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Susan E. Hickman Alexia M. Torke Greg A. Sachs Rebecca L. Sudore Anne L. Myers Qing Tang Giorgos Bakoyannis Bernard J. Hammes 《Journal of pain and symptom management》2019,57(6):1143-1150.e5
ContextIt is especially important that patients are well informed when making high-stakes, preference-sensitive decisions like those on the Physician Orders for Life-Sustaining Treatment (POLST) form. However, there is currently no way to easily evaluate whether patients understand key concepts when making these important decisions.ObjectivesTo develop a POLST knowledge survey.MethodsExpert (n = 62) ratings of key POLST facts were used to select items for a POLST knowledge survey. The survey was administered to nursing facility residents (n = 97) and surrogate decision-makers (n = 112). A subset (n = 135) were re-administered the survey after a standardized advance care planning discussion to assess the scale's responsiveness to change.ResultsThe 19-item survey demonstrated adequate reliability (α = 0.72.). Residents' scores (x = 11.4, standard deviation 3.3) were significantly lower than surrogate scores (x = 14.7, standard deviation 2.5) (P < 0.001). Scores for both groups increased significantly after administration of a standardized advance care planning discussion (P < 0.001). Although being a surrogate, age, race, education, cognitive functioning, and health literacy were significantly associated with higher POLST Knowledge Survey scores in univariate analyses, only being a surrogate (P < 0.001) and being white (P = 0.028) remained significantly associated with higher scores in multivariate analyses.ConclusionThe 19-item POLST Knowledge Survey demonstrated adequate reliability and responsiveness to change. Findings suggest the survey could be used to identify knowledge deficits and provide targeted education to ensure adequate understanding of key clinical decisions when completing POLST. 相似文献
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《Primary Care Diabetes》2022,16(3):417-421
AimsClinical inertia behaviour affects family physicians managing chronic disease such as diabetes. Literature addressing clinical inertia in the management of hypoglycemia is scarce. The objectives of this study were to create a measurement for physician clinical inertia in managing hypoglycemia (ClinInert_InHypoDM), and to determine physicians’ characteristics associated with clinical inertia.MethodsThe study was a secondary analysis of data provided by family physicians from the InHypo-DM Study, applying exploratory factor analysis. Principal axis factoring with an Oblimin rotation was employed to detect underlying factors associated with physician behaviors. Multiple linear regression was used to determine association between the ClinInert_InHypoDM scores and physician characteristics.ResultsFactor analysis identified a statistically sound 12-item one-factor scale for clinical inertia behavior. No statistically significant differences in clinical inertia score for the studied independent variables were found.ConclusionsThis study provides a scale for assessing clinical inertia in the management of hypoglycemia. Further testing this scale in other family physician populations will provide deeper understanding about the characteristics and factors that influence clinical inertia. The knowledge derived from better understanding clinical inertia in primary care has potential to improve outcomes for patients with diabetes. 相似文献
3.
Saisanjana Kalagara Adam E.M. Eltorai J. Mason DePasse Alan H. Daniels 《The spine journal》2019,19(1):182-185
BACKGROUND
Online physician rating websites are increasingly used by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.METHODS
Orthopedic spine surgeons were randomly selected from the North American Spine Society directory utilizing a random number generator. Surgeon profiles on three physician rating websites, namely, www.HealthGrades.com, www.Vitals.com, and www.RateMDs.com, were analyzed to gather qualitative and quantitative data on patients’ perceptions of the surgeons. Independent variables from the websites were analyzed in relation to overall physician or patient satisfaction rating. Comments were coded by subject into following three categories: professional competence, bedside manner, and practice characteristics.RESULTS
A total of 250 surgeons were evaluated, and 92% (n=230) of these doctors had at least one rating among the three websites. The surgeons with a higher average rating had significantly better trust (p<.01), scheduling (p<.01), staff (p<.01), helpfulness (p<.01), and punctuality (p<.01) scores but significantly less experience (p<.05). A linear regression model for the average rating of each surgeon (R2 value=0.754) yielded only following three significant variables: trustworthiness (p<.01), experience match (p<.05), and the average number of negative comments on surgeon's professional competence (p<.05). Trustworthiness (β=0.749) was the strongest predictor variable of physician rating, followed by the number of negative professional competence comments (β=?0.132) and experience match (β=?0.112).CONCLUSIONS
This investigation assessed spine surgeon online patient ratings and categorized factors that patients associate with quality care. Trustworthiness was the most significant predictor of positive ratings, whereas ease of scheduling, quality of staff, helpfulness, and punctuality were also associated with higher patient ratings. Understanding what patients value may help optimize care of spine surgery patients. 相似文献4.
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移情对建立新型医患关系伦理模式的利与弊 总被引:1,自引:0,他引:1
在现代社会这样一个转轨时期,医患矛盾越来越突出,如何缓和医患关系、建立新型医患关系伦理模式成为大家共同关心的课题。作者从移情的角度入手,阐述了新型医患关系伦理模式的内涵,分析了移情对于缓和医患关系有哪些有利之处与不利之处,并提出了如何适度利用移情的方法,使其发挥最大作用。 相似文献
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医院科室主任在科室管理中的作用 总被引:11,自引:2,他引:9
医院科室主任是医院管理系统中不可缺少的要素,他们是科室的行政负责人,也是科室的学科带头人,科主任的思想素质,业务水平,管理能力,敬业精神,拼搏精神,不仅关系到科室的兴衰,也关系到医院的建设和发展。 相似文献
9.
姚琪 《安徽卫生职业技术学院学报》2003,2(2):14-16
网络的出现和发展为信息的传播创造了十分便利的条件,卫生信息也因此进入了传播速度和信息量巨增的网络时代。但是,政府作为管理机构不仅要重视网络设备的建设,更重要的是要重视如何很好地运用网络设备来传播信息。卫生信息有着自身的独特性,它所包含的卫生新闻不完全等同于新闻学中定义的新闻,因为医学科普信息也是卫生信息,而且是内容广泛的群众迫切需要的卫生信息。如此大量的借助网络设备传播的卫生信息,需要有专人或者是一个有组织的群体来承担采编工作,政府部门不能陷入这些具体的事务中,而束缚了自己的管理职能。 相似文献
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