Launching a Virtual Decision Lab: Development and Field-Testing of a Web-Based Patient Decision Support Research Platform

Over 100 trials show that patient decision aids effectively improve patients’ information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions

Personal non-commercial use only

ABSTRACT. Objective. To develop an innovative stepped patient decision aid (StDA) comparing the benefits and harms of 13 nonsurgical treatment options for managing osteoarthritis (OA) and to evaluate its acceptability and effects on informed decision making. Methods. Guided by the Ottawa Decision Support Framework and the International Patient Decision Aid Standards, the process involved (1) developing a decision aid with evidence on 13 nonsurgical treatments from the 2012 American College of Rheumatology OA clinical practice guidelines; and (2) interviewing patients with OA and healthcare providers to test its acceptability and effects on knowledge and decisional conflict. Results. The StDA helped make the decision explicit, and presented evidence on 13 OA treatments clustered into 5 steps or levels according to their benefits and harms. Probabilities of benefits and harms were presented using pictograms of 100 faces formatted to allow comparisons across sets of options. It also included a values clarification exercise and knowledge test. Feedback was obtained from 49 patients and 7 healthcare providers. They found that the StDA presented evidence in a clear manner, and helped patients clarify their values and make an informed decision. Some participants found that there was too much information and others said that there was not enough on each treatment option. Conclusion. This innovative StDA allows patients to consider both the evidence and their values for multiple options. The findings are being used to revise and plan future evaluation. The StDA is an example of how research evidence in guidelines can be implemented in practice

Swine lairage pen cleaning and disinfecting : effects on prevalence and antimicrobial sensitivity patterns of Salmonella enterica isolates

The purpose of this study was to determine the effects of lairage pen cleaning and disinfecting (C & D) procedures on prevalence of S. enterica infected swine at slaughter and antimicrobial resistance patterns of residual S. enterica isolates. A series of four field trials were conducted in a large Midwestern abattoir. Each trial consisted of a cleaned (alkaline chloride detergent) and disinfected (H₂O₂ + peracetic acid sanitizer) pen (treated) and a control pen. Intestinal lymph nodes, cecal contents, and fecal contents were collected from 45 pigs in each pen at harvest and cultured for S. enterica. In all trials, cleaning and disinfection reduced the prevalence of S. enterica positive floor swabs in the treated pen (p\u3c0.05). In Trial 1, no significant difference in prevalence of S. enterica in pigs between treatment and control groups occurred. In Trials 2 and 3, prevalence of S. enterica was higher in pigs from treated pens vs. pigs from control group pens (91% vs. 40%, p\u3c0.0001 and 91% vs. 24%, p\u3c0.0001 respectively). In Trial 4, prevalence of S. enterica was lower in pigs from treated pens vs. pigs from control pens (5% vs. 42%, p\u3c0.0001). Pen swabs were collected from each treated lairage pen before and after application of C & D procedures. Antimicrobial resistance of recovered S. enterica isolates was determined using Kirby-Bauer disk diffusion test methods and results reported as sensitive, intermediate, or resistant to tested antimicrobials. Recovered isolates clustered into 10 resistance patterns. Prevalence of S. enterica positive pen swabs and resistance pattern diversity decreased after C & D procedures. C & D procedures appeared to be non-selective in overall residual S. enterica resistance patterns. Swine lairage pen C & D procedures consistently reduce, but do not eliminate residual S. enterica organisms within lairage pens. However, reductions in prevalence of S. enterica in lairage pens do not translate into reductions in prevalence if S. enterica infected pigs held in those pens. If C & D procedures are used in lairage situations, the impact on antimicrobial resistance of remaining isolates appears to be minimal

Development of instruments to measure the quality of breast cancer treatment decisions

Women with early stage breast cancer face a multitude of decisions. The quality of a decision can be measured by the extent to which the treatment reflects what’s most important to an informed patient. Reliable and valid measures of patients’ knowledge and their goals and concerns related to breast cancer treatments are needed to assess decision quality

Nivel de conocimiento y actitud sobre la vacuna contra el virus del papiloma humano de madres de niñas 9 a13 años, en centro de salud San Luis, Lima, 2017

Investigación que tuvo como objetivo, determinar la relación que existe entre el nivel de conocimiento y la actitud sobre la vacuna contra el Virus del Papiloma Humano de las madres de familia de las niñas de 9 a 13 años, en el Centro de Salud, San Luis, 2017. Estudio de tipo cuantitativo, método descriptivo correlacional de corte transversal, trabajado en una muestra de 134 madres. Para la recolección de datos se utilizó como instrumento dos cuestionarios, para la medición de las variables del estudio, ambos validados por juicios de expertos con el estadístico de K de Richardson para la variable conocimiento con un valor de 0.87 y según el Alfa de Cronbach para la variable actitud de las madres con una confiabilidad de 0.880.Research that was aimed, to determine the relationship between the level of knowledge and attitude about the vaccine against the Human Papilloma Virus from mothers of girls 9 to 13 years, in the health center, St. Louis 2017. Quantitative study, correlational descriptive method of cross section, worked in a sample of 134 mothers. For the collection of data was used as an instrument two questionnaires, for the measurement of the variables of the studies, both validated by expert with the statistic of K of Richardson for the variable a value of 0.87 knowledge and according to the Alpha's Cronbach for variable attitude of mothers with a reliability of 0.880

La toma de decisiones en salud y el modelo conceptual de Ottawa

This article analyses the Ottawa Decision-support Framework proponed by the Canadian nurse Annette M. O¿Connors to help strategic decision-making in Health and its usefulness in the nurses¿intervention in the family and the community. When conflicting opinions have to be considered before making a decision, the nursing professionals should assume a protagonist part. Therefore they have to develop abilities to support their patients when they face conflicts. The Ottawa Decision Support Framework is a very useful reference to help people, especially women, when they should assume a more active part in decisions that affect their health.Objetivo: Realizar un análisis del Modelo de Toma de Decisiones en Salud de Ottawa, planteado por la enfermera canadiense Annette M. O¿Connors, como una estrategia para resolver conflictos decisionales en salud. Se plantea su utilidad en la intervención que hace enfermería en la comunidad y la familia. Se concluye que el conflicto decisional surge frente a la toma de decisiones y los profesionales de la salud deben adoptar un rol protagónico en él, desarrollando habilidades para apoyar a sus pacientes o usuarios en los conflictos que deben enfrentar, teniendo el Modelo de toma de decisiones de Ottawa como un referencial útil para ayudarles, especialmente a las mujeres, a asumir un rol más activo en las decisiones que afectan su propia salud

La toma de decisiones en salud y el modelo conceptual de Ottawa Decision-making in health and the Ottawa decision-support framework

Objetivo: Realizar un análisis del Modelo de Toma de Decisiones en Salud de Ottawa, planteado por la enfermera canadiense Annette M. O’Connors, como una estrategia para resolver conflictos decisionales en salud. Se plantea su utilidad en la intervención que hace enfermería en la comunidad y la familia. Se concluye que el conflicto decisional surge frente a la toma de decisiones y los profesionales de la salud deben adoptar un rol protagónico en él, desarrollando habilidades para apoyar a sus pacientes o usuarios en los conflictos que deben enfrentar, teniendo el Modelo de toma de decisiones de Ottawa como un referencial útil para ayudarles, especialmente a las mujeres, a asumir un rol más activo en las decisiones que afectan su propia salud.<br>This article analyses the Ottawa Decision-support Framework proponed by the Canadian nurse Annette M. O´Connors to help strategic decision-making in Health and its usefulness in the nurses´intervention in the family and the community. When conflicting opinions have to be considered before making a decision, the nursing professionals should assume a protagonist part. Therefore they have to develop abilities to support their patients when they face conflicts. The Ottawa Decision Support Framework is a very useful reference to help people, especially women, when they should assume a more active part in decisions that affect their health

Personal non-commercial use only

ABSTRACT. Objective. To develop an innovative stepped patient decision aid (StDA) comparing the benefits and harms of 13 nonsurgical treatment options for managing osteoarthritis (OA) and to evaluate its acceptability and effects on informed decision making