Ethics of uncertainty

Uncertainty is inherent in clinical medicine. However, just because absolute certainty is unachievable does not mean that rational and optimal decisions cannot be made. It is argued that we need to distinguish legitimate from illegitimate scientific uncertainties that are generated by manufacturing doubts aiming to create mis- and disinformation. The attempt to create doubts implies that actions under uncertainties are impossible. Such a belief ultimately harms public, which requires reasoned actions within a context of genuine scientific and medical uncertainties. The latter indicates that rational decisions, even in the absence of guaranteed absolute certainty, are not only possible but, on average, beneficial both for society and individuals.     

The communication of uncertainty in health: A scoping review

ObjectiveTo conduct a scoping review of existing studies that examine communication strategies that address uncertainty in health and categorize them using the taxonomy of uncertainty.MethodsRelevant articles retrieved from ten databases were categorized according to the dimensions of the taxonomy of uncertainty, and study characteristics were extracted from each article.ResultsAll articles (n = 63) explored uncertainty in the context of probabilistic risk and related to scientific issues (n = 63; 100%). The majority focused on complexity (n = 24; 38.1%) and uncertainty experienced by patients (n = 52; 82.5%). Most utilized quantitative methods (n = 46; 73.0%), hypothetical scenarios (n = 49; 77.8%), and focused on cancer (n = 20; 31.7%). Theory guided messages and study design in fewer than half (n = 27; 42.9%).ConclusionsHeterogeneity in terminology used to refer to different types of uncertainties preclude a unified research agenda on uncertainty communication. Research predominately focuses on probability as the source of uncertainty, uncertainties related to scientific issues, and uncertainty experienced by patients.Practice implicationsAdditional efforts are needed to understand providers’ experience of uncertainty, and to identify strategies to address ambiguity. Future studies should use consistent terminology to allow for coherence and advancement of uncertainty communication scholarship. Continued efforts to refine the existing taxonomy should be undertaken.     

Uncertainty management for individuals with Lynch Syndrome: Identifying and responding to healthcare barriers

ObjectiveExamine the uncertainty management process of individuals with Lynch syndrome (LS).Methods19 phone interviews were conducted with individuals with LS. The interview guide included questions on family communication, risk perceptions, and uncertainty management. Data were analyzed using the constant comparison method to code for emergent themes.ResultsQualitative analysis found individuals with LS tried to manage their uncertainty through preventive care, but were often confounded by healthcare barriers. Healthcare barriers included cost and insurance issues, absence of coordinated care, insufficient provider knowledge, and lack of patient-centered communication. Participants reported increased uncertainty and anxiety due to these barriers and used alternative uncertainty management strategies such as advocating for themselves with providers, seeking information online, and communicating with family for emotional support.ConclusionHealthcare barriers identified in this study exacerbated uncertainty and anxiety for individuals with LS and challenged their ability to engage in preventive care. In response, participants used alternative uncertainty management strategies to reduce their uncertainty, which may have unintended negative consequences.Practice implicationsFindings support the need for providers to partner with specialists in genetics and/or LS to better care for individuals with LS. Findings highlight opportunities for interventions in healthcare to better support individuals with LS.     

HPLC 法测定硫酸氢氯吡格雷片有关物质的不确定度评定

目的：对高效液相色谱法(HPLC)测定硫酸氢氯吡格雷片有关物质的不确定度进行评估,找出影响不确定度因素。方法：建立数学模型,对有关物质测定过程中各影响因素进行分析评估。结果：通过计算各变量的不确定度,合成不确定度,最终得出测量结果的扩展不确定度。结论：分析产生不确定度的主要来源,为有效控制该有关物质测定方法的准确性提供可靠的理论依据。     

基于微信平台的患者管理模式对急性冠脉综合征患者疾病不确定感和焦虑抑郁情绪的改善效果

目的 考察基于微信平台的管理模式对急性冠脉综合征患者疾病不确定感和焦虑抑郁情绪的改善效果。方法 将2017年6—12月我院诊治的80例急性冠脉综合征患者随机分为观察组和对照组,每组各40例,对照组采用常规健康教育模式,观察组在对照组基础上联合应用微信平台健康教育模式,均干预12周,比较两组干预前后的疾病不确定感评分、抑郁自评量表(SDS)评分和焦虑自评量表(SAS)的评价结果。结果 干预前,两组患者复杂性、不明确性和疾病不确定感评分比较,差异无统计学意义(P0.05);经干预后,两组患者复杂性、不明确性和疾病不确定感评分均显著降低,且观察组显著低于对照组(P0.05);干预前,两组患者SDS评分和SAS评分比较,差异无统计学意义(P0.05);经干预后,两组患者SDS和SAS评分均显著降低,且观察组显著低于对照组(P0.05)。结论 微信平台的健康管理模式能改善急性冠脉综合征患者的疾病不确定感、焦虑和抑郁程度。     

乳腺癌患者的疾病不确定感及其与社会支持的相关性研究

目的分析乳腺癌患者的疾病不确定感的因素并探讨其与社会支持之间的相关性。方法对66例符合乳腺癌诊断的患者进行入院后疾病不确定感和社会支持的测量。结果乳腺癌患者的疾病不确定感属于中等程度。疾病不确定感与社会支持之间存在显著负相关。结论护理人员应重视患者的疾病不确定感感受和患者社会支持系统的作用。     

医药工业洁净室悬浮粒子的测量不确定度评定

目的：评定洁净室悬浮粒子的测量不确定度。方法对悬浮粒子的测量不确定度来源分析,建立数学模型,逐项评定悬浮粒子的不确定度的分量,合成标准不确定度,最后得出测量结果的扩展不确定度。结果粒径≥0.5μm的悬浮粒子数为（10490±2472）粒/m3,k=2;粒径≥5μm的悬浮粒子数为（923±296）粒/m3, k=2。结论悬浮粒子的测量不确定度主要来源是仪器的计量性能及试验重复性引起的不确定度,测量时应注意采样点的均匀性及代表性,多点采样,以减少不确定度,提高结果的可靠性。