The Placebogenic Phenomenon: Art in Psychiatric Nursing

Barcode-assisted medication administration (BCMA) is technology with demonstrated benefit in reducing medication administration errors in hospitalized patients; however, it is not routinely used in emergency departments (EDs). EDs may benefit from BCMA, because ED medication administration is complex and error-prone. A naïve observational study was conducted at an academic medical center implementing BCMA in the ED. The rate of medication administration errors was measured before and after implementing an integrated electronic medical record (EMR) with BCMA capacity. Errors were classified as wrong drug, wrong dose, wrong route of administration, or a medication administration with no physician order. The error type, severity of error, and medications associated with errors were also quantified. A total of 1,978 medication administrations were observed (996 pre-BCMA and 982 post-BCMA). The baseline medication administration error rate was 6.3%, with wrong dose errors representing 66.7% of observed errors. BCMA was associated with a reduction in the medication administration error rate to 1.2%, a relative rate reduction of 80.7% (p < 0.0001). Wrong dose errors decreased by 90.4% (p < 0.0001), and medication administrations with no physician order decreased by 72.4% (p = 0.057). Most errors discovered were of minor severity. Antihistamine medications were associated with the highest error rate. Implementing BCMA in the ED was associated with significant reductions in the medication administration error rate and specifically wrong dose errors. The results of this study suggest a benefit of BCMA on reducing medication administration errors in the ED.

Medication reconciliation was adopted as a National Patient Safety Goal by the Joint Commission in 2005 and is now standard practice across care settings. More recently, the concept of medication optimization has gained attention, recognizing that safe medication use requires more than reconciliation alone. Home healthcare (HHC) is one setting with a critical need for medication optimization. This work describes a pharmacist-led interdisciplinary team (IDT) effort to reduce hospitalization rates at Providence VNA Home Health by improving medication reconciliation, evaluation, and prescriber communication. The IDT developed a tool and a 1-hour training with operational definitions and scenarios for reconciliation and documentation, along with a separate training focused on medication evaluation. To assess training effectiveness, the primary outcome was to reduce 30-day hospitalizations among high-risk heart failure patients to below 12%. This outcome was met and sustained for 8 weeks post-implementation. A secondary goal—reducing 30-day rehospitalizations per Strategic Healthcare Programs (SHP)—was also met and sustained from April to December 2020. This quality improvement project demonstrated that enhancing medication reconciliation and evaluation in high-risk patients reduces hospitalizations. Reconciliation may be especially important in patients with two or more self-reported unreconciled medications in the EHR, which may signal suboptimal medication evaluation. Addressing the challenges HHC clinicians face in optimizing medications and reinforcing best practices can improve outcomes. Pharmacists play a key role in interdisciplinary teams in HHC, given the complexity of medications and their impact on quality measures.

Thirty semi-structured interviews were conducted with 5 dentists (3 male and 2 female) after first and second consultations with 15 newly enrolled dental phobic patients (2 male and 13 female) in a clinic specializing in the treatment of odontophobia. Analysis of the transcribed interviews was influenced by the principles of grounded theory. Five concepts/higher-order categories were grounded in the data: 1 core category: 'Relatedness, based on affective resonance and concordant roles' and 4 additional higher-order categories: 'the dental phobic patient's emotions'; 'the patient's verbal and non-verbal cues'; 'the dentist's role as a clinician: professional interpersonal skills'; and 'the dentist's role as a fellow-being: general interpersonal skills'. The model developed describes the dynamics of the dentist-patient interaction and has a theoretical application.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

To date, the conversation about facial rejuvenation surgery has focused on one goal: youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities conveyed by their faces. The term facial profiling has been used to describe this act of determining personality attributes through visual observation. To introduce the concept of facial profiling to the surgical literature and to evaluate and quantify the changes in personality perception that occur with facial rejuvenation surgery. This study was a retrospective evaluation of preoperative and postoperative photographs of 30 white female patients who underwent facial rejuvenation surgery between January 1, 2009, and December 31, 2013. Procedures included rhytidectomy (face-lift), upper blepharoplasty, lower blepharoplasty, eyebrow-lift, neck-lift, and/or chin implant. The 60 photographs (30 preoperative and 30 postoperative) of these patients were split into 6 groups, each with 5 preoperative and 5 postoperative photographs. The same patient's preoperative and postoperative photographs were not included in any single group to avoid any recall bias. At least 24 individuals rated each photograph for 6 personality traits (aggressiveness, extroversion, likeability, trustworthiness, risk seeking, and social skills), as well as for attractiveness and femininity. The raters were blinded as to the intent of the study. Ratings of personality traits, attractiveness, and femininity. Of the 8 traits that were evaluated, analysis revealed 4 traits with statistically significant improvements when comparing preoperative and postoperative scores: likeability (+0.36, P < .01), social skills (+0.38, P = .01), attractiveness (+0.36, P = .01), and femininity (+0.39, P = .02). Improvement in scores for perceived trustworthiness (+0.22, P = .06), aggressiveness (-0.14, P = .32), extroversion (+0.19, P = .14), and risk seeking (+0.10, P = .27) did not demonstrate statistically significant changes. Facial plastic surgery changes the perception of patients by those around them. Traditionally, these interventions have focused on improvements in youthful appearance, but this study illuminates the other dimensions of a patient's facial profile that are influenced by facial rejuvenation surgery. The data in this sample population demonstrate an increase in the perception of likeability, social skills, attractiveness, and femininity. To our knowledge, this is the first study in the surgical literature to evaluate these broader outcome measures after facial rejuvenation surgery. NA.

Holding the correct posture, maintaining the eye contact, assessing the patient’s feeling correctly, responding appropriately with student’s face, saying thepatient’s feelings in student’s own words can improvecommunication and empathy4. Interpersonal skillsdevelopment is considered as an essential prerequisite to demonstrate empathic behavior5, 6. Empathycan be enhanced by educational programmes to improve students' interpersonal skills that implicitly imply enhancement of the capacity for empathy7-9.Suchman et al10,11 identified three basic communication skills namely, "recognition" of patient's negativeemotions, concerns, and inner experiences(cognition); "exploration" of these emotions, concerns, and experiences (understanding); and"acknowledging" them to generate a feeling in thepatient of being understood (communicating). Thesethree skills have been usedto identify and promoteempathy hence ust nodding or saying: "I understandyour concern; let's work on it together" can improvethe communication process12.Hence nonverbal cues includeing: changes in tone ofvoice, eye contact, gaze and aversion of gaze, silence, laughter, teary eyes, facial expressions, handand body movements, trembling, touch, physical distance, leaning forward or backward, sighs, or othersigns of distress or uncomfortableness can help inestablishing an empathic clinician-patient relationship13-15.Psychological effects of nonverbal cues suchas folded arms (more likely to indicate defensiveeness, coldness, rejection, or inaccessibility) or moderately open arms (more likely to convey acceptanceand warmth) can also be taught in interpersonal skillstraining programs16. Also, teaching clinicians to try tomirror patients' postures, gestures, respiration rates,tempo and pitch of speech, and language pattern cancontribute to forming an empathic engagement17.

The epidemiological situation with tuberculosis in the Russian Federation in the current socioeconomic conditions continues to be quite tense. In addition to all kinds of introductions from practicing physicians to combat tuberculosis, a significant contribution comes from the activities of administrative bodies aimed at creating and implementing new draft laws on disability related to tuberculosis, including methods of social expertise and safety, various support measures for disabled citizens, and methods of rehabilitation for persons with a disability group assigned. All persons with tuberculosis are guaranteed the right to a medical and social expert evaluation. In connection with the release of the new order, there are actual data, which require attention not only of social security workers, but also of medical personnel. P u r p o s e : to reveal actual aspects of medical and social examination for tuberculosis in adults. Methods. Regulatory documents on social security of population were analyzed and the main reasons influencing the expert evaluation and decision of commission for medical and social protection in tuberculosis in adult stratum of population were singled out. R e s u l t s a n d d i s c u s s i o n . As of January 1, 2020, Order No. 585n of the Ministry of Labor and Social Protection of the Russian Federation of August 27, 2019, came into force. “On the classifications and criteria used in the implementation of medical and social expert assessment of citizens by federal state medical and social expert assessment institutions. The expert evaluation for tuberculosis is based on an analysis of the totality of persistent impairments of body functions, containing significant clinical components, due to the pathological process and the severity of restrictions to vital functions, which are affected by the localization and prevalence of the specific process, the degree of activity, MBT sensitivity to antituberculosis drugs, the nature of complications and the possibilities of surgical treatment. Presence or absence of mycobacterial discharge in a patient is one of the major criteria of therapy efficacy and favorable prognosis. C o n c l u s i o n . The medical and social expert evaluation is an important component in the evaluation of a person’s state of health, in the assignment of a disability group, and in the analysis of the leading medical criteria, which characterize the degree of restriction of vital functions. The aspect of reviewing normative-legal acts concerns not only employees of social protection, but also acting clinicians for a better understanding of all the socio-economic consequences assigned when making this or that diagnosis. Disability of the population due to tuberculosis remains a relevant area of analysis, requiring attention from both a clinical and legal perspective.

88 Background: Information regarding treatment options and prognosis is essential for patient decision making near end of life. However, physicians are frequently reluctant to deliver bad news due to multiple factors, including fear of being perceived as less compassionate. This randomized controlled double blind trial aimed to examine the patient’s perception of physician compassion after being exposed to a more optimistic vs. a less optimistic message. Methods: 100 patients were randomized to observe 2 standardized videos, depicting a physician discussing treatment and prognostic information (more optimistic message and less optimistic message) with a patient with advanced cancer. Both physicians displayed identical number of empathetic statements (5) and posture. Three sets of surveys were completed including the Physician Compassion Questionnaire (0=best, 50=worst). Actors and patients were blinded to the purpose of the study. Investigators were blinded to the video observed by the patient. Results: Patients reported significantly better compassion scores after watching the more optimistic video as compared to the less optimistic video [median (Q1-Q3): 15 (5-23) vs. 23 (10-31), p=0.0002]. Results were equally significant after parallel analysis of first video only and after cross-over analysis. There was also an order effect with compassion scores (p=0.0002) favoring the second video. Univariate analysis showed that degree of trust in the medical profession, ESAS fatigue, ESAS anxiety and ESAS depression had significant association with compassion perception independent of message observed. After applying Bonferonni correction, only degree of trust in the medical profession reached the corrected p value of p=0.0014 (p=0.0002). Conclusions: A more optimistic message resulted in a physician being perceived as more compassionate by the patient. The physician seen in second order is also perceived to be more compassionate. More research is needed to better understand patient perception of compassion in communication with physicians.

Introduction: interpersonal communication skills are required for training and represent one of the most significant parts concerning the character of student learning. In another idea, learning is a constant method and learners favor a position of knowledge forms according to their character and individual practices. Evaluate the correlation between the learning methods and interpersonal conversation abilities of the nursing undergraduate in Medical Sciences Tehran University in 2012 was the purpose of this research.Methods: In this regular detailed cross-sectional analysis, 361 students from the School of Nursing and Midwifery were chosen during a census method. The information collection instruments were regulated, giving a questionnaire called Interpersonal Communication Skills Standards exam and VARK Learning Styles questionnaire. Data was examined by SPSS application (18th edition) by using Mann-Whitney and Kruskal-Wallis test.Results: 320 questionnaires were finished. 60.6% of the members were females. The average number of the students’ conversation abilities level was 101.91 ± 10.35. More than half of the samples (58.8%) preferred multi-modal learning styles (Bi-Tri and Quad Modals) and 41.2% of the students preferred single modal learning styles. There were no significant differences between the Interpersonal Communication Skills and the learning styles (P= 0.46).Conclusion: According to no significant relationship between the communication skills of students with learning style and Demographic changeable and Lack of proper form of communication skills, we were ready to build different systems and courses related to improving the skills’ level.

Trust, authority and credibility in the digital environment have attracted the interest of many researchers in the recent years. Reliable and credible information are key factors for making numerous decisions in our everyday lives, from making political choices to choosing a healthy lifestyle. Various health-related narratives are present in the public sphere. Health advice and recommendations on vaccination, antibiotics, nutrition, exercise and numerous other topics are provided by different sources, scientific community, healthcare professionals, media, lay people, patients, social networks, etc. It was the infodemic associated with the coronavirus pandemic that again brought to the forefront the importance of reliable and credible health information and health information literacy in this complex digital environment. In such fragmented information ecosystem, characterized by the post-truth era, where misinformation and fake news spread by uninformed individuals or advocates of various conspiracy theories are considered equivalent to reliable scientific information, individuals have to choose whom to trust, based on their critical capacities and competencies, in order to make health decisions for themselves and their families. The young people of today, especially those born after the year 2000, represent the generation of digital natives, who grew up and spent their entire lives surrounded by digital technologies that have become an integral part of their lives. They think and process information differently than their predecessors. Most of them use the Internet as their primary source for accessing information, most often through smartphones, spend the vast majority of time online, increasingly use social networks for private and professional purposes, but at the same time have difficulty assessing the reliability of online information. The way they assess trust in digital information is different from the way they question information credibility in traditional media. Given that trust and credibility of information strongly influence the effect of information message itself, which, in extraordinary circumstances and public health crisis such as the coronavirus pandemic, is of vital importance for the lives of people, it is very important to understand how users decide whom to trust. Health information literacy is a multidimensional and dynamic concept that incorporates social, cognitive, economic, and personal skills to search, understand, and use health information in order to improve and maintain good health. The evaluation of online health information, i.e. its reliability and credibility, plays a significant role in the process of health behavior change. Research to date has not reached a consensus on unique framework for understanding the process of building user confidence in online health information. The focus of this doctoral dissertation are theoretical and analytical challenges of health information literacy as a multidimensional and dynamic concept, particularly in understanding the process of creating trust in online health information. By examining the attitudes and opinions of medical students about the evaluation of online health information we aimed to determine factors that influence the assessment of health information quality and credibility. The main research objective is to examine the element of information appraisal in the concept of health information literacy and to determine the processes of creating trust in health information in an online environment. The specific research objectives are as follows: 1. to identify factors and techniques for assessing the quality, reliability and credibility of online health information; 2. to determine the elements of cognitive heuristics for assessing the reliability of online health information; 3. to determine the impact of infodemic during a healthcare crisis on online health information trust issues; 4. to examine methods for assessing the quality and reliability of user-generated online health information; 5. to investigate medical students' attitudes and knowledge of the concepts and tools for assessing health information literacy. Our research aimed to determine common elements of information appraisal in the concept of health information literacy and related concepts dealing with online health information (health literacy, information literacy, media literacy, digital literacy, etc.). The research was performed using multiple methods conducted in three phases: 1. literature review and comparative analysis of selected tools and instruments for assessment of health information literacy and related concepts; 2. a survey questionnaire that examined the attitudes and opinions of medical students of the University of Zagreb School of Medicine regarding online health information appraisal, and 3. semi-structured interviews with a smaller subgroup of respondents in order to build on the findings from the survey questionnaire related to the determination of factors that influence trust in online health information, i.e. assessment of their quality and credibility. The results of our research demonstrated that medical students have the knowledge, skills and techniques necessary to assess the quality, reliability and credibility of online health information. Although medical students generally considered Internet to be a questionable source for health information, the majority reported that they always use online search engines as the first step when searching for health topics, regardless of their purpose (general interest, academic assignment, or personal or health problem among family and friends, etc.). Medical students consider the following analytical criteria when assessing the credibility of online health information: trustworthiness, completeness, objectivity and comprehensiveness of information, referencing other data sources and author disclosure. Apart from analytical criteria, medical students also use cognitive heuristics when assessing the reliability of online health information, especially user-generated content that is published and shared via social networks. Students also emphasized the importance of critical thinking, factual analysis, information verification on multiple sources, determination of source credentials as well as sharing information with family members, friends, colleagues, physicians and university professors who they consider as cognitive authorities in health communication. Research results indicate an overall positive relationship between perceived health information literacy of medical students, their ability to evaluate online health information and trust in the Internet as a source of health information. Students with high self-perceived level of e-health literacy more often use websites of government institutions and professional medical associations than other sources for online health information. Our research also revealed that the degree of trust that medical students have in online sources of information affects their behavior when searching and evaluating online health information. In healthcare crisis situations, medical students apply additional evaluation criteria for usergenerated health information on social media. In general, medical students expressed mistrust towards social networks, especially as a source of credible health information in the context of an infodemic. Although the majority of students use social networks only passively, they also believe that social networks present a platform that has the potential, if used appropriately, to convey reliable information and improve health information literacy. Students also stressed that, during infodemic, strategic crisis communication skills should be applied for proactive dissemination of credible, factual and scientific evidence in order to contribute to a faster and more efficient containment of the spread of misinformation and fake news on social media. The results of our research have shown that online health information should be comprehensive, accurate, evidence-based, objective and up-to-date in order to convey a quality health message. According to medical students, quality of information, source credibility, comprehensibility and readability, as well as verification of information in evidence-based sources are main predictors of trust in online health information. Understanding which health channels and sources are considered most reliable among different user groups can help health professionals reach at-risk patients in order to communicate health messages more successfully and implement interventions aimed at strengthening skills that are important for health information appraisal. By analyzing medical students` attitudes and opinions about credibility of online health information, we explored ways to promote critical thinking in the digital environment in order to empower individuals to make decisions in their everyday life based on verified and credible sources of information. Placing greater emphasis on lifelong learning about health, and formal and informal health information literacy education, enables greater autonomy and empowerment of individuals, and can be viewed as part of personal development towards an improved quality of life. Health information literacy increases individual and community resistance to harmful and misleading information and reduces the impact of the infodemic on human health. Improving health information literacy among population requires joint action and cooperation between stakeholders and policymakers (government authorities, media, scientific, educational and health institutions, healthcare professionals, scientists, researchers, librarians and others). Health information literacy is an important competence of every individual, but its implications for society are much broader. They include personal and social responsibility of individuals and taking ethical actions for the benefit of the community. A modern democratic society implies engaged citizens who autonomously reflect on political, ethical and social challenges in everyday life. Empowerment in health and social care, achieved by developing critical competencies, helps in distancing oneself from various social pressures, making independent informed decisions and taking responsibility for one's own health. Croatia, unlike most other European countries, still does not have an official strategy or action plan for developing and improving health information literacy among its population. Our research results point out the importance of including health information literacy in the national health policy and education strategy, with particular emphasis on developing critical thinking skills and competencies in evidence-based approach to online health information appraisal. The results of this research contribute to the conceptual linking of theoretical constructs on information appraisal and critical theories from information and communication sciences with constructs from the field of public health. The mentioned approach resulted in unifying the narratives of different domains, and synthesizing separate theoretical frameworks, namely health information and related literacies, which adds to the value of this research. The results of this research serve as a basis for defining skills for critical appraisal of online health information in order to increase the level of health information literacy and development of tools for evaluating the reliability of online health information. On the applicative level, this doctoral dissertation provides recommendations for communication of reliable online health information from the current infodemic perspective, in planning public health activities and interventions in the future.

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Compassionate communication: Keeping patients at the heart of practice in an advancing radiographic workforce

Autism spectrum disorders (ASD) are characterized by a reduced ability to appropriately express social greetings. Studies have indicated that individuals with ASD might not recognize the crucial nonverbal cues that usually aid social interaction. Social reciprocity depends on the ability to empathize with others, to be aware of emotional and interpersonal cues, and to respond appropriately; it requires joint attention and nonverbal social skills. Fortunately, there is evidence-based research which shows that augmented reality (AR) attracts the attention of children with ASD and allows them to focus on social cues. AR has also been proved effective for teaching social skills. However, there is a lack of appropriate instructional scaffolds in AR applications to help students organize learning materials. Therefore, in this study, we use AR combined with concept map (CM) strategy as a training tool to focus on the standard nonverbal social cues to teach children with ASD how to appropriately reciprocate when they greet others. The learner can integrate the AR with CM strategy to visually conceptualize the social scenarios in a tabletop role-play training platform. Single-subject research with a multiple-baselines across-subject design was used in this study. Our results showed substantial increases in the children’s target responses during the intervention phases compared with the baseline phases. Generalization probes were administered during baseline (4–8 sessions for 0.5–1 month), intervention (10 sessions for 1.2 months), and maintenance phases (4–8 sessions for 0.5–1 month) to assess the generalization and maintenance of learned skills. The three-phase test data suggest that the AR with CM intervention was moderately effective in teaching the target greeting responses to children with ASD. The practical and developmental implications of the findings are discussed.

Management of Psychiatric Disorders during the Perinatal Period.

Research on heart disease have found a strong and consistent evidence of association between some psychosocial risk factors, including depression, anxiety, self-efficacy, lack of social support and outcome of disease. Depression increases the risk of cardiac death and is highly predictive of reduced adherence to recommended treatments; anxiety appears to be linked to adverse cardiac outcomes. It was demonstrated that Cardiac Rehabilitation (CR) leads to substantial improvements and positive outcomes because combines the prescription of physical activity with the modification of risk factors and aims to reduce symptoms related to the disease and the risk of new cardiovascular events. The main objective of this study is to determine if a short and intense CR program can produce a positive impact on anxious and depressive symptoms revealed in cardiac patients, confirming results of previous researches. The protocol was proposed to all patients referred for an outpatient CR after an acute event who attended the short 2-week intensive rehabilitation program. A total of 157 patients recruited at the operating unit of Cardiology, in the Hospital of Cittadella (Italy), was included in the analysis. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to the patients. SPSS 17.0 was used for statistical analysis. T-tests for paired samples were used to evaluate differences between the beginning and the end of the CR program. There was a statistically significant difference between the beginning and the end of the CR program. Results for paired samples showed significant differences in all factors of the BDI-II and in the total score. In addition, a statistically significant difference was found even in the state - anxiety subscale. No significant difference was detected for the trait anxiety. According to recent studies, this research shows that the CR program has a significant impact on levels of anxiety and depression, because all activities focus their commitment on changing the patient's personal beliefs and perception of illness, promoting the exchange of information and sharing of concerns and fears, increasing the patient's resilience with the aim of enabling him/her to reorganize positively his/her personal, family and professional sphere.