Patient-important outcomes to inform shared decision making and goal setting for diabetes treatment

ObjectiveDespite well-established treatment guidelines, diabetes is difficult to manage for many individuals. The importance of using shared decision making to optimize diabetes treatment is recognized, yet what matters most to individuals with diabetes is not well established. Our goal was to identify patients’ goals and priorities for diabetes management.MethodsWe engaged 141 participants through interviews and group concept mapping to identify patient-important outcomes (PIOs) for diabetes care. We generated a master list of PIOs by aggregating interview data coded to “goals” and ideas brainstormed during concept mapping, and then a patient advisory board sorted the PIOs into higher-level domains.ResultsWe identified 41 PIOs sorted into 7 broad domains: optimize daily self-care, optimize long term health, learn about diabetes, achieve measurable goals, manage medications, manage diet and best utilize medical / professional services.ConclusionsMost (4/7) of PIO domains focused on personal and life goals, not medically-oriented goals. Use of these PIOs and domains may facilitate more effective SDM discussions for patients with diabetes.Practice implicationsUse of PIOs from this work can enable the empowerment of patients to voice their priorities during SDM conversations, thus facilitating development of truly individualized diabetes treatment plans.     

康复理念结合针灸推拿对小儿发育迟缓的康复效果

目的分析在小儿发育迟缓的治疗中应用针灸推拿结合现代康复理念对患儿康复效果的影响。方法按照随机数字表法将2017年2月—2019年2月本院收治的88例发育迟缓患儿进行分组调查,分别为对照组(针灸推拿治疗)和试验组(现代康复理念结合针灸推拿治疗),每组各包含患者44例,比较两组患者的康复效果。结果两组患者治疗前的肢体活动能力量表(GMFM)和日常生活能力(Barthel)量表评分差异不具有统计学意义(P>0.05);对照组患儿治疗后的GMFM和Barthel评分相较于试验组明显更低(P<0.05)。结论现代康复理念结合针灸推拿能够有效改善小儿发育迟缓患者的预后,对于提高患儿康复速度和生活能力具有重要意义,疗效确切。     

基于全生命周期理念的中药新药监管科学研究

中药是我国具有原创性优势的健康资源,近年来,国家高度重视中医药的价值,强调"传承精华,守正创新"以推动中医药行业的健康发展。但目前中药仍面临创新能力不足、中药新药发展缓慢的问题,严重制约中药产业的发展。中药新药研发具有政策导向性,全生命周期管理理念的运用和监管科学的兴起,将会促进中药监管体系与治理能力的发展,为中药研发提供政策指导。对中药全生命周期各阶段的特殊性及监管情况进行分析,探索中药监管科学建设思路,以期为改善中药新药监管效果提供参考。     

Clinical discussion of Medical Aid-in-Dying: minimizing harms and ensuring informed choice

ObjectiveThe implementation of medical aid-in-dying (MAID) poses new challenges for clinical communication and counseling. Among these, health care providers must consider whether to initiate a discussion of MAID with eligible patients who do not directly ask about it. Norms and policies concerning this issue vary tremendously across jurisdictions where MAID is legally authorized, reflecting divergent assumptions about patients’ rights to information about end-of-life options and the purpose and potential harms of clinical disclosure.MethodThis discussion forum essay draws on informed consent doctrine to analyze two policies concerning clinical communication about MAID: the legal prohibition against provider-initiated discussions of MAID in Victoria, Australia, and the Canadian Association of MAID Assessors and Providers (CAMAP) position that providers have an ethical and professional responsibility to inform eligible patients about MAID.ConclusionsInformed consent requires that clinicians strike a balance between minimizing potential harms to patients caused by initiating discussions of MAID and the imperative to inform and counsel patients about all of their legally available medical options.Practice implicationsClinicians should be aware of both the importance of communication as a tool to inform patients and the potential for clinical language to cause harm to or to unduly influence patients.     

Eutanasia: ¿es esta la ley que necesitamos?

La Ley de Eutanasia española introduce un nuevo derecho que se incorpora a la cartera de servicios del sistema sanitario, como una prestación cuya aplicación se garantiza en el plazo de 40 días. Desde la experiencia clínica se argumenta que, sin el derecho efectivo a unos cuidados paliativos de calidad, y con el actual déficit en las ayudas a la dependencia, esta ley puede ser un mensaje coactivo para aquellas personas especialmente frágiles y dependientes, que se sientan como una pesada carga para su familia y para la sociedad.Se razona de qué modo fundamentar el derecho a morir en la dignidad de la persona, puede tener repercusiones sociales inesperadas.El texto normativo muestra debilidades propias de una ley apresurada y sin apoyo de órganos consultivos. Hay cuestiones pendientes de aclarar en su aplicación dentro del contexto de la medicina de familia. Se concluye que esta nueva norma planteará más problemas de los que pretende resolver.Palabras clave: Eutanasia, Suicidio asistido, Medicina de familia, Cuidados paliativos, Bioética     

概念图法在护理研究中的应用——以居家安宁疗护障碍因素分析为例

概念图法是一种被广泛应用的混合性研究方法,实施步骤包括:前期准备、产生声明、声明结构化、概念图分析、解读概念图和概念图应用。目前,该方法在国内护理领域中应用尚少。本文以一项居家安宁疗护的研究为例,探讨概念图法在护理科研中的应用过程,以期为今后在护理领域运用概念图法提供参考。     

PDCA循环在预防肿瘤患者自杀管理中的应用

目的将PDCA循环应用于预防肿瘤患者自杀的管理中,以提高医护人员风险防范意识,减少或避免肿瘤患者自杀事件的发生。方法对肿瘤患者自杀事件的原因进行分析、制订相应措施、对执行措施进行检查,持续改进,以提前干预、预防为主。结果运用PDCA循环管理后医护人员对肿瘤患者自杀相关知识的知晓度提高(P0.01);肿瘤患者自杀发生率降低(P0.05)。结论运用PDCA循环管理可以提高医护人员风险防范意识。对自杀高危人群采取防范措施,有效减少自杀事件发生。