Significant reduction in the incidence of non-coronavirus infections in patients with chronic lymphocytic leukemia on ibrutinib and venetoclax treatment during the COVID-19 pandemic: An additional benefit of lockdown.

Effective treatment and prevention of infections challenge management of patients with chronic lymphicytic leukemia (CLL). The COVID-19 pandemic resulted in the reduction of outpatient hospital visits as a part of non-pharmaceutical interventions that could affect the incidence of infectious complications. Study enrolled patients with CLL receiving ibrutinib or/and venetoclax who were observed at the Moscow City Centre of Hematology from 01 April 2017 to 31 March 2021. We found a reduction in the incidence of infectious episodes after the implementation of the lockdown in Moscow in 01 April 2020, when compared to data on the year prior to the lockdown (p < 0.0001), as well as when compared to the predictive model (p = 0.02), and based on individual infection profiles using cumulative sums (p < 0.0001). Bacterial infections had 4.44-fold decrease, bacterial in combination with undefined infections had 4.89-fold decrease, viral infections had unsignificant changes. The decrease in the number of outpatient visits coincides with the time of the lockdown could be a likely factor, explaining a decline in the incidence of infection. Patients were clustered according incidence and severity of infectious episodes for subgroup mortality assessment. No differences in overall survival due to COVID-19 were observed. Typical respiratory infections, bacterial and undefined, the transmission of which may be affected by patient-to-patient contact in the settings of out-patient health care visits were decreased, possibly due to SARS-CoV-2 restrictive measures. A positive correlation between outpatient visits and the incidence of bronchial and upper respiratory tract infection points at the role of hospital-acquired infection and attests to the necessity of reorganizing care for all patients with CLL.

A Survey of Patient Experience in CML: American and Canadian Perspectives.

Purpose: With treatment, chronic myeloid leukemia (CML) has a favorable prognosis, however, individuals with CML experience impairment to their quality of life (QoL). The aim of this study was to examine the perspectives and experiences of individuals with CML and to understand their challenges communicating with their CML physician. Patients and Methods: An online survey in adults with CML (n=100) in the US and Canada assessed QoL, patient-provider relationships, treatment satisfaction, and understanding of CML and treatment goals via the MD Anderson Symptom Inventory, the Cancer Therapy Satisfaction Questionnaire and de novo survey questions. Participants were recruited via an external patient recruiter and CML Patient Groups. Results: Many participants reported hardships due to CML and its treatment. The main impacts were on the ability to work (21%), engage in personal activities (e.g., hobbies, 28%), and to enjoy sexual relations (median=2.00, IQR=8.50). A substantial proportion (21-39%) wished to discuss additional topics with their providers (e.g., management of CML and/or its impacts). While participants reported satisfaction with therapy overall (median=85.71, IQR=17.86), they indicated low to moderate treatment satisfaction with specific components, including concerns regarding side effects (median=43.75, IQR=43.75). Participants generally had a good understanding of CML (97%) and its treatment goals (92%). Conclusion: These findings advance our understanding of issues that need improvement to support QoL for individuals living with CML. Future work is needed to improve patient-provider relationships, address treatment-related side effects, and provide clinical information that is easier for patients to understand.

Validation of personal protective equipment ensembles, incorporating powered air-purifying respirators protected from contamination, for the care of patients with high-consequence infectious diseases.

BACKGROUND: The UK High-Consequence Infectious Diseases (HCID) Network of high-level isolation units provides care for patients with contact- or airborne-transmissible highly infectious and highly dangerous diseases. In most HCID units, the healthcare workers (HCWs) wear personal protective equipment (PPE) ensembles incorporating a powered air-purifying respirator (PAPR) for head and respiratory protection. Some PAPRs have components worn outside/over other PPE, necessitating decontamination of re-usable elements. Two alternative PAPRs, with all re-usable elements worn under PPE, were trialled in this study. AIM: To undertake scenario-based testing of PAPRs and PPE to determine usability, comfort and ability to remove contaminated PPE without personal cross-contamination. METHODS: Trained healthcare volunteers (N=20) wearing PAPR/PPE ensembles were sprayed with ultraviolet fluorescent markers. They undertook exercises to mimic patient care, and subsequently, after doffing the contaminated PPE following an established protocol, any personal cross-contamination was visualized under ultraviolet light. Participants also completed a questionnaire to gauge how comfortable they found the PPE. FINDINGS AND CONCLUSIONS: The ensembles were tested under extreme 'worst case scenario' conditions, augmented by physical and manual dexterity tests. Participating volunteers considered the exercise to be beneficial in terms of training and PPE evaluation. Data obtained, including feedback from questionnaires and doffing buddy observations, supported evidence-based decisions on the PAPR/PPE ensemble to be adopted by the HCID Network. One cross-contamination event was recorded in the ensemble chosen; this could be attributed to doffing error, and could therefore be eliminated with further practice.

Perspective changes through transcultural mediation training: A qualitative study of trainees, instructors, and experts.

To deal with cultural misunderstandings in health care due to increased migration, the Babel Centre-a training and mediation center-developed "transcultural mediation": a service meant to help health-care professionals encountering difficulties with migrant patients and their families. One of the center's health-care professionals, trained as a mediator, and a cultural broker jointly conduct the mediation session. In 2017, the center initiated a specialized training program to teach health-care professionals the skills needed to serve as transcultural mediators. We conducted a study to evaluate, through the trainees' and instructors' subjective experiences, the quality of this innovative training. We used semi-structured interviews and focus groups to question seven trainees, three instructors, and three experts in transcultural psychology at different stages of the 10-month program (before, at midpoint, and afterwards). We used Interpretative Phenomenological Analysis to explore the data. The themes are organized around the central concept of the transmission of knowledge from instructors to trainees and vice versa. Trainees were globally satisfied with this program by its end but did not feel able to lead a mediation by then, due to insufficient anthropology knowledge and practical training. Training in transcultural mediation resembles that for resolving situational problems. It cannot be taught by an approach based on reasoning by the inverse problem method, used for teaching medical sciences. Pedagogical tools more suited to problem solving, such as role-playing or use of senior-assisted mediations, should be used to improve the quality of this training.

Procura por serviços ou profissionais de saúde entre adolescentes: um estudo multinível / Demand for health services or professionals among adolescents: a multilevel study

Resumo O objetivo deste estudo foi analisar a procura por serviços ou profissionais de saúde pelos adolescentes com determinantes individuais e com variáveis contextuais, modalidade de ensino da escola e Índice de Vulnerabilidade Social. Os dados foram coletados no período de março a junho de 2018, em escolas públicas estaduais de Olinda, Pernambuco, através de um questionário estruturado com questões do Youth Risk Behavior Survey (YRBS) e da Pesquisa Nacional de Saúde do Escolar (PeNSE). Dentre os 2.454 adolescentes, a proporção daqueles que procuram por um serviço de saúde foi maior: no sexo feminino; em adolescentes cujas as mães tivessem escolaridade mínima de nove anos; naqueles fisicamente ativos; e cujos responsáveis não recebiam Bolsa Família. Observou-se que as variáveis contextuais não influenciaram a procura por serviços de saúde entre os adolescentes. No terceiro modelo da análise multinível, que analisou as variáveis individuais, observou-se que apenas o sexo feminino (OR=1,80), ter mãe com escolaridade maior ou igual a nove anos de estudo (OR=1,30), não receber Bolsa Família (OR=1,23) e ser ativo fisicamente (OR=1,32) foram associados a uma maior procura por serviços ou profissionais de saúde.

Abstract This study aimed to analyze the demand for health services or professionals by adolescents with individual determinants and contextual variables (school teaching modality and Social Vulnerability Index). Data were collected from March to June 2018, in state public schools in Olinda, Pernambuco, Brazil, through a structured questionnaire with questions from the Youth Risk Behavior Survey (YRBS) and the National School Health Survey (PeNSE). Among the 2,454 adolescents, the proportion of those looking for a health service was higher among women; in adolescents whose mothers had a minimum of nine schooling years; in the physically active; and whose parents did not receive a family aid (Bolsa Família). We observed that the contextual variables did not influence the demand for health services among adolescents. In the third model of the multilevel analysis, which analyzed the individual variables, we observed that only females (OR=1,80), having a mother with schooling greater than or equal to 9 years of study (OR=1,30), not receiving Bolsa Família (OR=1,23), and physically active (OR=1,32) were associated with an increased demand for health services or professionals.

Leveraging Oral Drug Development to a Next Level: Impact of the IMI-Funded OrBiTo Project on Patient Healthcare.

A thorough understanding of the behavior of drug formulations in the human gastrointestinal (GI) tract is essential when working in the field of oral drug development in a pharmaceutical company. For orally administered drug products, various GI processes, including disintegration of the drug formulation, drugrelease, dissolution, precipitation, degradation, dosage form transit and permeation, dictate absorption into the systemic circulation. These processes are not always fully captured in predictive in vitro and in silico tools, as commonly applied in the pre-clinical stage of formulation drug development. A collaborative initiative focused on the science of oral biopharmaceutics was established in 2012 between academic institutions and industrial companies to innovate, optimize and validate these in vitro and in silico biopharmaceutical tools. From that perspective, the predictive power of these models can be revised and, if necessary, optimized to improve the accuracy toward predictions of the in vivo performance of orally administered drug products in patients. The IMI/EFPIA-funded "Oral Bioavailability Tools (OrBiTo)" project aimed to improve our fundamental understanding of the GI absorption process. The gathered information was integrated into the development of new (or already existing) laboratory tests and computer-based methods in order to deliver more accurate predictions of drug product behavior in a real-life setting. These methods were validated with the use of industrial data. Crucially, the ultimate goal of the project was to set up a scientific framework (i.e., decision trees) to guide the use of these new tools in drug development. The project aimed to facilitate and accelerate the formulation development process and to significantly reduce the need for animal experiments in this area as well as for human clinical studies in the future. With respect to the positive outcome for patients, high-quality oral medicines will be developed where the required dose is well-calculated and consistently provides an optimal clinical effect. In a first step, this manuscript summarizes the setup of the project and how data were collected across the different work packages. In a second step, case studies of how this project contributed to improved knowledge of oral drug delivery which can be used to develop improved products for patients will be illustrated.

The Challenges of Providing Interventional Radiology Services to Rural and Smaller Community Hospitals.

OBJECTIVE: Recruitment and retention of interventional radiologists for rural and smaller community hospital practices is a serious physician staffing issue. This article explores rural interventional radiology and perspectives of various stakeholders, such as rural radiology group practices, rural hospitals, interventional radiologists, public and private academic institutions, and urban health care providers, and considers the unique health care needs of rural patients. CONCLUSION: Some early solutions are evident. Collaboration among all stakeholders will be necessary to properly address the challenges.

A Personalized Approach of Patient-Health Care Provider Communication Regarding Colorectal Cancer Screening Options.

BACKGROUND: Current colorectal cancer screening guidelines by the US Preventive Services Task Force endorse multiple options for average-risk patients and recommend that screening choices should be guided by individual patient preferences. Implementing these recommendations in practice is challenging because they depend on accurate and efficient elicitation and assessment of preferences from patients who are facing a novel task. OBJECTIVE: To present a methodology for analyzing the sensitivity and stability of a patient's preferences regarding colorectal cancer screening options and to provide a starting point for a personalized discussion between the patient and the health care provider about the selection of the appropriate screening option. METHODS: This research is a secondary analysis of patient preference data collected as part of a previous study. We propose new measures of preference sensitivity and stability that can be used to determine if additional information provided would result in a change to the initially most preferred colorectal cancer screening option. RESULTS: Illustrative results of applying the methodology to the preferences of 2 patients, of different ages, are provided. The results show that different combinations of screening options are viable for each patient and that the health care provider should emphasize different information during the medical decision-making process. CONCLUSION: Sensitivity and stability analysis can supply health care providers with key topics to focus on when communicating with a patient and the degree of emphasis to place on each of them to accomplish specific goals. The insights provided by the analysis can be used by health care providers to approach communication with patients in a more personalized way, by taking into consideration patients' preferences before adding their own expertise to the discussion.

A cooperation project between hospital pharmacists and general practitioners about drug interactions in clinical practice.

OBJECTIVES: (1) To evaluate drug-drug interactions (DDIs) in general practitioners' (GPs) prescriptions; (2) to implement a cooperation project between pharmacists and GPs to improve DDI management and patient care. METHODS: In 2013, pharmacists from the Community Drug Assistance ASL TO1 launched a cooperation project involving 48 GPs. As a first step, GPs were asked to select, from a list, drug associations for which they recommended analysis of occurrence in their prescriptions. The pharmacists (1) analysed GPs' prescriptions dated 2012-2014, according to the list of DDIs selected (n= 9); (2) evaluated solutions for DDI management, using the Micromedex DDI checker database and literature analysis; they then (3) disseminated DDI-related information to GPs through training meetings and (4) assessed the efficacy of these actions through a questionnaire submitted to the GPs in 2013. RESULTS: (1) Prescriptions analysis: a reduction in the number of DDIs was observed (-14% in 2013 vs 2012, -9% in 2014 vs 2012); in some cases these reductions were statistically significant (calcium carbonate + proton pump inhibitors (PPIs) -50%, p<0.0041, amoxicillin+lansoprazole -42%, p<0.0088). (2) Questionnaire: this was completed by 75% of GPs. The literature analysis was considered interesting by 94% of GPs; solutions were adopted by 89% of GPs and 34% of GPs affirmed that clinical improvements after application of the measures were observed in their patients, even if they could not provide quantitative data for this outcome. CONCLUSION: The cooperation project between pharmacists and GPs was effective because it established a professional exchange between the two health professionals. The pharmacist gave support to GPs, which benefited the patients, who gained clinical improvements and improved satisfaction with their medical care, as declared by the GPs in answers to the questionnaire.

The state of multiple sclerosis: current insight into the patient/health care provider relationship, treatment challenges, and satisfaction.

BACKGROUND: Managing multiple sclerosis (MS) treatment presents challenges for both patients and health care professionals. Effective communication between patients with MS and their neurologist is important for improving clinical outcomes and quality of life. METHODS: A closed-ended online market research survey was used to assess the current state of MS care from the perspective of both patients with MS (≥18 years of age) and neurologists who treat MS from Europe and the US and to gain insight into perceptions of treatment expectations/goals, treatment decisions, treatment challenges, communication, and satisfaction with care, based on current clinical practice. RESULTS: A total of 900 neurologists and 982 patients completed the survey, of whom 46% self-identified as having remitting-relapsing MS, 29% secondary progressive MS, and 11% primary progressive MS. Overall, patients felt satisfied with their disease-modifying therapy (DMT); satisfaction related to comfort in speaking with their neurologist and participation in their DMT decision-making process. Patients who self-identified as having relapsing-remitting MS were more likely to be very satisfied with their treatment. Top challenges identified by patients in managing their DMT were cost, side effects/tolerability of treatment, and uncertainty if treatment was working. Half of the patients reported skipping doses, but only 68% told their health care provider that they did so. CONCLUSION: Several important differences in perception were identified between patients and neurologists concerning treatment selection, satisfaction, expectations, goals, and comfort discussing symptoms, as well as treatment challenges and skipped doses. The study results emphasize that patient/neurologist communication and patient input into the treatment decision-making process likely influence patient satisfaction with treatment.

Avaliação da cultura de segurança do paciente em unidades de neonatologia na perspectiva da equipe multiprofissional / Evaluation of the safety culture of the patient in neonatology units from the perspective of the multiprofessional team

Introdução: A Segurança do paciente tem sido discutida mundialmente e considerada elemento fundamental nos diversos níveis de atenção à saúde. Entre as estratégias para otimizar a segurança do paciente em Unidades de Neonatologia, está o fomento da cultura de segurança, principalmente em virtude de se tratar de um ambiente de alta vulnerabilidade para os neonatos. Assim, a avaliação da cultura de segurança do paciente e os fatores que a influenciam são fundamentais para o planejamento e reorganização do processo de trabalho. Objetivo: Analisar a cultura de segurança do paciente em três unidades de neonatologia de hospitais públicos na perspectiva da equipe multiprofissional. Metodologia: Trata-se de uma pesquisa quantitativa do tipo survey transversal, realizada em três unidades de neonatologia de hospitais públicos de Minas Gerais. A coleta de dados foi realizada por meio da aplicação do instrumento validado, Hospital Survey on Patient Safety Culture (HSOPSC), com 514 profissionais da equipe multiprofissional de assistência à saúde, dentre eles enfermeiros, técnicos/auxiliares de enfermagem, médicos, fonoaudiólogos, fisioterapeutas, psicólogos, terapeutas ocupacionais e assistentes sociais. Para análise dos dados, utilizou-se o software R versão 3.3.2 e os testes estatísticos de Mann- Whitney, Kruskall-Wallis e correlação de Spearman. Resultados: Os dados obtidos não mostraram nenhuma dimensão considerada como área de força, porém algumas delas apresentaram oportunidades de melhoria. As dimensões com maior percentual de respostas positivas foram “Trabalho em equipe na unidade” (59,44%), “Expectativas e ações do supervisor/chefia para a promoção da segurança do paciente” (49,90%) e “Aprendizado organizacional - melhoria contínua” (49,29%). As dimensões com o maior percentual de respostas negativas foram “Resposta não punitiva ao erro” (55,45%), “Percepção geral da segurança do paciente” (43,63%) e “Quadro de funcionários” (40,86%)...

Introduction: Patient safety is a worldwide topic of discussion and a key element in the different levels of health care. Neonatal Intensive Care Units (NICUs) are an environment highly vulnerable for neonates and the effort to enhance safety culture is always among the main strategies to optimize patient safety. Therefore, to understand factors that influence patient safety and to promote patient safety culture assessment are preponderant actions for planning and reorganizing the work process at NICUs. Objective: To analyze the patient safety culture in three public hospitals’ NICUs from the multi-professional health care team’s perspective. Metodology: This is a quantitative transversal survey conducted in three public hospitals’ NICUs in Minas Gerais state. Data collection was done through the application of the validated instrument, Hospital Survey on Patient Safety Culture (HSOPSC), in 514 personnel of the multi-professional health care team, including nurses, nursing technicians, nursing assistants, physicians, speech therapists, physiotherapists, psychologists, occupational therapists, and social workers. The Software R 3.3.2 and statistic tests Mann-Whitney, Kruskall-Wallis, and Sperman correlation were used for data analyses. Results: Although the collected data did not show any dimension with strengths, some dimensions presented opportunities for enhancement. Dimensions with the highest percentage of positive responses were “Teamwork Within Units” (59.44%), “Supervisor/Manager Expectations and Actions Promoting Patient Safety” (49.90%), and “Organizational Learning - Continuous Improvement” (49,29%). Dimensions with the highest percentage of negative responses were “Nonpunitive Response to Error” (55.45%), “Overall Perceptions of Patient Safety” (43.63%), and “Staffing” (40.86%). The data collection instrument also presented culture outcome variables. One of which was the professional's perception about patient...

La empatía en l relacion médico-paciente como anifestacion del respeto por la dignidad de la persona: una aportación de edith stinn / Empathy i the phhysician-atient relationship as a demonstration of respeect for the dignity of the individual: a contribution by edith stein / A empatia narelaação médico-paciente como manifestação do repeito pela dignnidade da pessoa: uma contribuição de edith stein

Una medicina altamente tecnificada, con una certeza diagnóstica sin precedentes y con resultados bastante eficientes pero, a su vez, con una elevada tasa de desconfianza por parte de los usuarios, lo que da como resultado una medicina defensiva, es una realidad que se repite habitualmente en el ámbito sanitario. Al parecer, el poderío de la técnica sobre la vida ha dejado de lado lo eminentemente humano en el acto de curar, ocasionando una inevitable fractura en la esencia misma de la profesión. Frente a ello se plantea rehumanizar la relación clínica a través del uso de la empatía, para contribuir de este modo a la superación del excesivo positivismo en el que ha caído la medicina.

A high-tech medicine, with unprecedented diagnostic certainty and quite efficient outcomes but, at the same time, with a high level of distrust from the users, which results in a defensive medicine, is a reality that is often repeated in healthcare. Apparently, the power of technique over life has left aside the eminent humaneness in the act of healing, causing an inevitable split in the very essence of the profession. In the presence of this, the issue arises of re-humanizing the clinical relationship through the use of empathy, thus contributing to overcoming the excessive positivism in which medicine has fallen.

Uma medicina altamente tecnificada, com uma certeza diagnóstica sem precedentes e com resultados eficientes, mas, ao mesmo tempo, com uma elevada taxa de desconfiança por parte dos usuários, o que resulta numa medicina defensiva, é uma realidade que se repete habitualmente no âmbito sanitário. Ao que tudo indica, o poder da técnica sobre a vida tem deixado de lado o eminentemente humano no ato de curar, o que tem ocasionado uma inevitável fratura na essência em si da profissão. Diante disso, propõe-se reumanizar a relação clínica por meio do uso da empatia, para contribuir, desse modo, para a superação do excessivo positivismo no qual a medicina tem caído.

Colleen's story: reflections on the concept of "patient and family centered care".

As a patient who has also been a family caregiver, I would like to offer my reflections on the concept of "patient and family centered care." How is it defined from a patient perspective? Why is it important? In what circumstances is it evident? And where is it lacking? I would like to leave the reader with a list of relatively small but, in my experience, powerful things that health care workers can do today to improve the patient and family experience.

Development of a quality of patient-health care provider communication scale from the perspective of patients with rheumatoid arthritis.

OBJECTIVES: To devise a patient-perspective driven measure of the quality of patient-health care provider communication and to evaluate the psychometric properties of this scale in a sample of 150 patients with rheumatoid arthritis. METHODS: Items were developed from interviews with 15 patients with rheumatoid arthritis. Two rheumatologists, a behavioral scientist, and a nurse researcher provided item feedback. Exploratory factor analysis with Oblimin rotation was used to examine the dimensionality of the newly developed Patient-Health Care Provider Communication Scale (PHCPCS). Cronbach's alpha was computed to assess internal consistency. Test-retest reliability was determined using the intraclass correlation coefficient. Construct validity was tested by comparing the PHCPCS with the Perceived Involvement in Care Scale (PICS) using correlation analysis. RESULTS: The PHCPCS measured two dimensions of the quality of patient-health care provider communication [Quality Communication (α = 0.94) and Negative Patient-Health Care Provider Communication (α = 0.73)]. The total PHCPCS score and its Quality Communication Subscale were positively correlated with the total score on the PICS and with the doctor facilitation subscale of the PICS. DISCUSSION: This new measure of the quality of patient-health care provider communication has the potential for use in clinical practice, provider education, and further studies to improve health care to patients with rheumatoid arthritis.