Decision making about medical interventions in the end-of-life care of people with intellectual disabilities: A national survey of the considerations and beliefs of GPs,ID physicians and care staff

Objective

This paper explores the personal beliefs and specific considerations of professionals regarding decisions about potentially burdensome medical interventions in the end-of-life care for people with intellectual disabilities (ID).

Methods

A survey questionnaire covering decision making about potentially burdensome medical interventions was sent to nationally representative samples of 294 ID care staff-members, 273 ID physicians and 1000 GPs.

Results

Professionals predominantly believed that considerations about quality of life are most important. Quality of life and wellbeing were also frequently considered in both decisions to start/continue an intervention and decisions to forgo/withdraw an intervention. Seventy percent believed that people with ID should always be informed about interventions, and 61% would respect a refusal by the person. The family's wishes were explicitly considered more often than the wishes of the person with ID.

Conclusion

Although respondents agree that the quality of life is highly important, the wishes of people with ID (especially of those with severe/profound ID) were often not considered in decisions about potentially burdensome medical interventions.

Practice implications

To enhance the active involvement of people with ID in decision making we recommend that professionals integrate collaborative principles in decision making and make use of pictorial and easy reading resources.     

Clinical Social Networking—A New Revolution in Provider Communication and Delivery of Clinical Information across Providers of Care?

The adoption of social media technologies appears to enhance clinical outcomes through improved communications as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). The ability of providers to more effectively, directly, and rapidly communicate among themselves as well as with patients should strengthen collaboration and treatment as reported by Bacigalupe (Fam Syst Heal 29(1):1-14, 2011). This paper is a case study in one organization's development of an internally designed and developed social technology solution termed “Unite.” The Unite system combines social technologies' features including push notifications, messaging, community groups, and user lists with clinical workflow and applications to construct dynamic provider networks, simplify communications, and facilitate clinical workflow optimization. Modeling Unite as a social technology may ease adoption barriers. Developing a social network that is integrated with healthcare information systems in the clinical space opens the doors to capturing and studying the way in which providers communicate. The Unite system appears to have the potential to breaking down existing communication paradigms. With Unite, a rich set of usage data tied to clinical events may unravel alternative networks that can be leveraged to advance patient care.     

四种常用保肝药治疗药物性肝损伤的药物经济学分析

目的 评价4种常用保肝药物治疗药物性肝损伤的经济学效果.方法 构建决策分析模型,率值参数来源于文献资料的Meta分析结果,效果参数来源于专家意见,成本参数如使用规格、数量和单价来源于文献资料、专家意见、国家卫生和计划生育委员会与国家发展和改革委员会最新发布数据等.结果 4种用药方案中,双环醇组治疗效果(4.5118)最好、成本-效果比(86.2667)较小,增量成本-效果比(245.0118)最小且安全性最好;硫普罗宁肠溶片组治疗效果(4.1352)较差,但成本(296.9536)最低;以显效率作为产出计算,双环醇组显效率(73.10)最高,且成本-效果比(5.32)最低,增量成本效果比(4.93)最小.敏感度分析证实这一结果可靠.结论 双环醇可安全、有效的治疗药物性肝损伤,且具有成本效果优势.     

A new method for selectively enhancing hemisphere processing: Voice frequency amplification influences the strength of attribute framing

An attribute framing effect occurs when positive or negative associations produced by positive or negative frames are mapped onto evaluations resulting in a more favourable evaluation for the positively framed attribute. We used a new voice frequency manipulation to differentially enhance right versus left hemisphere processing. In doing so we found a strong attribute framing effect when a speaker with a low-frequency voice enhanced the contextual processing style of the right hemisphere. However, a framing effect was not obtained when a speaker with a high-frequency voice enhanced the inferential/analytical processing style of the left hemisphere. At the theoretical level our results provide evidence that the contextual processing style of the right hemisphere is especially susceptible to associative implications, such as those found in attribute framing manipulations. At the applied level we provide a simple method for altering the effectiveness of persuasion messages.     

Assessing clinical discharge data preferences among practicing surgeons

Background

It is believed that many postoperative patient readmissions can be curbed via optimization of a patient's discharge from hospital, but little is known about how surgeons make the decision to discharge a patient. This study explored the criteria that surgeons preferentially value in their discharge decision-making process.

Materials and methods

All surgical faculty and residents at a U.S. academic medical center were surveyed about the relative importance of specific criteria regularly used to make a discharge decision. Demographic and professional information was collected about each surgeon as well. A Kruskal–Wallis and Fisher's exact test were used to describe one-way analysis of variance between groupings of surgeons. Ordered logit regressions were used to analyze variations across multiple subgroups. Factor analysis was used to further characterize statistically relevant groupings of criteria.

Results

In total, 88 (49%) of the invited surgeons responded to the survey. Respondents reported statistically less reliance on common Laboratory tests and Patient demographics when making discharge decisions preferring Vital signs, Perioperative factors, and Functional criteria. Surgeon-specific factors that influenced discharge criteria preferences included years of clinical education and gender. Factor analysis further identified subtle variations in preferences for specific criteria groupings based on clinical education, gender, and race.

Conclusions

Surgeons use a wide range of clinical data when making discharge decisions. Typical measures of patient condition also appear to be used heterogeneously with a preference for binary rather than continuous measures. Further understanding the nature of these preferences may suggest novel ways of presenting discharge-relevant information to clinical decision makers to optimize discharge outcomes.     

数据挖掘在艾滋病病人CD_~4+T淋巴细胞与机会性感染关系的应用研究

目的利用数据挖掘技术分析艾滋病(AIDS)病人CD4+T淋巴细胞与机会性感染的关系,以期对合并机会性感染的AIDS病人的早期预防性用药提供决策支持。方法使用数据挖掘中的C4.5决策树算法,分析重庆市公共卫生医疗救治中心2003-2008年的207例AIDS病人的相关数据。结果 AIDS病人的CD4+T淋巴细胞值在A(0-50)区间,合并感染卡氏肺孢子虫肺炎(PCP)机会很大(概率为82.35%)。如果没有感染PCP,但是感染了隐球性脑膜炎(NMY),其CD4+T淋巴细胞值在A(0-50)区间;既没有感染PCP,也没有感染NMY,但合并感染丙型肝炎(丙肝)及乙型肝炎(乙肝)者,其CD4+T淋巴细胞值在D(201-300)区间;没有感染PCP,也没有感染NMY,但合并感染丙肝未感染乙肝,其CD4+T淋巴细胞值在C(101-200)区间。结论通过使用数据挖掘技术中的决策树算法,得出AIDS病人CD4+T淋巴细胞值在某一个区间,更容易合并某一种机会性感染,CD4+T淋巴细胞值与机会性感染有着重要的关系。     

Comparing genetic counseling with non-genetic health care interactions: Two of a kind?

OBJECTIVE: Increasingly clinicians other than genetic counselors will advise people with genetic risks. Although some express concerns about this development because of the need for non-genetic clinicians to have additional training, we argue that genetic counseling has more in common with other health care interactions than is generally assumed. METHODS: In this narrative review we investigate the health communication literature taking the perspective that all provider-patient/client interactions share the following goals: forming a relationship, the exchange of information, decision making, promoting health-related behavior and providing support. RESULTS: We found that both non-genetic and genetic 'disciplines' endorse an egalitarian relationship, based on a patient-centered approach and both have difficulties with attuning to the patients' agendas and enhancing patient understanding. Shared decision making is increasingly the preferred model for geneticists and non-geneticists alike, and both need skills to constructively discuss patients' risk-reducing behavior and provide emotional support. CONCLUSION: Rather than developing separate vocabularies and research traditions, the discipline of genetic counseling may benefit by drawing on non-genetic patient-provider interaction research. PRACTICE IMPLICATIONS: Since geneticists face the same challenges as non-geneticists, medical training should continue to improve basic consultation skills, regardless of whether the consultation involves genetic information.     

Protein cellular localization prediction with Support Vector Machines and Decision Trees

Many cellular functions are carried out in specific compartments of the cell. The prediction of the cellular localization of a protein is thus related to its function identification. This paper uses two Machine Learning techniques, Support Vector Machines (SVMs) and Decision Trees, in the prediction of the localization of proteins from three categories of organisms: gram-positive and gram-negative bacteria and fungi. For all categories considered, the localization task has multiple classes, which correspond to the possible protein locations. Since SVMs are originally designed for the solution of two-class problems, this paper also investigates and compares several strategies to extend this technique to perform multiclass predictions.