Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

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.

Simulated patient methodology as a“gold standard”in community pharmacy practice:Response to criticism

The simulated patient methodology(SPM)is considered the“gold standard”as covert participatory observation.SPM is attracting increasing interest for the investigation of community pharmacy practice;however,there is criticism that SPM can only show a small picture of everyday pharmacy practice and therefore has limited external validity.On the one hand,a certain design and application of the SPM goes hand in hand with an increase in external validity.Even if,on the other hand,this occurs at the expense of internal validity due to the trade-off situation,the justified criticism of the SPM for investigating community pharmacy practice can be countered.

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.

患者参与式决策结合早期心脏康复护理对急诊PCI术后患者风险感知及心脏康复的影响

目的 探究患者参与式决策结合早期心脏康复护理对急诊经皮冠状动脉介入治疗(PCI)术后患者风险感知及心脏康复的影响。方法 选择2022年2月至2023年2月我院收治的176例急性心肌梗死行急诊PCI术患者为研究对象,以随机数字表法将其分为对照组和观察组,每组88例。对照组急诊PCI术后接受常规护理,观察组在对照组基础上加施患者参与式决策结合早期心脏康复护理。比较两组的干预效果。结果干预后,观察组的社会心理风险、身体诊疗风险、经济风险评分低于对照组(P<0.05)。干预后,观察组的心输出量(CO)低于对照组,左心室射血分数(LVEF)高于对照组(P<0.05)。干预后,观察组的决策冲突量表(DCS)评分低于对照组,纽卡斯尔护理服务满意度量表(NSNS)评分高于对照组(P<0.05)。结论 患者参与式决策结合早期心脏康复护理用于急诊PCI术后护理中可降低患者风险感知及决策冲突,有助于提升护理满意度及心脏康复效果,值得推广。

Digital Disparities:How Artificial Intelligence Can Facilitate Anti-Black Racism in the U.S.Healthcare Sector

This paper delves into the intricate interplay between artificial intelligence(AI)systems and the perpetuation of Anti-Black racism within the United States medical industry.Despite the promising potential of AI to enhance healthcare outcomes and reduce disparities,there is a growing concern that these technologies may inadvertently/advertently exacerbate existing racial inequalities.Focusing specifically on the experiences of Black patients,this research investigates how the following AI components:medical algorithms,machine learning,and natural learning processes are contributing to the unequal distribution of medical resources,diagnosis,and health care treatment of those classified as Black.Furthermore,this review employs a multidisciplinary approach,combining insights from computer science,medical ethics,and social justice theory to analyze the mechanisms through which AI systems may encode and reinforce racial biases.By dissecting the three primary components of AI,this paper aims to present a clear understanding of how these technologies work,how they intersect,and how they may inherently perpetuate harmful stereotypes resulting in negligent outcomes for Black patients.Furthermore,this paper explores the ethical implications of deploying AI in healthcare settings and calls for increased transparency,accountability,and diversity in the development and implementation of these technologies.Finally,it is important that I prefer the following paper with a clear and concise definition of what I refer to as Anti-Black racism throughout the text.Therefore,I assert the following:Anti-Black racism refers to prejudice,discrimination,or antagonism directed against individuals or communities of African descent based on their race.It involves the belief in the inherent superiority of one race over another and the systemic and institutional practices that perpetuate inequality and disadvantage for Black people.Furthermore,I proclaim that this form of racism can be manifested in various ways,such as unequal access to opportunities,resources,education,employment,and fair treatment within social,economic,and political systems.It is also pertinent to acknowledge that Anti-Black racism is deeply rooted in historical and societal structures throughout the U.S.borders and beyond,leading to systemic disadvantages and disparities that impact the well-being and life chances of Black individuals and communities.Addressing Anti-Black racism involves recognizing and challenging both individual attitudes and systemic structures that contribute to discrimination and inequality.Efforts to combat Anti-Black racism include promoting awareness,education,advocacy for policy changes,and fostering a culture of inclusivity and equality.

患者参与式护理干预应用于骨科机器人辅助髋臼骨折微创手术患者的临床效果

目的:分析患者参与式护理干预应用于骨科机器人辅助髋臼骨折微创手术患者中的临床效果。方法:选取北京积水潭医院于2020年1月—2023年6月收治的120例骨科机器人辅助髋臼骨折微创手术患者,按1∶1比例原则随机分为两组,对照组采用常规护理,观察组在此基础上采用患者参与式护理干预。对比两组术后康复效果、患者依从性等。结果:观察组出院后1个月、3个月的Harris髋关节量表评分高于对照组,术后4周、8周时的数字分级法疼痛评分低于对照组,术后并发症发生率低于对照组。护理后,观察组与身体、心理及主动学习有关的锻炼依从性高于对照组,正性情绪高于对照组,负性情绪低于对照组。结论:患者参与式护理干预应用于骨科机器人辅助髋臼骨折微创手术中,能够提高患者髋关节功能康复效果,增加患者康复锻炼依从性,减轻患者术后疼痛和负性情绪,减少术后并发症的发生。

基于赋能理念的家长参与式干预策略在急性喘息性支气管炎患儿护理中的应用

目的探讨基于赋能理念的家长参与式干预策略在急性喘息性支气管炎患儿护理中的应用效果,以期为急性喘息性支气管炎患儿护理方案的选择提供参考。方法选取阜阳市妇女儿童医院2020年5月—2022年2月收治的140例急性喘息性支气管炎患儿为研究对象,采用随机数字表法分为对照组和观察组,每组70例。对照组患儿接受常规护理干预,观察组患儿在对照组基础上接受基于赋能理念的家长参与式护理干预。比较2组患儿的临床症状持续时间,干预前后心理行为发育状况、睡眠质量、生活质量,同时比较2组患儿的治疗依从性及家长护理满意度。结果观察组患儿喘息、咳嗽、发热、呼吸困难4项临床症状持续时间均短于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿盖瑟尔发育量表(GESELL)的动作能、应物能、言语能、应人能4个维度评分比较,差异均无统计学意义(P>0.05);干预后,2组患儿GESELL量表各维度评分均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿儿童睡眠习惯问卷(CSHQ)的就寝习惯、睡眠焦虑、睡眠持续时间、夜醒4个维度评分比较,差异均无统计学意义(P>0.05);干预后,2组患儿CSHQ问卷各维度评分均低于干预前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。干预前,2组患儿中文版儿童生活质量量表(PedsQL)的生理功能、躯体症状、情感功能、社交功能、认知功能5个维度评分比较,差异均无统计学意义(P>0.05);干预后,2组患儿PedsQL量表各维度评分均高于干预前,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组患儿的治疗依从率为92.86%(65/70),高于对照组的81.43%(57/70),差异有统计学意义(χ^(2)=4.080,P=0.043)。观察组患儿家长护理满意度为97.15%(68/70),高于对照组的87.14%(61/70),差异有统计学意义(χ^(2)=4.834,P=0.028)。结论基于赋能理念的家长参与式干预策略用于急性喘息性支气管炎患儿护理中,有助于有效缩短患儿临床症状持续时间,改善患儿心理行为发育状况、睡眠质量及生活质量,提高患儿治疗依从性及家长护理满意度,值得在临床推广。

BOPPPS教学模式在老年患者合理用药教学中的应用

目的探讨BOPPPS教学模式在老年人合理用药教学中的应用。方法将BOPPPS教学模式应用于老年人合理用药的教学中,观察评价学员学习效果并进行总结分析。结果BOPPPS教学模式强调教学过程中的学员参与性和反馈性,有助于激发自主学习的兴趣,笔者将BOPPPS教学模式引入老年人合理用药的教学,丰富了实践途径,收到了良好效果。结论BOPPPS教学模式有助于提高学员创新实践能力和自主学习能力,并且提高老年人合理用药教学的质量和效果。

Integrating value-chain approach with participatory multicriteria analysis for sustainable planning of a niche crop in Indian Himalayas

The value-chain approach(VCA)was used for exploring how a niche crop,namely large cardamom(Amomum subulatum Roxb.),can be developed sustainably to increase incomes and enhance rural livelihoods in the mountains.Large cardamom is a high-value,agro-climatically suitable,and non-perishable spice crop grown in the Himalayan region.Originating in Sikkim,the crop is important to the local economy and is sold in both domestic and international markets;however,its production in India has been declining significantly in recent years.Using VCA and participatory methods of data collection the study helped elicit value chain actors’perspectives on various reasons for the decline as well as potential strategies to improve the cardamom value chain.The results present the multiple environmental and climatic(e.g.water stress),social(e.g.women participation)and institutional(e.g.lack of trust between actors)challenges and corresponding upgrading strategies.Through participatory multi-criteria analysis(MCA),the strategies were prioritized based on the overall preferences of multiple stakeholders.The analysis considered eight criteria and 25 options,or strategies,and found that that marketability and profitability were the most important criteria,and increasing cardamom production,the most important optiontrait.Stakeholder discussions along with sensitivity analysis also showed how these options could be implemented and revealed how criteria preferences can change with expert inputs.This combination of VCA and MCA,because it supports participatory decision-making and balances multiple dimensions of sustainable development,can be effectively deployed in planning for agricultural development in the mountains.

同期放化疗食管癌患者参与式全程营养管理的效果评价

目的探讨患者参与式全程营养管理对同期放化疗食管癌患者营养状态和毒副作用的影响。方法选择2021年2—7月在泰安市肿瘤防治院拟行同期放化疗的食管癌患者50例作为对照组,予以常规肿瘤患者营养指导;按照组间基本资料具有可比性的原则选择2021年8月—2022年2月在泰安市肿瘤防治院行同期放化疗的食管癌患者50例作为观察组,予以患者参与式全程营养管理;两组均持续干预8周,对比两组患者行护理管理前后的营养状态[营养风险筛查表(2002)(NRS-2002)、患者主观全面评估(Scored Patient-Generated Subjective Global Assessment,PG-SGA)及相关血清蛋白指标]、癌性疲乏度[癌症疲乏量表(CFS)]、饮食依从性及放化疗毒副作用发生率。结果患者参与式全程营养管理后,两组营养不良风险发生率比较差异无统计学意义(P>0.05);观察组PG-SGA评分低于对照组,血清蛋白各项指标水平均高于对照组(P<0.05);观察组CFS评分低于对照组,能量及蛋白质摄入依从性评分均高于对照组(P<0.05)。两组患者的毒副作用发生率比较差异无统计学意义(P>0.05)。结论患者参与式全程式营养管理模式可有效改善患者的营养状况和癌性疲乏,提高患者的饮食依从性。

病人参与式护理在骨折病人压力性损伤护理中的应用

目的:探讨病人参与式护理下重组人表皮生长因子(recombinant human epidermal growth factor,rhEGF)结合银离子敷料治疗在降低骨折病人压力性损伤发生风险中的应用效果。方法:选取2021年1月—12月在我院治疗的198例骨折病人为研究对象,采取随机数字表法将其分为对照组和观察组,各99例。两组均给予rhEGF结合银离子敷料治疗,对照组给予常规护理,观察组在对照组的基础上给予病人参与式护理模式。比较两组压力性损伤发生率、临床疗效、炎症情况及病人护理参与行为。结果:干预2个月后,观察组压力性损伤发生率(5.05%)低于对照组(13.13%),压力性损伤临床疗效优于对照组;肿瘤坏死因子、血清超敏C反应蛋白、白细胞介素-6和白细胞介素-8炎症因子水平低于对照组;参与行为量表总分[(67.24±6.21)分]高于对照组[(54.23±4.82)分],差异均有统计学意义(P<0.05)。结论:病人参与式护理可提高骨折病人在压力性损伤护理中的参与度,降低病人压力性损伤发生风险,缓解炎症反应,促进创面愈合。

1例老年尿道畸形留置尿管患者的家庭参与式护理体会

本文总结1例老年尿道畸形留置尿管患者的家庭参与式护理体会。通过制定护理目标、护理计划、实施方案且对照护者进行有计划的培训和指导干预,有效提高了照护者的理论知识、操作技能及执行力,对预防留置尿管相关并发症起到积极作用。

Three Basic Modes for Patients' Clinical Decision-Making in China

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.

Clinical decision-making by the emergency department resident physicians for critically ill patients

The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by the Emergency Department of Peking Union Medical College Hospital were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents.The application of decision-making strategies by PG1 and PG3 groups,which means the residents in first year and the third year,were compared.The patients were treated according to pattern recognition(43.0%),hypotheticodeductive reasoning(23.4%),event-driven models(19.3%),and rule-using algorithms(5.9%).A significant difference was found between PG1 and PG3 groups(χ^(2)=498.01,P<0.001).Pattern recognition and hypotheticdeductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients.The decision-making processes applied by junior and senior residents were significantly different,although neither group adequately applied rule-using algorithms.Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.

参与式培训在ICU新入职护士培训中的应用效果

目的探讨参与式培训在ICU新入职护士培训中的应用效果。方法选取2017年6月我院ICU新入职护士62例作为研究对象,按照随机数字表法将其分为试验组和对照组,每组各31例,分别接受32学时的培训,对照组采用传统教学方法进行培训,试验组采用参与式教学进行培训,以具体病例为介入方式,理论结合实际。采用《湖北省统一护理质量控制标准》及《住院患者对护理服务满意度调查问卷》,比较两组新入职护士的医疗护理理论知识、护理质量控制及患者满意度情况。结果培训后,试验组的医疗护理理论知识平均成绩、护理质量控制平均成绩及患者满意度得分均高于对照组,差异有统计学意义(P<0.05)。结论参与式培训有助于提高新入职护士的医疗护理理论知识、护理质量及患者满意度,优化新入职护士培训工作。

参与式教学提高人文关怀能力和医患沟通水平的研究

目的观察参与式教学对医学生人文关怀能力和医患沟通水平的影响。方法采用随机、单盲的方法将48名医学生分为传统教学组和参与式教学组,每组24名。参与式教学组医学生进行癌痛规范化治疗、随访内容及方式的专业知识教学,同时采用参与式教学方法,医学生对肿瘤科的癌痛患者,根据随访表每周进行随访,随访方式为电话随访或面谈随访,在肿瘤专科医师的指导下对患者进行药物剂量或剂型随访的同时,着重进行人文关怀。传统教学组仅进行癌痛规范化治疗、随访内容及方式的专业知识教学培训。比较2组教学前后的笔试分数、面试分数及总分数。结果在教学后,2组比教学前的笔试分数、面试分数、总分均有提高,差异有统计学意义(P<0.05)。参与式教学组教学后面试分数和总分高于传统教学组,差异有统计学意义(P<0.001)。结论参与式教学方法相较于传统教学方法而言,能够更有效地提高医学生人文人文关怀能力和医患沟通水平,更有利于增加医学生职业认同感。

患者参与式护理干预对产妇产时认知和母婴结局的效果分析

目的:分析患者参与式护理对产妇产时认知和母婴结局的干预效果。方法:选取2015年8月-2017年8月本院产科收治的初产、足月产妇96例为研究对象,按照随机数字表法将其分为观察组和对照组,各48例。对照组采用产科常规护理,观察组在对照组基础上采用患者参与式产科护理干预,比较两组产时认知度、母婴结局及护理满意度。结果:观察组顺产率为93.75%,显著高于对照组的77.08%(P<0.05);观察组产妇总产程短于对照组(P<0.05);观察组总满意度为97.92%,高于对照组的83.33%(P<0.05);观察组产时生理认知、心理认知、精神状态、分娩知识储备均高于对照组(P<0.01);观察组纯母乳喂养率及母婴护理技巧掌握率均高于对照组(P<0.05)。结论:患者参与式护理具有提高产妇产时认知度和进一步改善母婴结局的优势作用,值得推广。

护患共同参与型护理模式对EGFRTKI获得性耐药晚期非小细胞肺癌患者的影响

目的:探讨护患共同参与型护理模式对EGFRTKI获得性耐药晚期非小细胞肺癌(NSCLC)患者的护理效果.方法:选取2018年12月-2019年8月本院收治的120例吉非替尼耐药晚期NSCLC患者为研究对象.将其随机分为干预组和对照组,每组60例.对照组实施常规护理,干预组实施护患共同参与型护理模式,比较两组患者肺癌相关症状、焦虑抑郁评分及患者满意度.结果:干预后,两组肺癌相关症状各项评分均下降,且干预组肺癌相关症状各项评分均低于对照组,差异均有统计学意义(P<0.05).干预后,两组焦虑及抑郁评分均低于干预前,且干预组焦虑及抑郁评分均低于对照组,差异均有统计学意义(P<0.05).干预组患者满意度评分明显高于对照组,差异有统计学意义(P<0.05).结论:护患共同参与型护理模式促进EGFRTKI获得性耐药晚期NSCLC患者参与自我护理,改善肺癌相关症状,缓解不良情绪,提高患者满意度.

Role of decision aids in orthopaedic surgery

Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.