Addressing personal parental values in decisions about childhood vaccination: Measure development

ObjectiveEvidence-based strategies to address vaccine hesitancy are lacking. Personal values are a measurable psychological construct that could be used to deliver personalized messages to influence vaccine hesitancy and behavior. Our objectives were to develop a valid, reliable self-report survey instrument to measure vaccine values based on the Schwartz theory of basic human values, and to test the hypothesis that vaccine values are distinct from vaccine attitudes and are related to vaccine hesitancy and behavior.MethodsParental Vaccine Values (PVV) scale items were generated using formative qualitative research and expert input, yielding 24 items for testing. 295 parents of children aged 14–30 months completed a self-report survey with measures of Schwartz’s global values, the PVV, vaccine attitudes, and vaccine hesitancy. Factor analysis was used to determine vaccine values factor structure. Associations between vaccine values, vaccine attitudes, vaccine hesitancy, and vaccination behavior were assessed using linear and logistic regression models. Late vaccination was assessed from electronic medical records.ResultsA six-factor structure for vaccine values was determined with good fit (RMSEA = 0.07, Bentler’s CFI = 0.91) with subscales for Conformity, Universalism, Tradition, Self-Direction, Security- Disease Prevention, and Security- Vaccine Risk. Vaccine values were moderately associated with Schwartz global values and vaccine attitudes, indicating discriminant validity from these constructs. Multivariable linear regression showed vaccine hesitancy was associated with vaccine values Conformity (partial R² = 0.10) and Universalism (0.04) and vaccine attitudes Vaccine Safety (0.52) and Vaccine Benefit (0.16). Multivariable logistic regression showed that late vaccination was associated with vaccine value Self-direction (OR = 1.80, 95% CI: 1.26–2.65) and vaccine attitude of Vaccine Benefit (OR = 0.44, 95% CI: 0.32–0.60).ConclusionsThe PVV scale had good psychometric properties and appears related to but distinct from Schwartz global values and vaccine attitudes. Vaccine values are associated with vaccine hesitancy and late vaccination and may be useful in tailoring future interventions.     

90后士兵主流价值观特点调查分析

目的 了解90后士兵主流价值观特点,为有针对性地价值观教育引导提供理论基础.方法 采用问卷调查的方式,测量90后士兵主流价值观的总体状况.结果 ①通过均分排序,普遍意义评定排在前3项的为国家观、法制观、健康观,社会意义为国家观、法制观、公正观,个人意义为健康观、亲情观、自我观；②通过标准差排序,在普遍意义情况下,重要性评定标准差最小为2.856,最大为4.107;在社会意义情况下,标准差最小为2.789,最大为3.951;在个人意义情况下,标准差最小为3.435,最大为4.329;③主流价值观的评定均分在普遍意义和社会意义以及普遍意义和个人意义间呈极其显著的正相关(r=0.824,0.873;P＜0.01);在个人意义与社会意义间呈显著正相关(r=0.569,P＜0.05)；④对14项消极价值观念,“存在”反应的百分比在72.0％～88.0％之间,平均为81.73％;“不认同”反应的百分比平均为89.09％.结论 90后士兵主流价值观的体系结构呈现出新特点,价值观念多元分化；价值观念社会视阈与个人视阈出现融合的趋势；90后士兵的价值观念是普遍积极的.     

Feasibility,acceptability, and effectiveness of a decision aid versus an informational website to promote clinical trial decision-making among cancer patients: A pilot randomized controlled trial

ObjectiveTo assess intervention feasibility and acceptability, and compare the effectiveness of the CHOICES Decision Aid (DA) versus the National Cancer Institute (NCI) Cancer Clinical Trials (CCT) website to improve knowledge about CCTs and preparedness to make an informed decision.MethodsOncology patients (n = 101) with a scheduled clinic visit were enrolled and randomized. Decision-making variables were collected at two timepoints. Post-intervention scores were examined via paired t-tests and multivariate regression analyses. Predictors of the magnitudes of the change in scores were examined in multivariable regression analyses.ResultsThe interventions were feasible to implement and acceptable to participants. Both interventions increased objective and subjective knowledge, improved clarity of opinions, and reduced decisional conflict (p-values < 0.01). Improvements in the belief that one could find out about CCTs were observed in the CHOICES DA arm (p < 0.001). Multivariable analyses controlling for educational attainment showed no significant differences in the magnitude of change in outcome variables between intervention arms, but did find that improvements in some variables in the NCI arm – but not CHOICES DA arm – were associated with previous educational attainment.ConclusionsInterventions were feasible to implement and acceptable. Improvements in knowledge and decision-making outcomes were observed in both arms, supporting the view that interventions to improve CCT decision making are effective and feasible. Our results suggest that the CHOICES DA may be more effective than an informational website in improving decision-making outcomes regardless of participants’ educational attainment.Practice implicationsCCT resources should support informed decision-making among all cancer survivors, regardless of educational attainment.     

不同b值下弥散加权成像及表观弥散系数在老年肺部肿瘤的临床研究

目的分析不同b值下弥散加权成像(DWI)与表观弥散系数(ADC)用于老年肺部肿瘤良恶性鉴别诊断的价值。方法采用分层整群抽样回顾性分析的方法,抽取我院2015年7月至2018年12月接诊的肺部肿瘤患者100例为研究对象,全部患者均接受磁共振技术弥散加权成像,分析不同病变性质肿瘤的弥散加权成像表现,对比不同良恶性肿瘤在不同b值下弥散加权成像信号强度分布情况及其对应的ADC值,经受试者操作特征曲线(ROC曲线)计算不同b值下ADC值对应曲线面积。结果100例老年肺部肿瘤患者中,检出良性肿瘤、恶性肿瘤例数分别为51例、49例。不同b值恶性肿瘤低信号占比均低于良性肿瘤,高信号占比均高于良性肿瘤,差异有统计学意义(P<0.05);不同b值下,恶性肿瘤ADC值均低于良性肿瘤,差异有统计学意义(P<0.05);且随着b值的升高,全部肺部肿瘤患者ADC值均呈下降趋势,差异有统计学意义(P<0.05);不同b值下ADC值ROC曲线下对应面积分别为0.884、0.834、0.754,AUC>0.5可作为鉴别诊断肺部肿瘤良恶性的有效指标,且以b值为500s/mm2时所得到的ADC指曲线下面积最大,在ADC值取1.470时,可获得最高诊断效能。结论b值为500s/mm2下的弥散加权成像技术信号强度与表观弥散系数用于老年肺部肿瘤良恶性鉴别诊断有着较高价值,患者整体表观弥散系数值随b值的升高而减小。     

护理文化建设和护士职业价值观的构建

价值观的性质决定了它对人的思想和行为起着决定性的指导作用。文化的核心是价值观念,文化传统会对价值观念进行渗透与影响。通过护理文化建设,可以促进护理人员形成正确的职业价值观,并通过群体文化氛围、意识、价值观等对护理人员产生更深层次的约束,进而使其产生自觉的护理职业行为,提高护理管理层次和效能,促进护理事业的可持续发展。     

New Reference Data on Bone Mineral Density and the Prevalence of Osteoporosis in Korean Adults Aged 50 Years or Older: The Korea National Health and Nutrition Examination Survey 2008-2010

This cross-sectional study was performed to investigate the reference values for bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and the prevalence of osteoporosis in the Korean population by applying domestic reference data. In total, 25,043 Korean adults ≥20 yr of age (11,792 men and 13,251 women) participated in the study. The BMDs of the total hip, femoral neck, and lumbar spine were measured by DXA (Discovery-W, Hologic Inc.), and subjects with a BMD - 2.5 standard deviations or lower than the mean BMD for young adults (20-29 yr old) were considered to have osteoporosis. When applying the new reference values determined in this study from Korean subjects, the overall prevalence of osteoporosis increased in men aged ≥50 yr compared with that provided by the DXA manufacturer from Japanese subjects (12.2% vs. 7.8%, P<0.001) and decreased in postmenopausal women aged ≥50 yr (32.9% vs. 38.7%, P<0.001). According to the findings of this study, use of the reference values provided by the DXA manufacturer has resulted in the underdiagnosis of osteoporosis in Korean men and the overdiagnosis of osteoporosis in Korean women. Our data will serve as valuable reference standards for the diagnosis and management for osteoporosis in the Korean population.

Graphical Abstract

相似文献   

Combining deliberation and intuition in patient decision support

Objective

To review the strengths and weaknesses of deliberative and intuitive processes in the context of patient decision support and to discuss implications for decision aid (DA) design.

Methods

Conceptual review of the strengths and weaknesses of intuitive and analytical decision making and applying these findings to the practice of DA design.

Results

DAs combine several important goals: providing information, helping to clarify treatment related values, supporting preference construction processes, and facilitating more active engagement in decision making. Many DAs encourage patients to approach a decision analytically, without solid theoretical or empirical grounding for this approach. Existing research in other domains suggests that both intuition and deliberation may support decision making. We discuss implications for patient decision support and challenge researchers to determine when combining these processes leads to better outcomes.

Conclusions

Intuitive and analytical decision processes may have complementary effects in achieving the desired outcomes of patient decision support.

Practice implications

DA developers should be aware that tools solely targeted at supporting deliberation may limit DA effectiveness and harm preference construction processes. Patients may be better served by combined strategies that draw on the strengths and minimize the weaknesses of both deliberative and intuitive processes.     

Narrative medicine as a means of training medical students toward residency competencies

Objective

This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism.

Methods

Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred.

Results

Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture.

Conclusion/Practice implications

Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance.     

纤支镜下一次置入2根双腔微导管在治疗肺大咯血中的价值及安全性评价

目的探讨纤维支气管镜(纤支镜)下一次性置入2根新型双腔微导管在治疗肺大咯血中的价值及安全性。方法 10例患者均先行X线胸片、胸部HRCT检查,初步明确出血部位及病因,按纤支镜操作常规准备。术前30min无水吞服30mg可待因,尽可能在大咯血间歇期进行。操作过程中边插入纤支镜边止血,直至找到目标支气管,随即沿工作通道放入引导导丝,在纤支镜直视下沿导丝放入第1根双腔微导管。判定球囊所能寻求支撑的着力点后,依据管径大小向球囊导管工作通道分别注入不等量冰生理盐水固定球囊。随后观察另一段或亚段支气管是否仍在持续出血,再继续按上述方法置入第2根球囊导管。纤支镜下观察3～5min,确定封堵目标支气管已停止出血后退出纤支镜。每隔1～2h向球囊的工作通道注入凝血酶500U,并回抽以观察微球囊封堵支气管内出血情况,以确定球囊导管放置时间。每6～8h回抽固定球囊液体量的一半,避免完全放松固定球囊而导致导管在气管内随呼吸发生移位。如在此期间或之后再次出现大咯血,则立即进行支气管动脉栓塞或手术治疗。以术后患者咯血量等症状的减轻,并结合从工作通道回抽吸液体颜色深浅的改变情况,分为出血完全停止、明显减少、有所减少、失败无效等4个层次进行疗效的判断。并通过该项技术与支气管动脉栓塞术(BAE)治疗肺大咯血对作比观察。结果 10例患者纤支镜下一次置入2根新型微导管操作顺利,操作时间约20～30min。大咯血即刻控制率达80%。术后出血即刻完全停止4例、明显减少3例、有所减少1例、失败无效2例。出血有所减少的1例术后4h经BAE术疗出血完全停止。失败无效的2例中,1例后经外科手术切除右肺中叶,出血完全停止。另外1例随即行BAE,但术后24h再次出现大咯血窒息死亡。结论一次性置入2根新型微导管治疗肺大咯血为有条件的患者和可能需要进一步行BAE,及外科手术治疗的患者创造了诊断和气道准备条件的时间。具有一定临床应用价值及可靠的安全性,值得在临床进一步推广应用。