RESUMEN
OBJECTIVE: To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund. METHODS: Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence. RESULTS: Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p=0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p<0.001). CONCLUSION: PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account. PRACTICE IMPLICATIONS: This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.
Asunto(s)
Toma de Decisiones , Técnicas de Apoyo para la Decisión , Depresión/psicología , Internet , Dolor de la Región Lumbar/psicología , Educación del Paciente como Asunto/métodos , Enfermedad Aguda , Adulto , Anciano , Conflicto Psicológico , Depresión/terapia , Femenino , Alemania , Humanos , Seguro de Salud , Dolor de la Región Lumbar/terapia , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Participación del Paciente/métodos , Prioridad del Paciente , Atención Dirigida al Paciente , Análisis de RegresiónRESUMEN
Argon Plasma Coagulation (APC) is an application of gas discharges in argon in electrosurgery, which is increasingly used especially in endoscopy. The major application fields are haemostasis, tissue devitalization and tissue reduction.This review describes the physics and technology of electrosurgery and APC. Some characteristics of the argon discharge are shown and discussed, and thermal effects in biological tissue are described. Subsequently, examples of medical applications are given.