Bladder diverticulum in Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is a group of hereditary connective tissue disorders which are clinically characterized by hypermobility of joints, hyperelasticity of skin and tissue insufficiency, sometimes leading to herniation, bleeding, and organ rupture. This is a case report of a 55-year-old man with EDS and a big bladder diverticulum in which we discuss treatment strategy in patients with EDS and bladder diverticula. Initially, treatment approach should be conservative due to high recurrence rates and potential complications following surgical procedures. Invasive procedures - preferably minimally invasive - may be indicated, based on an individual risk evaluation.

An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients' Experiences and Perspectives.

BACKGROUND: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients' self-management of health behaviors and improve well-being. OBJECTIVE: This study aims to explore patients' experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. METHODS: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. RESULTS: Our analysis suggested that patients' self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients' individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. CONCLUSIONS: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness.

The Danish linguistic validation of the Ureteral Stent Symptoms Questionnaire.

INTRODUCTION: The aim of the study was to validate the Ureteral Stent Symptom Questionnaire (USSQ) in Danish for patients with indwelling ureteral stents. METHODS: The linguistic validation of the original USSQ was performed following standardised multi-step translation procedures. Seventy patients with indwelling ureteral stents were asked to complete the Danish USSQ one and two weeks after stent placement and four weeks after stent removal. RESULTS: A total of 65 patients (92.9%) completed the USSQ. Statistical evaluation revealed good internal consistency in all domains except work performance. Satisfactory convergent validity (less-than -0.4 or greater-than 0.4) was demonstrated for urinary symptoms, body pain and global quality of life. The test-retest reliability-coefficient was statistically significant for urinary symptoms, general health, pain and sexual matters. Inter-domain associations were positive and monotone for all subscales. All sub-scores, except sexual matters, significantly decreased from one week after stent insertion to four weeks after stent removal (p less-than 0.001). CONCLUSION: The Danish USSQ is a reliable and valid instrument with which to evaluate urinary symptoms and general health in patients with indwelling ureteral stents. FUNDING: Ideforum, Vejle Hospital, University Hospital of Southern Denmark, granted 80,000 DKK to support this work. TRIAL REGISTRATION: The Danish National Ethics Committee and Region Syddanmark approved the study (Study approval number 20192000-168 and journal number 19-52219, respectively).

Healthcare Professionals' Experiences and Perspectives of Facilitating Self-Management Support for Patients with Low-Risk Localized Prostate Cancer via mHealth and Health Coaching.

Introduction: Self-monitoring of self-management interventions with the use of mobile health (mHealth) can enhance patients' well-being. Research indicates that mHealth and health coaching act symbiotically to providing a more constructive outcome. Nurse coaches seem to have a significant role in translating the patients' tracked data. Objective: The objective was to explore healthcare professionals' experiences of an intervention offering self-management support through mHealth and health coaching for patients with prostate cancer. Methods: We used the interpretive description methodology, combining semi-structured individual and focus group interviews and participant observations of patient-coach interactions and use of mHealth in coaching sessions. The study was conducted between June 2017 and August 2020. Results: The nurse coaches experienced motivation and autonomy when possessing the right competences for coaching. Furthermore, the nurse coaches experienced conflicting expectations of their roles when having to integrate mHealth. Conclusion: The experience of being competent, autonomous, and confident is important for the nurse coaches to be mentally present during the coaching sessions. On the other hand, the findings indicate that having the sense of not being confident in one's own ability to perform leads to reduced motivation.

Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review.

BACKGROUND: Self-management approaches are widely used to improve chronic care. In this context, health care professionals call for efficient tools to engage patients in managing their illness. Mobile health (mHealth), defined by WHO as medical and public health practice supported by mobile devices, is demonstrated to enhance self-management and health-coaching as an engaging tool in supporting behaviour change. Nevertheless, it is unclear how health-coaching and mHealth can benefit from each other. OBJECTIVE: We conducted a scoping review to provide a literature-overview and identify any existing gaps in knowledge of mHealth in combination with health-coaching interventions for improving self-management in patients with chronic diseases. PATIENT INVOLVEMENT: No patients were involved in the review process. METHODS: The five-stage framework by Arksey and O'Malley was used. The review surveys; PubMed, CINAHL, Embase, Scopus, and PsycInfo. Two independent reviewers performed review selection and characterization. RESULTS: The review points at two approaches; (i) coaching used to support mHealth and (ii) mHealth as support for coaching. The findings suggest that patients prefer physical interactions to telecommunication. mHealth was primarily used to facilitate telecommunication and to monitor disease aspects. DISCUSSION: We found that mHealth and health-coaching interventions benefit from each other. The review report on a considerable unclarity in the coaching-methods and that the patients were more satisfied with physical interactions than mHealth. We suggest to prioritize human contact and to explore more personalized health technology. PRACTICAL VALUE: This scoping review can provide a framework for researchers and care providers to support discussion and introduction of new approaches and technology in self-management for patients with chronic diseases, thereby improving patients' quality of life.