Coping up with the Information Overload in the Medical Profession

The recent technological advancement has proved to be tremendously helpful for medical consultants. However, this advancement has also generated an enormous volume and variety of data, with a high velocity causing an information load for the medical consultants. Information overload can be defined as a difficulty a person can have in comprehending issue and making judgments that are caused by the presence of too much information. Information overload occurs when the amount of input to a system surpasses its processing capability. Decision-makers have a limited cognitive processing ability. Consequently, when information overload happens, it is possible that a decline in decision quality will take place. Decision-makers, such as medical consultants, have fairly limited cognitive processing capacity. Consequently, when information overload occurs, it is likely that a reduction in decision quality will occur. The aim of this study is to assess the impact of information overload on medical consultants’ life, its causes, and potential ways to deal with it. We performed a literature review to find the effects of information overload on medical consultants. Twelve research papers were considered for thematic analysis using NVivo 10 tool. These papers revealed four themes: 1) traditional methods of data collection;2) modern ways of data collection;3) consequences of modern ways of data collection;and 4) the need for handling information overload. This study suggests the development of a Continuing Professional Development course that explains how to deal with information overload, and availing the same through E-Learning mode might be one immediate solution.

Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

共病药物治疗决策--全科医生接诊病案研究

慢性病共病患者常联合使用多种药物,疾病与药物之间潜在的复杂相互作用使全科医生面临着难以合理评估共病药物治疗获益与风险的决策困境。本文以1例在社区卫生服务中心就诊的慢性病共病患者为例,展示和阐述了全科医生运用共病药物治疗决策框架进行科学决策的过程,并基于阿里阿德涅原则为共病管理过程提出的多阶段目标,分析了全科医生在评估、沟通与制定治疗方案等方面的要点和注意事项。希望本文可以为改善社区慢性病共病药物治疗决策的质量提供借鉴。

Physicians’Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.

Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer

AIM:To evaluate the main factors associated with mortality in patients undergoing surgery for perforated peptic ulcer referred to an academic department of general surgery in a large southern Italian city. METHODS:One hundred and forty-nine consecutive patients (M:F ratio=110:39,mean age 52 yrs,range 16-95) with peptic ulcer disease were investigated for clinical history (including age,sex,previous history of peptic ulcer,associated diseases,delayed abdominal surgery,ulcer site,operation type,shock on admission,postoperative general complications, and intra-abdominal and/or wound infections),serum analyses and radiological findings. RESULTS:The overall mortality rate was 4.0%.Among all factors,an age above 65 years,one or more associated diseases,delayed abdominal surgery,shock on admission, postoperative abdominal complications and/or wound infections,were significantly associated (x^2) with increased mortality in patients undergoing surgery (0.0001<P<0.03). CONCLUSION:Factors such as concomitant diseases,shock on admission,delayed surgery,and postoperative abdominal and wound infections are significantly associated with fatal outcomes and need careful evaluation within the general workup of patients admitted for perforated peptic ulcer.

How reliable is online diffusion of medical information targeting patients and families?

AIM: To determine whether online diffusion of the "Ten Warning Signs of Primary Immunodeficiency Diseases(PID)'' adheres to accepted scientific standards.METHODS: We analyzed how reproducible is online diffusion of a unique instrument, the "Ten Warning Signs of PID", created by the Jeffrey Modell Foundation(JMF),by Google-assisted searches among highly visited sites from professional, academic and scientific organizations;governmental agencies; and patient support/advocacy organizations. We examined the diffusion, consistency of use and adequate referencing of this instrument.Where applicable, variant versions of the instrument were examined for changes in factual content that would have practical impact on physicians or on patients and their families.RESULTS: Among the first 100 sites identified by Google search, 85 faithfully reproduced the JMF model, and correctly referenced to its source. By contrast, the other15 also referenced the JMF source but presented one or more changes in content relative to their purported model and therefore represent uncontrolled variants, of unknown origin. Discrepancies identified in the latter included changes in factual content of the original JMF list(C), as well as removal(R) and introduction(I) of novel signs(Table 2), all made without reference to any scientific publications that might account for the drastic changes in factual content. Factual changes include changes inthe number of infectious episodes considered necessary to raise suspicion of PID, as well as the inclusion of various medical conditions not mentioned in the original.Together, these changes will affect the way physicians use the instrument to consult or to inform patients,and the way patients and families think about the need for specialist consultation in view of a possible PID diagnosis.CONCLUSION: The retrieved adaptations and variants,which significantly depart from the original instrument,raise concerns about standards for scientific information provided online to physicians, patients and families.

药学咨询门诊中高血压患者的用药依从性及影响因素分析

目的评估我院药学咨询门诊中高血压患者的用药依从性,并分析其影响因素。方法收集2021年6月至2023年6月就诊于我院药学咨询门诊的389例高血压患者资料,采用单因素、多因素Logistic回归分析影响高血压患者用药依从性及服用不同类别抗高血压药物依从性的相关因素。结果389例高血压患者中,有302例(77.63%)患者的用药依从性高。多因素Logistic回归分析结果显示,受教育程度[校正后的OR=2.25,95%CI(1.29,3.93),P=0.004]与用药依从性呈正相关,平均血压水平高[校正后的OR=0.19,95%CI(0.10,0.37),P<0.001]、无合并症[校正后的OR=0.47,95%CI(0.26,0.84),P=0.010]和抗高血压药物治疗方案为自由剂量联合[校正后的OR=0.27,95%CI(0.15,0.47),P<0.001]与用药依从性呈负相关;单因素Logistic分析结果显示,服用β-受体阻断药[OR=1.65,95%CI(1.06,2.57),P=0.027]、钙通道阻断药[OR=2.13,95%CI(1.33,3.42),P=0.002]和作用于肾素-血管紧张素系统药物[OR=2.04,95%CI(1.29,3.22),P=0.002]患者的依从性更高。结论我院药学咨询门诊中高血压患者的用药依从性仍需进一步提高;受教育程度越高、平均血压水平越低、有合并症和使用固定剂量组合方案的高血压患者以及应用作用于肾素-血管紧张素系统药物、钙通道阻断药和β-受体阻断药类抗高血压药物患者的依从性可能更高。

Using the Delphi method to propose foods for special medical purposes health effect evaluation indicators

Objective:The Delphi method was used to propose health effect evaluation indicators to assess foods for special medical purposes(FSMPs).This lays the foundation for the formation of a big data model for human health testing,as well as a big data platform for the health and safety evaluation of special medical foods.Methods:The Delphi method was used to conduct two rounds of expert consultation on the constructed FSMP health effect evaluation indicators.Results:Ten major items were identified after two rounds of expert consultation.Among these,there were 10 primary entries,32 secondary entries,50 tertiary entries,and 28 quaternary entries.Conclusion:The complete list of evaluation indicators contains 10 entries,which can comprehensively and systematically monitor adverse reactions to the use of FSMPs.The present findings lay the foundation for a big data platform to evaluate the health and safety of special foods.

药学门诊对儿童疱疹性咽峡炎用药干预分析

目的总结药学门诊参与儿童疱疹性咽峡炎用药管理的经验。方法选取2020年1月—2022年12月共832例就诊于我院药学门诊及儿科门诊的疱疹性咽峡炎病例,就诊于药学门诊的病例为干预组,就诊于儿科门诊的病例为对照组,干预组按照循证医学原则进行用药建议与指导,对照组不进行干预,所有患儿随访病情直至痊愈。结果832例患儿全部康复,无重症住院病例。干预组与对照组在发热、疼痛、疱疹愈合等时长及血液检查结果均差异无统计学意义(均P>0.05),干预组与对照组在药物使用方面差异有统计学意义(P<0.001),干预组不良反应数量(5例)及治疗费用[(44.30±5.23)元]均显著低于对照组[23例,(178.20±71.40)元](P<0.001)。结论疱疹性咽峡炎属于自限性病毒感染,应按照循证的原则予以对症支持,过度用药并未给儿童带来显著获益,反而增加不良反应风险,增加治疗费用。

我国医疗机构药学会诊工作模式分析:一项范围综述

目的系统总结我国药学会诊的工作模式,为药学会诊的流程标准化、内容规范化与服务同质化提供参考。方法系统检索中英文文献数据库,纳入我国医疗机构发表的药学会诊工作模式文献,由2名研究者筛选与提取关键信息,最终进行定性总结与描述性分析。结果基于纳入的11篇文献,我国临床药师探索的药学会诊工作模式中,会诊内容主要涉及抗感染、肠外营养、癌性疼痛等。药学会诊的总体思路应参考已构建的流程图,具体的会诊问题可参考路径、思维导图或决策树等框架性指导开展工作,最后可根据会诊系统或专科会诊模板撰写会诊意见,采用新型的工作模式(如药师主动会诊)也可促进药学会诊数量和接受率的提升。结论我国医疗机构已初步探索出一系列药学会诊的工作模式,但尚未完善,缺乏统一的质控与评价体系,未来的研究与实践应重点予以关注。

医院运营与改扩建并存下的停车动态管理保障思路与方法

在医院高质量发展的背景下,政府不断增加优质医疗资源建设规模,扩大优质医疗资源供给,为市民提供高水平的医疗卫生服务。在优质医疗资源建设的过渡期间,医院运营与改扩建并存,停车资源匮乏与交通压力持续影响着就诊患者的就医体验。本文通过介绍医院在改扩建工程建设过渡期间的停车动态管理保障思路与方法,为各地医院改善就诊患者“停车难”问题提供参考。

感知价值视角下移动医疗问诊系统设计评价与优化

文章从感知价值视角对移动医疗问诊系统设计进行评价,研究设计要素优先级,探讨优化设计方法。首先,采用层次分析法构建基于感知价值5个维度的移动医疗问诊系统设计评价体系,计算出评价指标的权重和评价公式。其次,依据设计要素的重要性,优化移动医疗问诊系统。最后,通过李克特量表获取30份优化前后两个设计方案的评价数据,对比评价结果。评价数据表明:基于感知价值的设计评价方法具有可行性和有效性,为移动医疗问诊系统指明了设计重点,明确了设计目标。移动问诊系统设计评价体系的建立避免了设计过程的主观性,未来该系统的设计开发可从功能价值、情感价值、效率价值、知识共享价值、信任价值5个维度的设计要素入手,全方位提高用户的感知价值。

医院口腔专科远程医疗平台建设与应用

目的为了充分发挥大型三甲口腔专科医院的学科优势,推动口腔医疗、教学等优质资源下沉,探索适宜口腔专科的远程医疗模式。方法结合口腔专科特点,应用5G网络,构建口腔专科远程医疗协同平台(包含椅旁移动会诊车、口腔内窥镜、术野相机等设备),探索椅旁式口腔专科远程医疗的实施模式。结果初步建立了“5G+牙椅旁式”口腔专科远程医疗平台,建立了“5G+牙椅旁式”口腔专科远程医疗模式,满足了各级口腔专科联盟和帮扶单位对口腔专科远程医疗的需求。结论根据口腔专科特色,充分利用5G网络,探索出一种适合口腔专业学科的远程医疗模式,突破了地域限制,有助于提高各地口腔患者的就医便利性和幸福感。

基于互联网医院医联体慢性伤口云端管理模式的应用研究

目的探讨基于互联网医院医联体慢性伤口云端管理模式在医联体慢性伤口患者管理中的构建和应用效果。方法采用不同病例前-后对照研究,将2020年4月至2021年4月医联体就诊慢性伤口患者90例设为对照组,将2021年5月至2022年5月医联体就诊慢性伤口患者96例设为观察组。对照组给予常规伤口护理管理,观察组采用构建的互联网医院医联体慢性伤口云端管理模式,对10家医联体医院的患者进行全程同质管理。比较两组患者的伤口愈合率、患者满意度,转诊率和伤口愈合时间。结果观察组患者伤口愈合率、患者满意度均高于对照组,转诊率较对照组低,伤口愈合时间较对照组短,两组比较,差异具有统计学意义(均P<0.05)。结论基于互联网医院医联体慢性伤口云端管理模式的实施能缩短医联体慢性伤口患者伤口愈合时间,提高伤口愈合率、患者满意度,提高医联体医院慢性伤口护理质量,为实现医联体医院慢性伤口同质化护理目标打好基础。

地方医学院校青年教师教学学术能力评价指标体系建构研究

构建地方医学院校青年教师教学学术能力评价指标体系。采用专家咨询法,于2022年9至12月通过邮件向29位专家发放两轮专家咨询表,综合专家积极程度、权威程度和协调程度等进行评价。两轮咨询的专家积极程度分别为93.1%、100.0%,专家权威程度分别为0.859、0.864,评价指标重要性和可行性的专家协调系数分别为0.35和0.39(P值均小于0.001)。构建的指标体系包括4项一级指标、10项二级指标26项三级指标。专家的积极程度和权威程度较高,专家意见协调程度较好,构建的地方医学院校青年教师教学学术能力指标体系可信。

北京中医医院用药咨询服务五年回顾性分析与展望

目的回顾性分析首都医科大学附属北京中医医院五年用药咨询服务情况,发现用药问题规律,分享服务经验,提高服务质量。方法回顾北京中医医院用药咨询中心2015年—2019年的所有用药咨询记录,对咨询问题分类并采用帕累托图法进行统计和分析。结果北京中医医院五年用药咨询服务人数呈上升趋势,共计解答咨询问题61759例次,日均服务50例次。将咨询问题类型分为5类,分别为复杂用药问题(4283例,占6.93%)、简单用药指导(4892例,占7.92%)、非用药问题(6422例,占10.40%)、药品库存咨询(16291例,占26.38%)、中药煎服指导(29871例,占48.37%)。结论通过对门诊用药咨询记录的分类统计,可以看出咨询问题类型及比例相对稳定,帕累托分析有助于发现患者的主要需求,并促进药学部门不断进行改进,保障患者合理用药。

某院肿瘤中心用药咨询的帕累托图及波士顿矩阵分析

目的提升临床合理用药水平。方法收集医院肿瘤中心抗肿瘤方向临床药师2023年1月至6月有效记录的用药咨询内容共86例,利用帕累托图及波士顿矩阵分析法分别对咨询对象、用药咨询方式、用药咨询内容、咨询药品种类、临床药师回答质量进行统计与分析。结果临床医师的咨询占比最高(47.67%),主要通过医师站咨询(44.19%)。咨询内容主要为药品用法用量(21.43%)、药品不良反应(19.39%)、药品厂家选择(12.24%)、联合用药(10.20%)、药代动力学(8.16%)、用药疗程(6.12%),累计构成比为77.55%,为A类主要因素。用药咨询涉及药品种类占比与回复质量得分存在差异,据此制订不同管理策略,以提升临床药师的业务能力,为临床药师提供发展方向。结论通过定期分析用药咨询工作,收集临床科室、患者等对用药咨询工作的建议和意见,制订并实施相应的持续改进方案,提升用药咨询服务质量。

医学工作者对医学统计学的认知态度和咨询服务需求现状调查

目的了解医学工作者对医学统计学的认知态度和咨询服务需求现状,为提高医学统计学咨询服务质量提供依据。方法于2021年12月使用自制问卷对不同专业的502名医学工作者进行在线调查。结果认知态度方面,93.63%的人认为医学统计学很重要,92.63%的认为学习难度大,仅4.98%的“总是能独立处理”统计相关问题。咨询服务需求方面,90.64%的人愿意接受医学统计学咨询服务,咨询需求最大的内容是研究设计,57.44%的咨询者需要经历至少3次沟通过程。结论医学工作者充分认识到医学统计学的重要性,但应用能力普遍较低,咨询服务需求大,现有咨询服务质量有待提高。

基于文本挖掘的患者反馈对医生服务行为的影响研究

[目的/意义]随着互联网医疗平台的发展,医患关系逐渐向“以患者为中心”转变,研究患者反馈如何影响医生的服务行为,有助于医患双方更好参与在线医疗服务。[方法/过程]根据好大夫平台的在线评论数据,利用基于情感词典的方面级情感分析方法获得多维度评论文本特征,建立评论信息量、评论文本特征与医生服务行为的研究模型并进行回归分析。[结果/结论]评论数量比评论丰富多样性更能促进医生服务行为;专业评价强度比软实力评价强度更能促进亲社会服务行为,而软实力评价强度比专业评价强度更能促进付费咨询服务行为。研究结论对改善医患关系和医疗平台发展具有参考意义。

糖尿病足病人就诊延迟率Meta分析

目的:系统评价糖尿病足病人就诊延迟情况。方法:计算机检索PubMed、EMbase、the Cochrane Library、Web of Science、中国知网、万方数据库、中国生物医学文献数据库和维普数据库建库至2022年7月3日有关糖尿病足病人就诊延迟的研究。由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata 15.0软件进行Meta分析。结果:共纳入12项横断面研究,涉及22920例糖尿病足病人。Meta分析结果显示,糖尿病足病人就诊延迟率为64%,95%CI(52%,75%)。结论:现有证据显示,糖尿病足病人就诊延迟率较高,受纳入研究的数量和质量的限制,研究结论尚需要更多高质量研究予以验证。