Journal of Patient-Centered Research and Reviews最新文献

Purpose: This study examines the representation of mammography on social media platforms, specifically, X (Twitter), Facebook, TikTok, and Instagram, from 2006 to 2023. X (Twitter) went public in 2006, Facebook in 2004, Instagram in 2012, and TikTok in 2018 (after merging with Musical.ly). The analysis starts from after the public launch years to analyze personal experiences shared online.

Methods: A retrospective content analysis was conducted on 1,771 posts using specific hashtags related to mammography. Posts were categorized into themes including emotional and psychological impacts, clinical and procedural details, and social and supportive interactions. The analysis involved summarizing the distribution of themes across different social media platforms, focusing on frequency counts and percentages.

Results: The analysis revealed that, among included posts, Instagram hosted the most discussions (621 posts), followed by TikTok (457 posts), X (Twitter) (403 posts), and Facebook (290 posts). Key themes identified included raising awareness (1,735 posts), spreading positivity (1,675 posts), and discussing clinical aspects, such as diagnosis (1,197 posts) and quality of life (1,011 posts). Posts often highlighted concerns about discomfort (701 posts) and anxiety (835 posts) related to mammography, while also emphasizing the importance of early detection and the support found within online communities.

Conclusions: Social media serves as a powerful tool for public health communication, offering a mix of positive narratives and highlighting concerns about mammography. The significant engagement from the general public reflects a diverse array of perspectives that can inform future health communication strategies.

Purpose: Performing self-care and domestic life tasks are key aspects of functional independence for older adults. While both depression and anxiety symptoms are correlated with increased functional limitation, these disorders are often studied separately, despite frequent co-occurrence and plausible interaction, and without the consideration of social health. This study examined the impact of comorbid depressive and anxiety symptoms, controlling for social participation and loneliness, on severity of functional limitation in a nationally representative sample of older adults to improve patient-centered care.

Methods: The National Social Life, Health, and Aging Project (NSHAP) Rounds 2 and 3 data were utilized. Primary outcomes were self-reported difficulty with activities of daily living and instrumental activities of daily living. All analyses were weighted for Round 2 to account for NSHAP sampling design.

Results: Approximately one-quarter of respondents documented either depressive or anxiety symptoms, with 9.4% documenting both. Those with both depressive and anxiety symptoms reported the greatest number of functional limitations and greatest difficulty with tasks when assessed after 5 years. Using multivariate linear regression, poorer mental health status and increased comorbidity burden significantly predicted severity of functional limitation. While loneliness was associated with slightly worse function, increased social participation appeared to be a protective factor.

Conclusions: These results build on existing literature calling for a more holistic assessment of health - physical, mental, and social - and further emphasize the need for mental health interventions as an avenue to increase functional independence in older adults to improve patient experience and patient-centered care.

Purpose: Barriers to communication and inaccurate provider assumptions about patient priorities limit the delivery of comprehensive, high-quality, patient-centered care (PCC) to people with Parkinson's (PWP). This study aimed to analyze priorities of PWP using a qualitative, unstructured single-question survey and to test associations with validated quality of life (QOL) measures.

Methods: During appointments at a subspecialty, interdisciplinary clinic, PWP (n=139) provided written responses to the prompt: "What is important for your care team to know about you?" Patient Health Questionnaire, Montreal Cognitive Assessment, and Hoehn and Yahr scales were obtained through retrospective chart review. Key qualitative themes were identified through grounded theory analysis, and associations with quantitative health measures were tested with correlation analyses.

Results: Common themes included participant health (eg, PD-related goals and comorbidities), non-illness identities (eg, family or community role), and the psychosocial impact of PD (eg, losing independence and uncertainty). Positive sentiments (n=73), such as motivation and optimism, were more common than negative sentiments (n=45), such as loss and fear. There was moderate concordance between worsened mental health and uncertainty (rho=0.206, p=0.02) and inverse concordance between worsened mobility and gratitude (rho=-0.174, p=0.04).

Conclusions: The range of priorities that PWP want to share with their care team is more diverse than that of common provider assumptions, is correlated with clinical outcomes such as mental health and mobility, and may not be captured by existing QOL assessment tools. An open-ended, qualitative prompt should be incorporated into routine specialist care for PWP as a valuable QOL indicator.

Purpose: This study aimed to describe the adherence of National Comprehensive Cancer Network guidelines to perform genetic screening for all colorectal cancer (CRC) specimens with molecular tumor testing, eg, immunohistochemical (IHC) testing, in a large community-based healthcare setting. The study also identified trends involving characteristics of CRC, individual reporting physician, and physician location and examined the potential impact of these trends on the performance of molecular tumor testing.

Methods: This was a retrospective, multi-center study using a centralized pathology database to assess molecular testing on CRC specimens. The primary endpoint was whether tumor testing of a CRC specimen was performed. Secondary endpoints included tumor location within the colon (ie, the right or left side), year of CRC diagnosis, and location of the pathologist within the Advocate Aurora Health (AAH) system. The data were collected from 2016 to 2020.

Results: A total of 2469 CRC cases, reviewed by 47 pathologists practicing in five separate hospitals, were identified within the AAH system for the selected five-year time period. IHC testing was performed in 1666 of these specimens (67.5%). There was no statistical difference between CRC sidedness and IHC testing performed (p = 0.9). There were no discernible features or trends for the ordering of IHC testing among different pathologists.

Conclusions: Molecular tumor testing for CRC specimens in this large community-based healthcare setting was inconsistent and below the ideal adherence rate of 100%. Secondary findings offered neither explanation nor trends in likelihood to send samples for IHC testing. Education would be beneficial for pathologists and all physicians who care for patients with CRC in community-based health care settings.

Climate change affects patient health through an array of exposures, including increasing heatwaves, extreme weather events, poor air quality, and expanding vector-borne illnesses. Physicians are at the forefront of addressing the health consequences of these exposures with patients, and environmental sustainability has become a priority for health care organizations. Accordingly, climate change and health is becoming a critical area for graduate medical education (GME). As GME leaders design and drive education in residency and fellowship programs, understanding those leaders' baseline knowledge on this topic and its alignment with their organizations' priorities is an essential step in the development of climate and health education programs. A search of existing climate and health knowledge assessments revealed an array of tools, yet most had limited applicability for physicians. We systematically created a brief GME climate and health baseline assessment requiring less than 10 minutes of users' time. The assessment was administered anonymously via an online survey tool to GME leaders at three sponsoring institutions across three states within our health care system. Responses from 115 of 155 individuals (74% response rate) yielded an average 62% correct (standard deviation = 16%) and a score range of 10% to 90%. This baseline assessment identifies GME leaders' knowledge gaps about climate change and its impacts on health, the role of health care organizations in producing planet-warming pollution accelerating climate change, and the prioritization of these issues within our organization.

Purpose: The lived experience of women undergoing axillary procedures as part of their breast cancer (BC) treatment remains unexplored. This lack of in-depth understanding could hamper implementation of person-centred care, which is concerning because BC is the most common form of cancer in women. The aim of this study was therefore to explore the lived experiences of women undergoing axillary lymph node dissection (ALND) due to BC.

Methods: Twelve women with a mean age of 59 years were interviewed about their lived experiences of axillary procedures as part of their BC treatment. The interviews were recorded, transcribed verbatim, and analysed using a phenomenological hermeneutical method. This narrative method enabled the researchers to reinterpret the worlds of the women with BC, as reflected in the data.

Results: The naïve understanding, ie, the meaning of the text as a whole, revealed that the participants were in a process of accepting and adapting to their life after ALND involving adjuvant chemotherapy and/or hormonal therapy. Thus, six main themes emerged in the thematic structural analysis illustrating the meaning of acceptance and adaptation when suffering from BC and undergoing a treatment trajectory, ie, establishing coherence, adjusting to treatment, safeguarding social belonging, re-defining oneself, feeling vulnerable, and accepting one's circumstances.

Conclusions: If healthcare professionals provided structure and consistency, the women's treatment and lived experiences made sense; the women experienced more certainty, freedom, and meaningful social interactions. Uncertainty occurred when the women became lost in their own sense-making process, leading to low self-efficacy. There is a need for a paradigm shift in surgical care from viewing women with BC as anatomical constructions in need of repair to deeply understanding that they are persons with an illness who require ongoing self-management support.

Purpose: Serum cytokine alterations are associated with increased Staphylococcus aureus bacteremia (SAB) mortality. Unfortunately, clinical use of these cytokines is uncommon due to limited availability and high cost. Complete blood count (CBC) with differential reflects the host immune response, and CBC subgroup parameters may have prognostic value in SAB. We sought to determine the association between CBC subgroup parameters on the day of index blood culture and 30-day all-cause mortality in SAB patients.

Methods: We conducted a retrospective study of adult SAB patients with infectious diseases consultation to evaluate the discriminatory capacity of CBC subgroup parameters in predicting SAB mortality. Clinical and microbiological data were collected, including severity of illness and CBC subgroup parameters, on the day of index blood culture. The primary outcome was 30-day all-cause mortality. A multivariable logistic regression model was used to determine the association between patient-level variables and mortality.

Results: A total of 119 patients were included. The overall 30-day all-cause mortality rate was 10.1%. The median neutrophil-to-lymphocyte count ratio (NLCR) among survivors was 13.6 vs 23.2 among non-survivors (p = .007). Median lymphocyte count among survivors was 0.9 x 103 cells/μL vs 0.6 x 103 cells/μL among non-survivors (p = .031). Median platelet count was higher among survivors than non-survivors (239 x 103 cells/μL vs 171 x 103 cells/μL, respectively; p = .018). All other CBC subgroup parameters were similar between the two groups. Known SAB mortality predictors, including age, were also associated with increased mortality. Lower lymphocyte count was independently associated with increased mortality (adjusted odds ratio [aOR] 0.236, 95% confidence interval [CI] 0.064-0.872), as was higher PITT bacteremia score (aOR 2.439, 95% CI 1.565-3.803).

Conclusions: CBC subgroup parameters may have prognostic value in SAB. Additional study is warranted to further ascertain the prognostic value of these readily available laboratory values.