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1.
Gan To Kagaku Ryoho ; 46(8): 1275-1279, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501369

RESUMO

BACKGROUND: The gap between patients' and physicians' expectations from treatment has been a difficult problem in oncology because it affects decision-making. This study identified patients' expectations from their treatment and concerns when palliative chemotherapy was initiated. METHODS: Patients completed a questionnaire, which included open-ended questions about their expectations from the treatment and their biggest concerns at that moment after a clear explanation that the nature of their metastatic or recurrent cancer treatment was palliative and not curative. One hundred and sixty-five consecutive Japanese patients were included in this study. RESULTS: Twenty-nine percent of the patients described their expectation as "symptomatic improvement,"28% as"objective treatment effect,"and 19%as"cure."The most common concern was the toxicity(41%). No significant change was revealed in later-line treatment. CONCLUSION: The patients' expectation from palliative chemotherapy and concerns should be considered more precisely in each phase. Dedicated palliative care and explanation of toxicity controlon the initiation of treatments are essential.


Assuntos
Motivação , Neoplasias , Tomada de Decisões , Humanos , Neoplasias/terapia , Cuidados Paliativos , Inquéritos e Questionários
4.
Stud Health Technol Inform ; 264: 1155-1158, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438106

RESUMO

Changing physician behaviors is difficult. Electronic health record (EHR) clinical decision support (CDS) offers an opportunity to promote guideline adherence. Behavioral economics (BE) has shown success as an approach to supporting evidence-based decision-making with little additional cognitive burden. We applied a user-centered approach to incorporate BE "nudges" into a CDS module in two "vanguard" sites utilizing: (1) semi-structured interviews with key informants (n = 8); (2) a design thinking workshop; and (3) semi-structured group interviews with clinicians. In the 133 day development phase at two clinics, the navigator section fired 299 times for 27 unique clinicians. The inbasket refill alert fired 124 times for 22 clinicians. Fifteen prescriptions for metformin were written by 11 clinicians. Our user-centered approach yielded a BE-driven CDS module with relatively high utilization by clinicians. Next steps include the addition of two modules and continued tracking of utilization, and assessment of clinical impact of the module.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Tomada de Decisões , Economia Comportamental , Humanos
5.
Stud Health Technol Inform ; 264: 1829-1830, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438364

RESUMO

The availability of statistical information is usually associated with 'better decision making', fundamentally within the paradigm of evidence-based decisions. Thus, it is interesting to understand the demands and expectations, interpretations and effective use of statistical information by decision-makers at the primary health care level, considering the implications of the recently implemented Information System in Public Health (Buenos Aires, Argentina).


Assuntos
Tomada de Decisões , Atenção Primária à Saúde , Argentina , Cidades
6.
Surg Clin North Am ; 99(5): 1019-1027, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446907

RESUMO

Shared decision making requires the exchange of information from the patient and the surgeon (and ideally involves the expertise of the entire multidisciplinary team) to determine the medical and/or surgical treatment that best aligns with the patient's goals and values. Should the surgical patient wish to transition to end-of-life care, the transition to comfort-focused care is within the scope of practice for surgeons. Incorporating the expertise of other health care professionals is an important consideration for whole-patient care. Integrating primary palliative care into surgical practice can help mitigate unnecessary suffering and allow a smoother transition to comfort-focused care.


Assuntos
Cuidados Paliativos , Assistência Terminal , Diretivas Antecipadas , Tomada de Decisões , Coração Auxiliar , Humanos , Obstrução Intestinal/terapia , Assistência Terminal/métodos
7.
Surg Clin North Am ; 99(5): 849-858, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446913

RESUMO

When making high-stakes decisions with their patients, surgeons may have only one opportunity to get a life-changing conversation right. These loaded conversations cover immense ground. Bad news, emotion, prognosis, treatment choices, and patient goals all play a part in coming up with the right plan for each individual patient. Surgeons and patients may overlook important factors when the language and process of informed consent is substituted for decision-making. "Best Case/Worst Case" is a communication tool based in scenario planning that promotes shared decision-making in high-stakes surgical conversations and is discussed at length in this review.


Assuntos
Tomada de Decisões , Relações Médico-Paciente , Prognóstico , Revelação da Verdade , Humanos , Consentimento Livre e Esclarecido , Participação do Paciente , Cirurgiões
8.
Surg Clin North Am ; 99(5): 967-975, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446921

RESUMO

Determining valid indications for vascular access creation and hemodialysis initiation in end-stage renal disease requires utilization of verified prognostication tools and recognition of triggers to initiate serious conversations, and implementation of concurrent palliative care and/or hospice care is recommended. Establishment of a multi-disciplinary team that includes consideration of interventionalists in the pre-dialysis medical situation is important. A "catheter best" approach may be the most appropriate for some patients to meet goals of care.


Assuntos
Cateterismo Periférico , Falência Renal Crônica/terapia , Diálise Renal , Tomada de Decisões , Cuidados Paliativos na Terminalidade da Vida , Humanos , Cuidados Paliativos , Equipe de Assistência ao Paciente
9.
Stud Health Technol Inform ; 263: 35-48, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411151

RESUMO

Information value chain theory provides a straightforward approach to information system evaluation and design. It first separates the different benefits and costs that might be associated with the use of a given information technology at different stages along a value chain stretching from user interaction to real world outcome. Next, using classical decision theoretic measures such as probabilities and utilities, the resulting value chain can be used to create a profile for a particular technology or technology bundle. Value chain analysis helps focus on the reasons for system implementation success or failure. It also assists in making comparative assessments amongst different solutions, to understand which might be best suited for different clinical contexts.


Assuntos
Tecnologia Biomédica , Tomada de Decisões , Avaliação da Tecnologia Biomédica , Probabilidade , Tecnologia
10.
Stud Health Technol Inform ; 263: 109-121, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31411157

RESUMO

The accumulation of medical knowledge, technology and expertise has provided people with more and more options to improve their health and increase longevity. However, healthcare options typically come with benefits as well as harms and often involve important and complex, high-stakes trade-offs. The ideal of Shared Decision Making (SDM), where a healthcare provider and a patient exchange information, bring in their respective professional and existential expertise and consider the options in light of what matters most from the patient's perspective, is a paradigm that is increasingly viewed as a gold standard for high quality care nowadays. eHealth provides ample opportunities to foster personal health choices and SDM through digital information exchange and personal values clarification support. The boosting framework attempts to describe how to foster people's competences to make choices. Its vision is to equip individuals with competences, for instance improved risk literacy, to empower them to make well-informed choices when facing a difficult choice, such as decisions about health issues. Application of the boosting framework to personal health choices and the SDM process unveils new and promising horizons for future research and could inform the design and evaluation of health informatics interventions such as decision support systems.


Assuntos
Técnicas de Apoio para a Decisão , Informática Médica , Participação do Paciente , Tomada de Decisões , Pessoal de Saúde , Humanos
11.
Rev Lat Am Enfermagem ; 27: e3169, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432922

RESUMO

OBJECTIVE: To develop a web software prototype to support retirement planning. METHOD: This is a methodological research, applied and based on the principles of prototyping model, which followed the steps of communication, planning, prototype creation, functional tests and consolidation of web software version 1. RESULTS: The functions of the web software prototype were defined from a flowchart and scope. In the creation stage, the screens that integrated the prototype, composed by interview, were projected from the filling of the Retirement Resources Inventory, screen of access to support planning materials, including lectures, scientific texts, and technical materials, retirement news screen, experiences screen, which allow users to post retirement expectations and comment on other users' posts. After performing tests, the prototype was made available at www.aposentarsecomsaude.com.br . CONCLUSION: the web software prototype consists of an interactive environment in which the user feels active in the reflection process about the retirement along the different screens. With clear language and expressions that are easily understood by the public, they are applicable to users of different professional profiles.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Aposentadoria , Desenho de Programas de Computador , Brasil , Instrução por Computador , Humanos , Acontecimentos que Mudam a Vida , Motivação , Sistemas On-Line , Reprodutibilidade dos Testes
12.
Stud Health Technol Inform ; 264: 1204-1207, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438116

RESUMO

There is evidence on interrelationships between several dental and chronic diseases. However, dentists and general practitioners often lack information when treating such multimorbid patients. Engagement of the patient in the decision making process may help to fill this gap and improve intersectoral care. The Dent@Prevent project therefore aims to develop a mobile application that can be used by patients to report information about their health status for interdisciplinary care. In this paper, the user interface concept and evaluation of the prototype of this mobile application is presented.


Assuntos
Aplicativos Móveis , Tomada de Decisões , Odontólogos , Humanos , Estudos Interdisciplinares , Participação do Paciente
13.
Stud Health Technol Inform ; 264: 1248-1252, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438125

RESUMO

Open Access provides researchers another opportunity of publishing, besides the traditional publication in subscription-based journals. Providing higher dissemination and therefore visibility as well as better accessibility, among others, Open Access helps to fulfil changed needs of authors and readers in our information and communication society of today. Though this publication model provides a lot of advantages both for readers and authors, there are also some obstacles. In order to identify the incentives that can lead scientists of medical informatics to an Open-Access-publication, we conducted a study consisting of group discussions, interviews, and surveys. This tripartite evaluation starts in its first part with group discussions and interviews. First results of them show that, among others, the higher visibility, indexing, Impact Factor and better accessibility are factors for an Open-Access-publication.


Assuntos
Acesso à Informação , Informática Médica , Tomada de Decisões , Motivação , Editoração
14.
Stud Health Technol Inform ; 264: 1288-1292, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438133

RESUMO

Low-back pain (LBP) is a leading cause of disability globally. It is complex and multifactorial, with a miriad of factors interwining and interacting to burden healthcare and individuals. Self-management support is central as part of best-practice to improve outcomes. In recent years, informatics has increasingly been considered to support care; however, due to its complex nature, several factors need to be unpacked in order to consider how technologies might support LBP. The present study utilised semi-structured interviews involving N = 20 participants (n = 10 practicing clinicains and n = 10 indidivuals living with chronic LBP (cLBP)) to collect user-centered perceptions and considerations for key factors central to technology succeeding in supporting cLBP. Six themes were identified: tracking, alterts, user-experience, communication, feedback, and content. Findings lay groundwork for future research aimed at developing technologies that can encourage shared-decision making in supporting cLBP management in a particpatory health paradigm.


Assuntos
Dor Crônica , Dor Lombar , Autogestão , Comunicação , Tomada de Decisões , Humanos , Manejo da Dor
15.
Stud Health Technol Inform ; 264: 541-545, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437982

RESUMO

Computerized simulators are important tools that support teaching in many areas. The use of these instruments is often described as significant for students and teachers. In this paper, a software piece was developed to aid decision-making in nursing, allowing the simulation of real situations, addressed in the classroom. The simulator architecture corresponds to a multi-agent system supported by a state machine model. To build the knowledge base, a list of contents was selected, including the Nursing Intervention Classification (NIC). An experiment was carried out with the participation of eleven students of the third year of the course. A questionnaire was applied and, as a result, there were more than 90% of acceptance as a relevant educational tool. The simulation, through this tool, contributed to apply theoretical knowledge to the students, besides helping in the development of the nursing decision-making ability.


Assuntos
Tomada de Decisões , Humanos , Estudantes de Enfermagem
16.
Stud Health Technol Inform ; 264: 576-580, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437989

RESUMO

A fast and frugal generic tool can provide decision support to those making decisions about individual cases, particularly clinicians and clinical commissioners operating within the budget and time constraints of their practices. The multi-national Generic Rapid Evaluation Support Tool (GREST) is a standard preference-sensitive Multi-Criteria Decision Analysis-based tool, but innovatory insofar as an equity criterion is introduced as one of six. Equity impact reflects the number of population QALYs lost or gained in moving from Old (current intervention) to New (contemplated intervention). In the exemplar UK implementation Claxton's NHS Willingness to Pay per QALY is the numeraire. Any weight from 0 to 100% may be assigned to the equity criterion but its presence affirms that it is persons-as-citizens who experience any opportunity harms or benefits arising from actions within the health service commons. A fully-operational but demonstration-only version is available on open access, as proof of concept and method.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Anos de Vida Ajustados por Qualidade de Vida
17.
Stud Health Technol Inform ; 264: 1997-1998, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438447

RESUMO

Serious games have been used to increase the accuracy and usege of clinical guidelines during routine clinical practice. This document presents the development of a serious game called SIM-GIC, a video game designed to simulate virtual patients and evaluate the decision making of players based on computer-interpretable clinical guidelines. The system is currently being developed with a content focus on antenatal care guidelines, where a number of obstetric guidelines were coded in XML files.


Assuntos
Jogos de Vídeo , Computadores , Tomada de Decisões , Feminino , Jogos Recreativos , Humanos , Gravidez
18.
Stud Health Technol Inform ; 264: 878-882, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438050

RESUMO

Diabetic Retinopathy (DR) is one of the most common microvascular complications presenting by patients diagnosticated with diabetic diseases. Uncontrolled hyperglycemia may manifest as visual impairment and blindness. The early detection of DR is essential to minimize the risk and consequence of visual diminishing. The standard gold diagnoses tool relies on different imaging modalities and requires a judgment of expert photographers, which are not available in most of the primary care centers or remote location. In that scenario, an automate or semiautomated DR screening systems can contribute to improving the accuracy of the diagnostic. Thus, we performed a Systematic Review and Meta-Analysis to evaluate the Decision Support Systems (DSS) in diagnosing DR. The overall Diagnostic Odds Ratio was 73.15 (95%CI: 37.54-142.50), sensitivity was 97.70 (95%CI: 97.50-97.90) and specificity was 90.30 (95%CI: 90.00-90.60). Our results corroborate with the concept of usefulness of DSSs in early diagnosis, screening and preliminary evaluation of suspicious images of DR.


Assuntos
Retinopatia Diabética , Tomada de Decisões , Sistemas Especialistas , Humanos , Programas de Rastreamento , Software
19.
Stud Health Technol Inform ; 265: 128-133, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431588

RESUMO

Patient-centred care and the empowerment of patients through shared clinical decision-making is a key goal of healthcare systems internationally. The Emergency Department is one of the first opportunities for shared decision-making to occur, with information exchanged between patient and clinician, between clinical disciplines, across the continuum of care, and between clinicians and ancillary departments including radiology and pathology laboratories. The successful development and implementation of sustainable health information technology (HIT) to support shared decision-making in Emergency care requires an understanding of the factors affecting this context. From a purposive, maximum variation sample of clinicians and a convenience sample of patients across three metropolitan and regional Emergency Departments in Australia, we identified three divergent discourses from an in-depth qualitative exploration of issues around shared decision-making. This allowed us to identify unanticipated factors affecting patient-centred care to inform context-sensitive implementation of HIT in the Emergency Department.


Assuntos
Tomada de Decisões , Serviços Médicos de Emergência , Austrália , Serviço Hospitalar de Emergência , Humanos , Assistência Centrada no Paciente
20.
Stud Health Technol Inform ; 265: 163-168, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431593

RESUMO

Individuals have different preferences in how they wish to relate to healthcare professionals such as doctors. Given choice, they also have preferences in relation to the type and location of support they want for their health and healthcare decisions. We argue that preference-based clusters within this heterogeneity constitute different contexts and that evaluations of decision aids should be context-sensitive in this respect. We draw attention to two distinct preference-based clusters: individuals with a preference for 'intermediative' decision support as a patient, implemented in a largely qualitative deliberative model, on the one hand, and for 'apomediative' decision support as a person, implemented in a largely quantitative multi-criteria decision analytic model, on the other. For convenience, we refer to the latter as Person Decision Support Tools (PDSTs), leaving Patient Decision Aids (PDAs) for its former, conventional use. Seeking to establish proof of method, we present an online PDST that can help individuals establish which of these two types of decision support they would find optimal. It is based on nine key attributes on which PDAs and PDSTs can be contrasted. Within population heterogeneity, preference clusters should be identified, and acknowledged and respected as contexts relevant to the evaluation of decision support tools.


Assuntos
Técnicas de Apoio para a Decisão , Médicos , Tomada de Decisões , Sistemas Especialistas , Humanos , Preferência do Paciente , Software
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