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.

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.

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.

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.

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.

非正式互动对新生代矿工不安全行为的影响

为了明晰非正式互动对新生代矿工不安全行为的影响机理,引入知识共享和安全胜任力这两个中介变量,在文献研究的基础上,建立非正式互动、知识共享、安全胜任力、不安全行为四者关系的假设模型。采用非正式互动量表、知识共享量表、安全胜任力量表和不安全行为量表,使用问卷调查法收集数据,通过各变量的相关分析和中介效应检验验证假设模型;同时,通过人员访谈,深入了解矿工们对于非正式互动、知识共享和安全胜任力的看法。研究显示:非正式互动会对新生代矿工的不安全行为产生直接影响,并且可以通过知识共享的中介作用、安全胜任力的中介作用以及二者的链式中介作用3条路径间接影响矿工的不安全行为。人员访谈结果显示,与领导和同事的互动可激发安全责任感,知识共享能增强危险源识别能力,安全胜任力可以在非正式互动中培养。企业应重视新生代矿工与他人之间的非正式互动,提升知识共享水平和安全胜任力,减少不安全行为。

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。

Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.

虚拟数字代言人赋能企客共同体的实现——以屈臣氏虚拟数字代言人“屈晨曦”为例

虚拟数字代言人的出现进一步变革了企客之间的交互方式,文章旨在剖析虚拟数字代言人如何赋能企客共同体的实现。以案例分析的方法,本文选择屈臣氏虚拟数字代言人屈晨曦作为案例对象,系统解读了虚拟数字代言人赋能企客共同体的实现过程。研究发现,第一,虚拟数字代言人赋能企客共同体纵向经历参与式文化智能渗透、人机交互智能渗透、共享符号智能渗透三个阶段。第二,赋能过程横向在数字能力的作用下经历着“认知—情感—行为”的进阶。第三,虚拟数字代言人赋能企客共同体实现从情感共同体、利益共同体到生态共同体的逐渐深化。文章的研究进一步拓展了虚拟数字代言人阶段性发展的框架,延展了虚拟数字代言人赋能企客共同体实现的黑箱,能够进一步为企业发展虚拟数字代言人提供理论与实践指导。

数字能力鸿沟的法治化弥合

数字能力鸿沟是基于数字生活能力而产生的一种新型数字鸿沟,它会引发技术赋权的不均衡性、能力鸿沟的自我强化、权利能力与行为能力的张力以及对尊严和平等价值的消解等深层问题与困境,从而对数字法治建设构成严峻挑战。这就需要遵循普惠公平、共建共享的价值原则,通过提高全民数字素养、加强算法治理、构建保障机制以及塑造数智人文生态等法治化路径,解决数字能力鸿沟带来的问题,将数字能力鸿沟转变为“数字能力跳板”,让所有人都能分享数字社会发展红利,促进数字权利的有效实现和可靠保障。

智慧教育赋能多样化综合学习体系——2022世界慕课与在线教育大会分论坛三综述

智慧教育已成为全球教育变革发展的必然趋势,以智慧教育赋能多样化综合学习体系,是构建更加多元的高等教育体系的必由之路,也是教育现代化的深刻内涵。2022世界慕课与在线教育大会智慧教育分论坛以“智慧教育赋能多样化综合学习体系”为主题,围绕数字素养与胜任力变革、数字化教与学生态构建、共建共享数字教育平台等议题展开,特别是对智慧教育赋能全人化培养、东西部高校课程共享联盟的探索与实践、学习与技术在变化世界中的挑战、慕课个性化学习、智能时代教育的未来需求、技术辅助的全局沉浸式教育等话题进行深入研讨,提出要坚持需求牵引、协同融合,完善以全方位育人为导向的智慧教育体系,促进虚拟教育与现实教育相互融合,协同产业发展与人才培养;要坚持应用为本、服务至上,以智慧教育促进教育资源公平配置,探索个性化培养的新型教育模式,并推进精准扶智;要坚持示范引领、合作共赢,建设全球智慧教育发展共同体,探索中国式现代化数字治理方式,为世界提供智慧“中国方案”,并推动国际智慧交流合作。

西藏经济韧性的测度与分析

科学评估西藏经济韧性,对于推动西藏各个地市的经济韧性协调发展、缓解高质量发展的不平衡和不充分问题具有重要的现实意义。文章运用核心变量法科学测度了2008-2020年西藏各个地市的经济韧性,并使用shift-share分解法将西藏经济韧性分解为产业结构分量和产业竞争力分量,以此分析西藏各个地市间经济韧性差异的内在机制。研究结果显示:西藏整体的抵抗力较弱、恢复力较强,产业竞争力是其中的关键;西藏各个地市间的经济韧性存在较大差异,在抵抗期,稳健的产业结构是抵抗外部冲击的关键,在恢复期,产业竞争力是经济恢复的关键,第三产业的竞争力显著提升,但同时还需要有健康的产业结构配套。文章结合研究结果和西藏实情提出了相应的建议。

炎症性肠病专业护士知识共享行为与护理信息能力的相关性研究

目的调查炎症性肠病(IBD)专业护士护理信息能力与知识共享行为现状,并探讨IBD知识共享行为的影响因素,为提高护士的知识共享行为水平提供参考。方法采用便利抽样法,选取2022年1—3月上海市、江苏省和浙江省18家收治IBD患者病区中的380名护士为研究对象,采用一般资料调查表、护理信息能力和知识共享行为量表进行调查。结果IBD护士护理信息能力总分为(122.79±22.53)分,知识共享行为总分为(59.30±17.30)分,护理信息能力与知识共享行为呈正相关(r=0.654,P<0.01)。分层回归显示,控制一般人口学资料后,护理信息能力能够解释知识共享行为总变异的24.3%。结论IBD专业护士的护理信息能力处于中等偏上水平,知识共享行为可进一步提升。

数据共享视域下个人信息“合理使用”的场景化判定

信息的流动本质和社会属性要求法律对信息主体权益作以必要限制,故而《中华人民共和国个人信息保护法》将个人信息合理使用界定为“知情同意”原则之外的另一项信息处理正当性基础。不同于“免责事由说”和“权益限制说”的性质认定,数据共享理念下合理使用应被界定为个人信息的一项基本权能,其既可基于公共利益维护、主体权益保障而生,也不排除合理的商业利用行为。个人信息的合理使用应当满足合理目的、合理方式和信息主体未受不合理侵害三大要件。以商业化的合理使用为例,基于经济效益和制度演变的考量,商业主体对个人信息的处理具有正当性,但囿于信息的人格属性,该情境下的处理行为当受信息低敏性和商家严格的披露管理义务两要素之限,从而实践应当以具体行为性质为主、信息固有性质为辅,对信息处理行为的合理性作出阶梯式认定。

护理人员共享决策能力自评量表的构建及信效度检验

目的构建护理人员共享决策能力自评量表,并检验其信效度,为测评护理人员共享决策能力提供工具。方法通过半结构式访谈和德尔菲法,构建护理人员共享决策能力自评量表,通过调查1247名护理人员对量表进行信效度检验。结果最终形成的护理人员共享决策能力自评量表包括知识与经验,技能与能力和综合素质3个分量表共51个条目;总量表Cronbach′sα系数为0.984,内容效度指数为0.974。探索性因子分析知识与经验分量表提取2个公因子,技能与能力分量表提取4个公因子,综合素质分量表提取2个公因子,累积方差贡献率分别为78.272%、75.975%及87.208%。结论护理人员共享决策能力自评量表信效度良好,可作为护理人员共享决策能力的测评工具。

Developing Skills in Intra-Workplace Rehabilitation Education: I

Japan has an advanced healthcare system, on par with any developed country;at the same time, it is challenged by a rapidly aging population. In line with other countries, medical and paramedical training differs from college or university to when the graduates start working in the hospital wards;it seems like a new career to freshmen. Rehabilitation draws together the most varied professional teams treating patients from a range of specialists, and physical therapists generally receive very little intra-workplace skills training. The aim of this paper is to develop the first of a two-part educational model that is useful for the professional development of therapists working in rehabilitation medicine, by incorporating, at least, Shared Decision-Making and Narrative-Based Medicine. The most productive systems of analysis are Bloom’s psychomotor taxonomy and the Japanese DIKW system. The Japanese DIKW model of “chishin”, which is based on Data, Information, Knowledge, and Wisdom, is similar to the professional attitude and rehabilitative mindset in the healthcare system, the convalescent rehabilitation wards. The individual, departmental, and hospital levels could all benefit from aspects of these systems. Rehabilitative medicine in Japanese terms is presented as a holistic medical care that heals the body and mind and restores dignity, such as personality and self-confidence, and it is also a place where unique Japanese cultural concepts such as “Ikigai” (reason to live) and “Omotenashi” (hospitality) can be nurtured as professional awareness.

风险社会的因应之道?经合组织全球素养概念框架的社会逻辑批判

经合组织提出的全球素养概念框架建立在西方现代化及其理论认知即风险社会理论的基础上。风险社会理论认为当前世界的基本特征是多元化、个体化和世界主义,因此,经合组织的全球素养概念框架强调跨文化能力、可持续发展与国际理解。然而这一概念框架缺乏对人的类主体性的认知,也缺乏对其他现代化路径的考量,使其存在着不可避免的缺陷。因此,必须超越经合组织全球素养概念框架,建立以人的类主体性为理论基础的概念框架,促进人类命运共同体的构建。

基于交叉销售的竞争供应链纵向契约研究

考虑市场上存在两个竞争性制造商和两个竞争性零售商,且每个制造商都由两个共同的零售商来分销产品,进而形成交叉销售的竞争供应链模型.研究该模型下制造商契约选择的动态演化过程.分析收益分享契约同时实现制造商与零售商利润改进的条件.结果显示:制造商的契约选择严重依赖于产品间的竞争强度,零售商间竞争强度只起到催化剂的作用.当产品间的竞争较弱,收益分享比例设置在合适范围内时,制造商由最初的批发价契约转化为收益分享契约,且此时收益分享契约为占优策略.否则,两者将因为收益分享比例无法达成一致,被迫以批发价契约进行交易.

零售商竞争环境下供应链定价策略与收益共享契约

研究了由一个制造商与两个竞争零售商组成的供应链定价协调问题。利用博弈理论对两种定价模型进行了分析,得到了供应链系统成员的最优定价策略和收益,分析了市场需求扩散程度对定价策略与收益的影响。对两种模型的收益进行了比较,发现分散决策使得供应链系统收益难以达到最优,据此给出了收益共享的定价协调策略,利用数值算例验证了本文的结论。

临床护士知识共享行为与其核心能力的相关性分析

目的:调查并分析临床护士知识共享行为对其核心能力的影响。方法:对湖南省衡阳市3所三级甲等医院448名临床护士进行问卷调查,了解临床护士知识共享行为和核心能力现状,并探讨两者间关系。结果:临床护士知识共享行为量表条目均分为(2.36±0.69)分,护士核心能力总均分为(2.78±0.55)分;知识共享行为量表总均分及4个维度得分与护士核心能力总均分及各维度得分均呈正相关(P<0.01)。分层回归分析显示,控制人口学变量后,组织沟通、个人互动、社区实践能够预测护士核心能力的39.9%。结论:护理管理者应根据临床护士知识共享行为的现状特点,采取科学可行的干预措施,以提高临床护士知识共享行为水平,促进其核心能力的发展。