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This JAMA Insights explores effective communication strategies for clinicians who do not specialize in treating obesity in how to introduce conversations about weight loss with their patients and offer them support and treatment.
This JAMA Patient Page describes peptic ulcers and their causes, signs and symptoms, diagnosis, and treatment options.
L’allarme burnout e dequalificazione per i sanitari
L’allarme burnout e dequalificazione per i sanitari
Objectives
The aim of this study is to explore patients with persistent somatic symptoms and functional disorders’ (PSS/FD) experiences of and preferences for multidisciplinary care across Europe. A further aim is to compare the experiences of and preferences for multidisciplinary care of patients to those of healthcare professionals (HCPs) in the Netherlands.
Design
Cross-sectional online survey.
Setting
Patients with PSS/FD from across Europe (Germany, Italy, the Netherlands and Poland) and HCPs working in the care for PSS/FD across all levels of care in the Netherlands.
Primary and secondary outcome measures
Outcome measures for both patients and HCPs related to experiences of multidisciplinary care, communication between professionals and patients, as well as the main point of contact for patients.
Results
600 patients responded (Germany: n=198; Italy: n=174; Netherlands: n=137; Poland; n=91), and 152 HCPs responded from the Netherlands. Compared with the other countries, patients from the Netherlands generally received less multidisciplinary care, from fewer disciplines. Regarding most variables related to interprofessional communication, patients in Italy rated their experience significantly better than in most other countries. Generally, patients preferred either their general practitioner (GP) or a medical specialist as their main point of contact, and not mental health professionals. In contrast, HCPs preferred mental health professionals as the main point of patient contact, followed by GPs. In all variables, patients in the Netherlands rated interprofessional communication significantly lower than HCPs in the Netherlands did.
Conclusions
Patients have different experiences of interdisciplinary communication, also reporting lower-quality communication than HCPs, though differences are seen between countries. Future studies should look at the reasons for this and how this can lead to improved care for PSS/FD.
Objectives
Transient loss of consciousness (TLOC) is one of the most common neurological complaints in the Emergency Department (ED), but little is known about the patient perspective. We aimed to explore patient perceptions of diagnostic assessment for TLOC.
Setting
ED, Acute Medical Unit and Syncope and Neurology clinics in a single tertiary teaching hospital in the north of England.
Participants
20 adult patients (60% female, age range 17–90 years) attending or referred with a first presentation of TLOC.
Primary and secondary outcome measures
Exploratory thematic analysis of semistructured qualitative interviews.
Results
We identified three themes within the data: satisfaction with care, unanswered questions and being left in limbo/no man’s land. Participants explored these themes through four topics: communication; the role of investigations; the role of authority and the social context of care.
Conclusions
Communication (including differential diagnosis, significance of investigations and further assessments, and interim safety advice) is emphasised in supporting ongoing self-management, even before a definitive diagnosis is made.
Annals of Internal Medicine, Ahead of Print.
Annals of Internal Medicine, Ahead of Print.
This JAMA Patient Page describes pericarditis signs and symptoms, complications, diagnosis, and treatment.
Looking to limit unnecessary office visits, more patients began relying on online portals for their medical questions during the COVID-19 pandemic, which has since led to an elevated volume of messages. The influx has created a greater burden for clinicians, often requiring responses outside of regular working hours.
Objective
To examine the association of patient–surgeon racial and ethnic concordance with postoperative outcomes among older adults treated by surgeons with California medical licences.
Design
Retrospective cohort study.
Setting
US acute care and critical access hospitals in 2016–2019.
Participants
100% Medicare fee-for-service beneficiaries aged 65–99 years who underwent one of 14 common surgical procedures (abdominal aortic aneurysm repair, appendectomy, coronary artery bypass grafting, cholecystectomy, colectomy, cystectomy, hip replacement, hysterectomy, knee replacement, laminectomy, liver resection, lung resection, prostatectomy and thyroidectomy), who were operated on by surgeons with self-reported race and ethnicity (21.4% of surgeons) in the Medical Board of California database. We focused our primary analysis on black and Hispanic beneficiaries.
Primary outcomes measure
The outcomes assessed included (1) patient postoperative 30-day mortality, defined as death within 30 days after surgery including during the index hospitalisation, (2) 30-day readmission and (3) length of stay. We adjusted for patient, physician and hospital characteristics.
Results
Among 1858 black and 4146 Hispanic patients treated by 746 unique surgeons (67 black, 98 Hispanic and 590 white surgeons; includes surgeons who selected multiple backgrounds), 977 (16.3%) patients were treated by a racially or ethnically concordant surgeon. Hispanic patients treated by concordant surgeons had lower 30-day readmission (adjusted readmission rate, 4.2% for concordant vs 6.6% for discordant dyad; adjusted risk difference, –2.4 percentage points (pp); 95% CI, –4.3 to –0.5 pp; p=0.014) and length of stay (adjusted length of stay, 4.1 d vs 4.6 days (d); adjusted difference, –0.5 d; 95% CI, –0.8 to –0.2 d; p=0.003) than those treated by discordant surgeons. We found no evidence that patient–surgeon racial and ethnic concordance was associated with surgical outcomes among black patients or mortality among Hispanic patients.
Conclusions
Patient–surgeon racial and ethnic concordance was associated with a lower postoperative readmission rate and length of stay for Hispanic patients. Increasing Hispanic surgeon representation may contribute to narrowing of racial and ethnic disparities in surgical outcomes.
Objective
There is evidence that those who typically contribute to patient and public involvement (PPI) activities do not reflect the diversity of the population, and individuals from underserved groups are less likely to participate in healthcare research. For some researchers, understanding how to embed diversity into their PPI work can be confusing and challenging. The aim of this communication article is to reflect on our experiences and share the lessons learnt from developing an ethnically diverse PPI group to co-deliver breast cancer research.
Key points
Researchers must be realistic about timelines at both the grant application stage and during the research project, as finding contributors for inclusive and diverse PPI work takes time. Researchers will benefit from utilisation of existing expertise and resources within existing PPI teams at research institutions. It is vitally important to be clear about what researchers need in terms of contributors and what the PPI activities will be at different stages of the research project.
Conclusions
Conducting effective, diverse and meaningful PPI is a research skill that needs to be learnt and practised just like any other. Well-developed inclusive PPI has significant benefits for both researchers and the public.
Background
Understanding the impact of COVID-19 on the unplanned patient flow within hospitals is crucial for future preparedness planning and response strategies. We examined the impact of COVID-19 on the unplanned patient flow in a Danish healthcare region, with particular focus on emergency departments (EDs).
Methods
A descriptive multicentre cohort study was conducted comparing unplanned patient contacts during the first year of the COVID-19 pandemic (1 March 2020–28 February 2021) with the previous year (1 March 2019–29 February 2020). The study examined changes in patient flow and key flow variables—number of contacts, length of stay (LOS), triage, re-contacts, mortality, International Classification of Diseases (ICD)-10 codes, isolations and SARS-CoV-2-positive patients—and compared differences between five EDs in the Central Denmark Region.
Results
The overall number of unplanned patient contacts decreased 3.6% from the previous period (257 657) to the COVID-19 period (248 706). The decrease was lowest in EDs compared with other departments and was primarily detected during lockdowns, which were followed by months of increased ED contacts.
Although overall patient contacts decreased, an increase in proportions was observed in contacts with a LOS
This concept elicitation study explores health-related quality-of-life domains from the perspective of patients with cutaneous chronic graft-vs-host disease, defining the domains most important to patients and comparing epidermal vs sclerotic disease manifestation.
This survey study evaluates the measurement properties for acne severity of the Acne Core Outcome Research Network (ACORN) patient global assessment.
This Viewpoint discusses strategies used with driving that can be applied to health care to promote consistent and predictable physician and patient actions.
