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The sustainability and viability of the public health services accessible to all has been widely discussed worldwide, due to the aging of the population, increasing burden of chronic diseases and consequent rising of healthcare expenditures. The mortality and burden of cardiovascular disease is one of the most important drivers of public and private expenses and hypertension and non-compliance with medical prescription one of the leading contributors. Therefore, strategies that promote therapeutic adherence are necessary to control cardiovascular disease and its major outcomes. A solution named PACTO was developed and emphasizes the role of the patient as an active partner of health professionals. PACTO is a mHealth solution with a variety of functionalities that accompanies the patient throughout the treatment journey, with multiple incentives that promote behavioural changes. Finally, PACTO may work in interoperability with other applications already in use in primary healthcare, reducing its initial investment and clinical teams' overload, while increasing adherence, patients' health and quality of life, and sustainability of health systems. [ABSTRACT FROM AUTHOR]

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Patient-centredness is considered integral to the delivery of modern healthcare. This qualitative, longitudinal study explored the meaning and development of the practice of pharmacy graduates, leading to a focus on patient-centredness. The approach adopted in this study aligned with the principles of hermeneutic phenomenology. Twelve pharmacy graduates (seven females) from The University of Queensland were observed at work and interviewed about their experiences of pharmacy practice every six months for two years following graduation. These 12 graduates initially understood and enacted pharmacy practice in a range of ways. A distinguishing characteristic related to how patients/customers featured in their practice. For some, ensuring the efficient supply or administration of correct and safe medicines with instructions was the focus, with patients viewed as source and recipient of information. For others, the focus was communicating effectively with patients/customers to provide individualised advice to avoid medication-related problems. A third group focused on achieving a broader goal, to provide individualised care to optimise health outcomes from medicines. Initial understanding of patient-centredness remained largely unchanged for most participants over the two years, despite the passage of time and experience gained. This study calls into question an assumption of a common meaning for patient-centredness. The findings highlight the need to question and debate what patient-centredness means in contemporary pharmacy practice, rather than simply being an aspirational or theoretical concept. It is important that pharmacists and educators appreciate the centrality of understanding of practice for development, to optimally facilitate the development of patient-centred pharmacists. • The meaning of patient-centredness in practice varies among new pharmacy graduates. • Patient-centredness is not absolute, either present or absent. • Patient-centredness doesn't necessarily develop with experience. [ABSTRACT FROM AUTHOR]

Despite the known prevalence of complementary medicine use by women during pregnancy and childbirth and the evolution of preferred models of maternity care, very little is known about the nature and characteristics of the care provided to women by complementary medicine practitioners during this important life stage. Woman-centred care is a speciation of person-centred care which has achieved prominence in maternity care policy in recent years. There is also evidence that the core principles of some complementary medicine systems of medicine emphasise patient-centredness and that these principles are core drivers toward complementary medicine use in multiple populations. This study aims to explore the approach to care delivered by complementary medicine practitioners to women during pregnancy and birth. Semi-structured individual interviews were conducted with 23 complementary medicine practitioners who identified as specialising in maternity care. Data from the interviews were analysed using a framework approach. The analysis of the perspective of complementary medicine practitioner's experiences providing care to pregnant and birthing women identified three main themes: Responding to women's expectations of care ; providing woman-centred care ; and the therapeutic relationship at the heart of woman-centred care. The approach to maternity care reported by complementary medicine practitioners aligns with the principles of woman-centred care, possibly due to the similarities between woman-centred care and the core features of many systems of medicine within complementary medicine. Complementary medicine practitioners may contribute to an overall experience of woman-centred maternity care for pregnant and birthing women. [ABSTRACT FROM AUTHOR]

Complex decision-making when dealing with situations such as feeding in the context of dementia, palliative care, and severe dysphagia is a complex clinical area for speech language pathologists (SLPs). The objective of this study was to provide an exploratory overview of complex feeding decisions, in order to highlight areas for improvement in clinical practice. A retrospective clinical chart audit of 82 participants was conducted within two hospital settings between 2012 and 2017 using an explorative approach. Complex feeding decisions were documented as "risk feeding" in 59.8% of instances and were most commonly made by the patient/family in consultation with the medical team (23.2%). Many of the complex feeding decisions were made without a multidisciplinary case conference (82.9%), without appropriate discussions with families regarding feeding decisions/options/alternatives (63.4%), and without relevant patient and family education (59.8%). Feeding decisions are ethically and clinically complex and therefore require a interdisciplinary and person-centred approach to discussion and education, as well as clear unbiased documentation. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this pilot study was to determine the feasibility of conducting a mixed- methods study assessing the extent patients with chronic health conditions perceive chiropractic care to be patient-centred.Design: A sequential mixed methods feasibility study with a quantitative priority.Setting: Two private chiropractic clinics in Calgary, Alberta, Canada.Main Outcome Measures: Feasibility outcomes included pilot study participation, consent and completion rates. Demographic and health information and a modified version of the Patient Assessment of Chronic Illness Care (PACIC).Results: Over three weeks, 90 participants were recruited, 86 enrolled, and 78 provided complete data, with only one who commented on the clarity of paperwork. Included participants were on average 47.1 years of age and 60.3% were female. They had an average of 1.8 chronic conditions with 60% having chronic spinal pain. They reported seeing an average of 2.9 other health professionals for their chronic health condition and averaged 12.9 chiropractic visits in the past year. The average overall modified PACIC score was 3.29 on a 5-point scale. Higher scores were seen on the 'patient activation', 'delivery system design/decision support', and 'problem solving/contextual' subscales, with lower scores seen on the 'goal-setting/tailoring' and 'follow-up/coordination' subscales. Interview data generally supported those findings.Conclusions: The pilot study results support the feasibility of the methods for a subsequent large-scale study. These preliminary results suggest that the degree of patient-centredness compares favourably to similar studies in primary medical care. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study evaluates the quality of information available on the internet for carers of children with epilepsy considering treatment with Vagus Nerve Stimulation (VNS).Methods: Selected key phrases were entered into two popular search engines (Google™, Yahoo™). These phrases were: "Vagus nerve stimulator", alone and in combination with "childhood epilepsy", "paediatric epilepsy" and "epilepsy in childhood"; "VNS", and "VNS epilepsy". The first 50 hits per search were then screened. Of 600 identified sites, duplicated (262), irrelevant (230) and inaccessible (15) results were excluded. 93 websites were identified for evaluation using the DISCERN instrument, an online validation tool for patient information websites.Results: The mean DISCERN score of all analysed websites was 39/80 (49%; SD 13.5). This equates to Fair to borderline Poor global quality, (Excellent=80-63; Good=62-51; Fair=50-39; Poor=38-27; Very poor=26-15). None of the analysed sites obtained an Excellent quality rating. 13% (12) obtained a Good score, 40% (37) obtained an Average score, 35% (33) obtained a Poor score, and 12% (11) obtained a Very poor score. The cohort of websites scored particularly poorly on assessment of whether reliable, holistic information was presented, for instance provision of reliable sources, (28%, SD 18) and discussion of alternative treatments, (30%, SD 14).Conclusion: To facilitate patient-centred shared decision-making, high quality information needs to be available for patients and families considering VNS. This study identifies that such information is difficult to locate on the internet. There is a need to develop focussed and reliable online patient resources for VNS. [ABSTRACT FROM AUTHOR]

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The global rate of diagnosis of autism spectrum disorder (ASD) is increasing and many parents are turning to complementary and alternative medicine (CAM) to help with the wide range of symptoms, including behavioural abnormalities. The aim of this review is to examine the efficacy of omega-3 supplementation, a popular CAM therapy for behavioural problems in children with ASD. Methods: The peer-reviewed literature published in the English language between 2007 and April 2015 was systematically searched using www.clinicaltrials.gov (US National Institute of Health database), CINAHL, Google scholar, PubMed (US National Library of Medicine) and Cochrane library databases, using a combination of the search terms Autism, ASD, Omega-3, fish oil, PUFA, EFA, EPA, DHA. Clinical studies examining the effects of omega-3 in ASD were considered. Results: Six studies were found to be relevant to this review (N = 168, ages 2 - 17). Two of these were open-label studies and four were randomised control trials. Conclusion: There is limited evidence supporting the use of omega-3 supplementation in clinical practice for the treatment of behavioural symptoms in children with ASD. However, some studies do show potential for this treatment option in a limited range of behavioural outcomes. Further studies are required. [ABSTRACT FROM AUTHOR]

Inappropriate prescribing of benzodiazepines is very common, despite known risks. This is a significant problem in older adults with further pressure being placed on health care services as this population increases. This presents an opportunity for herbal medicine to offer safe and effective alternatives. Anxiety and insomnia are the main conditions treated with benzodiazepines. Traditional and modern evidence supports the use of herbal medicine for the treatment of these conditions. In particular, Passiflora incarnata has shown strong potential as a substitute for benzodiazepines with minimal or no side effects. The challenge is in how to create awareness about these alternatives to provide patients with a choice. A patient-centred approach using a shared decision making model (EMPOWER trial) has been effective in benzodiazepine withdrawal for older adults. Including herbal medicine in the discussion would provide patients with further options for safe and simple alternatives. [ABSTRACT FROM AUTHOR]

Hypnosis in labour and childbirth is a complex intervention. Both qualitative and quantitative assessment methods have been used, but have targeted different outcomes. We followed a synergistic approach and a reconciliation strategy to further understand and evaluate this intervention. A mixed-method analysis of quantitative and qualitative evidence was conducted. The assessment of efficacy was based on a recent Cochrane review (9 trials, 2954 women randomised). Four qualitative studies and 4 case studies were included. The outcomes addressed by the qualitative studies (mostly concerning maternal experiences) and in the quantitative studies (mostly concerning analgesic use) overlapped slightly. Discrepancies across results from the two study types suggested that response shift issues could occur. Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience. • This study combines quantitative and qualitative results on hypnosis during labour and childbirth using an integrative model. • Combining qualitative and quantitative findings showed the legitimacy of both paradigms with equal levels of evidence. • In their evaluation, the outcomes addressed by these two types of study (qualitative and quantitative) only slightly overlap. • Results suggest that hypnosis could alter women's expectations and self-evaluation (response shift). • Patient-centred instruments to explore response shift are required. • Hypnosis can be presented as a technique enabling patients to have a positive birth experience. [ABSTRACT FROM AUTHOR]

Abstract: Obesity is set to become one of the biggest health problems facing governments in Europe. With a significant sequela of associated chronic conditions, treatment and prevention must become priorities in healthcare provision and policy. The cause and treatment of obesity is complex. However, evidence supports the patient-centred approach, which was the focus of discussion at a multidisciplinary educational event for healthcare students and patients held at the University of Southampton. The aim was to increase existing knowledge, promote shared learning and facilitate a better understanding of strategies needed to address the growing prevalence of obesity. The necessity for improved research strategies and a more integrated, multidisciplinary approach to treatment were echoed by the panel of expert researchers and practitioners who spoke. There was also a consensus that obesity needs to be seen as a chronic health concern by governments and health practitioners. In addition, the event provided a locus for inter-professional student groups to work collaboratively with obese (or formerly obese) patients to explore the patients’ perspective regarding obstacles to health improvement and possible solutions. Feedback indicated that both students and patients found this experience valuable and rewarding. Some patients were motivated to join other community health initiatives as a result, whilst students indicated that their understanding, future practice and research would be enhanced. Therefore it seems that this experiential approach to collaborative learning may provide a model for further educational events with a focus on patient-centred treatment of similar long term chronic health problems. [Copyright &y& Elsevier]

Abstract: The College of Medicine was launched at the end of 2010 and this was its inaugural conference. Its core values; are science, service and healing, underpinned by the belief that best possible, sustainable and cost effective healthcare can only be delivered by bringing together clinicians, scientists and most importantly patients on an equal footing. A more patient-centred approach improves outcomes, particularly in chronic conditions. These values will be sustained by our inclusive and non tribal professional approach and grounded through our structure, in particular our patient''s council. The keynote from Dean Ornish illustrated the vast potential for lifestyle change to impact gene expression and possibly survival in prostate cancer, whilst William Bird and Michael Depledge updated us on how an environment conducive to wellbeing and a self empowered exercise programme might be delivered within the UK. The College''s Innovation Network provides benchmarks for local initiatives of excellence. Stephen Holgate was also able to contextualise the increase of allergic disease within our changing environment. Support for this new and innovative organisation was clearly expressed by both politicians and many senior members of the medical establishment and we look forward to the College being in the vanguard of the changing face of medicine. [Copyright &y& Elsevier]