Patient autonomy and education in specific medical knowledge

The asymmetry between the patient as a layman and the physician as an expert is a key element in health economics. However, a change to a higher degree of patient autonomy has taken place. Furthermore, there is a consensus in a positive correlation between general education and productivity of medical care. This paper focuses on the individual investments of laymen in specific medical education as a decision problem in which the ex-post strategies of the individual are consultation and self-care as imperfect substitutes. It is assumed that specific knowledge increases the self-diagnosis competence (self-protection) and the self-care productivity (self-insurance) as dimensions of autonomy. The analysis is divided into two forms of ex-post decision making according to individual rationality: 1. ambiguity 2. uncertainty. An elaboration of necessary conditions for investments in education is undertaken. --patient autonomy,education,self-care,ambiguity,uncertainty

Implementation of TeamSTEPPS

This scholarly project focused on implementing Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in an emergency room (ER). The aim of TeamSTEPPS is to improve patient outcomes by educating healthcare professionals on communication and teamwork skills. TeamSTEPPS teaches healthcare professionals leadership skills, shared mental models, mutual trust, and closed loop communication. The purpose of the scholarly project was to improve teamwork and communication. The study method was descriptive analysis of 51 pre and posttest questionnaires, specifically looking for increased knowledge of TeamSTEPPS tools. The participants included: ER physicians, ER nurses, ER certified nursing assistants/health unit coordinators, a pharmacy technician, public safety officers, and patient revenue management organization (PRMO). Further research is needed to evaluate how to significantly increase staff knowledge on TeamSTEPPS tools in a class setting

Performance Comparison of Knowledge-Based Dose Prediction Techniques Based on Limited Patient Data.

PurposeThe accuracy of dose prediction is essential for knowledge-based planning and automated planning techniques. We compare the dose prediction accuracy of 3 prediction methods including statistical voxel dose learning, spectral regression, and support vector regression based on limited patient training data.MethodsStatistical voxel dose learning, spectral regression, and support vector regression were used to predict the dose of noncoplanar intensity-modulated radiation therapy (4π) and volumetric-modulated arc therapy head and neck, 4π lung, and volumetric-modulated arc therapy prostate plans. Twenty cases of each site were used for k-fold cross-validation, with k = 4. Statistical voxel dose learning bins voxels according to their Euclidean distance to the planning target volume and uses the median to predict the dose of new voxels. Distance to the planning target volume, polynomial combinations of the distance components, planning target volume, and organ at risk volume were used as features for spectral regression and support vector regression. A total of 28 features were included. Principal component analysis was performed on the input features to test the effect of dimension reduction. For the coplanar volumetric-modulated arc therapy plans, separate models were trained for voxels within the same axial slice as planning target volume voxels and voxels outside the primary beam. The effect of training separate models for each organ at risk compared to all voxels collectively was also tested. The mean squared error was calculated to evaluate the voxel dose prediction accuracy.ResultsStatistical voxel dose learning using separate models for each organ at risk had the lowest root mean squared error for all sites and modalities: 3.91 Gy (head and neck 4π), 3.21 Gy (head and neck volumetric-modulated arc therapy), 2.49 Gy (lung 4π), and 2.35 Gy (prostate volumetric-modulated arc therapy). Compared to using the original features, principal component analysis reduced the 4π prediction error for head and neck spectral regression (-43.9%) and support vector regression (-42.8%) and lung support vector regression (-24.4%) predictions. Principal component analysis was more effective in using all/most of the possible principal components. Separate organ at risk models were more accurate than training on all organ at risk voxels in all cases.ConclusionCompared with more sophisticated parametric machine learning methods with dimension reduction, statistical voxel dose learning is more robust to patient variability and provides the most accurate dose prediction method

Psychodynamic approaches to teaching medical students about the doctor-patient relationship: Randomised controlled trial

Aims and method: To evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor-patient communication and the doctor-patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor-patient relationship administered at baseline, at 3 months and at 1 year. Results: At 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline. Clinical implications: Psychodynamic psychotherapy teaching methods are effective in increasing students’ knowledge of the doctor-patient relationship and potentially also improving their communication skills

Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease.

BackgroundReducing dietary sodium has potential to benefit patients with chronic kidney disease (CKD). Little research is available defining dietary sodium knowledge gaps in patients with pre-dialysis CKD. We designed a brief screening tool to rapidly identify patient knowledge gaps related to dietary sodium for patients with CKD not yet on dialysis.MethodsA Short Sodium Knowledge Survey (SSKS) was developed and administered to patients with pre-dialysis CKD. We also asked patients if they received counseling on dietary sodium reduction and about recommended intake limits. We performed logistic regression to examine the association between sodium knowledge and patient characteristics. Characteristics of patients who answered all SSKS questions correctly were compared to those who did not.ResultsOne-hundred fifty-five patients were surveyed. The mean (SD) age was 56.6 (15.1) years, 84 (54%) were men, and 119 (77%) were white. Sixty-seven patients (43.2%) correctly identified their daily intake sodium limit. Fifty-eight (37.4%) were unable to answer all survey questions correctly. In analysis adjusted for age, sex, race, education, health literacy, CKD stage, self-reported hypertension and attendance in a kidney education class, women and patients of non-white race had lower odds of correctly answering survey questions (0.36 [0.16,0.81]; p = 0.01 women versus men and 0.33 [0.14,0.76]; p = 0.01 non-white versus white, respectively).ConclusionsOur survey provides a mechanism to quickly identify dietary sodium knowledge gaps in patients with CKD. Women and patients of non-white race may have knowledge barriers impeding adherence to sodium reduction advice

The Patient as a construction and a non-participant member of a change-process.

The contribution of this paper is a discussion about how the patient as a phenomenon is constructed and used by employees for different purposes, enabling and inhibiting change. The results are based on a three year case study in which data has been collected with interviews and observations. They have then been analyzed and interpreted within a framework consisting of theories about thinking collectives, structuration, information and knowledge management. The findings indicate that “the patient” has implications for how project management is conducted and a patient record upgraded at the anesthesia and intensive care unit of a hospital.the patient; anesthesia information management; constructionism; thinking collectives; knowledge management; structuration.

A survey of UK medical schools' arrangements for early patient contact

Background: Many U.K. medical schools have patient contact in the first two years of the undergraduate course. Aim: To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives. Methods: A telephone survey of lead educators in UK medicals schools. Categories of contact were plotted against phases of the course to discern patterns of organisation. Results: The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact. Conclusions: Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training

Capturing Scientific Knowledge on Medical Risk Factors

In this paper, we describe a model for representing scientific knowledge of risk factors in medicine in an explicit format which enables its use for automated reasoning. The resulting model supports linking the conclusions of up-to-date clinical research with data relating to individual patients. This model, which we have implemented as an ontology-based system using Linked Data, enables the capture of risk factor knowledge and serves as a translational research tool to apply that knowledge to assist with patient treatment, lifestyle, and education. Knowledge captured using this model can be disseminated for other intelligent systems to use for a variety of purposes, for example, to explore the state of the available medical knowledge

A systematic review of weight-related communication trainings for physicians: What do we know and how can we inform future development of training programs?

It is reported that physicians lack training to address weight-related concerns with patients. To overcome this, training programs have been implemented in medical settings to prepare physicians to have conversations with patients. However, it is unclear the degree of consistency among existing training programs and factors associated with better outcomes. The objective of this study was to systematically review the existing literature in this area to determine differences in content, outcomes, and implementation of existing studies that test weight-related communication training programs for physicians. A systematic literature review of online databases including PubMed, PsycINFO, and Proquest was conducted with the assistance of a librarian. Search terms included: health communication, training, physician training, weight, and obesity. Studies were selected based on the following inclusion criteria: physicians are post-graduate medical doctors; trainings encompassed weight-related communication; and outcomes were tied to physician uptake of skills, knowledge, and self-efficacy, or patient-related outcomes. Two coders reviewed studies using detailed inclusion criteria. Disagreements were resolved by consensus among authors. Half of studies assessed outcomes in both patients and physicians. Trainings including motivational interviewing (MI) assessing patient outcomes found increases in patient knowledge, satisfaction, motivation, and weight loss, respectively. Whereas, non-MI trainings assessing patient outcomes found an increase in patient weight loss, confidence and motivation, or no changes in patient outcomes. This review was the first to examine programs aimed to teach physicians to communicate with patients about weight. Future studies should examine the effect of physician communication on BMI.https://scholarscompass.vcu.edu/gradposters/1025/thumbnail.jp