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.

Bi-level model for shared parking decision-making based on parking lot assignment simulation

In order to carry out comprehensive decision-making of multi-class shared parking measures within a region, a bilevel model assisting decision-making is proposed. The upper level selects parkers＇ average satisfaction and the violation rate during peak hours as indices in object function, and sets probability distribution models describing dynamic parking demand of each site, the feasibility of shared parking scenarios and occupancy requirements during peak hours of each parking lot as restrictions. The simulation model in the lower level sets up rules to assign each parker in the random parking demand series to the proper parking lot. An iterative method is proposed to confirm the state of each parking lot at the start of formal simulations. Besides, two patterns linking initialization and formal simulation are presented to acquire multiple solutions. The results of the numerical examples indicate the effectiveness of the model and solution methods.

The Impact of Simulation Education on Self-Efficacy in Pre-Registration Nursing Students

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. .

Decision-Making in Driver-Automation Shared Control:A Review and Perspectives

Shared control schemes allow a human driver to work with an automated driving agent in driver-vehicle systems while retaining the driver’s abilities to control.The human driver,as an essential agent in the driver-vehicle shared control systems,should be precisely modeled regarding their cognitive processes,control strategies,and decision-making processes.The interactive strategy design between drivers and automated driving agents brings an excellent challenge for human-centric driver assistance systems due to the inherent characteristics of humans.Many open-ended questions arise,such as what proper role of human drivers should act in a shared control scheme?How to make an intelligent decision capable of balancing the benefits of agents in shared control systems?Due to the advent of these attentions and questions,it is desirable to present a survey on the decision making between human drivers and highly automated vehicles,to understand their architectures,human driver modeling,and interaction strategies under the driver-vehicle shared schemes.Finally,we give a further discussion on the key future challenges and opportunities.They are likely to shape new potential research directions.

The concept of narrative evidence-based medicine and shared decision-making in traditional Chinese medical practice

For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.

Older Patients’ Involvement in Shared Decision-Making—A Systematic Review

Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

Theories behind a nursing intern’s error in terms of clinical decision-making

Clinical decision-making and judgment is an essential skill that should be acquired by nursing interns.However,many studies reveal that a large proportion of nursing interns have difficulty in meeting the basic expectation of clinical decision-making.This article begins with a brief review of some theories related to clinical decision-making.Then it takes a case,for example,to show how the wrong decision is made.Furthermore,it makes a general analysis on the case drawing on the concept of bounded rationality,dual-process model,and skills acquisition theory.This article ends with some reflections from the case,to improve the consciousness and skills in decision-making for nursing interns.

Emancipatory reflection on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients

Objective: This study aimed to demonstrate and promote the skill of critical emancipatory reflection through reflecting on a nursing practice-based ethical issue about nurses' paternalistic decision-making for patients. Meanwhile, critical awareness will be developed and the underlying issues of paternalism in nursing decision-making will be analyzed. Then, by applying the procedure, improvement in nursing decision-making practice will be expected.Methods: Taylor's model of emancipatory reflection with four steps, including construction, deconstruction, confrontation, and reconstruction, is utilized to guide the author's reflection.Results: Guided by the socialization theory, the author's personal and professional socialization is seen to be associated with the formation of the value of paternalism. The theory of reflexivity is applied to unearth the related issues, including deeper personal value,work environment, as well as historical and cultural contexts. Moreover, the power derived from policy, work relationship, and nursing administration, which could induce paternalism in the author's nursing decision-making practice, was critically debated using the hegemony theory. Finally, new insights into paternalism will be achieved, which enable change in terms of how to facilitate patients' autonomous decision-making.Conclusions: The process of refection makes it clear that respecting patients' right and performing patient-centered caring are the bases to change the paternalism existing in the nursing decision-making practice currently. The reconstruction step assists the author in terms of how to value the patients' autonomy and balance patients' safety and choice, rather than being overprotective; carry out risk assessment, and search for strong evidence to counterbalance the positive and negative aspects of risk-taking; communicate with patients appropriately in a manner that they can comprehend; spend more time to explore patients' preference and choice; make every effort to elevate the patients' decision-making capacity; implement patient-centered care and shared decision-making in nursing practice; consult with other colleagues and obtain the required support when limitations or challenges exist; try to justify and avoid hidden paternalism behind policy or guidelines; deal with the power in hand well and fairly; and also positively face the powers that constrain the author.

Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado,United States:Real-world data

BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.

非暴力沟通联合think-pair-share模式培训在普外科护士在职培训中的应用研究

目的:探讨非暴力沟通联合think-pair-share(TPS)模式培训在普外科护士在职培训中的应用效果。方法:2020年10月至2021年10月选取本院普外科的4个护理单元,通过随机抽签法分为试验组和对照组,试验组参加非暴力沟通联合TPS模式培训,对照组参与常规非暴力沟通培训。对比两组护士临床沟通能力、患者满意度以及教学满意度的差异。结果:试验组护士临床沟通能力、患者满意度、教学满意度调查结果均优于对照组(P<0.001)。结论:非暴力沟通联合TPS模式培训在普外科护士在职培训中能提高普外科护士的护患沟通能力,提升其岗位胜任力。

Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

SHARE交接班模型在术后患者转运中的应用及临床获益分析

目的建立术后患者SHARE转运交接班模型,并评价其临床应用效果。方法选取2022年10月—2023年3月于我院住院的手术患者200例。随机分为观察组和对照组,每组100例。观察组采用SHARE转运交接班模型,对照组采用传统术后转运交接模型。比较两组患者采取不同的转运交接模型的不良事件发生率、转运时间、转运规范性和满意率。符合正态分布的计量资料以xˉ±s表示,组间比较采用t检验;计数资料以例数(%)表示,采用χ^(2)检验或Fisher确切概率法。结果观察组患者的引流管打折固定不规范、导尿管受压、留置针拔脱的发生率较对照组均明显下降,差异均有统计学意义(χ^(2)分别为4.613、6.157、5.158,P均<0.05)。观察组患者的手术室至复苏室所用时间为(3.48±0.38)min,从复苏室至病房所用时间为(5.94±0.24)min,均显著小于对照组的(3.85±0.39)min、(7.46±0.39)min,差异均有统计学意义(t值分别为-3.29、-16.77,P均<0.05)。观察组转运患者的规范性明显提高(χ^(2)=10.317,P<0.01)。观察组患者、医师及护士对于医疗过程的满意率均明显高于对照组,差异均有统计学意义(χ^(2)分别为12.374、4.500、7.791,P均<0.05)。结论SHARE转运交接班模型有利于降低术后患者不良事件发生率、节约转运时间、提高转运规范性及满意率。

Conditions for autonomous choice： a qualitative study of older adults＇ experience of decision-making in TAVR

Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.

Multidisciplinary Approach to Breast Cancer:A New Outlook on Nursing Care

The treatment and general care for womendiagnosed with breast cancer has made a tremendous change andadvance in the last decades. Better methods for early detectionand screening of the disease, higher compliance of women to gofor screening, an open social and political discourse of women andthe health care team and others, are just a few that both enabledand are a result of this change. Nurses have been highly involvedin these changes, which resulted in the specialization of nursingin the field of breast cancer. This article will focus on the mainfour points that influence the nursing specialist care, that is, thetailoring of treatment and the ability to offer women treatmentwhich is more specific to their own cancer; the importance of themultidisciplinary team as providing a State of the Art care; theinvolvement of women in the decision-making regarding theirtreatment and the specific developing role of the specialist breastcare nurse.

晚期癌症患者基于共享决策理论的预立医疗照护计划干预

目的探讨基于共享决策理论的预立医疗照护计划干预对晚期癌症患者的实施效果。方法将107例晚期癌症患者按入院时间分为两组,2023年5-7月收治的54例患者为对照组,2023年8-10月收治的53例患者为干预组。对照组实施常规护理干预,干预组在对照组基础上实施基于共享决策理论的预立医疗照护计划干预。干预4周后,比较两组预立医疗照护计划接受度、决策参与满意度及尊严得分。结果干预后干预组预立医疗照护计划接受度总分及各维度得分、决策参与满意度总分显著高于对照组,而尊严总分显著低于对照组(均P<0.05)。结论对晚期癌症患者实施基于共享决策理论的预立医疗照护计划干预,能提高其预立医疗照护计划接受度,改善决策参与满意度,维护临终患者尊严。

护理专业虚拟仿真实验教学资源共享平台建设探讨

分析高校护理专业虚拟仿真实验平台建设现状,探讨虚拟仿真实验平台、资源及共享机制建设等,提出优化虚拟仿真实验平台及共享机制的策略,确保高校护理专业虚拟仿真实验平台长效、可持续发展。

ICU护士知识共享、人际沟通、组织信任与授权型领导力的相关性

目的探讨重症监护室(ICU)护士知识共享、人际沟通、组织信任与授权型领导力的相关性。方法选取山东省和吉林省共8所三级甲等医院2022年7月至10月206名ICU护士作为研究对象,采用一般资料问卷、护士知识共享,授权型领导力、沟通能力及组织信任量表分析。结果护士知识共享(3.87±0.59)分;授权型领导力(3.71±0.52)分;沟通能力(3.71±0.55)分;组织信任(3.69±0.62)分。护士授权型领导力、沟通能力、组织信任与知识共享相关(P<0.05),授权型领导力对护士知识共享行为的直接效应为0.548,间接效应为0.098,总效应为0.647;沟通能力对护士知识共享行为的直接效应为0.161,间接效应为0.084,总效应为0.245。结论为了提高护士的知识共享行为,不仅要提高护理管理者的赋权水平、护士的沟通能力,而且在护理组织的人力资源管理方案中,有必要探索提高护士对组织信任的方案。

基于AHP和ANSYS的养老院共享轮椅设计与研究

文章旨在研究养老院的轮椅设施使用现状,并提出养老院共享轮椅的方案,鼓励老人们走出房间,与其他老人交流和建立社交关系,提高养老生活质量。运用层次分析法得到具体需求权重,进行养老院共享轮椅设计,通过ANSYS有限元分析验证该轮椅的结构安全性。完成养老院共享轮椅的模型及系统设计。集成AHP层次分析法和ANSYS分析的轮椅创新设计流程,分析求解得到该轮椅主要承重结构可靠,确保老人使用安全,实现养老院内健康安心养老。

护理人员共享决策能力现状及影响因素研究

目的了解护理人员共享决策能力的现状并探讨影响因素,为共享决策能力教育与培训提供依据。方法采用一般资料调查表、护理人员共享决策能力量表、杰弗逊共情量表和组织支持感量表对7所综合医院的2363名护理人员进行调查。结果护理人员共享决策能力得分(3.79±0.72)分,共情能力(5.64±0.70)分,组织支持(3.73±0.79)分。多元线性回归分析显示,工作年限、是否接受过共享决策教育培训、共情能力、组织支持是护理人员共享决策能力的影响因素(均P<0.05)。结论护理人员共享决策能力处于中等水平。护理管理者应根据相关影响因素,制定培训计划,以提高护理人员共享决策能力。

手术病人决策辅助的研究进展

介绍病人决策辅助的定义、使用情景、意义、内涵、形式以及开发的理论基础、质量评价、应用现状、目前存在的问题,以期为我国开展相关研究提供参考。