools in practice is challenging. We systematically reviewed barriers and facilitators to using decision support tools, as perceived by patients. Methods: A systematic search of scientific articles was performed in MEDLINE, CENTRAL, EMBASE and CINHAL databases. Search strategies combined pre-defined free-text words and MeSH, or database equivalent, derived from the following broad topic areas: decision support tools, barriers and facilitators, use or implementation and user perceptions. Eligible studies qualitatively presented patients’ views on using tools. These views were thematically analyzed, starting from an existing taxonomy of barriers to and facilitators of the implementation of healthcare innovations. Results: Electronic searches yielded a total of 7067 unique references; 365 full-text articles were retrieved, of which 33 publications met the inclusion criteria. Seven additional publications were included after reference searching. Key descriptive themes were classified in three broad categories of tool-, user- and environment-related barriers and facilitators. The most commonly identified themes were perceived usefulness, ease of use, the health professional-patient relationship, quality and quantity of information and need as motivation to use tools.Conclusions: Patients express a need for decision support, but experience obstacles to using tools. The two most common, attitude-related, barriers to tool use were the perceived difficulty of using a tool and its dubious efficacy. The results of this review can support researchers in the design of development and evaluation strategies that specifically address the identified barriers and facilitators and thus further the implementation of decision support tools.
The MacNew heart disease health-related quality of life questionnaire: Updated reference data for users
Authors: Höfer Stefan , Turk-Adawi Karam , Oldridge Neil
Published: October 2016

Background: The key to interpreting patient-reported health-related quality of life [HRQL] scores for use in person-centered healthcare approaches in clinical practice is having normative reference data to place the scores in the context of a meaningful reference group. The purpose of this analysis is to update and extend existing norms for the MacNew HRQL questionnaire.Methods: Patients with angina, myocardial infarction, or heart failure enrolled in the HeartQoL Project provided MacNew HRQL Global scale and Physical, Emotional and Social subscale data from which norms have been generated.Results: Patients (n=6,130; angina, 32.4%; myocardial infarction, 37.5% and heart failure, 30.1%) living in 22 different countries provided MacNew HRQL scores. Mean MacNew Global HRQL in the total group was 5.04 (±1.1); Global scale and Physical, Emotional, and Social subscale scores were higher in patients with MI than in patients with either angina or heart failure (p<0.001) and higher in patients with angina than in patients with heart failure (p<0.001). Mean Physical subscale scores were lower than either Emotional or Social subscale scores. Mean MacNew Global scale and subscale scores were higher in males and older patients than females and younger patients. The minimal important difference of 0.5 points on the 7-point MacNew was consistent with a 0.5 standard deviation around the mean MacNew scores in each diagnosis. Conclusion: Norms for the MacNew questionnaire have been updated permitting meaningful interpretation of HRQL for an individual patient or for groups of patients with angina, myocardial infarction or heart failure.
Hayes, E.L. Pathways through Care at the End of Life, London: Jessica Kingsley Publishers, 2014. ISBN 978-1-84905-364-8
Authors: Lindsay Margot
Published: October 2016

No abstract
Person-centered support for adults with learning difficulties: an evaluation
Authors: Ellis Roger , Hogard Elaine , Carson Juli
Published: October 2016

This paper describes an evaluation of a Personalisation Programme provided by the UK Charity Choice Support for adults with learning difficulties.Personalisation, synonymous with patient-centred care, means thinking about care and support services in an entirely different way. This involves starting with the person as an individual with strengths, preferences and aspirations and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives. It requires a significant transformation of adult social care so that all systems, processes, staff and services are geared up to put people first.The Choice Support Personalisation Programme had three main features: Person Centred Planning; Individual Service Funds and Better Nights, a new form of night support which encourages greater independence. Person Centred Planning means exploring in detail what each individual wants and needs and planning support accordingly. An Individual Service Fund represents a notional allocation of money to each individual for support based on individual need and preference as opposed to a block grant and a standard support for all. Better Nights was a shift from ‘Waking Nights’ with support staff available and monitoring individuals throughout the night to ‘Sleep In’ where the care staff followed normal waking and sleeping patterns together with the individuals thus encouraging a more normal life style with greater independence. The Social and Health Evaluation Unit (SHEU) of the Buckinghamshire New University, UK, has completed two programme evaluations; one of Better Nights and one of personalisation more broadly. In each case the Unit’s Trident method was used focusing evaluation questions on outcomes; process and stakeholder perspectives. Data from the evaluation were assessed together with the substantial savings achieved. Specially devised audit tools were used to assess quality of life and risk management. Overall the results of these audits showed a maintenance or improvement in quality of life for the service users and effective management of risks. The process of implementation was described in sufficient detail to allow replication, learning and continuous improvement. Stakeholder perspectives were surveyed from care staff, parents and relatives and social services staff. Overall the programme had achieved its stated outcomes in person-centred care with substantial savings. For the minority of service users whose quality of life did not appear to improve, further detailed analysis and planning is being undertaken.
Person-centered health policy in the US: the case of the Patient-Centered Outcomes Research Institute (PCORI)
Authors: Tanenbaum Sandra
Published: October 2016

The Patient-Centered Outcomes Research Institute, known as PCORI, was created by the U.S. healthcare reform legislation of 2010. The Affordable Care Act (ACA), sometimes referred to as “Obamacare,” provided for a public-private institute concerned primarily with funding and guiding comparative effectiveness research. Through a uniquely American blend of anti-statist ideology, corporate interest and disability activism, the determination of comparative effectiveness would also be tasked with patient-centeredness, a concept which PCORI has defined and operationalized. This represents a step toward person-centered healthcare, but unresolved issues of true personalization remain.