Study on the Impact of Medical Risk Perception on Clinical Treatment Decision-making in Preoperative Patients with Malignant Tumors / 中国医学伦理学

【Objective:】 To understand the current status and related impacts of medical risk perception and treatment decision-making in preoperative patients with malignant tumors. 【Methods:】 The 350 malignant tumor patients who were hospitalized for surgical treatment in two tertiary hospitals in Liaoning Province were selected. The general information questionnaire, medical risk perception questionnaire, and participation in treatment decision-making questionnaire were used as survey tools. SPSS26.0 software, data statistical methods such as the Kappa test and multiple linear regression were used to analyze valid data. 【Results:】 Among the 350 subjects, the mean scores of the actual level of participation in treatment decision-making and attitude towards participation in treatment decision-making were(1.75±0.50) and(1.56±0.52), respectively, and the consistency between them was poor(Kappa=0.134, P<0.001). The total score of medical risk perception in preoperative patients with malignant tumors was(57.13±16.2). The results of multiple linear regression analysis showed that the actual degree of patient participation in treatment decision-making was influenced by the experience of surgical treatment(β=-1.744, P<0.05), economic risk in medical risk perception(β=0.478, P<0.05), and time risk (β=0.478, P<0.05). Economic risk in medical risk perception(β=0.043, P<0.05), time risk (β=0.646, P<0.05), and psychological risk(β=-0.329, P<0.05) were the influencing factors of patients’ attitude towards participating in treatment decision-making. 【Conclusion:】 Medical professionals should pay more attention to the influence of medical risk perception of malignant tumor patients on treatment decision-making. Malignant tumor patients should fully exercise their right to choose treatment plans independently, and jointly improve the actual level and attitude of the group when participating in treatment decision-making.

Clinical classification and treatment decision of implant fracture / 北京大学学报(医学版)

OBJECTIVE@#To propose a set of two-dimensional clinical classification of fractured implants based on the follow-up of fracturing pattern of implant body and peri-implant bone defect morphology of 32 fractrued implants, and summarize the treatment decisions of fractured implants according to this new set of classification, so as to provide guidance for clinical practice.@*METHODS@#During 25 years of clinical practice, clinical records of 27 patients of 32 fractured implants in 5 481 patients with 10 642 implants were made. The fracturing pattern of implant body, implant design, peri-implant bone defect morphology and treatment options were analyzed. A set of two-dimensional clinical classification based on the morphology and bone absorption of implant fracture was proposed. The treatment decision-making scheme based on the new classification of implant fracture was discussed.@*RESULTS@#In the new classification system, vertical fracture of implant neck (Type 1 of implant fracture morphology, F1) and horizontal fracture of implant neck (Type 2 of implant fracture morphology, F2) were common, accounting for 50% and 40.6% respectively, while deep horizontal fracture of implant body (Type 3 of implant fracture morphology, F3) (9.4%) were rare, while the three types of bone defects (D1, no bone defect or narrow infrabony defects; D2, wide 4-wall bone defects or cup-like defects, D3, wide 3-wall or 2-wall defects) around implants were evenly distributed. In the two-dimensional classification system of implant fracture, F1D1 (31.3%) and F2D2 (25%) were the most frequent. There was a significant positive correlation between F1 and D1 (r=0.592, P < 0.001), a significant positive correlation between F2 and D2 (r=0.352, P=0.048), and a significant negative correlation between F1 and D2 (r=-0.465, P=0.007). The most common treatment for implant fracture was implant removal + guided bone regeneration(GBR) + delayed implant (65.6%), followed by implant removal + simultaneous implant (18.8%). F1D1 type was significantly related to the treatment strategy of implant removal + simultaneous implantation (r=0.367, P=0.039). On this basis, the decision tree of implant fracture treatment was summarized.@*CONCLUSION@#The new two-dimensional classification of implant fracture is suitable for clinical application, and can provide guidance and reference for clinical treatment of implant fracture.

Research progress of patients′decision self-efficacy in treatment decision-making / 中国实用护理杂志

Patients′ decision self-efficacy in treatment decision-making refers to the patient′s level of confidence in their ability to make medical decisions, which can affect the patient′s confidence and readiness to participate in their treatment or care decision-making, and it is a key facilitator for patients as collaborators working with health care providers to make high-quality treatment and care decisions. In order to comprehensively understand the research progress of patients′ self-efficacy of treatmentdecision-making, this paper reviews the connotation, assessment tools, status quo, influencing factors and intervention strategies of patients′ decision self-efficacy of treatment decision-making, providing the basis for objectively evaluating patients′ decision self-efficacy of treatment decisions in the future and the development of related research.

In Vitro Comparison of ICDAS And DIAGNOdent Pen in The Diagnosis and Treatment Decisions of Non-Cavitated Occlusal Caries / Comparación In Vitro de ICDAS y DIAGNOdent Pen en el diagnóstico y decisiones de tratamiento de la caries oclusal no cavitada

Abstract The aim of this study was to compare the efficacy of the ICDAS and the DIAGNOdent Pen in the diagnosis of occlusal caries lesions without cavitation, and for basing treatment decisions on the results obtained. Eighty permanent molar teeth that were healthy and non-cavitated or that had an initial occlusal lesion were evaluated. All teeth were investigated using DIAGNOdent Pen and ICDAS by four examiners. Histological evaluation of teeth was performed using stereomicroscopy by a histologist and different experienced dentist. For evaluation of the data, weighted kappa values (kw), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and likelihood ratio (LR+) values of the tests were calculated. The diagnostic results obtained using the DIAGNOdent Pen were found to correlate better with the results obtained from histological sections than those obtained using ICDAS. When the treatment decisions of the observers depending on the results of ICDAS, and ICDAS and DIAGNOdent Pen combination were compared with the decisions made based on histological examinations, the decisions based on ICDAS and DIAGNOdent Pen combined (kw: 0.522) were more accurate than the ones based on ICDAS (kw: 0.415) alone. In conclution, professional experience is an effective factor in diagnosing occlusal caries lesions without cavitation with ICDAS and in making treatment decisions for them. DIAGNOdent Pen is sufficient in diagnosing occlusal caries lesions without cavitation.

Resumen El objetivo de este estudio fue comparar la eficacia de ICDAS y de DIAGNOdent Pen en el diagnóstico de lesiones de caries oclusales no cavitadas. Ochenta molares permanentes sanos y no cavitados fueron utilizados. Todos los dientes fueron investigados usando DIAGNOdent Pen e ICDAS por cuatro examinadores. La evaluación histológica de los dientes se realizó mediante estereomicroscopía por un histólogo y por un dentista con previa experiencia. Los resultados diagnósticos obtenidos con el DIAGNOdent Pen se correlacionan mejor con los resultados obtenidos a partir de las secciones histológicas cuando comparados a los obtenidos utilizando ICDAS. Las decisiones basadas en el uso combinado de ICDAS y DIAGNOdent Pen (kw: 0.522) fueron más precisas que los basados en ICDAS (kw: 0.415). En conclusión, la experiencia profesional es un factor eficaz en diagnóstico de lesiones de caries oclusal sin cavitación con ICDAS y en la toma de decisiones de tratamiento. DIAGNOdent Pen es una herramienta confiable para diagnosticar lesiones de caries oclusales sin cavitación.

Patient's Cognitive Function and Attitudes towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. MATERIALS AND METHODS: A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea andwere asked to express their preferences forfamily involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). RESULTS: Both patients and family caregivers preferred greater family dominance in treatment decision makingwith the increasing the level of cognitive impairment (39.7%, 60.9%, and 86.6% for patients and 45.0%, 66.2%, and 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all three scenarios (weighted κ=0.32, κ=0.26, and κ=0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. CONCLUSION: Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.

Development Status and Enlightenment of Foreign Clinical Knowledge Base / 医学信息学杂志

The paper investigates 31 foreign representative clinical knowledge base,analyzes development status including the establishment and maintenance institutions,user version control,localization application,clinical evidence resources,clinical specific content representation,evidence quality evaluation criteria and so on,summarizes revelation for domestic clinical knowledge base construction.

Ethical Consideration about Family Members' Participation in Cancer Treatment Decision-making / 中国医学伦理学

The defense for paternalism is based on that family members' decisions are usually beneficial for patients' best interests.However,this premise remains to be demonstrated.The moral theory of maintaining family members' interests challenged the ethical principle of respecting patients' autonomy,which believed that treatment decisions should be discussed by the whole family members.However,the principle of autonomy does not always dissever the relationship between individual and family members.It resorted East Asia family autonomy of Chinese traditional culture and emphasized on the value of objective goodness and family dependence.However,patients often do not play a proper role in families' decision-making.Besides,the Confucian bioethics also needs to provide more sufficient argumentation to deal with the relationship between subjective goodness and objective goodness.The unconditional acquiescence of family members' domination in decision-making is worthy reflecting in the current medical environment.

Opinión de los miembros de la Justicia Nacional en lo Penal y Civil (Familia) en situaciones de limitación del soporte vital en pediatría / Opinions of members of the National Civil (Family Proceedings) and Criminal Courts in withholding or withdrawing of life support situations in pediatrics

Introducción. La posibilidad de sostener artificialmente las funciones vitales hace más difícil diferenciar al paciente en agonía terminal del paciente con posibilidades de supervivencia, lo que pone al grupo que lo rodea frente a un dilema. Por un lado, se presenta la continuación de soporte que solo prolongue un proceso irreversible, que causa daños físicos, psíquicos y a su dignidad. Por otro, la abstención o retiro de soporte vital sin la reflexión y el esfuerzo diagnóstico-terapéutico apropiado puede dejar sin esperanza y llevar a la muerte a un niño potencialmente recuperable. Además, la toma de decisiones, en estas circunstancias, enfrenta diversas barreras que dificultan lograr el mejor interés del paciente. Entre ellas, los temores legales son un factor importante. ¿En qué medida esos temores están justificados? Objetivo. Explorar la opinión del Poder Judicial de la Nación respecto al enfoque que, desde el derecho, se da a situaciones de limitación de soporte vital. Población y métodos. Profesionales activos del ámbito penal, civil y médico forense. Encuesta semiestructurada sobre tres casos hipotéticos con decisiones sobre la limitación del soporte vital. Resultados. Se repartieron 185 encuestas; se contestaron 68 (36,76%) y 51 (30,3%) fueron respondidas en forma completa. No tipificaron ningún delito en ninguno de los tres casos 28 (55%) encuestados. Trece (25%) interpretaron como delitos las decisiones de los tres casos; 6 (12%), alguno de los casos; y 4 (8%), 2 de los 3 casos. Los delitos seleccionados por los encuestados incluyeron homicidio doloso, homicidio culposo y abandono de persona. Conclusiones. El 45% de los encuestados consideraron que hubo alguna forma de delito en las decisiones tomadas.

Introduction. The possibility of sustaining life functions makes it difficult to distinguish between a dying patient and a patient with chances of survival, raising a dilemma for everyone around them. On the one side, continuing with life support techniques that would only extend an irreversible process and result in physical and psychological damage and harm their dignity. On the other side, withholding or withdrawing life support without an adequate reflection and diagnostic-therapeutic effort which may lead to the death of a potentially recoverable child. In addition, making decisions in this context implies facing barriers that hinder the possibility of pursuing the patient's best interest. Among such barriers, the fear of litigation plays a major role. To what extent is this fear justified? Objective. To explore the opinions of the members of the National Judiciary regarding the approach to withholding or withdrawing of life support from a legal stance. Population and methods. Professionals working in the criminal, civil and forensic medicine settings. Semistructured survey on three hypothetical case histories that implied making a decision to withhold or withdraw life support. Results. One hundred and eighty-five surveys were distributed; 68 (36.76%) were partially completed and 51 (30.3%), in full. Twenty-eight (55%) survey respondents did not criminalize any of the three cases presented. Thirteen (25%) respondents considered that the decisions made in the three cases constituted a crime; 6 (12%), only in one case; and 4 (8%), in two out of the three. Crimes described by survey respondents included intentional homicide, wrongful death, and failure to render assistance. Conclusions. Forty-five percent of survey respondents considered that decisions made involved some form of crime.

Clinical Decision Support System on Basis of Case-Based Reasoning for Traditional Chinese Medicine / 世界科学技术-中医药现代化

Real world clinical diagnosis and treatment activity is a complicated decision-making task. The effective clinical cases of traditional Chinese medicine (TCM) of highly experienced physicians play an important role in the routine diagnosis and treatment and the formulation of medical knowledge . Based on TCM electronic medical record data, this paper proposed a decision support prototype system on TCM clinical diagnosis and treatment based on TCM effective clinical cases and case-based reasoning (CBR) algorithm, which is used to assist inexperienced clinicians to make more reliable clinical decisions, and thereafter to improve the clinical curative effectiveness. The system integrates TCM clinical cases data set from a TCM clinical data warehouse, and retrieves the similar cases based on CBR method. In particular, according to the underlying personalized diagnosis and treatment for patients in TCM, this system implemented a flexible diagnosis and treatment modification mechanism based on correlation analysis among symptoms, diagnoses (syndrome or pattern in TCM) and medicine. Finally, through a demonstration of clinical application, we made an initial evaluation of the usefulness and practical effects of the system.