化疗患者血管通路装置决策辅助工具的应用现状

决策辅助工具可以为患者提供更多的信息,减少其决策冲突,帮助患者选择最佳的血管通路。对化疗患者血管通路的重要性,决策辅助工具的类型(包括电子处方系统可集成工具、癌症患者血管通路困难置管工具、AVATAR工具、成人静脉通路困难认知辅助工具、结构化评估和决策工具、成本效用分析工具)、应用及效果、影响因素等进行综述,旨在为促进临床应用血管通路装置决策辅助工具,落实患者参与决策提供参考。     

Active transcutaneous bone conduction implant: audiological results in paediatric patients with bilateral microtia associated with external auditory canal atresia

Objective: To describe, in terms of functional gain and word recognition, the audiological results of patients under 18 years of age implanted with the active bone conduction implant, Bonebridge?. Design: Retrospective case studies conducted by reviewing the medical records of patients receiving implants between 2014 and 2016 in the public health sector in Chile. Study sample: All patients implanted with the Bonebridge were included (N?=?15). Individuals who had bilateral conductive hearing loss, secondary to external ear malformations, were considered as candidates. Results: The average hearing threshold one month after switch on was 25.2?dB (95%CI 23.5–26.9). Hearing thresholds between 0.5 and 4?kHz were better when compared with bone conduction hearing aids. Best performance was observed at 4?kHz, where improvements to hearing were observed throughout the adaptation process. There was evidence of a significant increase in the recognition of monosyllables. Conclusions: The Bonebridge implant showed improvements to hearing thresholds and word recognition in paediatric patients with congenital conductive hearing loss.     

Are hearing aid owners able to identify and self-report handling difficulties? A pilot study

Objective: Although clinician administered surveys evaluating hearing aid handling skills exist, the development of a self-administered version may reduce clinical load, save consultation time, and facilitate more frequent use than face-to-face consultations allow. However, there is currently no evidence to support whether hearing aid owners can accurately self-report hearing aid handling skills via self-report survey that systematically evaluates the ability to accurately perform the individual aspects of hearing aid handling required for effective hearing aid management. Design: An explorative pilot study using a prospective research design. Study sample: Nineteen adult hearing aid owners, aged between 65 and 93 years. Results: The self-administered survey demonstrated high sensitivity when compared with clinician evaluation of skills, with 93% of participants accurately self-identifying and reporting whether hearing aid handling skill training was required. Conclusions: Hearing aid owners are able to accurately self-report hearing aid handling difficulties when provided with an itemised list of skills.     

Creatine in Health and Disease

Although creatine has been mostly studied as an ergogenic aid for exercise, training, and sport, several health and potential therapeutic benefits have been reported. This is because creatine plays a critical role in cellular metabolism, particularly during metabolically stressed states, and limitations in the ability to transport and/or store creatine can impair metabolism. Moreover, increasing availability of creatine in tissue may enhance cellular metabolism and thereby lessen the severity of injury and/or disease conditions, particularly when oxygen availability is compromised. This systematic review assesses the peer-reviewed scientific and medical evidence related to creatine’s role in promoting general health as we age and how creatine supplementation has been used as a nutritional strategy to help individuals recover from injury and/or manage chronic disease. Additionally, it provides reasonable conclusions about the role of creatine on health and disease based on current scientific evidence. Based on this analysis, it can be concluded that creatine supplementation has several health and therapeutic benefits throughout the lifespan.     

Influence of Shared Decision Making on Decisional Conflict and Regret in Postpartum Mother–Infant Care: A Randomized Controlled Trial

ObjectivesAlthough postpartum rooming-in is encouraged by the World Health Organization, independent separated nursery care is still widely adopted in Eastern countries. Our aim is to evaluate the effect of shared decision making (SDM) assisted by patient decision aids on subjective decisional conflict and regret among women who are required to make choices regarding postpartum infant care.MethodsA total of 196 pregnant women who came for routine checkups 1 month before delivery were randomly assigned to the SDM group or the classic group. Before the mothers were discharged after delivery, their decision-making difficulties were evaluated. The primary outcome was the decisional conflict, which was assessed using the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) scale. The secondary outcome was the decisional regret, which was measured using the Decision Regret scale.ResultsCompared with the classic group, SDM group had surer feelings about the choice (P＜.001), felt more confident about knowing the benefits and risks of each option (P＜.001), had a clearer understanding of the benefits and risks (P＜.001), and felt sufficiently supported with enough advice to make a suitable choice (P＜.001). No significant difference was noted in the Decision Regret scores between groups. The choice of 24-hour rooming-in, 12-hour rooming-in, and separated nursery care was not significantly different between groups.ConclusionsSDM reduced the decisional conflict and uncertainty of the mothers. Available choices of postpartum mother–infant care should be provided to mothers through SDM that includes individual values, health goals, and clear knowledge and transparency.     

The effect of different styles of medical illustration on information comprehension,the perception of educational material and illness beliefs

ObjectiveTo explore how the addition of a medical illustration and its style affected information comprehension, perception of educational material and illness beliefs.Methods204 people recruited in a supermarket were randomised to read one of the four leaflets about gout and fill out a questionnaire. Three leaflets had a picture showing gout in the form of a cartoon, an anatomical drawing or a computed tomography scan (CT). The control leaflet did not contain images.ResultsSeeing an illustrated leaflet helped correctly identify treatment for gout X²(1, N = 204) = 5.51, p=0.019. Out of the three images, only the cartoon was better than text in conveying information about treatment X²(1, n = 102) = 8.84, p=0.018. Participants perceived illustrated leaflets as more visually appealing t(70) = 3.09, p = 0.003, and the anatomical image was seen as more helpful for understanding of the illness than the cartoon. Pictures did not significantly influence lay illness perceptions about gout.ConclusionPictures aid the understanding of health information and increase the visual appeal of materials. While simpler illustrations convey information more effectively, people prefer more detailed anatomical images; CT scans offer no benefits over simpler images.Practice implicationsThe results can help guide the use of images in gout education material.