决策辅助在关节置换患者中的应用效果

摘要：[目的] 探讨决策辅助在关节置换患者中的应用效果。[方法] 将120例关节置换患者以简单随机化法分组,奇数分配到对照组,偶数分配到观察组,每组各60例,对照组按常规实施护理,观察组在常规护理基础上实施决策辅助,比较两组患者焦虑抑郁、生活质量和关节功能得分有无差异。[结果] 两组患者焦虑得分、生活质量部分维度（社会功能、精神健康、精力、躯体疼痛）、关节功能得分有统计学差异（P<0.05）。[结论] 决策辅助能改善关节置换患者的焦虑和关节功能状况,在一定程度上提高生活质量。     

妇科肿瘤患者PICC知情同意移动医疗决策辅助程序的设计与实施

目的设计并实施PICC知情同意移动医疗决策辅助程序,增强患者决策参与意愿。方法将妇科肿瘤科行PICC化疗的86例患者随机分为观察组和对照组各43例,对照组采用常规PICC知情同意,观察组在对照组基础上,利用移动护理信息系统,构建并实施妇科肿瘤患者PICC知情同意移动医疗决策辅助程序。结果观察组焦虑抑郁状态评分显著低于对照组,患者的决策实际参与程度显著高于对照组,患者决策参与满意度总分及各维度得分显著高于对照组(P<0.05,P<0.01)。结论PICC知情同意移动医疗决策辅助程序为妇科肿瘤患者提供精准化的决策辅助,缓解了患者置管时的焦虑抑郁情绪,提高了患者决策实际参与程度及满意度。     

决策辅助在关节置换病人中的应用效果

目的：探讨决策辅助在关节置换病人中的应用效果。方法将2014年1月至2014年10月于我科行关节置换的120例病人以简单随机化法分为对照组和观察组,每组60例,对照组实施常规护理,观察组在常规护理基础上实施决策辅助。采用焦虑自评量表和抑郁自评量表评估两组病人术后3d的焦虑、抑郁情况,采用SF?36健康调查量表评估两组病人出院1个月后的生活质量,采用Harris髋关节评分系统或美国特种外科医院（American hospital for special surgery, HSS）膝关节评分系统评估两组病人术后出院当天、出院1个月后的关节功能。结果两组病人焦虑得分、生活质量评分体系中的社会功能、精神健康、精力、躯体疼痛4个维度的得分以及关节功能得分比较,差异有统计学意义（均P＜0.05）。结论决策辅助能改善关节置换病人的焦虑和关节功能,在一定程度上提高其生活质量。     

功能锻炼决策辅助在髋膝关节置换术患者加速康复中的应用

目的探讨功能锻炼决策辅助在关节置换术患者加速康复的应用效果。方法将132例髋膝关节置换术患者随机分为对照组和观察组各66例。对照组给予常规加速康复护理措施,观察组在此基础上给予功能锻炼决策辅助。比较两组术后首次下床时间、握力和关节功能状态。结果干预后,观察组首次下床时间显著缩短,握力和关节功能得分显著高于对照组(P<0.05,P<0.01),术后肌肉和关节功能改善明显。结论功能锻炼决策辅助有助于关节置换患者加速康复进程。     

乳腺癌手术切除患者术前决策与术后住院期康复护理分析

目的:探讨乳腺癌手术切除患者术前决策与术后住院期康复体验护理方法与效果。方法:乳腺癌切除术患者240例分为治疗组和对照组各120例,两组都采用常规乳腺癌手术切除术与一般护理方法,在此基础上治疗组采用积极的术前决策与术后住院期康复体验护理。结果:两组疼痛程度随术后恢复呈逐渐减轻的趋势,治疗组在术后1日、4日疼痛程度低于对照组(P<0.05)。治疗组术后1日收缩压升高幅度明显低于对照组(P<0.05)。两组术后心率明显升高,组间差异不明显。结论:乳腺癌手术切除患者术前决策与术后住院期康复体验护理应充分倾听理解患者个体意愿,从而有利于患者更好地应对手术和促进术后康复。     

基于问题提示清单和个人决策指导的急性阑尾炎患儿决策辅助干预

目的 探讨基于问题提示清单和个人决策指导的决策辅助干预在急性阑尾炎患儿治疗决策中的应用效果。方法 便利选取急性阑尾炎患儿监护人为研究对象,按照患儿就诊时间分为对照组和干预组各49人。对照组实施常规术前谈话和健康教育,干预组在对照组基础上实施基于问题提示清单和个人决策指导的决策辅助干预。比较两组决策困境、决策准备度和决策参与满意度。结果 干预后,干预组患儿监护人决策困境总分显著低于对照组,决策准备度及决策参与满意度总分显著高于对照组(均P<0.05)。结论 基于问题提示清单和个人决策指导的决策辅助干预,能够降低急性阑尾炎患儿监护人决策困境,提高其决策准备度和决策参与满意度。     

原发性开角型青光眼患者决策辅助方案的构建及应用

目的 探讨决策辅助方案在原发性开角型青光眼患者中的应用效果。方法 将100例原发性开角型青光眼患者按住院时间分为对照组与观察组各50例;对照组行常规护理,观察组在常规护理基础上实施决策辅助方案。分别于干预后（出院前）、出院后1、3个月评价干预效果。结果 干预后观察组决策困境得分显著低于对照组,决策准备得分显著高于对照组,出院后1、3个月药物依从性得分显著高于对照组,出院后3个月目标眼压达标率显著高于对照组（均P＜0.05）。结论 决策辅助方案的应用可有效降低原发性开角型青光眼患者决策困境水平,提高决策准备度,增强用药依从性,从而提高目标眼压达标率。     

三镜联合治疗胆总管结石患者基于决策辅助的术前教育

目的探讨基于决策辅助的术前教育在三镜联合治疗胆囊并胆总管结石患者加速康复外科中的应用效果。方法选取行三镜联合治疗胆囊并胆总管结石患者60例,采用随机数字表法将患者分成干预组和对照组各30例。对照组采取常规术前教育,干预组采取基于决策辅助的术前教育。结果干预结束时,干预组决策参与满意度得分和术后治疗依从性得分显著高于对照组,干预组术后首次排气时间、引流时间和住院时间显著短于对照组(P0.05,P0.01)。结论基于决策辅助的术前教育有助于提高三镜联合治疗胆囊并胆总管结石患者的决策参与满意度、术后治疗依从性,有利于促进患者术后恢复。     

功能锻炼决策辅助对单侧全膝关节置换恐动症患者的影响

目的探讨决策辅助对单侧全膝关节置换恐动症患者术后功能锻炼依从性的影响。方法按照住院时间将单侧全膝关节置换术后恐动症患者143例分为对照组72例和干预组71例。对照组给予常规治疗和护理,干预组在循证基础上,通过专家会议,构建并实施功能锻炼决策辅助方案。比较两组患者出院时、术后1个月和3个月功能锻炼依从性、恐动症和膝关节功能评分。结果干预后两组功能锻炼依从性、恐动症和膝关节功能评分的时间效应、组间效应和交互效应显著(P<0.05,P<0.01)。结论决策辅助有利于提高单侧全膝关节置换恐动症患者术后功能锻炼依从性,降低恐动水平,改善其膝关节功能。     

医患共同决策对痤疮患者负性情绪和遵医行为及治疗效果的影响

目的:探讨医患共同决策模式在痤疮患者中的应用效果。方法:采用随机抽样法将130例面部痤疮患者随机分为对照组和观察组,每组65例。对照组予常规痤疮医疗护理沟通,观察组在常规医疗护理沟通的基础上实施医患共同决策模式,在治疗护理各环节使患者及家属参与决策。比较两组患者的负性情绪、遵医行为及治疗效果。结果:两组患者治疗后皮损消退率显著改善,观察组治疗有效率为84.62%高于对照组的73.85%,差异有统计学意义(P0.05)。两组患者治疗后SAS及SDS得分均有所降低,且观察组干预后SAS得分(36.55±6.51)分低于对照组(45.83±4.62)分,观察组干预后SDS得分(33.67±4.15)分低于对照组(44.04±6.18)分,差异有统计学意义(P0.05)。观察组患者遵医行为及自我护理知识得分均优于对照组,差异有统计学意义(P0.05)。结论:医患共同决策模式能够改善痤疮患者的负性情绪、遵医行为及治疗效果,值得在临床推广应用。     

Surgical decision making

Decision making is an integral part of surgical practice and is a skill that is as important as the ability to operate. Sound decision making is the result of acquiring ‘surgical wisdom’, which is achieved through learning, experience and reflection. This paper reviews the processes of surgical decision making with respect to choosing the correct procedure and deciding when to operate, and how operative decisions are made, together with the factors that influence our surgical decisions.     

Pilot trial of a computerized decision aid for breast cancer prevention

This study sought to evaluate a shared decision-making aid for breast cancer prevention care designed to help women make appropriate prevention decisions by presenting information about risk in context. The decision aid was implemented in a high-risk breast cancer prevention program and pilot-tested in a randomized clinical trial comparing standard consultations to use of the decision aid. Physicians completed training with the decision aid prior to enrollment. Thirty participants enrolled (15 per group) and completed measures of clinical feasibility and effectiveness prior to, immediately after, and at 9 months after their consultations. The decision aid was feasible to use during the consultations as measured by consultation duration, user satisfaction, patient knowledge, and decisional conflict. The mean consultation duration was not significantly different between groups (24 minutes for intervention group versus 21 minutes for control group, p = 0.42). The majority found the decision aid acceptable and useful and would recommend it to others. Both groups showed an improvement in breast cancer prevention knowledge postvisit, which was significant in the intervention group (p = 0.01) but not the control group (p = 0.13). However, the knowledge scores returned to baseline at follow-up in both groups. Decision preference for patients who chose chemoprevention post consultations remained constant at follow-up for the intervention group, but not for the control group. The decision framework provides access to key information during consultations and facilitates the integration of emerging biomarkers in this setting. Initial results suggest that the decision aid is feasible for use in the consultation room. The tendency for the decision choices and knowledge scores to return to baseline at follow-up suggests the need for initial and ongoing prevention decision support.     

A systematic review of decision aids for gender affirming therapy

BackgroundTransgender and gender diverse (TGD) persons considering gender affirming therapy have to make many complex medical decisions, potentially without understanding the associated harms or benefits of hormonal and surgical interventions. Further, clinicians are often unaware of how best to communicate information to persons seeking gender affirming therapy. Patient decision aids have been developed to provide evidence-based information as a way to help people make decisions in collaboration with their clinicians. It is unclear whether such tools exist for persons seeking gender affirming therapy. The objective of our systematic review is to search for and determine the quality of any existing patient decision aids developed for TGD persons considering gender affirming therapy, and the outcomes associated with their use.MethodsWe adapted a search strategy for databases using two key concepts “decision support intervention/patient decision aid” and “transgender”. We also conducted a brief online search of Google and abstracts from relevant conferences to identify any tools not published in the academic literature. Following study selection and data extraction, we used the International Patient Decision Aid Standards instrument (IPDASi) to assess the quality of patient decision aids, and the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) checklist to assess the quality of evaluations.ResultsWe identified 762 studies; none were identified from Google or conference content. One tool met our inclusion criteria: an online, pre-encounter patient decision aid for transmasculine genital gender-affirming surgery developed in Amsterdam, translated in English and Dutch. The tool met all the IPDASi qualifying criteria, and scored a 17/28 on the certification criteria, and 57/112 on the quality criteria. The efficacy of the patient decision aid has not been evaluated.ConclusionsDespite multiple decisions required for gender affirming therapies, only one patient decision aid has been developed for transmasculine genital reconstruction. Further research is required to develop patient decision aids for the multiple decision points along the gender affirming journey.     

澳门护理本科生感知临床决策力的调查

目的了解澳门护理本科生的感知临床决策力,为教学方法的改进提供参考。方法采用中文版护理临床决策量表对澳门一所护理学校完成本学年临床实习的217名一至四年级护理本科生的感知临床决策力进行调查。结果护理本科生感知的临床决策力评分为(132.96±7.96)分,不同年级及是否参与高仿真模拟训练的护理本科生感知临床决策力评分比较,差异有统计学意义(均P0.01)。结论护理本科生临床决策意识处于中等偏上水平,高年级及参与高仿真模拟训练的护理本科生感知有较好的临床决策力。临床情境学习可增强护理本科生知识与技能的运用,促进临床信息的综合运用及作出决策。     

PSA-based prostate cancer screening: the role of active surveillance and informed and shared decision making

Since the first publication describing the identification of prostate-specific antigen (PSA) in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.