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Effectiveness of simulation-based learning regarding management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students:A quasi-experimental study
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作者 Thakur Malvika Eenu +3 位作者 Kumar Yogesh Sarin Jyoti Nitesh Kumawat Shatrughan Pareek 《Journal of Acute Disease》 2023年第3期96-101,共6页
Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.M... Objective:To assess the effectiveness of simulation-based learning regarding the management of post-COVID complications in terms of knowledge,clinical decision-making ability,and self-efficacy among nursing students.Methods:This was a quasi-experimental study conducted among 1152nd-year nursing students.The participants were selected by a simple random sampling technique.The participants were divided into an experimental(n=56)and a comparison group(n=59)by a random table method.Data were analyzed using descriptive and inferential statistics with SPSS version 20.Results:There were significant differences in mean post-test knowledge scores(P=0.03)and mean post-test self-efficacy scores(P=0.001)between the experimental and the comparison groups while the difference in mean post-test clinical decision-making ability scores between the two groups was non-significant(P=0.07).A positive correlation was found between knowledge and clinical decision-making ability in pre-test(P=0.03)and in post-test(P<0.001)and a non-significant correlation was found between pre-test knowledge and self-efficacy score(P=0.52)among the experimental group.Conclusions:Simulation-based learning regarding the management of post-COVID complications is effective among nursing students.Simulation labs should be established in health care settings where simulation training can be provided for updating the knowledge,clinical decision-making ability,and self-efficacy of nursing personnel during program installment and continuous nursing education. 展开更多
关键词 Simulation KNOWLEDGE clinical decision making ability SELF-EFFICACY Post-COVID complications
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Current advancements in application of artificial intelligence in clinical decision-making by gastroenterologists in gastrointestinal bleeding
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作者 Hasan Maulahela Nagita Gianty Annisa 《Artificial Intelligence in Gastroenterology》 2022年第1期13-20,共8页
Artificial Intelligence(AI)is a type of intelligence that comes from machines or computer systems that mimics human cognitive function.Recently,AI has been utilized in medicine and helped clinicians make clinical deci... Artificial Intelligence(AI)is a type of intelligence that comes from machines or computer systems that mimics human cognitive function.Recently,AI has been utilized in medicine and helped clinicians make clinical decisions.In gastroenterology,AI has assisted colon polyp detection,optical biopsy,and diagnosis of Helicobacter pylori infection.AI also has a broad role in the clinical prediction and management of gastrointestinal bleeding.Machine learning can determine the clinical risk of upper and lower gastrointestinal bleeding.AI can assist the management of gastrointestinal bleeding by identifying high-risk patients who might need urgent endoscopic treatment or blood transfusion,determining bleeding stigmata during endoscopy,and predicting recurrence of gastrointestinal bleeding.The present review will discuss the role of AI in the clinical prediction and management of gastrointestinal bleeding,primarily on how it could assist gastroenterologists in their clinical decision-making compared to conventional methods.This review will also discuss challenges in implementing AI in routine practice. 展开更多
关键词 Gastrointestinal bleeding Artificial intelligence Machine learning Artificial neural networks clinical decision making
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Ten misconceptions regarding decision-making in critical care
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作者 Tara Ramaswamy Jamie L Sparling +1 位作者 Marvin G Chang Edward A Bittner 《World Journal of Critical Care Medicine》 2024年第2期72-82,共11页
Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper... Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes. 展开更多
关键词 clinical reasoning Cognitive bias Critical care Debiasing strategies decision making Diagnostic reasoning Diagnostic error HEURISTICS Medical knowledge Patient safety
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Practice Rationale Care Model: The Art and Science of Clinical Reasoning, Decision Making and Judgment in the Nursing Process
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作者 Jefferson Garcia Guerrero 《Open Journal of Nursing》 2019年第2期79-88,共10页
Nurses must be enlightened that clinical reasoning, clinical decision making, and clinical judgement are the key elements in providing safe patient care. It must be incorporated and applied all throughout the nursing ... Nurses must be enlightened that clinical reasoning, clinical decision making, and clinical judgement are the key elements in providing safe patient care. It must be incorporated and applied all throughout the nursing process. The impact of patients’ positive outcomes relies on how nurses are effective in clinical reasoning and put into action once clinical decision making occurs. Thus, nurses with poor clinical reasoning skills frequently fail to see and notice patient worsening condition, and misguided decision making arises that leads to ineffective patient care and adding patients suffering. Clinical judgment on the other hand denotes on the outcome after the cycle of clinical reasoning. Within this context, nurses apply reflection about their actions from the clinical decision making they made. The process of applying knowledge, skills and expertise in the clinical field through clinical reasoning is the work of art in the nursing profession in promoting patient safety in the course of delivering routine nursing interventions. Nurses must be guided with their sound clinical reasoning to have an optimistic outcome and prevent iatrogenic harm to patients. Nurses must be equipped with knowledge, skills, attitude and values but most importantly prepared to face the bigger picture of responsibility to care for every patient in the clinical field. 展开更多
关键词 clinical REASONING decision making JUDGEMENT PRACTICE RATIONALE COMPETENCY
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Making Evidence-based Decisions in the Clinical Practice of Integrative Medicine 被引量:10
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作者 徐浩 陈可冀 《Chinese Journal of Integrative Medicine》 SCIE CAS 2010年第6期483-485,共3页
In 1948, the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill,a noted British biostatistician, who introduced rigorous theory of ... In 1948, the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill,a noted British biostatistician, who introduced rigorous theory of mathematical statistics into clinical design the first time and successfully evaluated the therapeutic effect of streptomycin on tuberculosis. 展开更多
关键词 In EBM making Evidence-based decisions in the clinical Practice of Integrative Medicine CAM
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Prognostic value of decision criteria for emergency liver transplantation in patients with wild mushroom induced acute liver injury 被引量:1
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作者 Youn-Jung Kim Hyung Joo Lee +5 位作者 Seung Mok Ryoo Shin Ahn Chang Hwan Sohn Dong-Woo Seo Kyoung Soo Lim Won Young Kim 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2018年第3期210-213,共4页
Background: The reported mortality rate of mushroom-induced acute liver failure with conventionaltreatment is 1.4%–16.9%. Emergency liver transplantation may be indicated and can be the only curativetreatment option... Background: The reported mortality rate of mushroom-induced acute liver failure with conventionaltreatment is 1.4%–16.9%. Emergency liver transplantation may be indicated and can be the only curativetreatment option. This study aimed to assess the prognostic value of criteria for emergency livertransplantation in predicting 28-day mortality in patients with mushroom-induced acute liver injury.Methods: A retrospective cohort study was performed between January 2005 and December 2015. Alladult patients aged≥18 years admitted with mushroom intoxication at our emergency department wereevaluated. All patients with acute liver injury, defined as elevation of serum liver enzymes (〉5 timesthe upper limit of normal, ULN) or moderate coagulopathy (INR 〉 2.0) were included. The ability of the King’s College, Ganzert’s, and Escudié’s criteria to predict 28-day mortality was evaluated. 展开更多
关键词 Liver failure Mushroom poisoning Liver transplantation clinical decision making
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The quality of older adults'involvement in clinical communication with general practitioners:evidence from rural towns in Australia 被引量:1
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作者 Mohammad Hamiduzzaman Noore Siddiquee +2 位作者 Harry James Gaffney Muhammad Aziz Rahman Jennene Greenhill 《Global Health Journal》 2023年第4期186-193,共8页
Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health... Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health intake visits.Methods:It was a cross-sectional study between January 2021 and April 2022.The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software.This online survey was administered by sending an email request to the Renmark Rotary Club,which actively promoted this study across five rural towns in South Australia.121 participants completed the surveys.Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes,specifically initiation of information,active participation,and emotional expression.We employed different methods including t-tests,ANOVA,and leaner regressions to analyse data.Results:The demographic profile of participants characterised by a female predominance(58.7%,71/121),a majority falling within the 65-<70 age bracket(47.1%,57/121),and a high level of educational attainment(58.7%had completed high school or higher,71/121).Additionally,35%of the participants predominantly spoke a language other than English at home.Regarding the initiation of information with GPs,the mean sum-score was(20.5+3.7),indicating a marginally above-average level of engagement.Contrarily,the active participation was suboptimal,as suggested by a mean sum score of(35.9±6.3).Furthermore,the emotional expression was relatively low,with a mean score of(13.9±1.8).Substantial variations were discerned in the quality of patient-GP communication,contingent upon factors such as educational background,language spoken at home,health literacy,and preparatory measures for clinical visits.Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs(P<0.o01).Higher educational attainment was positively correlated with increased active participation(P<0.001).Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation(P<0.001).Conclusion:Meaningful engagement through recognition,empowerment,and support(health literacy programs)for older rural adults is suggested for improving their quality of involvement in communication with GPs. 展开更多
关键词 Shared decision making clinical communication General practitioners Older adults Rural health AUSTRALIA
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Three Basic Modes for Patients' Clinical Decision-Making in China 被引量:4
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作者 李恩昌 王臻 +1 位作者 张文英 赵亮宇 《Chinese Journal of Integrative Medicine》 SCIE CAS 2014年第11期876-880,共5页
In China,there are three basic clinical decision-making modes for patients,namely patients autonomous decision-making mode,family decision-making mode and patient and family codetermination.They were produced under th... In China,there are three basic clinical decision-making modes for patients,namely patients autonomous decision-making mode,family decision-making mode and patient and family codetermination.They were produced under the unique background of Chinese medicine,Confucian philosophy and law in China,l this paper,the concepts,advantages and disadvantages of these three decision-making modes were analyzed In addition,some suggestions were put forward for the improvement.The first is that we suggest to establis standards for choosing decision-making modes;the second is to further learn and publicize relevant laws;thirdly the legal system needs to be further refined;and the last one is to carry out ethical ward round. 展开更多
关键词 patients' clinical decision-making Chinese medicine Confucianism patients' autonomous decision-making family decision-making mode patient and family codetermination ethical ward round
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Computerized decision support in adult and pediatric critical care
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作者 Cydni N Williams Susan L Bratton Eliotte L Hirshberg 《World Journal of Critical Care Medicine》 2013年第4期21-28,共8页
Computerized decision support(CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care... Computerized decision support(CDS) is the most advanced form of clinical decision support available and has evolved with innovative technologies to provide meaningful assistance to medical professionals. Critical care clinicians are in unique environments where vast amounts of data are collected on individual patients, and where expedient and accurate decisions are paramount to the delivery of quality healthcare. Many CDS tools are in use today among adult and pediatric intensive care units as diagnostic aides, safety alerts, computerized protocols, and automated recommendations for management. Some CDS use have significantly decreased adverse events and improved costs when carefully implemented and properly operated. CDS tools integrated into electronic health records are also valuable to researchers providing rapid identification of eligible patients, streamlining data-gathering and analysis, and providing cohorts for study of rare and chronic diseases through data-warehousing. Although the need for human judgment in the daily care of critically ill patients has limited the study and realization ofmeaningful improvements in overall patient outcomes, CDS tools continue to evolve and integrate into the daily workflow of clinicians, and will likely provide advancements over time. Through novel technologies, CDS tools have vast potential for progression and will significantly impact the field of critical care and clinical research in the future. 展开更多
关键词 clinical decision support systems Critical CARE COMPUTERS COMPUTER-ASSISTED decision making
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The Impact of Simulation Education on Self-Efficacy in Pre-Registration Nursing Students
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作者 Ahmed A. Hakami Aisha Hussin Rabie +2 位作者 Sultan Ghormallah M. Alzahrani Faisal Mohammed Alnakhilan Khalid Awaidhalharbi 《Open Journal of Nursing》 2024年第1期51-76,共26页
This literature review primarily aims to explore and synthesise the previous studies in simulation education research conducted over the past five years related to the effects of simulation training on the self-effica... This literature review primarily aims to explore and synthesise the previous studies in simulation education research conducted over the past five years related to the effects of simulation training on the self-efficacy of undergraduate pre-registration nursing students. The second aim of this study is to explore additional outcome variables that were examined in the previous studies. Five electronic databases were searched systematically. These databases were MEDLINE, CINAHL Plus, Scopus, Embase and PsycINFO. The PICO model was employed to identify the search terms, with a thesaurus being used to provide synonyms. Reference lists of relevant articles were examined and hand searches of journals were also undertaken. The quality of each study was assessed using the Simulation Research Rubric (SRR). A total of 11 studies were included. All studies explored the impact of simulation education on undergraduate pre-registration nursing. Six studies explored nursing students’ competence and performance and two papers examined their critical thinking. Problem solving, learning motivation, communication skills and knowledge acquisition were examined once. The majority of studies indicated that simulation training has a positive impact on pre-registration nursing students’ self-efficacy and other outcome variables. Furthermore, the study results indicate that simulation training is more dependable than traditional training, and students were extremely satisfied with the simulation training. However, most of the studies included in this review had several gaps, including study design, sample size and dissimilarities between the scales used. Further research with large samples, reliable and valid instruments, and outcomes measures (such as critical thinking and transferability of skills) is required to provide better insight into the effectiveness of simulation in undergraduate nursing education. . 展开更多
关键词 Simulation Education SELF-EFFICACY Pre-Registration Nursing Students clinical Skills Undergraduate Nursing Education Teaching Techniques decision-making
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DxR Clinician软件在神经内科护理实践中学生临床思维培养的应用评价
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作者 张元菊 朱菊训 范树腾 《卫生职业教育》 2024年第17期92-96,共5页
目的分析和探讨DxR Clinician软件在神经内科中护生临床思维培养的应用。方法选取神经内科86名实习护生作为研究对象,随机分为对照组和观察组。观察组实施DxR Clinician软件教学模式,对照组实施传统带教模式。分析两组护生的评判性思维... 目的分析和探讨DxR Clinician软件在神经内科中护生临床思维培养的应用。方法选取神经内科86名实习护生作为研究对象,随机分为对照组和观察组。观察组实施DxR Clinician软件教学模式,对照组实施传统带教模式。分析两组护生的评判性思维、临床决策能力、理论和操作考试成绩及满意度。结果观察组护生评判性思维的5个维度(创新能力、总结能力、认知能力、分析能力、自信能力)与对照组护生有显著差异;两组护生临床决策能力的4个方面(发现问题、决断方案能力、实施决策能力和评价反馈能力)有显著差异;观察组护生的理论和操作考试成绩高于对照组;两组护生对教学工作的满意度有差异。结论DxR Clinician软件让护生通过扮演临床护士进行角色职业训练,提高护生的评判性思维和临床决策能力;同时,应用此软件给护生带来身临其境的学习体验,提高了其临床知识储备量和满意度。 展开更多
关键词 DxR clinician软件 临床思维 虚拟教学 评判性思维 临床决策能力 神经内科护理实践
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基于信息-知识-智能转化律的循证医学信息服务主体转型 被引量:4
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作者 田杰 娄钦 +3 位作者 黄维茜 陈蕊 姚海燕 罗志宏 《中华医学图书情报杂志》 CAS 2017年第5期56-58,共3页
在分析国内外有关循证医学信息服务的机构主体和人员主体的基础上,引入信息-知识-智能转化律作为循证医学信息服务主体角色转型的理论依据,提出作为机构主体的医学图书馆应积极转型为"信息库+思想库",作为人员主体的临床医学... 在分析国内外有关循证医学信息服务的机构主体和人员主体的基础上,引入信息-知识-智能转化律作为循证医学信息服务主体角色转型的理论依据,提出作为机构主体的医学图书馆应积极转型为"信息库+思想库",作为人员主体的临床医学馆员应转型为"证据员+决策咨询员"并具备相应素质。 展开更多
关键词 信息-知识-智能转化律 医学图书馆 思想库 临床医学馆员 决策咨询员
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BMJ快速推荐《SGLT-2抑制剂和GLP-1受体激动剂治疗成人2型糖尿病的临床实践指南》解读 被引量:16
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作者 安康 李舍予 《中国全科医学》 CAS 北大核心 2021年第26期3269-3275,共7页
BMJ快速推荐栏目结合最新循证医学证据,发布了《SGLT-2抑制剂和GLP-1受体激动剂治疗成人2型糖尿病的临床实践指南》,深入探讨了在成人2型糖尿病患者中选用两种新型降糖药物SGLT-2抑制剂和GLP-1受体激动剂的诊疗策略。该指南采用了基于... BMJ快速推荐栏目结合最新循证医学证据,发布了《SGLT-2抑制剂和GLP-1受体激动剂治疗成人2型糖尿病的临床实践指南》,深入探讨了在成人2型糖尿病患者中选用两种新型降糖药物SGLT-2抑制剂和GLP-1受体激动剂的诊疗策略。该指南采用了基于基线风险,而非基于糖化血红蛋白或血糖控制水平的决策模式。其提供的高度可视化的证据和推荐呈现工具,便于全科医生快速查询,并为医患共同决策提供了可能。 展开更多
关键词 糖尿病 2型 SGLT-2抑制剂 GLP-1受体激动剂 临床实践指南 医患共同决策
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成本-收益视角下的肿瘤治疗决策 被引量:1
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作者 吕东来 陆林 桑秋菊 《医学与哲学》 2019年第18期23-25,36,共4页
目前,抗肿瘤治疗决策的制订更多地是取决于临床试验的P值,但恶性肿瘤的诊治需要兼顾医疗获益与经济成本的平衡,这种对平衡性的追求决定了其临床决策的复杂性。从临床获益与统计学P值的关系出发,结合目前国内肿瘤治疗所面临的现实问题,... 目前,抗肿瘤治疗决策的制订更多地是取决于临床试验的P值,但恶性肿瘤的诊治需要兼顾医疗获益与经济成本的平衡,这种对平衡性的追求决定了其临床决策的复杂性。从临床获益与统计学P值的关系出发,结合目前国内肿瘤治疗所面临的现实问题,应用一些实例从成本-收益的角度来分析目前肿瘤治疗决策中的一些其他选择。认为随着相关理念进步,肿瘤科医生应更多地从成本-收益角度多维度权衡疗效、生命质量及资源费用以指导临床决策的制订。 展开更多
关键词 肿瘤 临床决策 卫生经济学
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McKenzie Therapists Adhere More to Evidence-Based Guidelines and Have a More Biopsychosocial Perspective on the Management of Patients with Low Back Pain than General Physical Therapists in Japan 被引量:1
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作者 Hiroshi Takasaki Takeshi Saiki Yoshihiro Iwasada 《Open Journal of Therapy and Rehabilitation》 2014年第4期173-181,共9页
Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of M... Design: Cross-sectional. Objective: Aim 1 was to preliminarily explore the contributions of the following factors to adherence to LBP practice guidelines using regression modeling: 1) the credential qualification of Mechanical Diagnosis and Therapy (MDT);2) balance of biomedical and behavioral (i.e. biopsychosocial) oriented approach for low back pain (LBP);3) demographics;4) academic degree and 5) the attitude towards updating information for evidence-based clinical practice. Aim 2 was to investigate whether therapists credentialed in MDT (Cred.MDT) were more behavioral oriented and less biomedical oriented than general physical therapists. Summary of Background Data: LBP practice guidelines are not adhered to by every physical therapist. MDT is a behavioral modification approach. Thus, it was hypothesized that the Cred.MDT therapist was more behavioral oriented and more adherent to LBP practice guidelines compared with general physical therapists. Methods: One-hundred-twenty Cred.MDT therapists and 2000 general physical therapists in Japan were contacted. For regression modeling, the dependent variable was adherent to guidelines using a questionnaire with a vignette. Independent variables included balance of biomedical and behavioral perspectives for LBP using the Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT), demographics, academic degree and the attitude towards updatinginformation for evidence-based clinical practice. The ratio of the two mean scores of the biomedical and behavioral subscales in the PABS-PT was compared between the Cred.MDT therapist group and the general physical therapists group. Results: Data of 46 general physical therapists and 44 Cred.MDT therapists were available. The Cred.MDT therapist group was significantly (P < 0.05) more behavioral oriented and more adherent to LBP practice guidelines compared with the general physical therapist group. The regression indicated significance of the two predictors of adherence to guidelines, Cred.MDT (β = 0.58, P < 0.001) and academic degree (β = 0.19, P = 0.03). Conclusions: Cred.MDT therapists are more guideline-consistent and have a more biopsychosocial treatment orientation than general physical therapists in Japan. 展开更多
关键词 clinical Behavior clinical decision making clinical Guidelines Low Back Pain Mechanical Diagnosis and Therapy
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基于CAD-RADS的稳定性胸痛患者冠脉CTA结构式报告临床应用价值 被引量:1
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作者 赵建春 龚沈初 +1 位作者 张凡 曹强 《海南医学》 CAS 2022年第14期1839-1843,共5页
目的研究基于冠状动脉疾病报告和数据系统(CAD-RADS)的稳定性胸痛患者冠状动脉CT血管成像(冠脉CTA)结构式报告一致性和临床应用价值。方法按照CAD-RADS报告和数据系统构建稳定性胸痛患者的冠脉CTA结构式报告模板。回顾性分析南通市通州... 目的研究基于冠状动脉疾病报告和数据系统(CAD-RADS)的稳定性胸痛患者冠状动脉CT血管成像(冠脉CTA)结构式报告一致性和临床应用价值。方法按照CAD-RADS报告和数据系统构建稳定性胸痛患者的冠脉CTA结构式报告模板。回顾性分析南通市通州区人民医院2019年12月至2020年12月期间的371例患者冠脉CTA检查影像资料和临床资料,按CAD-RADS类别将其分为CAD-RADS 0~5六组。2名不同年资的诊断医师盲法独立阅片,采用Kappa检验分析观察者间一致性。分别统计患者的性别、年龄、体质量指数、吸烟史、收缩压、舒张压、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、空腹血糖等相关影响因素及临床评估、治疗等资料,采用卡方检验、单因素方差分析、秩和检验分析CAD-RADS组间差异,采用二元Logisitic回归分析临床管理决策的指导因素,评价CAD-RADS结构式报告对稳定性胸痛患者危险因素的预测价值、临床管理决策的指导能力。结果不同年资诊断医师对CAD-RADS类别的评估具有极好的观察者间一致性;CAD-RADS类别与有创冠状动脉造影(ICA)狭窄程度结果对照显示:CAD-RADS结构式报告具有较好的一致性和诊断效能;性别、年龄、吸烟史、收缩压、空腹血糖在CAD-RADS类别中比较差异均有统计学意义(P<0.05);临床管理决策中功能评估、ICA及抗心肌缺血、降压药、他汀类、阿司匹林、支架植入在CAD-RADS类别中比较差异均有统计学意义(P<0.05);二元Logistic回归分析显示不同CAD-RADS类别区间对临床管理决策有重要指导意义。结论基于CAD-RADS的稳定性胸痛患者冠脉CTA结构式报告加强了医务人员间有效沟通,对患者危险因素具有预测价值,能精准指导临床路径,值得临床推广使用。 展开更多
关键词 结构式报告 冠状动脉CT血管成像 冠状动脉疾病报告和数据系统 稳定性胸痛 临床管理决策
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医疗决策中自主性审视及临床实践策略--以肾病综合征患者为例 被引量:1
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作者 汤丽丽 谢王斌 崔建玲 《中国医学伦理学》 2022年第10期1073-1076,共4页
以肾病综合征为例对慢性病患者医疗决策中的自主性进行了分析,发现患者存在信息、表述、功能、决策以及执行五大维度的自主性;尊重患者自主性可以让患者作出符合其最大利益的决定,是相关医疗决策制定的基础,但慢性疾病医疗决策中尊重患... 以肾病综合征为例对慢性病患者医疗决策中的自主性进行了分析,发现患者存在信息、表述、功能、决策以及执行五大维度的自主性;尊重患者自主性可以让患者作出符合其最大利益的决定,是相关医疗决策制定的基础,但慢性疾病医疗决策中尊重患者自主性也面临着部分慢性病患者自主性受限、医疗信息沟通不畅或资源匮乏弱化慢性病患者医疗决策自主性以及健康素养和健康管理能力的差异影响患者自主性发挥等问题。以肾病综合征患者为例,提出认清慢性病患者自主性的局限性,灵活运用不同方式尊重患者自主性;提升临床医务人员沟通能力与共同决策经验,实现充分尊重患者自主性;提升患者健康素养和健康管理能力,以实现对患者自主性的尊重的临床实践策略。 展开更多
关键词 肾病综合征 医疗决策 自主性 临床实践
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上海市某地区2014-2018年医疗损害责任案件的原因分析及其对策 被引量:1
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作者 孙畅 《医学临床研究》 CAS 2021年第10期1453-1456,共4页
【目的】分析医疗损害责任案件发生原因.为预防和处理医疗损害责任案件提供建议和方法。【方法】对2014-2018年上海市某地区发生的医疗损害责任案件446例进行回顾性分析,通过专家论证法、统计分析法,查找出案件中存在的医疗质量和医疗... 【目的】分析医疗损害责任案件发生原因.为预防和处理医疗损害责任案件提供建议和方法。【方法】对2014-2018年上海市某地区发生的医疗损害责任案件446例进行回顾性分析,通过专家论证法、统计分析法,查找出案件中存在的医疗质量和医疗安全管理漏洞,提出针对性建议。【结果】医疗损害高发于三级医院;手术和非手术科室发生医疗损害案件差异有统计学意义(χ^(2)=6.734,P=0.014)。高风险医疗损害科室为急诊科、骨科等5个科室;高风险医疗损害原因为告知不充分、病情观察不严等5个原因。【结论】卫生行政部门及医疗机构应加强病历质量管理,加强医学人文关怀和沟通交流培训,加强医疗质量安全事件督查。 展开更多
关键词 医疗差错 防御医学 临床决策 上海
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COVID-19 pandemic:Building organisational flexibility to scale transplant programs
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作者 Jeevan Prakash Gopal Vassilios E Papalois 《World Journal of Transplantation》 2020年第10期277-282,共6页
The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner.The pandemic has had a significant impact on transplantation worldwide.The logistics of travel restrictions,stretchi... The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner.The pandemic has had a significant impact on transplantation worldwide.The logistics of travel restrictions,stretching of available resources,unclear risk of infection in immunosuppressed transplant recipients,and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant activity.We must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our patients.Building a culture of honesty and transparency(with patients,families,colleagues,societies,and authorities),keeping the channels of communication open,working in collaboration with others(at local,regional,national,and international levels),and not restarting without rethinking and appraising all elements of our practice,are the main underlying principles to increase the flexibility. 展开更多
关键词 Organisational flexibility clinical decision making COVID-19 Organ donation Care delivery TRANSPLANTATION
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Impact of recipient functional status on 1-year liver transplant outcomes 被引量:1
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作者 Natasha H Dolgin Babak Movahedi +3 位作者 Frederick A Anderson Isabel MA Brüggenwirth Paulo N Martins Adel Bozorgzadeh 《World Journal of Transplantation》 2019年第7期145-157,共13页
BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS s... BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival. 展开更多
关键词 Patient SURVIVAL TRANSPLANTATION Liver disease clinical decision-making GRAFT SURVIVAL Risk assessment/risk STRATIFICATION
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