Modeling patients' acceptance of provider-delivered e-health

ObjectiveHealth care providers are beginning to deliver a range of Internet-based services to patients; however, it is not clear which of these e-health services patients need or desire. The authors propose that patients' acceptance of provider-delivered e-health can be modeled in advance of application development by measuring the effects of several key antecedents to e-health use and applying models of acceptance developed in the information technology (IT) field.DesignThis study tested three theoretical models of IT acceptance among patients who had recently registered for access to provider-delivered e-health.MeasurementsAn online questionnaire administered items measuring perceptual constructs from the IT acceptance models (intrinsic motivation, perceived ease of use, perceived usefulness/extrinsic motivation, and behavioral intention to use e-health) and five hypothesized antecedents (satisfaction with medical care, health care knowledge, Internet dependence, information-seeking preference, and health care need). Responses were collected and stored in a central database.ResultsAll tested IT acceptance models performed well in predicting patients' behavioral intention to use e-health. Antecedent factors of satisfaction with provider, information-seeking preference, and Internet dependence uniquely predicted constructs in the models.ConclusionInformation technology acceptance models provide a means to understand which aspects of e-health are valued by patients and how this may affect future use. In addition, antecedents to the models can be used to predict e-health acceptance in advance of system development.     

结直肠癌患者术前疾病不确定感的影响因素及治疗性沟通护理对患者生活质量的影响

目的:探究结直肠癌患者术前疾病不确定感的影响因素及治疗性沟通护理对患者生活质量的影响。方法:选取2016年8月～2017年9月天津市人民医院收治的226例结直肠癌患者作为研究对象,随机分对照组116例行常规护理,观察组116例行治疗性沟通护理。收集患者临床资料并行Mishel疾病不确定感量表(Mishel's uncertainty in illness scale,MUIS)评分,采用Logistic回归分析危险因子;并比较干预前、后生活质量核心问卷(quality of life questionnare-core30,QLQ-C30)评分。结果:自我性格内向、付费方式自费、家庭月收入低于3 000元、家庭住址在农村以及文化程度大专以下的患者其MUIS得分均显著增加,差异有统计学意义(P<0.05),且Logistics回归分析显示其均为危险因素。在生活质量方面,观察组患者干预后部分得分有所增高,而对照组患者干预前、后差异无统计学意义(P>0.05);治疗后观察组患者在情绪功能、角色功能和整体生活质量得分显著高于对照组患者,差异有统计学意义(P<0.05)。结论:自我性格、付费方式、家庭月收入、家庭所在地、文化程度均为结直肠癌患者术前疾病不确定感的影响因素,而治疗性沟通护理的应用则有利于提高患者生活质量。     

网络讨论的现状与策略探讨

现有网络平台提供的各种实时、非实时的交互工具已经能够满足网络环境下学生与教师、以及学生与学生之间的交互需求,并随着技术的进步与成熟将愈加显现出网络交互的优势。但技术的进步并不能直接促进交互的发生,为使网络环境下的讨论活动有效进行,就必须对其进行精心的设计与组织。文章分析了目前网络讨论的组织与实施状况,在此基础上进一步探讨了促进网络讨论的交互设计策略。     

网络教学支撑平台中交互功能模块分析

网络教学支撑平台是计算机网络技术、多媒体技术在教育中的典型应用,它实现了网络环境下处于分离状态的教与学的再度整合,其作用的发挥很大程度上依赖于平台所提供的各种交互功能模块的有效性。文章在分析网络教学支撑平台中交互功能模块的现状和存在问题的基础上,阐述了问题的解决策略,即提出了支持多种教学模式的弹性变化、动态呈现的构建模型及其交互活动的组织与实施。     

辅助生殖技术中影响出生婴儿性别比的相关因素分析

目的探讨辅助生殖技术（ART）中影响出生婴儿性别比的相关因素。方法收集2008年1月~2014年3月于我院接受ART
治疗并成功分娩的4348个周期的患者的临床资料,包括男女双方年龄、不孕原因、授精方式、移植胚胎期别、移植胚胎类型、分
娩类型（单胎、双胎分娩）、既往ART流产次数、ART分娩次数和分娩的5607名新生儿的性别,分析不同因素对于分娩新生儿性
别的影响。结果共有3019名男婴和2588名女婴出生,性别比为116∶100;单胎分娩的3087名新生儿出生性别比为117∶100;双
胎分娩的2520名新生儿性别比为116:100;经ART治疗一胎分娩5542名新生儿出生性别比为117∶100;二胎分娩新生儿65名,
出生性别比为117∶100。在单胎妊娠活产婴儿中,若女方或男方高龄,出生男婴比例较对照组（年龄<35 岁）显著增高(分别为
58.4% vs 52.8%,P=0.012;56.4% vs 52.3%;P=0.026）,同时观察到ICSI组出生男婴比例较IVF组明显较低（45.7% vs 55.6%,P<
0.001）,其它因素则对出生婴儿性别比无显著影响;在双胎妊娠活产新生儿组中,上述不同因素对出生新生儿性别比均无显著
性差异。ART治疗后生育一胎新生儿中,女方高龄组出生男婴比例显著高于对照组（57.4% vs 53.0%, P=0.009）,并可知ICSI组
中出生男婴比例显著低于IVF组（48.6% vs 55.4%, P=0.001）;而ART治疗后生育二胎新生儿中,不同因素各组间出生婴儿性别
比均无显著性差异。单因素Logistic 回归分析提示,女方年龄（OR：0.836,95% CI 0.731~0.955,P<0.05）、授精方式（OR∶
1.151,95% CI 1.027~1.289,P<0.05）对出生婴儿性别比产生的影响有统计学意义,其它因素对出生婴儿性别比则无显著影响。
进一步行多因素Logistic回归分析提示,无独立的预测因素。结论经ART治疗后高龄女性生育男性婴儿比例更高,在单胎活
产婴儿中男方高龄与出生男婴比例增加相关,而ICSI授精方式较IVF女性婴儿比例更高。
     

家庭自我管理在糖尿病儿童居家护理中的应用效果研究

目的:研究家庭自我管理在糖尿病儿童居家护理中的应用效果。方法:选取2015年3月至2016年7月医院住院部收治的糖尿病儿童80例,随机分为对照组(n=40)和观察组(n=40)。对照组采用常规健康宣教的方法护理,观察组在对照组基础上采用家庭自我管理护理,通过出院后的家庭访视及电话回访指导患儿家庭进行居家护理,强化家庭在疾病治疗中的作用。比较两组患儿血糖控制情况、遵医率、并发症发生率及患儿家长糖尿病健康知识掌握度。结果:两组患儿出院前空腹血糖、餐后2 h血糖及糖化血红蛋白水平比较差异无统计学意义(P>0.05);观察组通过家庭自我管理后空腹血糖、餐后2 h血糖及糖化血红蛋白水平,均低于对照组(P<0.05),差异有统计学意义;观察组家庭自我管理后遵医行为中门诊就诊、血糖监测、饮食规律、运动锻炼及安全用药率,均高于对照组(P<0.05);观察组并发症发生率,低于对照组(P<0.05),差异有统计学意义。两组出院前患儿家长糖尿病健康知识掌握度比较差异无统计学意义(P>0.05);观察组出院3个月后患儿家长糖尿病健康知识掌握度高于对照组(P<0.05),差异有统计学意义。结论:糖尿病儿童治疗中实施家庭自我管理效果理想,有利于控制患儿血糖,降低并发症发生率,值得推广应用。     

Factors affecting physicians' decisions to forgo life-sustaining treatments in terminal care

OBJECTIVES: Treatment decisions in ethically complex situations are known to depend on a physician's personal characteristics and medical experience. We sought to study variability in decisions to withdraw or withhold specific life-supporting treatments in terminal care and to evaluate the association between decisions and such background factors. DESIGN: Readiness to withdraw or withhold treatment options was studied using a terminal cancer patient scenario with alternatives. Physicians were asked about their attitudes, life values, experience, and training; sociodemographic data were also collected. SETTING: Finnish physicians, postal survey. SURVEY SAMPLE: Five hundred general practitioners, 300 surgeons, 300 internists, and 82 oncologists. RESULTS: Treatments most often forgone were blood transfusion (82%) and thrombosis prophylaxis (81%). Least willingly abandoned were intravenous (i.v.) hydration (29%) and supplementary oxygen (13%). Female doctors were less likely to discontinue thrombosis prophylaxis (p=0.022) and supplementary oxygen (p<0.001), but more readily x ray (p=0.039) and laboratory (p=0.057) examinations. Young doctors were more likely to continue antibiotics (p=0.025), thrombosis prophylaxis (p=0.006), supplementary oxygen (p=0.004) and laboratory tests (p=0.041). Oncologists comprised the specialty most ready to forgo all studied treatments except antibiotics and blood transfusion. The family's wishes (alternative 1) significantly increased treatment activity. Young and female practitioners and oncologists were most influenced by family appeal. Advance directives (alternative 2) made decisions significantly more reserved and uniform. Different factors in the physician's background were found to predict decisions to withdraw antibiotics or i.v. hydration. CONCLUSION: The considerable variation observed in doctors' decisions to forgo specific life-sustaining treatments (LST) was seen to depend on their personal background factors. Experience, supervision, and postgraduate education seemed to be associated with more reserved treatment decisions. To increase the objectivity of end of life decisions, training, and research are of prime significance in this ethically complex area of medicine.     

虚拟现实技术在Web课件中的应用

通过对虚拟现实技术在实际教学中的应用研究,概括了Web课件中虚拟现实技术的应用特点,并分别介绍了Web课件中的二维虚拟技术、三维虚拟技术、VRML技术和Flash虚拟技术,同时结合实例,对每种虚拟效果的制作过程做了讲解,指出了在Web课件中应用虚拟现实技术时应注意的事项.     

医院实施药学服务的影响因素与对策

目的：探寻目前医院实施药学服务过程中存在的问题,分析其原因并提出相应对策。方法：选取广州市四家三级甲等医院的药学人员进行问卷调查。结果：大部分药学人员认为法规因素和药师观念是阻碍药学服务实施的主要因素,药师专业因素和教育因素也是阻碍医院实施药学服务的重要因素。结论：建议国家有关部门应尽快出台针对医院药学服务的法律、法规和规章,明确药师开展药学服务的内容、程序;改革药学教育模式;完善医院药师继续教育工作;加强医疗机构自身管理,建立健全药学服务管理制度,加大药学服务的宣传力度。     

Some factors affecting acceptance of family planning in Manus.

This paper examines selected factors affecting the acceptance and delivery of modern family planning from health centres in Manus. A survey was carried out of mothers attending Maternal and Child Health clinics and a written questionnaire was given to health workers. The survey of mothers demonstrated the importance of the husband's approval for contraceptive practice and showed that knowledge about traditional methods of family planning is widespread. The health workers' questionnaire demonstrated a high level of dissatisfaction with the current family planning program delivered by health clinics: 45% found the program ineffective; 68% wrote that health workers' attitudes discouraged mothers from attending for family planning. The perceived and actual benefits and costs of children and the role of men should be assessed locally before planning future family planning programs. Widespread retraining and motivating of health workers is essential if improved coverage is to be achieved through health services. The efficacy of alternative methods of delivery of family planning such as local community-based and social marketing programs should also be investigated.     

Patient self-management of chronic disease in primary care

Thomas Bodenheimer, MD; Kate Lorig, RN, DrPH; Halsted Holman, MD; Kevin Grumbach, MD

JAMA. 2002;288:2469-2475.

Patients with chronic conditions make day-to-day decisions about—self-manage—their illnesses. This reality introduces a new chronic disease paradigm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient education offers information and technical skills, self-management education teaches problem-solving skills. A central concept in self-management is self-efficacy—confidence to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced when patients succeed in solving patient-identified problems. Evidence from controlled clinical trials suggests that (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Self-management education for chronic illness may soon become an integral part of high-quality primary care.

     

Onconet: a secure infrastructure to improve cancer patients' care

The shared care paradigm is the current response to the crisis of industrial countries' health systems. The underlying information systems have to meet the shared care paradigm of communication and co-operation between all the partners involved in. This communication and co-operation must be provided in a secure way. The paper presents the required security infrastructure which has been analysed, specified, and developed within the TrustHealth projects funded by the European Commission. Meeting the challenges of the TrustHealth-2 project for large scale implementations of secure real applications, the ONCONET has been established in the German federal state of Saxony-Anhalt facilitating the shared care of cancer patients. Both security infrastructure and application functionalities are demonstrated in some detail.     

Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients' need for symptom management support: a randomized clinical trial

Objective

To examine the effects of a computer-assisted, interactive tailored patient assessment (ITPA) tool in oncology practice on: documented patient care, symptom distress, and patients'' need for symptom management support during treatment and rehabilitation.

Design and methods

For this repeated measures clinical trial at a university hospital in Norway, 145 patients starting treatment for leukemia or lymphoma were randomly assigned to either an intervention (n=75) or control group (n=70). Both groups used the ITPA for symptom assessments prior to inpatient and outpatient visits for up to one year. The assessment summary, which displayed patients'' self-reported symptoms, problems, and distress in rank-order of the patient''s need for support, was provided to physicians and nurses in the intervention group only but not in the control group.

Results

Significantly more symptoms were addressed in the intervention group patient charts versus those of the control group. Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories.

Conclusion

This is the first study to show that an ITPA used in an interdisciplinary oncology practice can significantly improve patient-centered care and patient outcomes, including reduced symptom distress and reduced need for symptom management support.     

前臂骨折小夹板固定后的居家护理

目的:干预前臂骨折患者采取小夹板固定后的居家护理。方法:对108例入院接受小夹板固定的前臂骨折患者在出院前进行居家健康宣教,指导患者进行日常的生活自理能力、饮食、功能锻炼、伤肢观察护理及相关注意事项等。出院后每周电话回访,跟进患者是否遵循医嘱指导。结果:患者对护士的指导及电话回访满意度提高,提高了其自护能力和遵医行为。结论:通过对患者的居家指导,患者掌握日常的生活自理能力,减轻家庭负担,提高患者生活质量。     

家庭远程监护网络系统设计

本文设计了一种家庭医疗保健远程监护网络系统,并详细介绍了远程监护技术与家庭医疗保健相结合的应用实例--家庭远程监护网络.     

Factors determining patients' satisfaction in a family practice residency teaching center

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.