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This cross-sectional study of 56 dialysis providers from 3 dialysis clinics examined providers' attitudes and perception of autonomy support for patients' medication adherence behaviors. Respondents completed surveys assessing attitudes and perception of autonomy support. Compared to all other provider types, physicians and nurse practitioners (MD/NP) thought it was "less true" that phosphate binder medications are very important for dialysis patients (MD/NP vs others 5.1 [1.4] vs 6.1 [1.1]; P = 0.02). More dialysis technicians (19%) offered the highest level of support. Attitudes and perception of autonomy support for medication adherence are suboptimal, vary by dialysis provider type, and are targets for quality improvement in dialysis care. This study addresses critical gap in existing knowledge about these two novel provider-based psychosocial factors and their potential impact on phosphate binder medication adherence.Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.Good quality sleep is considered to be essential for healthy living and recovering from illness. It would be logical to think that good quality sleep is most required when a patient is critically ill in an intensive care unit (ICU). Several studies have demonstrated poor quality of sleep while the patients are in ICU. Subjective tools such as questionnaires while simple are unreliable to accurately assess sleep quality. Relatively few studies have used standardized polysomnography. The use of novel biological markers of sleep such as serum brain-derived neurotrophic factor concentrations may help in conjunction with polysomnography to assess sleep quality in critically ill patients. Attempts to improve sleep included nonpharmacological interventions including the use of earplugs, eye sleep masks, and pharmacological agents including ketamine, propofol, dexmedetomidine, and benzodiazepines. The evidence for these interventions remains unclear. Further research is needed to assess quality of sleep and improve the sleep quality in intensive care settings.

Definitions of shared decision-making (SDM) have largely neglected to consider goal setting as an explicit component. Applying SDM to people with multiple long-term conditions requires attention to goal setting. We propose an integrated model, which shows how goal setting, at 3 levels, can be integrated into the 3-talk SDM model.

The model was developed by integrating 2 published models.

An integrated, goal-based SDM model is proposed and applied to a patient with multiple, complex, long-term clinical conditions to illustrate the use of a visualization tool called a Goal Board. A Goal Board prioritizes collaborative goals and aligns goals with interventional options.

The model provides an approach to achieve person-centered decision-making by not only eliciting and prioritizing goals but also by aligning prioritized goals and interventions.

Further research is required to evaluate the utility of the proposed model.

Further research is required to evaluate the utility of the proposed model.Hospitals have eliminated many in-person interactions and established new protocols to stem the spread of COVID-19. Inpatient psychiatric units face unique challenges, as patients cannot be isolated in their rooms and are at times unable to practice social distancing measures. Many institutions have experimented with providing some psychiatric services remotely to reduce the number of people physically present on the wards and decrease the risk of disease transmission. This case report presents 2 patient perspectives on receiving psychiatric care via videoconferencing while on the inpatient unit of a large academic tertiary care hospital. One patient identified some benefits to virtual treatment while the second found the experience impersonal; both were satisfied with the overall quality of care they received and were stable 2 weeks after discharge. These cases demonstrate that effective care can be provided remotely even to severely ill psychiatric patients who require hospitalization.A significant role of intensive care unit (ICU) workforce is ongoing communication with and support for families of critically ill patients. The COVID-19 pandemic has created unanticipated challenges to this essential function. Restrictions on visitors to hospitals and unprecedented clinical demands hamper traditional communication between ICU staff and patient families. In response to this challenge, we created a dedicated communications service to provide comprehensive support to families of COVID-19 patients, and to create capacity for our ICU teams to focus on patient care. In this brief report, we describe the development, implementation, and preliminary experience with the service.Positive patient experiences are associated with illness recovery and adherence to medication. To evaluate the virtual care experience for patients with COVID-19 symptoms as their chief complaints. We conducted a cross-sectional study of the first cohort of patients with COVID-19 symptoms in a virtual clinic. The main end points of this study were visit volume, wait times, visit duration, patient diagnosis, prescriptions received, and satisfaction. Of the 1139 total virtual visits, 212 (24.6%) patients had COVID-19 symptoms. The average wait time (SD) for all visits was 75.5 (121.6) minutes. The average visit duration for visits was 10.5 (4.9) minutes. The highest volume of virtual visits was on Saturdays (39), and the lowest volume was on Friday (19). Patients experienced shorter wait times (SD) on the weekdays 67.1 (106.8) minutes compared to 90.3 (142.6) minutes on the weekends. The most common diagnoses for patients with COVID-19 symptoms were upper respiratory infection. Patient wait times for a telehealth visit varied depending on the time and day of appointment. Long wait times were a major drawback in the patient experience. Based on patient-reported experience, we proposed a list of general, provider, and patient telehealth best practices.The COVID-19 pandemic has led to rapid change in health care, accelerating the use of digital health services, including telehealth. Moreover, growth in value-based care has compelled consumers to become more engaged in care processes. It has also provided opportunities to enhance patient experiences by increasing patients' access to online health information and services. This study assessed online patient engagement practices for 6 common patient touchpoints by reviewing the websites of the top 32 hospitals, including the top 10 children's hospitals. The great majority of these hospitals provided some information related to these patient touchpoints. However, the scope and extent of task automation varied significantly and many options were not convenient. Based on this study, it is clear that patient experience can be enhanced by improving online patient engagement, particularly during the current global pandemic.The experience of pregnant and postpartum patients continues to evolve during the COVID-19 pandemic. Limited clinical data and the unknown nature of the virus' impact and transmission routes have forced constant changes to traditional care delivery. Dependence on telehealth technology such as telephonic and videoconferencing has surged, and patients' willingness to visit traditional health care facilities has plummeted. We set out to create an ongoing surveillance system to monitor changes to prenatal and obstetric care and the patient experience during the COVID-19 pandemic.As of May 13, 2020, the number of confirmed SARS-CoV-2 (novel corona virus, COVID-19) infections has risen to 4 300 000 worldwide, with over 1 300 000 confirmed cases in the United States. Various prediction models of spread indicate more hospitalization, increased ventilator use, and the shifting of medical resources to most efficiently serve the patient's needs. Additionally, mitigation strategies such as monitoring for symptoms, social distancing, safer at home, and the wearing of masks caused our institution to implement significant operational changes to our usual practice. This included screening patients and staff for symptoms, rescheduling routine medical visits, postponing procedures, converting face-to-face visits to telephone or video visits, and changing visitor visit policies. In this article, we describe the various ways we deployed empathic communication messaging and resources across the institution during the COVID-19 pandemic.The purpose of preparing this Feature Article was to explore and share my lived experience of living with multiple layers of chronic pain, with a diagnosis of advanced, aggressive and metastasized prostate cancer, and COVID-19. My exploration begins with the manifestations of chronic pain from a bicycling accident, psoriatic arthritis, with cancer treatments and the pain it creates during a panademic has added to the challenges of social distancing, isolation, and medical treatments. As with many patient experiences, we the person as patient outside of health care sometimes struggle to find the right words, the proper sentence structure and as Tamas writes about the expectation of others to provide, "Clean and reasonable scholarship about messy, unreasonable experiences is an exercise in alienation." I write this while living with extreme chronic pain, continue cancer treatments while the threat and additional anxiety of COVID-19 looms over me. This is my story.The COVID-19 pandemic has crosses every health care area (from primary care to specialist ones), leading to a review of all public health policies. The use of smart working allows important technological innovations, but it must be accompanied by a review of hospital and residential programs and locations. Since many institution are talking about economic investments for mental health (a crucial area for a full recovery of the society), specific funds are needed in mental health professionals (eg, psychologists), skills, and innovation of locations and technology, such as the conversion of psychiatric wards to community services that carefully must consider the patient experience and clinician's point of view. Some considerations on the COVID-19 experience in Italy are reported, and suggestions on future directions for public mental health service organization are hypothesized.Thrombosis is one of the major underlying pathogenetic mechanisms leading to increased morbidity and mortality among COVID-19 patients. Thromboembolic events as well as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are the major causes of death in this continued pandemic. While elevated D-dimer level suggests worse thrombotic outcomes, levels at which benefits of anticoagulation outweigh the bleeding risk is yet to be determined. In this report, we present a case of a 72-year-old man with COVID-19 presented with confusion and subsequently developed acute hypoxic respiratory failure. On hospital day 7, patient developed extensive peripheral arterial thrombosis with acute rise of D-dimer from 800 to 14,899 ng/ml. He was treated with heparin drip and underwent urgent brachial, radial and ulnar embolectomy under general anesthesia. In this report, we also discuss the pathogenetic mechanisms and management of thromboembolism in COVID-19 patients, highlighting the role of early detection and aggressive therapeutic interventions that could be life and / or limb saving strategy.