bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of participatory design in the development of person-centred web-based support for persons with long-term illness
Authors: Sparud-Lundin Carina , Josefsson Ulrika , Berg Marie , Hellstrom Anna-Lena , Koinberg Ingalill , Nolbris Margaretha Jenholt , Ranerup Agneta , Skarsater Ingela 
Published: October 2016

Background: E-health solutions are increasingly being developed to meet patients’ preferences and promote their participation in healthcare. Few studies have explored the participatory design process from the perspective of person-centeredness, including how it becomes materialized in technology. This paper explores how applied participatory approaches and the design of 4 web-based interventions directed towards long-term illness correspond to key areas of person-centeredness. Methods: Data were collected during 2009 to 2012, from 4 Swedish research projects. The analysis followed an inductive approach involving a step-wise cross-case analysis. The purpose was to create shared knowledge and understanding of each separate case and to generate relevant categories.Results: A number of question areas describe the dialogue with the case participants. Results of the dialogue are categorized into 4 support areas: psychological/emotional, personal, information and technical. Person-centeredness becomes visible in the participatory design process as the approach promotes the development of a holistic view of the person and the illness and a partnership between patients and carers. The use of communication technology exemplifies concrete materialization of person-centeredness in the design of the web-based supports. The purpose of the web supports and the shaping of the actual use of the functionalities are more abstract forms of materialization.Conclusions: Our results contribute to a central development area within eHealth involving increased opportunities for patients to contribute actively in real time, obtaining access to information and sometimes interacting with carers. However, neither participatory approaches nor technology for online information and communication, can guarantee person-centeredness in isolation.
A task-fit measure of health information technology use
Authors: Tsang Sandro 
Published: October 2016

Rationale, aims and objectives: Introducing profession concerns into the evaluation of health information technology (HIT) use is an important and developing practice. A comprehensive evaluation should include the intellect elements of HIT use. This paper proposes a task-fit measure of HIT that integrates an information/knowledge quality scale into a validated judicious HIT use measure. It also presents some statistics that have implications for policy-making and curriculum development.Methods: Statistical analyses were performed on a subset of survey data. A structural equation modelling technique was applied to examine the associations among intent to use HIT, professional concerns and information/knowledge quality.Results: The statistical results show that altruism, autonomy, physician-patient relationship, (subconscious) autonomy, digestible information and medical history associate with each other to different extents. Only altruism and medical history show to be significant determinants of intent to use at P<0.001 and P<0.05 respectively. The scaled χ2 difference test shows that this model is not significantly different from the judicious HIT use model.Conclusion: The statistical results suggest that professional concerns, digestible information and person-related information are HIT use decision factors. Perhaps physicians may prefer HITs considered to be compatible with practising the science, humanism and ethics of medicine simultaneously. This research direction will potentially contribute to identifying the task-fit HITs and the corresponding policies for re-orientating medicine to be a science-using and compassionate practice in this eHealth era, thereby promoting the development of person-centered healthcare.
Cultivating person-centered medicine in future physicians
Authors: Garneau Kevin , Hutchinson Thomas , Zhao Qinyi , Dobkin Patricia 
Published: October 2016

Person-centered medicine, while valued implicitly, is not always taught explicitly in medical schools or during residency programs. Threats to educating and practicing person-centered medicine include perceived lack of time, stress, burnout and a paucity of mentors with a systematic approach to modeling and teaching students how to relate to patients in a way that addresses them as whole persons. Herein we review how trainee stress and burnout negatively impact patient care and outline a program designed to teach mindful medical practice that may be an antidote to these problems. Moreover, we present quantitative data and a student’s narrative to highlight how to cultivate person-centered medicine in trainees.Fifty-eight 4th year medical students completed questionnaires pertaining to: depression, burnout, stress, wellbeing, self-compassion and mindfulness before and after taking a 4-week elective entitled, Mindful Medical Practice. Statistically significant improvements were found on emotional exhaustion, depression, self-compassion and mindfulness. One student’s experiences highlighted how what he learned in the elective guided him during his family medicine residency. We conclude with a discussion of how the culture of medicine and the training of future physicians in particular, need to take the whole persons of both the physician and patient into account in order for all to be satisfied with and benefit from medical care.
Co- and multimorbidity patterns in an unselected Norwegian population: cross-sectional analysis based on the HUNT Study and theoretical reflections concerning basic medical models
Authors: Tomasdottir Margret Olafia , Getz Linn , Sigurdsson Johann A , Petursson Halfdan , Kirkengen Anna Luise , Krokstad Steinar , McEwan Bruce , Hetlevik Irene 
Published: October 2016

Rationale and aims: Accumulating evidence shows that diseases tend to cluster in diseased individuals, so-called multimorbidity. The aim of this study was to analyze multimorbidity patterns, empirically and theoretically, to better understand the phenomenon. Population and methods: The Norwegian population-based Nord-Trøndelag Health Study HUNT 3 (2006-8), with 47,959 individuals aged 20-79 years. A total of 21 relevant, longstanding diseases/malfunctions were eligible for counting in each participant. Multimorbidity was defined as two or more chronic conditions.Results: Multimorbidity was found in 18% of individuals aged 20 years. The prevalence increased with age in both sexes. The overall age-standardized prevalence was 42% (39% for men, 46% for women). ‘Musculoskeletal disorders’ was the disease-group most frequently associated with multimorbidity. Three conditions, strategically selected to represent different diagnostic domains according to biomedical tradition; gastro-esophageal reflux, thyroid disease and dental problems, were all associated with both mental and somatic comorbid conditions. Conclusions and implications: Multimorbidity appears to be prevalent in both genders and across age-groups, even in the affluent and relatively equitable Norwegian society. The disease clusters typically transcend biomedicine’s traditional demarcations between mental and somatic diseases and between diagnostic categories within each of these domains. A new theoretical approach to disease development and recovery is warranted, in order to adequately tackle ‘the challenge of multimorbidity’, both empirically and clinically. We think the concept allostatic load can be systematically developed to “capture” the interrelatedness of biography and biology and to address the fundamental significance of “that, which gains” versus “that, which drains” any given human being.
Evaluation of a four-week Rehabilitation Assessment program introduced at an Australian Community Care Units setting: mental health consumers and clinicians perspectives
Authors: Nguy Jodie , Petrakis Melissa , Wilson Michael 
Published: October 2016

Background: Community Care Units (CCUs) are purpose built residential accommodation for adults with severe and enduring mental illness. The CCUs are staffed by clinical mental health staff 24 hours per day and there are consistent guidelines as to the process these programs utilise to prioritise who would most benefit from them. A CCU based in the Inner East of Melbourne, Australia, has utilised one bed as a ‘review program’ to assess patients’ functional livings skills and potential for engagement with the long-term rehabilitation program as part of a general more person-centered healthcare approach. Aims: The purpose was to evaluate: (1) patient perception of the program and if this benefits their rehabilitation, (2) the perception of clinicians who refer to the program and (3) the perception of clinicians of the CCU multidisciplinary team (MDT). Method: A purposive sample of patients and clinicians was employed. Semi-structured interviews were conducted with 7 patients who had participated in the review program between January 2010 - April 2012 and an online survey was conducted with responses from 5 case managers who had referred patients and 9 clinicians in the CCU MDT team who had participated in conducting the review. Results: Our results indicated that patients found the process somewhat overwhelming and an adjustment to their daily routine; they were generally unclear as to the rationale for referral to the program. Clinicians found the program to be a useful process in assisting a more in-depth understanding of their patients’ needs. Conclusion: Results suggest that review and modification to program delivery could enhance patient benefits and enhance more person-centered approaches to care.
Physician Styles of Decision Making for a Complex Condition: Type 2 Diabetes with Comorbid Mental Illness
Authors: Trachtenberg Felicia , Pober David , Welch Lisa , McKinlay John 
Published: October 2016

Rationale, aims, and objectives: Variation in physician decisions may reflect personal styles of decision making, as opposed to singular clinical actions, and these styles may be applied differently depending on patient complexity. The objective of this study is to examine clusters of physician decision making for type 2 diabetes, overall and in the presence of a mental health comorbidity. Method: This randomized balanced factorial experiment presented video vignettes of a “patient” with diagnosed but uncontrolled type 2 diabetes. “Patients” were systematically varied by age, sex, race, and comorbidity (depression, schizophrenia with normal or bizarre affect, eczema as control). 256 primary care physicians, balanced by gender and experience level, completed a structured interview about clinical management. Results: Cluster analysis identified three styles of diabetes management. “Minimalists” (N=84) performed fewer exams or tests compared to “middle of the road” physicians (N=84). “Interventionists” (N=88) suggested more medications and referrals. A second cluster analysis, without control for comorbidities, identified an additional cluster of “information seekers” (N=15) who requested more additional information and referrals. Physicians ranking schizophrenia higher than diabetes on their problem list were more likely “minimalists” and none were “interventionists” or “information seekers”. Conclusions: Variations in clinical management encompass multiple clinical actions, and physicians subtly shift these decision making styles depending on patient comorbidities. Physicians’ practice styles may help explain persistent differences in patient care. Training and continuing education efforts to encourage physicians to implement evidence-based clinical practice should account for general styles of decision making and for how physicians process complicating comorbidities.
AUSTRALIAN PATIENTS USING A CARDIAC-DIABETES WEB-BASED INTERVENTION PROGRAM: CONTRIBUTIONS TO PERSON-CENTERED CLINICAL PRACTICE
Authors: Wu Chiung-Jung (Jo) , Atherton John J , Chang Anne M , Courtney Mary , Strodl Esben , Clark Alexander M , Thompson David R , Ramis Mary-Anne , McPhail Steven M 
Published: October 2016

Rationale, aims and objectives: Patients with both cardiac disease and diabetes have poorer health outcomes than patients with only one chronic condition. While evidence indicates that internet based interventions may improve health outcomes for patients with a chronic disease, there is no literature on internet programs specific to cardiac patients with comorbid diabetes. Therefore this study aimed to develop a specific web-based program, then to explore patients’ perspectives on the usefulness of a new program.Methods: The interpretive approach using semi-structured interviews on a purposive sample of eligible patients with type 2 diabetes and a cardiac condition in a metropolitan hospital in Brisbane, Australia. Thematic analysis was undertaken to describe the perceived usefulness of a newly developed Heart2heart webpage.Results: Themes identified included confidence in hospital health professionals and reliance on doctors to manage conditions. Patients found the webpage useful for managing their conditions at home.Conclusions: The new Heart2heart webpage provided a positive and useful resource. Further research on to determine the potential influence of this resource on patients’ self-management behaviours is paramount. Implications for practice include using multimedia strategies for providing information to patients’ comorbidities of cardiac disease and type 2 diabetes, and further development on enhancement of such strategies.
The case of case reports: A decade of publications by staff at a major university hospital
Authors: Wynn Rolf , Nissen Trygve , Bergvik Svein 
Published: October 2016

Rationale: The place of case reports in the medical literature has been much debated in recent years. This study was undertaken to gain knowledge about the publication practice of case reports and case series from a major university hospital.Method: We decided to conduct a retrospective, bibliographic, descriptive study of published case reports and case series from a university hospital in a period of 10 years. The following variables were studied: number of reports, authorship characteristics, collaboration practices, titles, medical specialities represented, educational versus non-educational purpose and number of citations.The data were extracted from the national research information system database in Norway.Results: 2.2%of all the publications were case reports. Multiple authorship was common. Male authors outnumbered female authors. Collaboration across hospitals and nations occurred for one third of the articles. 43%of the titles did not contain information that identified them as case reports or case series. The most frequently represented specialties were neurology, rheumatology, plastic surgery and medical genetics. Nine out of 10 articles were non- educational. A third of the articles had not been cited.Conclusions: The case report seems to be a minor, although viable, genre. The proportion of case reports and case series was low. A plausible hypothesis could be that clinician-researchers at the study hospital prioritized controlled clinical and paraclinical/laboratory studies that rank higher on the evidence hierarchy. Since case reports document the presentations of individual patients and their treatment, a declining interest in their publication has a significant implication for person-centered healthcare education and training.
PATIENT PREFERENCES FOR THE PHARMACOLOGICAL TREATMENT OF OSTEOARTHRITIS: A FEASIBILITY STUDY USING ADAPTIVE CHOICE-BASED CONJOINT ANALYSIS (ACBCA)
Authors: Al-Omari Basem , Sim Julius , Croft Peter , Frisher Martin 
Published: October 2016

Rationale, aims and objectives Patient preferences are an important part of optimizing the pharmacological treatment of osteoarthritis (OA). Recent choice experiments have explored this issue using two types of conjoint analysis: choice-based conjoint analysis (CBCA) and adaptive conjoint analysis (ACA). The aim of this study was to examine the feasibility of using adaptive choice-based conjoint analysis (ACBCA) methods to determine patient preferences for pharmacological treatment of OA. The specific outcomes were patient evaluations of a) eight attributes in an ACBCA task, b) the computer skills required to complete the task, and c) the perceived utility of the results. Method Participants were drawn from members of a Research Users’ Group (RUG) who had been diagnosed with osteoarthritis. Participants took part in two feasibility studies. In the first feasibility study, four RUG members critically examined the implementation of a computerized ACBCA task. In the second feasibility study, 11 RUG members completed an ACBCA task on medication preferences for osteoarthritis. The ACBCA task was evaluated by a set of self-completed questions and through semi-structured interviews. ResultsThe first feasibility study helped to shape the design and contents of the ACBCA task. In the second feasibility study, no participants reported the ACBCA task to be hard to read or understand. Most participants agreed that the task was adjusting appropriately as the session proceeded and that it helped them in making decisions about preferences. Older patients and patients with little computer experience appeared to find no substantial challenges in using this interactive computer-based technique. ConclusionsThese studies indicate that, with the involvement of patients, face and content validity of an ACBCA task can be achieved through a developmental process taking account of participants’ requirements.
Development of a communication skills based workshop for Shared Decision-Making (SDM)
Authors: Kelly-Blake Karen , Olomu Adesuwa , Dwamena Francesca , Dontje Katherine , Henry Rebecca , Rovner David R , Rothert Marilyn L , Holmes-Rovner Margaret 
Published: October 2016

Rationale, aims and objectives:Shared Decision-Making (SDM) is increasingly recommended to improve patient-centered care. Implementation of SDM in routine practice has been challenging. Our aim was to develop and evaluate a brief SDM workshop based on a communication skills approach for primary care physicians (PCPs). The clinical problem chosen was one in which over-treatment is a concern: screening and treatment options in stable coronary artery disease (CAD) following a mildly abnormal stress test. Method: Essential training tasks were identified from existing communication skills and shared decision-making skills. A 90-minute workshop was developed for use with a patient decision aid. Didactic content and role plays featuring 3 case scenarios with interactive feedback formed the approach. Participants were academic internal and family medicine PCPs. Retrospective pre-post surveys evaluated self-reported effectiveness in actual clinic encounters. Results: Seventy-two percent (21/29) of PCPs in the 2 clinics participated in the Communication-Shared Decision Making (COMM-SDM) Training Program. Providers reported increased confidence in doing shared decision-making with CAD patients. Decreases in confidence occurred in the specific task of “setting the stage for the encounter”. Some PCPs were uncomfortable with counseling patients making decisions about optimal medical therapy or percutaneous coronary intervention (PCI), preferring the cardiologist to discuss the options.Conclusions: SDM as an extension of a communication approach appears logistically feasible. The essential tasks of this training approach may be applicable to other clinical decisions where shared decision-making is appropriate, either because the decisions are preference sensitive or because testing and treatment patterns are frequently inconsistent with scientific evidence.
Inhabiting the interspaces within emergency care
Authors: Elmqvist Carina 
Published: October 2016

Aim: To describe and develop an understanding of the patient’s first encounter with different professionals at the scene of an accident and at the emergency department (ED), with a special focus on describing the meaning of emergency care of patients in these care contexts. Design and Methods: The study, having a descriptive design, was carried out with a reflective lifeworld (RLR) approach founded on phenomenological philosophyResults: The general structure revealed that emergency care is characterized by a hand-over of responsibility, which is characterized by life-saving medical actions and constitutes a doing. Those life-saving actions need a conscious presence, which at the same time means an existential support for the patient that is constituted by a being. The responsibility then intertwines the doing and the being and all persons involved are brought together into a mutual space. When the patient’s condition allows for increased physical distance from the professionals, a gap or an interspace in the intertwining between doing and being arises as well as an interspace in the patient's understanding of the encounter. For the patient and next-of-kin, this interspace means an empty space with paradoxical feelings of being interesting and at the same time uninteresting - a paradox of care. For the professionals, this interspace provides a needed breathing space, but also feelings of being split between the high demands of efficiency and the patient's need for existential support and a meaningful encounter - an ethical dilemma.Discussion: Knowledge of the temporal meaning ofthe encounter, to be here andnow,can give professionals an opportunityto fillthe interspacedespite increasingphysical distance as patient health improves. Furthermore, it will also give professionals an opportunity toreflect on howthe available timeis used.
How do we know we do what it says on the tin? Ensuring adherence to a person centered approach within Occupational Therapy Mental Health Services in Higher Education.
Authors: Creaner Brian , Nolan Clodagh 
Published: October 2016

Current Irish mental health policy demands a shift towards person centred service delivery. Occupational therapy is well placed to implement and develop services in line with this policy as it has person centred care at the core of its theoretical constructs. This study examines the use of person centred models in an occupational therapy service for students with mental health disabilities in higher education that is, the Person Environment Occupation (PEO) and Recovery models. As documentation offers the best insight into the integration of theory to practice, the aim of this study was to examine if documentation adhered to its theoretical underpinnings. Thus 195 Electronic case files were reviewed and 47 in a re-assessment process. Results demonstrated adherence to the recovery model was an area of strength for the service as was alignment to international best practice standards. However, recording of goals and interventions in line with the PEO model was lacking. Following a period on consultation with senior therapists and the clinical director changes were made to further embed the models into the documentation processes. Following this consultation re-assessment demonstrated greater adherence to person centred models in all interactions with the students with mental health disabilities. This research demonstrates that it is necessary not only to examine ones practice but to develop context specific tools to ensure person centred care signifying integration of theory to practice.