The Spherical q-Linear Diophantine Fuzzy Multiple-Criteria Group Decision-Making Based on Differential Measure

Spherical q-linearDiophantine fuzzy sets(Sq-LDFSs)provedmore effective for handling uncertainty and vagueness in multi-criteria decision-making(MADM).It does not only cover the data in two variable parameters but is also beneficial for three parametric data.By Pythagorean fuzzy sets,the difference is calculated only between two parameters(membership and non-membership).According to human thoughts,fuzzy data can be found in three parameters(membership uncertainty,and non-membership).So,to make a compromise decision,comparing Sq-LDFSs is essential.Existing measures of different fuzzy sets do,however,can have several flaws that can lead to counterintuitive results.For instance,they treat any increase or decrease in the membership degree as the same as the non-membership degree because the uncertainty does not change,even though each parameter has a different implication.In the Sq-LDFSs comparison,this research develops the differentialmeasure(DFM).Themain goal of the DFM is to cover the unfair arguments that come from treating different types of FSs opposing criteria equally.Due to their relative positions in the attribute space and the similarity of their membership and non-membership degrees,two Sq-LDFSs formthis preference connectionwhen the uncertainty remains same in both sets.According to the degree of superiority or inferiority,two Sq-LDFSs are shown as identical,equivalent,superior,or inferior over one another.The suggested DFM’s fundamental characteristics are provided.Based on the newly developed DFM,a unique approach tomultiple criterion group decision-making is offered.Our suggestedmethod verifies the novel way of calculating the expert weights for Sq-LDFSS as in PFSs.Our proposed technique in three parameters is applied to evaluate solid-state drives and choose the optimum photovoltaic cell in two applications by taking uncertainty parameter zero.The method’s applicability and validity shown by the findings are contrasted with those obtained using various other existing approaches.To assess its stability and usefulness,a sensitivity analysis is done.

Foundations of medical decision-making for older adults with cardiovascular disease

In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical ex- amples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.

Artificial intelligence promotes shared decision-making through recommending tests to febrile pediatric outpatients

BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.

Behavioral Decision-Making of Key Stakeholders in Public-Private Partnerships:A Hybrid Method and Benefit Distribution Study

Public-private partnerships(PPPs)have been used by governments around the world to procure and construct infrastructural amenities.It relies on private sector expertise and funding to achieve this lofty objective.However,given the uncertainties of project management,transparency,accountability,and expropriation,this phenomenon has gained tremendous attention in recent years due to the important role it plays in curbing infrastructural deficits globally.Interestingly,the reasonable benefit distribution scheme in a PPP project is related to the behavior decisionmaking of the government and social capital,aswell as the performance of the project.In this paper,the government and social capital which are the key stakeholders of PPP projects were selected as the research objects.Based on the fuzzy expected value model and game theory,a hybrid method was adopted in this research taking into account the different risk preferences of both public entities and private parties under the fuzzy demand environment.To alleviate the problem of insufficient utilization of social capital in a PPP project,this paper seeks to grasp the relationship that exists between the benefit distribution of stakeholders,their behavioral decision-making,and project performance,given that they impact the performance of both public entities and private parties,as well as assist in maximizing the overall utility of the project.Furthermore,four game models were constructed in this study,while the expected value and opportunity-constrained programming model for optimal decision-making were derived using alternate perspectives of both centralized decision-making and decentralized decision-making.Afterward,the optimal behavioral decision-making of public entities and private parties in four scenarios was discussed and thereafter compared,which led to an ensuing discussion on the benefit distribution system under centralized decision-making.Lastly,based on an example case,the influence of different confidence levels,price,and fuzzy uncertainties of PPP projects on the equilibrium strategy results of both parties were discussed,giving credence to the effectiveness of the hybrid method.The results indicate that adjusting different confidence levels yields different equilibriumpoints,and therefore signposts that social capital has a fair perception of opportunities,as well as identifies reciprocal preferences.Nevertheless,we find that an increase in the cost coefficient of the government and social capital does not inhibit the effort of both parties.Our results also indicate that a reasonable benefit distribution of PPP projects can assist them in realizing optimum Pareto improvements over time.The results provide us with very useful strategies and recommendations to improve the overall performance of PPP projects in China.

Medical treatment for a fish bone-induced ileal micro-perforation:A case report

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography(CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

A Concept Analysis of Decision-Making by Families in Critical Life Situations

Background: In 2017, the elderly made up 27.3% of Japan’s population, accounting for 57.2% of all ambulance trips. When an elderly person is in a critical life situation, it is difficult to ascertain their decisions about treatment choices, and for family members who become surrogate decision-makers, this is a grave responsibility. Aim: This study aimed to shed light on the constructs that support decision-making by family members and medical staff in critical situations, and to investigate decision-making by families of the elderly in critical situations. Method: We selected 29 papers published in Japan and elsewhere that focused on families involved in treatment decisions in critical life situations and analyzed them using Rodgers’ concept analysis approach. Results: From 475 codes, we extracted six attributes, four antecedents, and four consequences. The unusual setting of the “critical care unit”, lack of time, and unstable psychological state are all considered by family members making treatment decisions, along with the patient’s prognosis, their relationship with the patient, conjecture about the patient’s wishes, and taking other family member’s views into account. Medical staff supports the family throughout the process, through provision of treatment, preparing family members to face reality, empathizing with the difficulty of decision-making, building relationships with family members, monitoring the decision-making process, and being attentive to family members’ feelings until the end. Conclusion: Our results indicate the importance of advance confirmation of patients’ wishes, and the role played by cultural context and family relations in decision-making by family members of the elderly.

Building towards Expertise in CME （Continuous Medical Education）： Suggestions for a New Paradigm

To build towards expertise, one has to accept to modify his way of practicing, including： （1） a need to reflect on and about the action; （2） a continuous concern about our competence to practice; （3） tireless effort to combine metacognition and mental practice in a trans-disciplinary approach; （4） adding research with neuroscience, understanding neuroplasticity, modulation and artificial intelligence. Usual practice actually does not include a continuous concern for CME （continued medical education） and is intermittent at best. This new paradigm constitutes the basis of our approach. Expertise starting in 2015 is described as an asymptotic curve unable to be obtained with usual practice and intermittent education. We suggest a new way of conceiving CME combining practice, reflection on action and in-situ simulation laboratory near work. We are describing TEE （technology-enhanced education） coupled with certain neuro-enhancers to achieve a break in the asymptotic curve of expertise. This is in reality a new conception of CME in medicine.

急诊危重症患者替代决策者参与医疗决策期望现状及影响因素分析

目的了解急诊危重症患者替代决策者参与医疗决策期望现状及影响因素,为改善急诊危重症患者及家属就医体验,提升其医疗决策参与能力提供参考。方法采用便利抽样法,选取2022年10月至2023年6月在广西某三级甲等医院急诊科参与替代决策的226名危重症患者家属为研究对象,通过问卷调查一般资料、应对方式以及决策倾向性,分析其参与医疗决策期望现状及影响因素。结果急诊危重症患者替代决策者参与医疗决策期望的总分为(50.10±5.10)分;Pearson相关性分析显示,急诊危重症患者替代决策者参医疗决策期望总分与积极应对呈正相关,与消极应对呈负相关(P<0.05);多元线性回归分析显示,替代决策者文化程度、与患者的关系、患者疾病种类以及是否理解医生的病情谈话内容均是急诊危重症患者替代决策者参与医疗决策期望的影响因素(均P<0.05)。结论急诊危重症患者替代决策者参与医疗决策期望较高且受多种因素影响,文化程度较高、患者子女、急性病就诊患者、理解医生的病情谈话内容的替代决策者参与医疗决策期望更高,采用个性化的决策辅助方案能够帮助医护人员改善其决策参与意愿,提高决策质量。

医学生职业期望的国内外研究进展

医学生作为医学储备人才,其职业期望对未来的职业选择、价值取向及医疗系统的可持续发展有深远的影响。通过医学生职业期望概念内涵解读,在此基础上系统比较分析国内外医学生职业期望研究内容、研究工具和研究结果,为探索科学、系统地测量医学生职业期望,完善医学教育和医学储备人才的健康发展提供参考。

基于ECSI模型的医疗服务满意度评价研究——以S市公立医院为例

目的 深入分析公立医院在医疗服务满意度方面存在的问题,构造更具适用性和解释能力的医疗服务满意度评价模型,为患者医疗服务满意度提升路径提供参考。方法 基于ESCI模型,提出研究假设,编制《S市公立医院医疗服务满意度评价量表》,选择S市公立医院为研究对象,从患者角度对其展开医疗服务满意度评价。结果 目前影响S市公立医院患者医疗服务管理满意度提升的问题主要为:硬件质量方面亟需提升诊疗技术,同时需要优化公立医院的环境卫生;软件质量方面缩短就医候时是眉睫要务。S市公立医院医疗服务满意度评价得分为3.76,S市公立医院患者对其医疗服务满意度处于中等偏低水平。结论 针对上述问题,建议从强化重点专科建设、强化人才队伍建设、优化就诊流程、开放数字化联动服务、强化服务管理等方面进行改革,以推动患者医疗服务满意度进行提升。

数字化医疗场景下基于等待的信息设计研究

医疗场景中等待行为的普遍性、时间的不确定性,是影响患者就医体验的重要因素,数字化医疗服务体系的快速发展,为提供更加即时、高效和个性化的医疗信息服务、提升用户就医等待体验带来了可能性。目的以数字化、信息化医疗服务为技术背景,基于用户等待过程中的信息获取需求,探讨等待服务环节的信息结构要素,以支持患者建立明确的等待预期、改善等待体验,为相关信息设计提供参考。方法根据认知心理学的时间知觉理论,结合医疗候诊场景下的排队特点,将建立明确等待期望转化为时间定位问题,提出基于等待的信息构成要素模型,并通过不同就医阶段场景对不同要素组合的形式有效性和用户满意度进行验证。结果提出基于等待的信息构成模型由时序信息、时距信息、时点信息、时变信息四类信息要素组成,并提出完整的四要素组合设计方案能够同时满足用户不同场景下预判等待时间的信息需求,验证了四要素信息模型的有效性。结论基于医疗等待场景的信息设计要素模型及其组合方案设计研究,能够支持用户建立明确的等待时间预期,并能为其他等待相关场景下的信息设计提供参考框架。

妊娠期有症状泌尿系结石诊疗及护理的研究进展

该文围绕妊娠期有症状泌尿系结石的发病情况、危害、诊断方法、保守治疗、解除梗阻外科手段及后续延续性诊疗措施进行分析和归纳总结,旨在为深入研究妊娠期有症状泌尿系结石患者长期医疗处置及护理干预的方式提供参考。多学科联合及基于循证医学的规范诊疗可提高妊娠期有症状泌尿系结石孕产妇的孕期安全及生活质量,并提供更多的理论视角和研究思路。

西藏阿里地区医务人员对军队援藏人员角色期望的质性研究

目的 探索西藏阿里地区医务人员对军队援藏人员的角色期望。方法 采用目的抽样的方法,于2023年6月,采用半结构式访谈法对西藏阿里革吉县人民医院的16名医务人员进行结构式访谈,运用Colaizzi 7步分析法对访谈结果进行整理分析,提炼主题。结果 经过分析,主要提炼出4个主题,分别是技术帮扶者、管理帮带者、品行引领者和远期指导者。结论 军队医院应选派身心素质过硬、专业技能突出、沟通协调能力好、责任使命感强的医务人员到西藏阿里地区进行医疗帮扶,以更好地达成援藏目标。

基层护理管理者对医疗护理员角色期望的质性研究

目的探索基层护理管理者对医疗护理员的角色期望,以更好地提高护理服务质量和患者满意度。方法采用质性研究中的现象学研究方法对广州市某三级甲等医院的10名基层护理管理者进行半结构性访谈,运用Colaizzi分析方法对访谈资料进行整理、分析。结果基层护理管理者对医疗护理员的角色期望可归纳为4个主题:职业规范期望、职业技能期望、职业知识期望、职业素养期望。结论医疗护理员的角色定位应以规范从业作为前提,以专业照护作为核心,亟需构建完善的医疗护理员培训体系和管理制度。

医疗器械非劣效设计临床试验界值设定的现状与分析

本文选取了近20年来在《新英格兰医学杂志》(NEJM)、《柳叶刀》(Lancet)和《美国医学会杂志》(JAMA)三大医学期刊上发表的83项医疗器械非劣效设计临床试验,介绍和分析了非劣效界值设定现状。建议采用简捷的阳性对照预期值百分比方法设定非劣效界值,且界值百分比不宜超过50%,特别是当对照组预期值大于10%时,否则需要提供充分的理由。

新生儿重症监护病房患儿父母参与医疗决策期望现状及影响因素分析

目的:调查分析新生儿重症监护病房(NICU)患儿父母参与医疗决策期望,以期为推动危重症患儿医患共享决策提供参考。方法:采用病人参与医疗决策期望量表对2021年5月-2022年5月医院收治的237名NICU患儿父母进行调查。结果:NICU患儿父母参与医疗决策期望得分为(51.96±5.70)分,得分最高的维度为信息需求。多因素分析显示,家庭年收入、患儿出生情况、与患儿关系以及照顾者年龄为NICU患儿父母参与医疗决策期望的影响因素(F=14.882,P<0.001)。结论:NICU患儿父母参与医疗决策期望水平较高,尤其是家庭收入较高、患儿超低出生体重、患儿母亲以及年龄较高的患儿父母。

医学本科生骨科见习期间学习的动机、目标和期待——学生角度:一份开放性问卷和访谈带来的启示

高校骨科教学是一个由教师、学生和教学环境组成的生态环境。教师应关注学生的阶段性学习目的、态度和困难期待等。医学院学生是一特殊群体,文章通过随机发放开放性问卷和访谈方法,对该校大学2014级五年制学生进行调查和访谈,了解医学生在新的教学理念模式下的学习动机、目标和期待需求,旨在建构和谐共生的骨科教学课堂。

基于服务质量差距模型的江苏某口腔医院医疗服务现状与对策

回顾性收集江苏某口腔医院2019—2021年医患纠纷卷宗,建立医疗服务质量(SERVQUAL)量表,利用二维象限分析法,分析患者就医期望与实际感知的差距和问题。结果发现,在患者期待与实际感知的测算比较中,患者就医流程(-0.35)、就医挂号时间(-0.43)、医院人文氛围(-0.37)、医护专业态度(-0.28)四个指标呈现明显排序差异;在服务质量评价二维象限分析中,医院人文氛围、医患沟通制度、医学治疗效果三个指标处于“改进区域”。研究发现,通过强化医院和医护人员服务意识,提升医院整体人文氛围,重点加强对投诉占比较高科室的管理、监督,加强医患沟通,正确认知患者期望等对策可以有效缓解该口腔医院医疗纠纷现状。

卓越医生核心素养的认知现状及其培养——基于1138位医患调查对象的分析

目的:调研卓越医生核心素养,探讨卓越医生的培养。方法:编制现阶段我国卓越医生核心素养内容及重要性认知问卷,调研五类人群对于卓越医生核心素养的认知与重要性评价;采用秩和检验分析医患群体对于卓越医生核心素养的认知差异。结果:卓越医生应具有临床技能、沟通技能、批判性思维和研究、管理能力、职业精神与职业化素养五大核心素养。结论:构建以卓越医生核心素养提升为导向的临床医生人才培养路径。

基于SERVQUAL模型对多院区医疗服务同质化的研究

目的分析医院一院三区医疗服务同质化水平,为多院区提高医疗同质化管理提供参考。方法调查某院多院区住院患者对医疗服务质量的期望与实际感受之间的差距,运用SERVQUAL量表从5个维度对医院一院三区住院患者进行问卷调查并对调查结果进行统计学分析。结果患者个体特征对满意度评价没有影响,医院三院区医疗服务质量总体上无差异,5个维度无差异,22个具体指标中存在差异的仅有两项。从象限分析结果得出三院区都做得比较好的方面包括有形性、可靠性和保证性3个维度。结论SERVQUAL量表适用于医院多院区医疗服务质量的评价研究,可以为医院改进医疗服务的薄弱环节和提高多院区同质化管理提供帮助。