长期住院精神分裂症患者病情及社会支持状况

目的:了解长期住院精神分裂症患者病情及社会支持状况。方法:通过检索住院病历及相关问卷评定等对住院患者进行现况调查,首先,根据患者住院病历采集患者人口学资料、病程、躯体疾病状况、治疗情况等患者疾病基本信息,并使用阳性与阴性症状量表(PANSS)及临床总体印象(CGI)评估疾病严重程度;其次,使用个体和社会功能量表(PSP)评估患者社会功能,同时使用社会支持评定量表(SSRS)和自制问卷调查了患者的社会支持水平及对家属探视的满意度。结果:共入组患者77人,其中男性39人(50.65%),女性38人(49.35%),患者平均年龄为(58.09±8.93)岁。值得注意的是,77.92%的患者为未婚或离异,其中未婚35人(45.45%)、离异25人(32.47%)。患者阳性与阴性症状量表总分为(83.36±17.27),其中阳性症状和阴性症状平均分分别为(19.33±8.01)和(21.74±6.13),其临床总体印象病情严重程度总分为(5.08±1.07)。全部77例患者均合并有躯体疾病,平均躯体疾病数(7.79±3.86)个,躯体疾病分类以消化系统疾病最多,发生率高达90.91%,其他依次为内分泌营养和代谢疾病、循环系统疾病,发生率均为76.62%,神经系统疾病发生率57.14%,肌肉骨骼系统和结缔组织疾病发生率48.05%。对各系统疾病进行进一步统计分析发现,便秘发生率最高,发生率(66.23%),其他依次为高脂血症(49.35%),脂肪肝(46.75%),锥体外系综合征(40.26%)。在用药方面,全部77例患者均使用抗精神病药物治疗,使用1种抗精神病药者44.16%,2种抗精神病药联用者51.95%,3种抗精神病药联用者3.90%。另外77例患者中,76名患者合并使用躯体疾病药物,使用比例为98.70%。在社会支持方面,患者社会支持总分平均分为(19.81±4.73);个人与社会表现量表总分平均分为(52.75±16.43),另外61.04%的患者对家属探视不满意。结论:长期住院精神分裂症患者年龄偏大、婚姻状况不佳。他们精神症状丰富,阴性及阳性症状均突出,疾病严重程度偏重。联合使用抗精神病药物及合并其他精神科药物常见;合并躯体疾病种类多且发生率高,合并使用治疗躯体疾病药物亦相当常见。另外,患者的家庭探视不足,社会支持及社会功能较差。     

Family companions’ involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction

Objective

To examine the association between family companion presence during pre-surgical visits to discuss major cancer surgery and patient-provider communication and satisfaction.

The time is now: Fostering relationship-centered discussions about patients’ social determinants of health

Objective

This paper discusses the importance of developing best practices in communication strategies to identify and act on social determinants of health (SDOH) in care settings in ways that minimizes shame and builds patient trust in the process.

Examining the context and helpfulness of family companion contributions to older adults’ primary care visits

ObjectiveOlder adults commonly involve family (broadly defined) in their care. We examined communication behaviors of family companions during older adults’ primary care visits, including whether these behaviors vary with respect to how older adults manage their health, preferences for involving family in medical decision-making, and ratings of companion helpfulness.MethodsAnalysis of audio-taped primary care visits of older patients who were accompanied by a family companion (n = 30 dyads) and linked patient surveys.ResultsFamily companions predominantly facilitated doctor and patient information exchange. More than half of companion communication behaviors were directed at improving doctor understanding of the patient. Companions were more verbally active during visits of patients who delegated the management of their health to others than visits of patients who co-managed or self-managed their health. Companions were rated as more helpful by patients who preferred active involvement of family in medical decision-making.ConclusionFamily companion participation and helpfulness in primary care communication varies by patients’ preferences for involving family in medical decision-making and approach to manage their health.Practice implicationsResearch to examine the effects of clarifying patient and family companion expectations for primary care visits could inform strategies to improve the patient-centeredness of medical communication.     

Efficacy of a social support and problem-solving intervention on heart failure self-care: A pilot study

Objective

The purpose of this study was to examine the preliminary effects of a coping partnership intervention comprised of social support and problem-solving on HF self-care maintenance, management, and confidence.

E-mail communications in primary care: what are patients' expectations for specific test results?

OBJECTIVES: The objectives of this study were to assess patients' willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends. METHODS: A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response. RESULTS: The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients' expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income. CONCLUSIONS: These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services.     

Patient-physician social concordance, medical visit communication and patients' perceptions of health care quality

Social characteristics (e.g. race, gender, age, education) are associated with health care disparities. We introduce social concordance, a composite measure of shared social characteristics between patients and physicians.

Objective

To determine whether social concordance predicts differences in medical visit communication and patients’ perceptions of care.

Methods

Regression analyses were used to determine the association of patient-provider social concordance with medical visit communication and patients’ perceptions of care using data from two observational studies involving 64 primary care physicians and 489 of their patients from the Baltimore, MD/Washington, DC/Northern Virginia area.

Results

Lower patient-physician social concordance was associated with less positive patient perceptions of care and lower positive patient affect. Patient-physician dyads with low vs. high social concordance reported lower ratings of global satisfaction with office visits (OR = 0.64 vs. OR = 1.37, p = 0.036) and were less likely to recommend their physician to a friend (OR = 0.61 vs. OR = 1.37, p = 0.035). A graded-response was observed for social concordance with patient positive affect and patient perceptions of care.

Conclusion

Patient-physician concordance across multiple social characteristics may have cumulative effects on patient-physician communication and perceptions of care.

Practice implications

Research should move beyond one-dimensional measures of patient-physician concordance to understand how multiple social characteristics influence health care quality.     

Kenyan patients’ attitudes regarding doctor ethnicity and doctor-patient ethnic discordance

Objective

This study explored Kenyan patients’ perspectives on the role of ethnicity in the doctor-patient relationship.

Methods

221 participants completed questionnaires on ethnicity in doctor-patient relationships; eight focus groups were held with low- and middle-income urban and rural women.

Results

About half of participants expressed no preference for doctor ethnicity. Participants rated demographic factors as less important than factors related to the doctor's qualifications, communication skills, and cost of service. Those who did indicate a preference were more likely to prefer Indian doctors for eye problems and Europeans for major surgery, cancer, and heart problems. With less severe medical issues participants were more likely to prefer a doctor who was ethnically concordant with them. Reasons for this centered around communication issues. In contrast, several focus group participants did not want to be treated by doctors from their own ethnic group because of concerns about confidentiality.

Conclusion

Additional research is needed on negative implications of patient-provider concordance.

Practice implications

Medical service providers must be aware of concerns about ethnic concordance. Alternatively medical centers that deal with sensitive medical information need to consider hiring staff who are not of the majority ethnic group in their region.     

It takes two to tango: A dyadic approach to understanding the medication dialogue in patient-provider relationships

Objective

To describe typologies of dyadic communication exchanges between primary care providers and their hypertensive patients about prescribed antihypertensive medications.

大学生职业自我效能的影响因素分析

目的：探讨大学生职业自我效能特点及其影响因素。方法：采用问卷共调查了清华大学和北京中医药大学的278名本科生。结果：①职业自我效能存在着性别和学校类型方面的差异。②大学生的职业自我效能更受到了家庭的职业引导、知觉到的社会支持的影响。结论：加强家庭对于大学生的职业引导，并提供足够的社会支持，能提高大学生的职业自我效能水平。     

Measuring nonverbal behavior in clinical interactions: A pragmatic guide

Objective

Understanding nonverbal behavior is key to the research, teaching, and practice of clinical communication. However, the measurement of nonverbal behavior can be complex and time-intensive. There are many decisions to make and factors to consider when coding nonverbal behaviors.

How does patient-provider communication influence adherence to asthma medications?

ObjectiveTo assess hypothesized pathways through which patient-provider communication impacts asthma medication adherence.MethodsA national sample of 452 adults with asthma reported assessments of patient-provider communication, proximal outcomes (understanding of asthma self-management, patient-provider agreement, trust in the clinician, involvement in care, motivation), and adherence to asthma medications. Structural equation modeling was used to examine hypothesized pathways.ResultsSignificantly positive direct pathways were found between patient-provider communication and all proximal outcomes. Only positive indirect pathways, operating through trust and motivation, were found between patient-provider communication and medication adherence.ConclusionPatient-provider communication influences many desirable proximal outcomes, but only influences adherence through trust and motivation.Practice implicationsTo promote better adherence to asthma medication regimens and, ultimately positive asthma outcomes, healthcare providers can focus on implementing communication strategies that strengthen patients’ trust and increase patient motivation to use asthma medications.     

三类家庭初中生社会支持与应对方式的比较研究

对 5 72名来自三类家庭 (完整、离异、组合 )初中生的家庭社会支持与应对方式进行问卷调查后发现 ,完整家庭社会支持明显优于离异和组合家庭 ;与完整家庭相比 ,离异和组合家庭初中生较多采用发泄、幻想、忍耐等消极应对方式     

护士家庭功能与社会支持及应对方式的关系研究

目的探讨护士家庭功能与社会支持、应对方式的相互关系。方法用家庭功能(FAD)、社会支持量表(SSRS)和应对方式问卷(CSQ)对某医院的护士进行调查。结果家庭功能各维度均处于一个较好的水平,分值在2.08~2.38之间;家庭功能中的问题解决、沟通、总的功能与应对方式中的解决问题存在显著的负相关(r=-0.15,-0.19,-0.16;P<0.05);角色、情感反应、情感介入、总的功能与自责存在显著的正相关(r=0.26,0.19,0.18,0.15;P<0.05);沟通、角色、情感反应、总的功能与求助因子存在显著的负相关(r=-0.34,-0.28,-0.22,-0.35;P<0.01);问题解决、沟通、总的功能3因子与积极应对存在显著的负相关(r=-0.20,-0.28,-0.25;P<0.01);角色、情感反应、情感介入3因子与消极应对因子存在显著的正相关(r=0.23,0.15,0.26;P<0.05);沟通、角色、情感反应、情感介入、总的功能与对支持的利用度存在显著的负相关(r=-0.28,-0.27,-0.23,-0.24,-0.37;P<0.01);回归分析表明,对支持的利用度和求助可以显著地预测整个家庭功能(F=12.58,P=0.00)。结论护士家庭功能与社会支持及应对方式有显著的相关,对支持的利用度和求助2个因子对整个家庭功能状况有一定程度的预测作用。     

家庭环境、人格对大学生社会支持的影响

目的：揭示家庭环境与人格如何影响大学生社会支持的获得。方法：采用问卷调查法收集大学生家庭环境、人格以及社会支持的数据资料．应用路径分析方法探索三者间的关系。结果：家庭环境的亲密度与组织性除了对社会支持有直接影响（效应系数分别为0．202和0．140）外．还可以通过人格因素对社会支持产生间接影响（效应系数分别为0．155和0．056）．此外．人格特质的内外向维度以及神经质维度对社会支持也有直接影响（效应系数分别为0．133和-0．168）。结论：社会支持的获得受家庭环境和人格因素的共同影响，家庭的亲密度与组织性越高．大学生获得社会支持的水平越高；人格特质中大学生越外向，情绪越稳定．获得社会支持的水平越高。     

What do humble doctors do? A conceptualization of clinician humility from the patient’s perspective

ObjectiveHumility is a desirable trait for clinicians (e.g., physicians, nurse practitioners, physician assistants), but it can be difficult to achieve. Although commentary and empirical studies on clinician humility exist, the literature has overlooked what exactly constitutes a humble clinician through the patients’ eyes. Using a mixed-methods approach, this study explored clinician humility from the patient’s perspective.MethodParticipants (N = 326; 42.1% female; Mage = 40.65, SDage = 11.73) listed humble behaviors that their clinician displayed and evaluated their clinician’s overall humility through an online survey. All participants were from the United States of America.ResultsParticipants rated their clinician favorably on humility, M = 4.06, SD = 0.94 (on a 1–5 scale). Through thematic analyses, we created five themes about clinician humility: approachability, respect for patient, nonverbal communication, patient-focus, and acknowledgement of limitations. Conclusions: The themes coincide with facets of humility within the literature and overlap with important strategies to improve the clinician-patient relationship.Practice ImplicationsClinician humility may serve as a useful framework to categorize important clinician behaviors in the medical interaction. Instead of attempting to remember a myriad of concepts, one may need to keep in mind a modest unifying notion: “be humble”.     

家庭功能及社会支持对农村老年人孤独的影响

目的:探讨社会支持及家庭功能对农村老年人孤独的影响。方法:分层整群抽取安徽省三个乡镇5652名≥60岁的农村老年人,采用统一调查表进行问卷调查。结果:农村老年人独孤平均得分为41.92±9.22分。高年龄组、文化程度低、未婚、离异或丧偶、家庭经济收入低、家庭人口数少、家庭功能和社会支持不好的老年人,孤独评分较高。逐步回归分析结果表明,家庭功能、主观支持、支持利用度等变量可显著预测孤独。结论:农村老年人孤独较为普遍;家庭功能和社会支持是影响老年人孤独的重要因素。