Doctor–patient relationship: A resource to improve respiratory diseases management

Santus, Pierachille; Picciolo, Stefano; Proietto, Alfio; Falcone, Franco H.; A, Mangiacavallo; Pellegrino, Giulia; Sereno, Francesca; Radovanovic, Dejan; Blasi, Francesco; Girbino, Giuseppe; Centanni, Stefano

doi:10.1016/j.ejim.2012.04.004

Cited by 27 publications

(17 citation statements)

References 25 publications

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“…In the process of anamnestic collection, for example, also the communication, disease perception, and relation between doctor and patient are important and could influence the medical report [6]. …”

Section: Signs and Symptomsmentioning

confidence: 99%

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Soldati¹,

Smargiassi

Mariani³

et al. 2017

Multidiscip Respir Med

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Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent informative phenomena to be integrated for inferring a diagnosis. Thus, diagnosis begins with “signs” and finishes in a probability of disease. The abductive reasoning process is the generation of a hypothesis to explain one or more observations (signs) in order to decide between alternative explanations searching the best one. This process is iterative during the diagnostic activity while collecting further observations and it could be creative generating new knowledge about what has not been experienced before. In the clinical setting the abductive process is not only theoretical, conversely the physical exploitation of the patient (palpation, percussion, auscultation) is always crucial. Through this manipulative abduction, new and still unexpressed information is discovered and evaluated and physicians are able “to think through doing” to get the correct diagnosis. Abductive inferential path originates with an emotional reaction (discovery of the signs), step by step explanations are formed and it ends with another emotional reaction (diagnosis). Few bedside instruments are allowed to physicians to amplify their ability to search for signs. Stethoscope is an example. Similarities between ultrasound exploration and percussion can be found. Bedside ultrasonography can be considered an external amplifier of signs, a particular kind of percussion and represents a valid example of abductive manipulation. In this searching for signs doctors act like detectives and sometimes the discovering of a strategic, unsuspected sign during abductive manipulation could represent the key point for the correct diagnosis. This condition is called serendipity. Ultrasound is a powerful tool for detecting soft, hidden, unexpected and strategic signs.

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Section: Signs and Symptomsmentioning

confidence: 99%

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Soldati¹,

Smargiassi

Mariani³

et al. 2017

Multidiscip Respir Med

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“…Patients want procedures to be as simple as possible, and one study found that 18% of patients stopped inhaled therapy spontaneously due to perceived complexity 53. Complexity and confusion between required techniques may ensue when mixed types of inhaler devices are prescribed for the delivery of different drug therapies 34…”

Section: Components Of Patient Preference and Satisfaction With Inhalersmentioning

confidence: 99%

Patients’ perspectives and preferences in the choice of inhalers: the case for Respimat<sup>® </sup>or HandiHaler<sup>®</sup>

Dekhuijzen¹,

Lavorini²,

Usmani³

2016

PPA

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Poor inhaler technique hampers the efficacy of drug therapy in asthma and chronic obstructive pulmonary disease. Not only does this affect individual patient care, but it also impacts on the wider health care economics associated with these conditions. Treatment guidelines recommend a systematic approach to drug class selection; however, standardization of inhaler selection is currently difficult owing to the complexity of the interaction between the inhaler device and the patient. Specifically, individual patient preference can influence how successful a treatment is overall. This article reviews inhaler devices from the patient perspective, with a particular focus on the dry powder inhaler HandiHaler® and Respimat® Soft Mist™ Inhaler. It discusses factors that influence device preference and treatment compliance and reviews tools that can aid health care professionals to better match inhaler devices to individual patients’ needs.

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“…Adherence to inhaled treatment is a major issue in routine practice and may represent another factor responsible for the difference between the results from RCTs and real life studies. In a recent survey, 18% of patients with chronic respiratory disorders reported discontinuation of the prescribed inhaled treatment because the difficulties in using the inhalers [93]. Several real life studies have assessed adherence to asthma medication with different formulations and treatment regimens.…”

Section: Real Life Studies: Advantagesmentioning

confidence: 99%

Randomized controlled trials and real life studies. Approaches and methodologies: a clinical point of view.

Saturni¹,

Bellini²,

Braido³

et al. 2014

Pulmonary Pharmacology & Therapeutics

197

155

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a b s t r a c tRandomized Controlled Trials (RCTs) are the "gold standard" for evaluating treatment outcomes providing information on treatments "efficacy". They are designed to test a therapeutic hypothesis under optimal setting in the absence of confounding factors. For this reason they have high internal validity. The strict and controlled conditions in which they are conducted, leads to low generalizability because they are performed in conditions very different from real life usual care. Conversely, real life studies inform on the "effectiveness" of a treatment, that is, the measure of the extent to which an intervention does what is intended to do in routine circumstances. At variance to RCTs, real life trials have high generalizability, but low internal validity. Recently the number of real life studies has been rapidly growing in different areas of respiratory medicine, particularly in asthma and COPD. The role of such studies is becoming a hot topic in respiratory medicine, attracting research interest and debate.In the first part of this review we discuss some of the advantages and disadvantages of different types of RCTs and analyze the strengths and weaknesses of real life trials, considering the recent examples of some studies conducted in COPD. We then discuss methodological approaches and options to overcome some of the limitations of real life studies.Comparing the conclusions of effectiveness and efficacy trials can provide important pieces of information. Indeed, these approaches can result complementary, and they can guide the interpretation of each other results.

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Doctor–patient relationship: A resource to improve respiratory diseases management

Cited by 27 publications

References 25 publications

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Patients’ perspectives and preferences in the choice of inhalers: the case for Respimat<sup>® </sup>or HandiHaler<sup>®</sup>

Randomized controlled trials and real life studies. Approaches and methodologies: a clinical point of view.

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Doctor–patient relationship: A resource to improve respiratory diseases management

Cited by 27 publications

References 25 publications

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Patients&rsquo; perspectives and preferences in the choice of inhalers: the case for Respimat<sup>&reg; </sup>or HandiHaler<sup>&reg;</sup>

Randomized controlled trials and real life studies. Approaches and methodologies: a clinical point of view.

Contact Info

Product

Resources

About

Patients’ perspectives and preferences in the choice of inhalers: the case for Respimat<sup>® </sup>or HandiHaler<sup>®</sup>