癌症患者的信息需求--病人、亲属、医护人员观点比较

目的：探讨癌症患者、亲属、医护人员对医患之间交流肿瘤信息观点的异同。方法：随机抽取501例癌症患者、169位亲属和86位医护人员，进行IPQCP 2、INQ、DQ测定和分析。结果：在癌症患者、亲属、医护人员之间，患者与亲属或与医护人员之间，关于应否告知癌症患者其诊断、可能的生存时间和病人应否参与制定治疗方案，IPQCP总均分和各维度均分、总的信息内容和信息量选择倾向、交流形式(包括信息来源、告知方式、时间、地点、在场人员及医生态度等)均有显著性差异。结论：在临床上，给予癌症患者信息和医息交流的主要依据是患者本人的意见。     

Perceptions of educational needs for patients after myocardial infarction

Twelve physicians, 33 nurses, and 30 patients completed questionnaires to elicit similarities and differences in perceptions of educational needs of post-myocardial infarction (MI) patients. Results, using chi-square analysis, indicated that the three groups generally agreed upon which areas should be included in education programs for such patients. The topics rated most important by all three groups were: "knowing the signs and symptoms of a heart attack"; "knowing how to modify or change personal risk factors"; "knowing the names, dosages, and side effects of medications"; and "knowing personal risk factors." Congruence of perceived educational needs of post-MI patients should not be misconstrued to mean that an educational needs assessment for these patients is not necessary.     

Discrepancy between physicians' perceptions and practices during pelvic examinations in Taiwan

OBJECTIVE: This study explored (1) physicians' perceptions of pelvic examination (PE) procedures and (2) the discrepancy between physicians' perceptions and their practices as observed by their attending nurses. METHOD: Data were collected from 20 physician-completed questionnaires on the perceived importance of 23 PE procedures. Each physician's practice of the same 23 PE procedures was assessed by 4-6 attending nurses (100 nurse observations). Physicians and nurses were sampled by convenience from the obstetrics/gynecology outpatient departments of 3 teaching hospitals in central Taiwan. Discrepancies between physicians' perceptions and their practices as assessed by attending nurses were examined by the Mann-Whitney U test. RESULTS: Physicians' mean scores ranged from 3.15 to 4.00, indicating that PE procedures were generally perceived as important. The procedures were rank ordered according to the mean scores from highest to lowest. Physicians' 5 top-ranking procedures were wearing gloves during the PE, asking agreement for the examination, paying attention to privacy during the PE, protecting the woman's personal information, and protecting the woman's medical records. Physicians' 5 lowest ranking procedures were telling the woman before inserting the speculum that she will feel some pressure, explaining the procedure before the PE, proactively providing information, asking the woman how she feels during the PE, asking a woman's permission to examine prior to commencing the PE, and describing observations to the woman during the PE (the last two procedures were tied for 5th rank). For 15 of the 23 PE procedures, physicians' perceptions did not differ significantly from their practices as assessed by attending nurses. The remaining 8 procedures were statistically significant between physicians' perception and their practices, and were rated higher by physicians (perception) than by attending nurses (practice). CONCLUSION: The 5 top-ranking PE procedures in terms of perceived importance were related to procedural behaviors, whereas the 5 lowest ranking procedures were verbal statements with explicit affective content. During nurse-observed PEs, Taiwanese physicians consistently practiced the procedural aspects of PEs they perceived as important (e.g., communication and consultation, protection and skilled technique, and confidentiality). However, physicians' practices were less consistent in affective aspects (e.g., explanation and consent, information and instruction, and sensitivity). PRACTICE IMPLICATIONS: Our results suggest that physicians should concentrate not only on procedural behaviors, but also on affective behaviors. These findings could be incorporated in medical education, particularly for medical students training to become obstetric and gynecological physicians.     

Comparison of CD-Rom and Internet access to clinical information

INTRODUCTION: The New Zealand National Poisons Centre has developed an extensive clinical poisons information database, TOXINZ. This resource was originally provided on a CD-Rom, and in 2002 made accessible solely via the Internet (www.toxinz.com). It was unknown whether users would prefer the CD-Rom or Internet version to access the same information. METHODS: In September 2003 a total of 100 questionnaires were mailed to the emergency departments of 15 hospitals to be answered by medical and nursing staff utilizing the Internet version of TOXINZ. The results were then compared with a nearly identical questionnaire conducted in the same way in the same hospitals when only the CD-Rom database version was available. RESULTS: There was a 79% response rate with both medical and nursing staff rating the poisons management recommendations highly when accessed both on CD-Rom and Internet. Statistically significant differences (p<0.05, Mann-Whitney U-test) identified the Internet accessed database as: supplying better visual aids, being more repetitive, harder to search, and more difficult to print. CONCLUSION: Those developing Internet accessible databases for a healthcare environment are encouraged to incorporate robust search functionality, mobility solutions, and an ability to integrate with other healthcare applications.     

Effects of affirmative action in medical schools. A study of the class of 1975

In the early 1970s, affirmative-action programs were introduced to accomplish a number of social goals, including increasing the supply of minority physicians and improving the health care of the poor. To assess the success of such programs, we analyzed data on people who graduated from U.S. medical schools in 1975 to determine how specialty choice, practice locations, patient populations served, and board-certification rates differ between minority and nonminority graduates. A larger proportion of minority graduates (55 per cent vs. 41 per cent, P less than 0.001) chose the primary-care specialties of family practice, general internal medicine, general pediatrics, and obstetrics-gynecology. Significantly more minority physicians (12 per cent vs. 6 per cent, P less than 0.01) practiced in locations designated as health-manpower shortage areas by the federal government and had more Medicaid recipients in their patient populations (31 per cent for blacks, 24 per cent for Hispanics, 14 per cent for whites; P less than 0.001). Physicians from each racial or ethnic group served disproportionately more patients of their own racial or ethnic group (P less than 0.001), but minority physicians did not serve significantly more persons from other racial or ethnic minority groups than did nonminority physicians. Many minority physicians served patient populations much like those of their nonminority colleagues, which indicates that substantial integration of the medical marketplace has taken place. Significantly fewer minority graduates had become board-certified by 1984 (48 per cent vs. 80 per cent, P less than 0.001), and most of this disparity was associated with differences in premedical-school characteristics and in the patient populations they served. Our analysis shows that minority graduates of the medical school class of 1975 are fulfilling many of the objectives of affirmative-action programs.     

Cognitive factors influencing perceptions of clinical documentation tools

Identifying healthcare providers' perceptions of clinical documentation methods can inform the design of computer-based documentation tools. The authors investigated the cognitive factors underlying such perceptions by performing a qualitative analysis that included open-ended in-depth interviews of a convenience sample of healthcare providers who use a variety of documentation methods. A total of 16 providers participated in the study; subjects included physicians and nurse practitioners from medical and surgical specialties who used paper- and computer-based documentation tools. Based on interview data, authors identified five factors that influenced satisfaction with clinical documentation tools: document system time efficiency, availability, expressivity, structure, and quality. These factors, if validated by subsequent investigations, can be used to develop a formal conceptual model of providers' perceptions of their satisfaction with various documentation systems.     

Medical students' involvement in outpatient clinical encounters: a survey of patients and their obstetricians-gynecologists.

PURPOSE: To study women's prior exposure to medical students during office visits, and the association between this and other factors in the likelihood of patients consenting to medical students' involvement in obstetrical-gynecological (ob-gyn) care. Physicians also were surveyed regarding their perceptions of patients' preferences. METHOD: In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit and to their providers at six community campuses of Michigan State University College of Human Medicine. The questionnaire asked for patients' demographic information and prior experience with medical students, factors important when deciding to allow medical students to participate in their care, and how knowledge of medical students' involvement influences patients' choice of an ob-gyn. RESULTS: Seventy-two physicians and 1,059 patients returned the questionnaire. Four hundred eighty-eight (49%) patients reported prior experience with medical students. Patients and physicians rated interpersonal skills as most important when deciding about medical students' participation. Forty-three (63%) physicians thought students should participate in the history and physical examination compared to 299 (31%) patients. Prior experience with medical students was a major facilitating factor for medical students' involvement while patients' needs were a limiting factor. Patients' age and medical students' gender also predicted patients' attitudes. CONCLUSIONS: Most women would allow medical students to participate in their care, a finding moderated by a number of factors. A small proportion of women were biased against participation of male medical students. Physicians overestimated patients' ratings and might themselves be a source of bias regarding medical students' involvement.     

Medical informatics training programme to support the Romanian health care management information system

The Health Management Information System (HMIS) project initiated by the Romanian Ministry of Health as a component of the healthcare reform is aiming to ensure the technical, functional and operative support for: (i) a better overview of the population health status, of the medical care needs and of the Health System performances; (ii) the improvement of the resource allocation and consumption; and (iii) reform support. This system is supposed to assure a better information flow from the lower to the upper levels of the healthcare network by help of a modern IT support. In the first development stage the system is planned to link the Ministry of Health with the 41 District Health Authorities (DHAs) and with more than 200 pilot health units. The implementation of such a large system raises serious problems of acceptability and a thorough training programme for both technical staff and end users must be considered in order to face this challenge.     

How doctors learn: education and learning across the medical-school-to-practice trajectory.

People have needs they address daily over the course of their lives. They address these needs through identifying and resolving problems in ways that reflect their identities. This means that education, including medical education, is an identity development process because it provides people with more and better ways to satisfy their needs. Also, education does this by providing them with the knowledge and skills they use to occupy identifiable niches in society. These niches are describable in terms of what people do and the ways in which they relate to others. Medical education, in other words, allows medical students and residents to take on physicians' identities, and their identities go a long way toward defining when, where, and how they will address their psychosocial needs. Doctors begin developing the skills and knowledge they need in medical school and continue developing them through residency and into practice. However, there are important differences among medical students, residents, and practicing physicians, and these differences have an impact on how the individuals satisfy their psychosocial needs. These differences also bear on how well they will satisfy their needs later in their careers; i.e., the things physicians-in-training do to satisfy their psychosocial needs in the course of learning to become doctors are expected to prepare them to address their psychosocial needs later in life in their roles as both healers and professionals. It is against this background of describing how education helps physicians solve problems and so address their recurring psychosocial needs that the author presents 12 conclusions concerning physicians' learning.     

An international summer school on health informatics: a collaborative effort of the Amsterdam Medical Informatics Program and IPhiE--the International Partnership for Health Informatics Education

PURPOSE: Today, the need for health informatics training for health care professionals is acknowledged and educational opportunities for these professionals are increasing. To contribute to these efforts, a new initiative was undertaken by the Medical Informatics Program of the University of Amsterdam-Academic Medical Center and IPHIE (IPhiE)-the International Partnership for Health Informatics Education. In the year 2004, a summer school on health informatics was organized for advanced medical students from all over the world. METHODS: We elaborate on the goals and the program for this summer school. In developing the course, we followed the international guidelines of the International Medical Informatics Association-IMIA. Students provided feedback for the course through both summative and formative evaluations. As a result of these evaluations, we outline the lessons we have learned and what consequences these results have had in revising the course. RESULTS: Overall the results of both the summative and formative evaluation of the summer school showed that we succeeded in the goals we set at the beginning of the course. Students highly appreciated the course content and indicated that the course fulfilled their educational needs. The decision support and image processing computer practicums however proved too high level. We therefore will redesign these practicums to competence requirements of medical doctors as defined by IMIA. All participants recommended the summer school event to other students. CONCLUSIONS: Our experiences demonstrated a true need for health informatics education among medical students and that even a 2 weeks course can fulfill health informatics educational needs of these future physicians. Further establishment of health informatics courses for other health professions is recommended.     

Information exchange in the NICU: what sources of patient data do physicians prefer to use?

BACKGROUND: There are significant gaps in understanding what sources of patient information physicians utilize in the Neonatal Intensive Care Unit (NICU). OBJECTIVE: We conducted a qualitative study of physicians' self-report of information-seeking behaviors in the NICU of an academic medical center. METHODS: The study used a survey design to assess resident and faculty physicians' perceptions of their utilization of written and verbal sources of patient information. Faculty and resident responses were compared by t-tests to assess how perceptions of information-seeking behavior might differ between these two groups. RESULTS: Of the options listed in our survey, the three most commonly reported information sources were: (1) the bedside flowsheet; (2) conversations with resident physicians; and (3) conversations with nurses. Notes written by physicians-especially resident notes-were the least reported source of patient information. CONCLUSIONS: Physicians' preference to use verbal communication is consistent with prior studies. This study identifies that the bedside flowsheet is also an important source of information, while other written sources-especially resident notes-appear not to be utilized as frequently. Understanding why physicians use or fail to use different sources of patient information may shed light on ways to improve information exchange and reduce medical error in complex settings such as the NICU.     

Understanding Physicians’ and Nurses’ Adaption of National-Leading Patient Safety Culture Policy: A Qualitative Study in Tertiary and General Hospitals in Korea

BackgroundIn Korea, the safety culture is led by national policy. How the policy ensures a patient safety culture needs to be investigated. This study aimed to examine the way in which physicians and nurses regard, understand, or interpret the patient safety-related policy in the hospital setting.MethodsIn this qualitative study, we conducted four focus group interviews (FGIs) with 25 physicians and nurses from tertiary and general hospitals in South Korea. FGIs data were analyzed using thematic analysis, which was conducted in an inductive and interpretative way.ResultsThree themes were identified. The healthcare providers recognized its benefits in the forms of knowledge, information and training at least although the policy implemented by the law forcibly and temporarily. The second theme was about the interaction of the policy and the Korean context of healthcare, which makes a “turning point” in the safety culture. The final theme was about some strains and conflicts resulting from patient safety policy.ConclusionTo provide a patient safety culture, it is necessary to develop a plan to improve the voluntary participation of healthcare professionals and their commitment to safety. Hospitals should provide more resources and support for healthcare professionals.     

Two complementary personal medication management applications developed on a common platform: case report

Background

Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs.

Objective

Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet).

Methods

The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC.

Results

We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children.

Conclusions

These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.     

Decision support needs for shared clinical decision-making regarding HPV vaccination among adults 27–45 years of age

ObjectiveIdentify HPV information needs and shared clinical decision-making preferences among adults 27–45 and describe differences in needs and preferences among underserved and vulnerable populations.MethodsParticipants 27–45 years old with no history of HPV vaccination completed a cross-sectional web-based survey between April-May 2020 (N = 702). Preferred role in shared clinical decision making was described across demographic groups and sociodemographic correlates of HPV vaccine information needs.ResultsMost (77.6%) reported a preference to make a medical decision on their own or after consulting with a healthcare provider, while the remaining respondents preferred to make a joint decision (17.0%) or for their doctor to make the decision (5.4%). Over 80% needed more information about safety, effectiveness, personal benefit, provider recommendation, side effects, and risks. Education was the strongest demographic factors associated with higher information needs (p<0.05).ConclusionThe majority of individuals across demographic groups were individually focused with regard to their healthcare decisions and wanted more information about HPV vaccine safety, side effects, and risks, in addition to personalized information about benefits from HPV vaccination.Practical implicationsPatient-centered interventions are needed to engage adults in shared decision-making regarding HPV vaccination.     

Nurses' and nurse students' demands of functions and usability in a PDA

INTRODUCTION: Healthcare organisations are nowadays expecting the support of IT in the daily routines. Personal digital assistants (PDAs) are in use in some healthcare organisations but in an irregular and unplanned way. The aim of the present study was to describe nurses' and nurse students' demands of functions and usability in a PDA. METHODS: Interviews were made with 12 nurses at the County Hospital of Kalmar and a questionnaire was given to nurse students (n=84) in their last, i.e. third, year at the Department of Health and Behavioural Sciences, University of Kalmar. RESULTS: There was a need for nurses to make the information in general more rich and efficient by means of a PDA. In a PDA, the nurses and nurse students expected access to information about the patients, knowledge resources and functions for their daily work. CONCLUSIONS: The nurses and nurse students had high expectations of a PDA for information retrieval. A PDA has the potential to be accepted as a supportive tool in healthcare organisations if it contains the demanded content which must be adapted to the users' needs and the general IT-system used, and the PDA must have a user friendly design.     

Significance testing as perverse probabilistic reasoning

Truth claims in the medical literature rely heavily on statistical significance testing. Unfortunately, most physicians misunderstand the underlying probabilistic logic of significance tests and consequently often misinterpret their results. This near-universal misunderstanding is highlighted by means of a simple quiz which we administered to 246 physicians at two major academic hospitals, on which the proportion of incorrect responses exceeded 90%. A solid understanding of the fundamental concepts of probability theory is becoming essential to the rational interpretation of medical information. This essay provides a technically sound review of these concepts that is accessible to a medical audience. We also briefly review the debate in the cognitive sciences regarding physicians' aptitude for probabilistic inference.