Patient preference and adherence最新文献

Background: Heart valve replacement is one of the primary treatments for valvular heart disease. Postoperatively, patients require long-term anticoagulation therapy to prevent life-threatening thromboembolic events. However, poor patient adherence to anticoagulation can lead to complications such as thrombosis and embolism, adversely impacting patient prognosis. This study aimed to systematically search for the best available evidence on anticoagulation adherence management to provide evidence-based guidance for the clinical practice concerning adult patients after heart valve replacement.

Methods: Following the "6S" evidence resource model, evidence retrieval was conducted in a top-down manner, collecting relevant guidelines, best practices, evidence summaries, systematic reviews, and expert consensuses. The search period was limited to databases from January 1, 2015, to May 31, 2025. Two evidence-trained researchers independently appraised the quality of the included literature. Evidence was then extracted and summarized according to the JBI evidence grading and recommendation system.

Results: A total of 13 articles were finally included, comprising 5 clinical decisions, 1 evidence summary, 3 guidelines, 2 systematic reviews, 1 expert consensus, and 1 randomized controlled trial. Eighteen best evidence statements were summarized from four dimensions: symptom assessment, monitoring modalities and methods, quality control and management, and patient education.

Conclusion: This study summarized the best evidence for anticoagulation adherence management after heart valve replacement across four dimensions. This can provide guidance for clinical or community healthcare professionals in developing and implementing interventions and practice programs to improve patient adherence to anticoagulation, thereby improving clinical outcomes and quality of life for patients post-heart valve replacement.

Purpose: For patients with antithrombotic therapy combined with mixed hemorrhoid bleeding, the contradiction between antithrombotic and hemostatic treatments often requires surgical intervention. However, multi-country guidelines recommend the use of injection sclerotherapy (IST), but there is little research on the application of polidocanol foam IST. The purpose of this study is to explore the retrospective single-center case series experience of polidocanol foam IST in those patients and review the related literature.

Patients and methods: From March 2018 to May 2023, we retrospectively analyzed the clinical data of 7 patients with mixed hemorrhoid bleeding in the General Surgery Department of Yangpu Hospital affiliated with Tongji University. These patients all received antithrombotic treatment and their bleeding could not be stopped by conservative treatment. Finally, they all received polidocanol foam IST. We summarized the single-center clinical application experience of polidocanol foam IST in those patients. Through a literature search, the related literature concerning the application of polidocanol foam IST in patients with antithrombotic therapy combined with mixed hemorrhoid bleeding were reviewed.

Results: Seven patients were successfully treated with polidocanol foam IST, and the bleeding stopped. The operation time ranged from 10-30 minutes, and no serious complications occurred. At the 4-week postoperative follow-up evaluation, none of the patients had bleeding again, and hemoglobin significantly increased (106.0±17.4 g/L vs 70.9±19.7 g/L, p=0.004). Four weeks after surgery, the overall clinical efficacy rate reached 100%, with a satisfaction rate of 100%. Through a literature review, three studies were ultimately included for analysis.

Conclusion: Polidocanol foam IST is a relatively safe and effective method for patients receiving antithrombotic therapy combined with mixed hemorrhoid bleeding. However, larger multicenter prospective studies are needed before this is the preferred treatment for such patients.

Purpose: Dissatisfaction with outpatient experiences can cause patient disengagement, reduced adherence, and poorer outcomes. Due to the absence of an appropriate outpatient experience assessment tool in China, our study aims to translate the Health Services Outpatient Experience (HSOPE) scale into the Chinese context, evaluate its psychometric properties, and identify factors (eg, patient characteristics, interpersonal dynamics, and clinical specifics) that determine patient satisfaction and healthcare quality among Chinese outpatients.

Patients and methods: Our study consisted of two phases: translation of the HSOPE scale and psychometric validation and analysis. The scale was translated into Chinese using both forward and backward translation methods. A cross-sectional study was then conducted among outpatients from a general hospital in China from October 2023 to April 2024. We collected data from 556 participants, and the total sample was randomly split for validation: one subset for exploratory factor analysis (EFA) and another for confirmatory factor analysis (CFA). We assessed the scale's reliability and validity through measures of internal consistency, item analysis, EFA, and CFA, and used linear regression to identify determinants of outpatient experiences.

Results: The 10-item Chinese HSOPE scale demonstrated high reliability (Cronbach's alpha: 0.93; Guttman split-half: 0.92) in the full sample (n = 556). EFA (n = 385) extracted one factor, explaining 56.01% of the variance, and CFA (n = 171) confirmed a good model fit (χ²/df = 1.69, RMSEA = 0.06). Older age and being single were associated with positive experiences. Negative experiences were linked to visiting gynecology/obstetrics or pediatrics, poor doctor communication, lack of pre-test information, inadequate medication instructions, perceived privacy violations, insufficient doctor thoroughness, and long wait times (1-2 hours or > 2 hours) (all P < 0.05).

Conclusion: The 10-item Chinese HSOPE scale is a reliable and valid tool for assessing outpatient experiences in China. The identified factors, such as communication, privacy protection, and wait times, can guide targeted improvements to enhance patient satisfaction and healthcare outcomes.

Objective: To compare the quality and comprehensiveness of information on peripherally inserted central catheters (PICCs) provided by Google and the artificial intelligence (AI) tool ChatGPT, and to identify the implications for patient understanding, informed decision-making, and potential adherence in oncology care.

Methods: In a simulated study, the top 20 PICC-related frequently asked questions (FAQs) were identified via a standardized Google search. These questions were posed to both platforms, and the responses were systematically analyzed and compared for source, type, and content.

Results: Google's answers were fragmented and sourced mainly from government websites (45%). In contrast, ChatGPT provided comprehensive, synthesized responses, primarily from academic sources (70%), as inferred from the content, given its lack of explicit source attribution. Critically, significant discrepancies in key clinical information were found. For instance, Google's top answer for PICC longevity was "two to six weeks", while ChatGPT suggested "up to six months or more", creating a high potential for patient confusion and undermining trust in prescribed care plans.

Conclusion: ChatGPT has the potential to offer more integrated health information than traditional search engines, thereby influencing how patients access knowledge. However, the presence of conflicting and decontextualized information introduces significant risks, such as patient confusion and anxiety, which can negatively impact trust, shared decision-making, and adherence to medical advice.

Objective: To explore the severity of demoralisation in patients with colorectal cancer (CRC) and its relationship with medical coping style, psychological resilience and perceived social support.

Methods: This cross-sectional study sequentially recruited a total of 253 patients with CRC between August 2023 and April 2024. Socio-demographic and clinical information were collected using a survey. The Demoralisation Scale II (DS-II) was used to assess demoralisation, and results from a Chinese version of the medical coping style questionnaire, a perceived social support scale and a simplified psychological resilience scale were collected. Pearson correlation and multiple linear regression analyses were performed to analyse the relationship between demoralisation and other variables.

Results: The mean score of the DS-II was 11.71 ± 6.32, with 40.7%, 44.3% and 15% of patients with CRC exhibiting low, moderate and high levels of demoralisation, respectively. Demoralisation was significantly correlated with gender, education level, marital status, occupation, family residence, family per capita monthly income, health insurance type, presence of a caregiver, past medical history, number of chronic diseases, length of hospitalisation, number of hospitalisations, disease stage, metastasis and presence of an enterostomy (p < 0.05). Multiple linear regression analysis indicated that metastasis, medical coping style, social support and psychological resilience were independent risk factors significantly associated with demoralisation in patients with CRC (adjusted R ² = 0.801; p < 0.05).

Conclusion: Demoralisation is associated with medical coping style, social support and psychological resilience in patients with CRC. Early and regular monitoring using specially designed and effective tools is essential. This innovative study combines demoralization with coping, support, and resilience to reveal its profound impact on nursing practice and enhance the quality of patient care.

Background: To investigate the relationship between stroke patients' illness perception and rehabilitation exercise adherence, while also exploring the potential mediating influences of frailty and family care, as well as the moderating impact of nutrition.

Methods: A total of 307 ischemic stroke patients underwent surveys utilizing the Illness Perception Questionnaire, the Frailty Assessment Scale, the Family APGAR Index, the Rehabilitation Adherence Assessment Scale, and the Mini Nutritional Assessment-Short Form. Pearson correlation analysis was used to examine the associations among the scores of various scales. Following data standardization, mediation and moderation effects were tested using PROCESS v4.1 Models 6 and 83, with the Bootstrap method employed to assess the robustness of these effects.

Results: Illness perception was negatively correlated with rehabilitation exercise adherence (r=-0.532, P<0.01). Both frailty (β=-0.17, 95% CI [-0.26, -0.079]) and family care (β=-0.101, 95% CI [-0.156, -0.052]) had significant independent mediating effects between illness perception and rehabilitation exercise adherence, and the chain mediation effect was also significant (β=-0.087, 95% CI [-0.14, -0.045]), accounting for 68.45% of the total effect. Nutrition moderated the relationship between illness perception and frailty (β=-0.176, P<0.001), with the positive influence of illness perception on frailty weakening as the level of nutrition increased.

Conclusion: Illness perception is negatively associated with rehabilitation exercise adherence, exacerbating frailty and reducing family care. The impact of illness perception on escalating frailty is primarily manifested through inadequate nutritional status. Therefore, healthcare providers are required to help stroke patients establish correct illness cognitions, prevent the occurrence of frailty, encourage family members to provide sufficient family care, and pay attention to patients' nutritional status to promote better recovery.

Objective: To develop a health literacy intervention program for patients with hypertriglyceridemia-induced acute pancreatitis based on Timing It Right.

Methods: Guided by the Timing It Right framework, a preliminary version of the intervention program was developed through a comprehensive literature review and semi-structured interviews. From August to October 2023, two rounds of Delphi expert consultations were carried out with a panel of 15 medical and nursing experts from four provinces and municipalities (Jiangsu, Sichuan, Heilongjiang, and Shanghai). The feedback obtained through this process was used to refine and finalize the intervention program.

Results: Following two rounds of consultation, a consensus was reached among all 15 experts. The authority coefficients of the experts were 0.825 and 0.813, respectively, with a 100% response rate. The Kendall's coefficients of concordance were 0.203 and 0.206 (P < 0.001). In the second round, the coefficients of variation for all items ranged from 0.071 to 0.188. The final health literacy intervention program comprised 4 first-level items, 10 second-level items, and 52 third-level items.

Conclusion: The health literacy intervention program developed using the Timing It Right framework demonstrates scientific validity, reliability, feasibility, and practical applicability. It effectively addresses the clinical needs of patients and offers structured guidance for enhancing their health literacy. Further clinical validation is warranted to confirm its effectiveness.

Background: Approximately 50% of older adults experience sleep disturbances. The preservation of high-quality sleep is essential; consequently, there is a pressing need for effective interventions to enhance sleep quality.

Purpose: This study aimed to determine the effectiveness of the Mindfulness-Based Art Therapy (MBAT) on sleep quality, depression anxiety stress, and mindful attention awareness among older adults in urban contexts.

Patients and methods: A quasi-experimental study with a one-group pretest-posttest design was conducted from March to May 2025. A random sample of 35 older adults with sleep problems was selected from 98 volunteers in Bangkok to participate in a six-week MBAT program using Mandala coloring. Data collection included a Personal Information Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Depression Anxiety Stress Scales (DASS-21), and the Mindful Attention Awareness Scale (MAAS) at baseline (pre-test), 6 weeks (post-test), and 10 weeks (follow-up). Data were analyzed using descriptive statistics, one-way repeated measures ANOVA, and the Friedman test.

Results: Significant changes in PSQI scores (p < 0.001) and DASS-21 scores (p < 0.050), were observed over the 10 weeks study. Multiple comparisons revealed that participants showed significant improvements in PSQI scores from baseline to the 6 weeks and from baseline to 10 weeks (p < 0.001 and < 0.001, respectively) and DASS-21 scores were significantly different between the 6 weeks and 10 weeks (p < 0.050). Effect sizes indicated large effects for PSQI scores and DASS-21 scores. MAAS scores showed medium effects that were not statistically significant.

Conclusion: The MBAT program enhances relaxation for older adults, improving their sleep quality and mental health. It incorporates education on sleep hygiene, stimulus control, sleep restriction, relaxation techniques, and weekly telenursing sessions. The findings suggest it should be integrated into standard nursing care, and future research should consider extending the program's duration to better change the MAAS score.

Trial registry number: Thai Clinical Trials Registry (TCTR20250409001).(https://www.thaiclinicaltrials.org/show/TCTR20250409001).

Background: Acne vulgaris is a common, chronic skin condition that affects both physical appearance and psychological well-being. Effective management requires long-term, personalized strategies that prioritize maintenance and adherence. Most research has focused on Western populations, primarily examining topical and oral therapies, while procedural treatments are more prevalent in Thailand. This study aims to explore treatment preferences among individuals with acne, the factors influencing their choices, and adherence patterns.

Materials and methods: A cross-sectional survey was conducted among 1,237 Thai participants aged 18 to 45 years, utilizing a validated 22-item self-administered questionnaire. The questionnaire assessed demographics, treatment usage, preferences, decision-making factors, satisfaction, and adherence. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression analyses.

Results: Topical treatments were the most used (68.07%), although only 16.25% of patients relied on them alone. Comedone extraction was reported by 51.90% of patients, and 42.28% used over-the-counter products. Oral therapies were less common, with antibiotics used by 16.01% and isotretinoin by 10.67%. Overall, most patients reported using combination therapies. The treatment preferences of the participants closely aligned with their actual usage. Adherence to acne treatment was only observed in 33.71% of participants. Factors significantly associated with higher adherence included a longer treatment duration, the use of multiple treatment modalities, a greater impact of acne on quality of life, and high satisfaction with treatment and communication with healthcare providers. Key barriers to adherence included the cost of treatment, lack of noticeable results, and side effects.

Conclusion: This study reveals real-world patterns of acne treatment in Thailand, where patients commonly favor topical and procedural therapies, while oral treatments are underutilized. Gender differences, cultural norms, and social influences shape choices. These findings underscore the need for culturally sensitive patient education and evidence-based guidance to improve adherence, satisfaction, and treatment outcomes.

Purpose: To evaluate antihypertensive therapy adherence and to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) for implementation in Romanian cardiology outpatient practice.

Patients and methods: In this cross-sectional pilot study, 144 adult hypertensive patients completed a Romanian-translated, culturally adapted HBCTS. Mean arterial pressure (MAP) served as an indicator of blood pressure control. Receiver operating characteristic (ROC) analysis determined the optimal adherence cut-off, and multivariable modelling assessed the relationship between HBCTS scores and MAP, adjusting for potential confounders. This study was conducted at an outpatient cardiology clinic in Targu Mureș, Romania, Patients inclusion criteria: adult patients (≥18 years) with diagnosed primary hypertension receiving at least one year of continuous antihypertensive therapy, and exclusion criteria: cognitive/communication barriers and secondary hypertension.

Results: The HBCTS demonstrated acceptable internal consistency (McDonald's ω = 0.75; Cronbach's α = 0.70) and retained a three-factor structure. ROC analysis identified 50 points as the optimal adherence threshold (AUC = 0.81; sensitivity = 0.83; specificity = 0.57). After adjustment, 52.1% of participants met the adherence criterion. Each one-point increase in HBCTS score corresponded to a 35% increase in the odds of achieving controlled blood pressure (OR = 1.35; 95% CI: 1.19-1.53; p < 0.001). Older age was associated with lower probability of adherence (OR = 0.94; 95% CI: 0.89-0.98, p = 0.006), whereas permanent employment status increased the chance of higher adherence (OR = 3.36; 95% CI: 1.57-7.22, p = 0.002). Patients overreported their adherence by 18.5% compared with MAP-defined blood pressure control.

Conclusion: These findings support the applicability of the HBCTS in Romanian cardiology outpatient settings and identify key demographic factors associated with patient's adherence. The validated scale offers cardiology practitioners a reliable instrument to detect adherence barriers among high-risk patients, thereby supporting the implementation of targeted, patient-centered interventions.