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At least 217 records · Page 12Linked to original sources
PubMed2005

Usefulness of the USP Medication Counselling Behavior Guidelines.

OBJECTIVE: To assess the perceived usefulness of the United States Pharmacopeia (USP) Medication Counselling Behavior Guidelines among Finnish community pharmacists. The Guidelines were systematically disseminated to pharmacists through a 4-year project (TIPPA 2000-2003). METHOD: A postal questionnaire was sent to a random sample (n = 734) of Finnish community pharmacists (response rate 51%). RESULTS: More than one quarter (27%) of the respondents was aware of the Guidelines. The Guidelines were made known to the respondents mostly via a book on patient counselling skills (41% of those knowing the Guidelines), continuing education (37%), and in-house training (28%). Over 60% of those who knew about the Guidelines regarded them as a good or very good instrument for learning the principles of patient counselling. The Guidelines were considered less useful as an instrument for the self-evaluation of performance in different settings. CONCLUSION: The results of this study indicate that even though the USP Guidelines have been promoted strongly through basic and continuing education during the TIPPA Project, more than half of the respondents were not aware of the Guidelines. The Guidelines were considered more useful in learning the principles of patient counselling than learning self-evaluation of performance.

Adult↗
PubMed2006

Tobacco cessation counseling across the ages.

OBJECTIVES: To examine recent rates of tobacco cessation counseling and whether patient age or sex was associated with providers' adherence to tobacco cessation guidelines. DESIGN: Survey study. SETTING: The 2002 National Ambulatory Medical Care Survey (NAMCS). PARTICIPANTS: Analysis of 22,605 records representing 687 million ambulatory care appointments with adults from the 2002 NAMCS. MEASUREMENTS: The proportion of visits by sex and age category during which physicians identified a patient's tobacco use status and counseled tobacco users to quit. RESULTS: The rates at which providers inquired about tobacco use were similar across groups, ranging from 65% of visits with men aged 20 to 44 to 73% of visits with women aged 45 to 59, but providers' rates of tobacco cessation counseling differed by age, ranging from 27% of visits with male tobacco users aged 45 to 59 to 6% of visits with male tobacco users aged 75 old and older. CONCLUSION: Although providers frequently ask their patients about tobacco use, they infrequently counsel patients to quit, especially if those patients are older men. Provider time constraints, misconceptions about older patients' ability and willingness to quit, or doubt about the potential health benefits of tobacco cessation in this age group may explain the lower counseling rates provided to older male patients. Because rates of counseling have declined in the last decade, providers should be reeducated about the need for and effectiveness of tobacco cessation counseling for men and women of all ages.

Adult↗
PubMed2004

Advising cancer patients on natural health products--a structured approach.

BACKGROUND: Many patients with cancer (45-60%) use natural health products (NHPs). Pharmacists often find it difficult to advise these patients effectively. OBJECTIVE: To explore pharmacists' perceptions of the information needed to advise cancer patients on NHPs and develop a structured counseling approach. METHODS: A qualitative study was conducted using a focus group of pharmacists from an integrated cancer care organization in Canada. The outcome measures were the definitions of and reasons for the information needed to advise patients on NHPs and a counseling approach using laymen terms. RESULTS: Eight focus group sessions took place, from which 6 categories of information emerged: role of the advisor, evaluation of evidence, assessment of efficacy, assessment of toxicity, monitoring parameters, and provision of a closure. A patient counseling approach was developed based on this information. CONCLUSIONS: The findings provided a description of and rationale for categories of information needed to advise cancer patients on NHPs. A structured, step-by-step approach to counseling these patients was developed.

Biological Factors↗
PubMed2006

Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling.

PURPOSE: Low birth weight (LBW), preterm births, abnormal placentation, and miscarriages have been associated with prior induced abortions. An incidence-related effect has been suggested. The objective of this study is to assess the effects of prior induced abortions on obstetric risk factors and pregnancy outcome in conditions of free high-standard maternity care used by almost the entire pregnant population in Finland. METHODS: We analyzed a population-based database including 26,976 singleton pregnancies from 1989 to 2001, of which 2364 were among women with one prior induced abortion and 355 women had had at least two prior induced abortions. Data included maternal risk factors, pregnancy characteristics, and obstetric outcome measures and were based on results of a self-administered questionnaire at 20 weeks of pregnancy and clinical records. Odds ratios (ORs) concerning pregnancy outcomes were calculated in multiple logistic regression analysis. RESULTS: Induced abortions were associated with several known pregnancy risk factors; specifically, maternal age older than 35 years, unemployment, unmarried status, low educational level, smoking, alcohol consumption, overweight condition, and chronic illnesses. Preterm birth (OR, 1.19; 95% confidence interval, 1.01-1.41) in women with one prior abortion (7.3% versus 6.2%) and LBW (OR, 1.54; 95% confidence interval, 1.02-2.32) in women with two or more prior abortions (7.0% versus 4.7%) appeared to be more common, but after logistic regression analysis, we found no evidence of adverse pregnancy outcomes. CONCLUSIONS: Induced abortion is not an independent risk factor for adverse obstetric outcome. Marked health behavioral pregnancy risks are associated with prior induced abortions. Health counseling of these women is a challenge, but this objective has not yet been achieved.

Abortion, Induced↗
PubMed2006

Preventive health counseling for adolescents.

The leading causes of adolescent mortality are accidents (death from unintentional injury), homicide, and suicide. Additional morbidity is related to drug, tobacco, and alcohol use; risky sexual behaviors; poor nutrition; and inadequate physical activity. One third of adolescents engage in at least one of these high-risk behaviors. Physicians should specifically target these risk factors with preventive counseling, although adolescents may be reluctant to initiate discussions about risky behaviors because of confidentiality concerns. The key to providing relevant and useful preventive counseling for adolescent patients is developing the trust necessary to discuss the specific issues that impact this age group.

Adolescent↗
PubMed2004

Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician.

AIMS: To compare health effects and risk reduction in two different strategies of nutritional counselling in primary health care for patients at high risk of ischaemic heart disease. METHODS: In a cluster-randomized trial 60 general practitioners (GPs) in the Copenhagen County were randomized to give nutritional counselling or to refer patients to a dietician. Patients were included after opportunistically screening (n=503 patients), and received nutritional counselling by GP or dietician over 12 months. Health effects were measured by changes in weight, waist circumference and blood lipids. Risk of cardiovascular disease was calculated by The Copenhagen Risk Score. Data on use of medicine and primary health care was obtained from central registers. RESULTS: Altogether 339 (67%) patients completed the intervention. Weight loss was larger in the dietician group (mean 4.5 kg vs. 2.4 kg), and increase of HDL-cholesterol was larger in the GP group (mean 0.13 mmol/l vs. 0.03 mmol/l). The reduction of the cardiovascular risk score was significantly larger in the GP group (P=0.0005). Other health outcomes were not significantly different. CONCLUSIONS: GPs were aware of substantial risk factors of cardiovascular disease and addressed these when counselling. The guidance from a GP was of significant importance for risk reduction in relation to IHD. However, a long-term lifestyle intervention by GP was difficult to implement. In the case of obesity it was effective to refer to long-term nutritional counselling by a dietician.

Adolescent↗
PubMedDate not supplied

[HIVAb, HCVAb and HBsAg seroprevalence among inmates of the prison of Bologna and the effect of counselling on the compliance of proposed tests].

OBJECTIVES: The aims of the study were to evaluate the HIVAb, HCVAb and HBsAg seroprevalence among Italian and foreign inmates of the prison of Bologna, to evaluate if the extensive counselling of "new" inmates has significantly enhanced adherence to laboratory tests. DESIGN: The serological status was determined by a blood withdraw following the informed consent. Before asking their consent, patients were informed by cultural mediators who had been instructed about the aims of the study/exam during introductory meetings. The initial step managed by mediators was followed by further individual counselling interventions, carried out by hospital infective disease unit, prison and prison drug abuse service physicians. The laboratory tests were performed in an external structure. SETTING: Prison of Bologna. PARTICIPANTS: The study was conducted on 433 subjects among a whole population of 900 inmates in the local prison: 390 subjects were males (90.1%) and 43 were females (9.9%). The median age of the whole population was 34.86 years (+/- 9.9). The studied population counted 147 (33.9%) intravenous drug users (IDU) and 286 not addicts (66.1%). As regards nationality, 212 subjects were Italian (48.9%) and 221 (51.1%) foreigners. Among the total 433 inmates considered, 78 (18%) were known as previous IDU with conviction history or condemned to long term sentences, while 59 (13.6%) were inmates recently convicted active IDU assisted by the internal drug abusers service. The third group was composed by 296 inmates imprisoned during the summer (103 Italians and 193 foreigners) self declared not IDU. RESULTS: A. 12.5% of inmates were HIV positive, 8.1% HBV positive and 31.1% HCV positive. 25 subjects were found positive both to HIV and HCV; 1 both to HIV and HBV and 5 to HIV, HBV and HCV. HIV positivity is more common among Italian vs. foreigners inmates, among IDU vs. not IDU. HCV positivity is more common among Italian vs. foreigners inmates, and among IDU vs. not IDU. The distribution of HBV seropositivity among the different groups shows no statistically significant differences. All subjects receiving multi-focal counselling reached better compliance levels: 10% vs. 1% for HIV, 16% vs. 1% for HBV and 35% vs. 0.3% for HCV, with statistically significant coefficients of contingency. CONCLUSIONS: In the prison of Bologna drug addiction is prevalent in italian seropositive personers and it is often associated with HIV and HCV positivity. Foreign inmates, mostly in the not-IDU group, show a lower prevalence of these two infections. Multi-focal counselling before test increased significantly the adherence of inmates to the study.

Adult↗
PubMed1997

[Ethical problems in molecular genetics and their reflection in clinical medicine].

There are at least two groups of issues connected with an impact of a realization of the "Human Genome Project": a) philosophical; b) ethical, which can be divided into four groups: 1) the influence of DNA technologies on everyday applications of bioethical principles; 2) ethical aspects of genetic diversity; 3) ethical aspects of genetic screening; 4) somatic and germ-cell gene therapy; Unlike essential philosophical issues practical realization of issues in question can be largely expressed as only revitalization of old ones and concerns: the principle of justice-equal access and priorities; protection of reproductive choices; disclosure to patients and to relatives at genetic risk (disclosure and exclusion tests); prenatal diagnosis for "mild to moderate" diseases with and without genetic indication-commercialization; insurance policy; non-directive and directive genetic counseling. Maybe there are regional and other differences, but in practice, the main ethical issues are likely to involve screening for genetic risk of common diseases of adult life e.g. hypertension, diabetes, gout, dyslipoproteinemia, genes for premature atherosclerosis, etc. because of the possible direct impact on a patient, an implication for life-insurance, employers and commercial exploitation.

Ethics, Medical↗
PubMedDate not supplied

Lifestyle modification counseling of patients with dyslipidemias by pharmacists and other health professionals.

OBJECTIVES: To establish whether patients who are taking lipid-lowering medications receive information on lifestyle modifications from health care providers when originally prescribed and whether they continue to receive follow-up information on lifestyle modifications, and to establish where patients with dyslipidemias are receiving information about lowering their serum cholesterol levels through lifestyle modifications. DESIGN: Cross-sectional survey. SETTING: Two community pharmacies and two hospitals in two medium-sized cities in the midwestern area of the United States. PARTICIPANTS: 234 patients taking medication to lower serum lipids. INTERVENTION: Paper-based survey. MAIN OUTCOME MEASURE: Responses to survey items. RESULTS: Nearly three quarters (73.9%) of participants received information about lowering their serum lipids through lifestyle modifications when they were first diagnosed with elevated serum cholesterol concentrations. Of these, most (83.8%) said that the information came from their physician. Fewer than one half (48.3%) of all participants said that they continued to receive this type of information. Those who received lifestyle modification information at their original diagnosis and who continued to receive this type of information were more likely to be actively trying to lower their serum lipid levels through diet (93.1%) and exercise (71.6%). Participants visited their pharmacy more often than their physician's office each year, yet they recalled pharmacists offering less patient counseling on lifestyle modifications than did physicians and nurses. CONCLUSION: Despite being well positioned to assist patients with elevated serum cholesterol concentrations, pharmacists offer less patient counseling about therapeutic lifestyle modifications compared with physicians and nurses.

Adult↗
PubMed2006

Counselling of hearing aid users is highly cost-effective.

Hearing aids (HAs) are often left unused. Several investigations have shown that the use of HAs and the skills to use them can be significantly improved through counselling. Follow-up counselling is often restricted by increased cost. The objective of the study was to assess the cost and the effect of follow-up counselling on HA use. In a prospective pre-post design study, 98 first-time HA users were counselled 6 months after the fitting of a HA, and the use of and benefit from HAs were measured by means of an interview and the short form of the hearing handicap inventory for the elderly (HHIE-S) and the EuroQoL (EQ-5D) questionnaires. The results obtained before and 6 months after counselling were compared and the cost of counselling was calculated. After follow-up counselling, over half of the occasional users of a HA and as many as one third of the non-users became regular users. The number of regular users increased by 16 subjects, and non-users decreased from 29 subjects to 17. The HHIE-S results showed a significant positive change, but the EQ-5D results showed practically no change. The additional expense of follow-up counselling at home was approximately 8.8% (83 euro per visit) of the calculated 942 euro cost of fitting a HA. Bringing one unused HA into regular use required 508 euro. The results show that HA use and the consequent benefit can be significantly increased through counselling. The expense caused by follow-up counselling at home is highly acceptable in addition to the cost of fitting a HA.

Aged↗
PubMed2005

Randomized controlled trial of physical activity counseling for older primary care patients.

BACKGROUND: Regular physical activity reduces the risk for chronic diseases among older adults. Older adults are likely to be seen by primary care clinicians who can play a role in promoting physical activity among their patients. DESIGN: In this randomized controlled trial (1998-2003; data analyzed 2004-2005), we compared the effects of brief advice to exercise from a clinician supplemented by telephone-based counseling by health educators (extended advice) to brief advice from a clinician alone (brief advice). SETTING/PARTICIPANTS: A total of 100 primary care patients (63.2% female, 14.7% minority, mean age=68.5 years) participated in the trial. INTERVENTIONS: The extended-advice intervention consisted of clinician advice plus exercise counseling via telephone provided by research staff, and the brief advice condition consisted of clinician advice alone. Both interventions focused on promoting moderate-intensity physical activity. MAIN OUTCOME MEASURES: Self-reported physical activity using the 7-Day Physical Activity Recall instrument and objective activity monitoring using Biotrainers were assessed at baseline, and at 3 and 6 months. RESULTS: Participants in the extended-advice arm reported significantly greater participation in moderate-intensity physical activity than the brief-advice group at 3 months (+57.69 minutes vs 12.45 minutes; 3.84 kcal/week vs 0.83 kcal/week) and 6 months (+62.84 minutes vs 16.60 minutes; 4.19 kcal/week vs 1.1 kcal/week). Objective activity monitoring also showed significantly increased physical activity among extended-advice versus brief-advice participants at both time points (+50.79 vs -11.11; +42.39 vs -24.18, respectively). CONCLUSIONS: These data indicate that clinician advice with follow-up counseling can promote adoption of moderate-intensity physical activity among older, primary care patients.

Aged↗
PubMed2002

Nurse-patient power relationship: preliminary evidence of patients' power messages.

The interactive relationship that is based on sharing power and control is the goal of health counseling practice. This research examined the nurse-patient power relationship and emphasized the patient's perspective. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis (CA). The purpose of this research was to describe in detail how patients' minimized power asymmetry during hospital counseling. The results indicate that power is a complex and polysemic phenomenon that can be created jointly. Nurses' power is associated with their medical knowledge, which also patients construct. However, patients have several options to construct their power and influence the flow of interaction, for example, directing the counseling with questions, interruptions, and extensive disclosure, in which also nurses participated. The results are discussed in terms of earlier research on power messages and implications for a future power sharing practice.

Adolescent↗
PubMed2006

Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses.

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group x Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.

Aged↗
PubMed1992

A cognitive-existential analysis of counselor responses to HIV-positive substance misusers in an outpatient methadone program and a residential therapeutic community.

Counselors of HIV-afflicted substance abusers not only must apply counseling strategies directed toward curbing drug use, but also are called upon to assess suicide risk, attend to the promotion of social support, treat adverse affective reactions, and respond to spiritual and existential concerns. The present study attempted to explore systematically the self-reported feelings, thoughts, and behaviors of counselors as they confront such demands. All counselors reported experiencing increased stress as a result of working with HIV-afflicted clients, and cognitive distortions were sometimes noted in counselor responses. However, more generally, thoughts seemed clearly formulated, and planned behaviors appeared directed toward rendering the best treatment possible.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Genetics and molecular biology of haemophilias A and B.

The development of rapid procedures for the characterization of mutations is advancing the knowledge of the molecular biology of the haemophilias and transforming the strategies for the diagnoses required for genetic counselling. In haemophilia B more than 300 mutants have been fully characterized. These comprise complete and partial deletions, rare insertions, and 'point' mutations. The latter may impair transcription (promoter mutations), RNA processing (splicing mutations) and translation (frameshifts and stop codons) or cause single amino acid (aa) changes. Eighty-four residues are involved in the 105 presumed detrimental aa substitutions reported so far and these are usually conserved in the factor IX homologues (factors VII, X and protein C) and/or the factor IX of different mammalian species. There are clear correlations between the mutation and clinical features. In addition mutations causing gross physical or functional loss of coding information appear to predispose to the development of antibodies against therapeutic factor IX. Hotspots of mutations have been identified and are usually associated with CpG sequences. In haemophilia A the size and complexity of the factor VIII gene has hindered the analysis of mutants. Most of the studies published so far have analysed only a small fraction of the essential region of the factor VIII gene and this led to the repeated observation of specific types of mutation. The recent development of a rapid method to analyse RNA splicing and the whole coding region of the factor VIII gene should unblock this situation. With regard to genetic counselling, the direct detection of gene defects has increased the proportion of haemophilia B families that can be helped from 60% to virtually 100% and similar expectations may now be formulated for haemophilia A. In the UK a national database of haemophilia B mutations is being constructed to optimize genetic counselling. This should offer a model for a similar development in haemophilia A.

DNA Mutational Analysis↗
PubMed2004

Brief alcohol interventions with mandated or adjudicated college students.

This article summarizes the proceedings of a symposium presented at the 2003 RSA Meeting in Ft. Lauderdale, Florida, organized and chaired by Nancy Barnett. The purpose of the symposium was to present information and efficacy data about approaches to brief intervention with students who get into trouble on their campuses for alcohol and as a result are required to attend alcohol education or counseling. Presentations were (1) Differences Between Mandated College Students and Their Peers on Alcohol Use and Readiness to Change, by Tracy O'Leary Tevyaw; (2) An Effective Alcohol Prevention Program for Mandated College Students, by Kim Fromme; (3) Two Brief Alcohol Interventions for a Referred College Population, by Kate Carey; and (4) Brief Motivational Intervention With College Students Following Medical Treatment or Discipline for Alcohol, by Nancy Barnett. The data presented in this symposium indicated that students who are evaluated or disciplined for alcohol use are on average heavy drinkers who drink more heavily than their closest peers. Brief intervention approaches described by the speakers included group classroom sessions, individual motivational intervention, individual alcohol education, and computerized alcohol education. Reductions in consumption and problems were noted across the various intervention groups. Brief motivational intervention as a general approach with mandated students shows promise in that it reduced alcohol problems in a group of mandated students who were screened for being at risk (in the Borsari and Carey study) and increased the likelihood that students would attend further counseling (in the Barnett study).

Adolescent↗
PubMed2003

Determinants of osteoporosis prevention in low-income Mexican-American women.

BACKGROUND: Prevention is the most cost-effective means of managing osteoporosis. However, little is known about osteoporosis-related preventive practices in Mexican-American women. We examined factors that might influence women's decision to start preventive measures for osteoporosis. METHODS: Information was gathered through a cross-sectional survey of low-income Mexican-American women who were seen at two clinics in southern Texas. RESULTS: Of the 270 participants, 37% reported calcium supplementation, and 41% reported regular weight-bearing exercise to prevent osteoporosis. Fifty (41%) of the postmenopausal women were currently using hormone replacement therapy. Only 15% of the premenopausal and 13% of the postmenopausal women recalled that their health care provider had counseled them about prevention. Multivariate analysis showed that public education, bone densitometry evaluation, knowledge of osteoporosis, and counseling were determinants of prevention. CONCLUSION: Although osteoporosis is a preventable condition, our findings suggest that the majority of Mexican-American women do not receive adequate preventive measures or counseling about osteoporosis. Furthermore, we found that their health care provider's counseling about osteoporosis was a major determinant of osteoporosis prevention in these women.

Adolescent↗
PubMed2006

Smoking cessation counseling by Russian oncologists: opportunities for intervention in the Russian Federation.

The goal of this study was to examine the degree to which Russian oncologists are trained in providing smoking cessation counseling to patients and to assess physician smoking cessation practices and attitudes about providing smoking cessation treatment. Sixty-three oncologists at a large cancer center in Moscow completed a brief survey. The results showed that Russian oncologists: (a) lack training in smoking interventions; (b) rarely offer cessation treatment; (c) exhibit beliefs about smoking that may serve as barriers to providing cessation counseling; and (d) desire training in cessation counseling. These results can be used to guide the development of smoking cessation training programs for Russian physicians.

Adult↗