Patient-Centered Care for Women: Delphi Consensus on Evidence-Derived Recommendations

ObjectivePatient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW.MethodsWe used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women’s health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7.ResultsThe response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6).ConclusionThe recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.     

Nature and Predictors of Response Changes in Modified-Delphi Panels

ObjectivesTo describe the extent and nature of changes in participants’ responses after exposure to group feedback and discussion in modified-Delphi panels and to identify factors affecting those changes.MethodsWe analyzed data from 2 online modified-Delphi panels, each consisting of 2 rating rounds and an online discussion round. We included responses from 55 participants who answered 38 questions in both rating rounds. Because not all participants answered each question twice, our sample consisted of 1846 cases (response changes). We used mixed-effect logistic and multinomial logistic regression to identify factors predicting response changes and their direction relative to group median—our consensus measure.ResultsParticipants changed, on average, 49% of their responses. A response was changed in 47% of the 1846 cases: 28% of responses were changed toward consensus and 19% away from it. Although some measures of subjective participation experiences had a marginally significant impact on the propensity and direction of response changes, several objective measures of discussion engagement were statistically significant predictors of both the presence and direction of response changes.ConclusionOur results illustrate the nature of response changes and highlight the importance of exposing participants to alternative perspectives and encouraging them to explain their perspectives.     

上海市医患纠纷人民调解中的专家咨询制度

在医患纠纷人民调解工作中,上海市实行了专家咨询指导工作,并建立了900余名专家库、建立了专家咨询工作标准,规定了专家咨询的工作程序,形成了一整套的专家咨询制度.在专家咨询形式上作出了有益的探索和思考.     

Consistent with: what doctors say and jurors hear

While there is an extensive body of literature regarding the factors that influence how juries interpret medical expert statements, there is limited empirical evidence regarding the effects of word choice. The term ‘consistent with’ is widely used in legal proceedings and expert witness statements, so it is important to understand what this term means to a jury. The aim of this research is to understand how potential jurors interpret the phrase ‘consistent with’ in a forensic medical context. Potential jurors were recruited for a survey containing three mock vignettes where the doctor stated that the injury was ‘consistent with’ either self-inflicted injury, accidental injury, or injury by a third party. Participants were asked what the doctor meant, using a range of options taken from the United Nations’ Istanbul Protocol definitions of medico-legal terms used to describe lesions caused by torture. The results from 151 surveys indicate there was no consistent interpretation of the phase within each vignette or between vignettes. This research demonstrates that the phrase ‘consistent with’ can be interpreted in a variety of ways: caution is therefore required when using this expression in legal proceedings. Further research regarding the best choice of terms to use in court is required.     

两种DRG绩效评价方法的应用效果比较研究

目的探讨两种DRG绩效评价方法的应用效果。方法一种方法为灰色关联熵权法,它是在DRG指标同质化基础上,结合熵权法和灰色关联度确定各科室DRG绩效值;另一种方法是专家咨询法计算绩效值。对比这两种评价方法的绩效排序。结果两种方法的评价结果呈弱正相关（Kendall秩相关系数为0.333,P＜0.05）,评价结果差异无统计学意义（配对秩和统计量为0.824,P＞0.05）。专家咨询法评价中有16个科室绩效值相同,而灰色关联熵权法评价中未出现科室绩效值相同情况。结论与专家咨询法相比,灰色关联熵权法的评价区分度更高,客观性更强,可为管理决策提供科学有效的依据。     

Competencies required for General Practice Clinical Pharmacists providing the Scottish Pharmacotherapy Service: A modified eDelphi study

Due to work load pressures in primary care, increasing efforts are being made internationally to implement pharmacists working alongside general practitioners. While there is wide interest in the contributions pharmacists can make within primary care, there is limited research which explores the competencies pharmacists need to safely and effectively provide care in this arena. Therefore, a modified eDelphi study was conducted between July 2019 and January 2020 among pharmacists working in General Practice in Scotland in order to (a) generate a list of competencies required to undertake pharmacotherapy tasks within General Practice using content analysis; and (b) establish consensus regarding the importance of these competencies using a rating scale ranging from 1 (“not important”) to 10 (“very important”). A framework of competencies was developed, containing eight competency categories with a total of 31 individual competency items. Overall, study participants considered all eight competency categories as being important, with a mode of 10 and a median >8; agreement among participants was high, with the majority of individual competency items rated 8 or above by more than 75% of participants. There was, however, variation in responses with regards to specific tasks such as medicines reconciliation and medication compliance reviews. Findings indicate that the GP setting requires a broad set of competencies—covering areas including the use of IT systems; clinical knowledge; and communicating with patients and other healthcare professionals. This implies that further emphasis on clinical and consultation skills should be added to training programmes aimed at GP pharmacists; furthermore, ongoing support is also needed with regards to generic skills such as the use of IT systems, documentation, and general procedures and processes within primary care, some of which might need to be tailored to the specific practice context.     

胆管癌光动力治疗临床应用技术规范专家共识

光动力治疗（PDT）是一种有效的肿瘤微创治疗手段,可联合胆管支架、胆道外引流、化疗等全身治疗方法治疗胆管癌,主要适用于不可手术切除胆管癌的治疗和术后肿瘤残留或局部复发的辅助性治疗,可有效控制肿瘤局部进展、解除胆道梗阻、改善患者生活质量、延长生存期,具有微创、精准及可重复等优点。目前用于胆管癌PDT的临床循证医学证据有限,缺乏临床诊疗技术规范和共识。中华医学会外科学分会外科手术学组、中华医学会外科学分会胆道外科学组及中国医师协会外科医师分会胆道外科医师委员会组织相关专家,对其适应证、禁忌证、技术操作规范、疗效评价及并发症处理等进行讨论,并达成共识,旨在为PDT在胆管癌治疗中的临床应用提供参考。     

对《胃食管反流病中医诊疗专家共识意见(2017)》的思考

通过回顾古今相关文献,特别是近些年中医诊治胃食管反流病的共识意见,结合自身实践经验,从病名、病机、诊断、证型、治疗目标、诊治流程6个方面对《胃食管反流病中医诊疗专家共识意见(2017)》进行探讨。认为中医也应当使用"胃食管反流病"作为统一病名,正确理解反酸的发生机制尤为重要;建议发挥中医药试验性治疗及针灸穴位探查在胃食管反流病诊断中的作用,临诊之时首分有无典型反流症状,再结合兼症、舌脉进行辨证;以"治反"为主要策略,以治病求本为治疗原则。同时,重新勾勒中医诊治胃食管反流病的流程图,为临床诊治本病提供帮助和参考。