Correlates of Patient Satisfaction Among Menopausal Women

Patient satisfaction can increase compliance and health outcomes in many populations. Menopausal-age women present unique physical and psychosocial concerns that separate them from other populations in their health care needs and preferences. We surveyed 48 women (ages 45–60) regarding their satisfaction with a recent annual exam office visit in a family practice clinic. Women reported the number of quality of life issues they discussed during this visit and which of these they considered most important, as well as menopausal symptoms and perceived health competence. Regression analyses identified variables most related to patient satisfaction. Of three components of visit satisfaction (Quality, Humaneness, and General Satisfaction), Quality was predicted by quality of life issues discussed. Physical, psychological, and functional domains were considered most important to the patients, whereas physical, psychological, and social domains were most often actually discussed in the visit.     

关于结直肠患者的PCQ风险评分系统的运用进展

摘要：回顾关于结直肠患者的PCQ（patient consultation questionnaire,问卷量表一加权评分系统）风险评估体系自1999年产生以来的运用进展情况。查阅了1999年至今的相关文献,分析总结PCQ系统的评估原理、评估流程、评估效果,并作一综述。结果显示：PCQ系统对各种疾病的分辨能力较高,随着WNS（weighed numerical score,加权分数）分数的增加,各种疾病分数表现为阶梯状上升的层级分布图。癌症患者与非癌症患者的平均WNS分剐是70-80、40-55之间,有统计学意义。当以WNS分数60为界时,WNS系统的敏感度、特异度可分别达到86.5％、84.5％。以WNS50为转诊标准,仅40％的患者需紧急转诊,发现91％的癌症患者。提示PCQ系统的准确性高、特异性强,是一个很有发展前景的评估体系,可以进一步的开展多中心研究进行验证,进而推广使用并引进到中国。     

由新药临床试验中的依从性问题引发的思考

本文就如何看待新药临床试验中的依从性问题提出了自己的看法：应用整体观、认识论的方法辩证地分析、处理依从性问题,以保证临床试验的顺利进行和质量可靠;文中通过实例并结合当前的医改背景,对临床医疗工作中的医患关系提出一些启发和看法,建议医务人员从自身出发重视患者的依从性。     

Toward a Model Informed Consent Process for BRCA1 Testing: A Qualitative Assessment of Women's Attitudes

As an initial part of a project to develop a model informed consent process for BRCA1 testing, we conducted a series of focus groups. At the groups, women initially expressed great interest in testing, but their interest diminished after learning more. If offered testing, women would most want to learn about test accuracy, practical details of testing, and management options if the result was positive. Perceived benefits of testing included gaining information leading to risk reduction, relief of uncertainty, more responsible parenting, and assisting in research. Perceived risks included the discomfort and cost of the testing process itself, and anxiety after a positive result. The risk of possible insurance discrimination was rarely mentioned spontaneously. Many women would want their providers to make recommendations, rather than be nondirective about testing. We observed that women vary greatly in their informational and counseling needs, and suggest that the informed consent process should be individualized, taking into account a woman's perception and her preferences for how testing decisions should be made.     

Communication Differences Between Physicians and Their Patients in an Oncology Setting

The physician-patient relationship has critical importance in the quality of medical care, especially in the oncology setting. Of particular interest over the past two decades has been the communication between physicians and their patients. It is understood that communication is related to patient and physician satisfaction as well as other medical outcomes. However, despite this interest and attention, investigators have only recently begun to assess the communication between physicians and patients from the patient's point of view. Additionally, previous investigations have primarily relied upon retrospective reports of the interaction from patients or physicians. The current investigation assessed physician–patient communication in an oncology setting, both as it was occurring and following the interaction. The units of analysis included participant ratings as well as those of trained observers. Findings revealed that physicians and patients disagree as to the valence of the messages which transpired. Additionally, results suggest that it is the patients who distort the messages in the positive direction. Research and clinical implications of this disagreement and positivity bias are discussed.     

EFFECTS OF PROBLEM-BASED SCHEDULING ON PATIENT WAITING AND STAFF UTILIZATION OF TIME IN A PEDIATRIC CLINIC

The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.     

The Importance of Written Information Packages in Support of Case-Finding Within Families at Risk for Inherited High Cholesterol

Inherited High Cholesterol is treatable, but highly underdiagnosed. To detect undiagnosed blood relatives at a presymptomatic stage, in the Netherlands written information packages are available to facilitate family communication. To investigate the role of those packages in the detection of carriers, we conducted a qualitative evaluation (plus-minus method combined with semistructured interviews with index patients and relatives). Our data suggest that interviewees approved the family approach for finding carriers, although reluctantly. The packages aided family disclosure by reducing hesitation. However, index patients only informed first-degree relatives and generally communicated the risk only once. This may be due to the cultural context and a limited understanding of genetics. For relatives the packages served as a cue to action and as a legitimation to gain access to a diagnostic cholesterol test. Despite the value of these written materials, they should not be used as the only communication between index patient and relatives.     

Effects of Participant’s Choice of Different Digital Interventions on Outcomes for Binge-Spectrum Eating Disorders: A Pilot Doubly Randomized Preference Trial

It is unclear whether offering individuals a choice between different digital intervention programs affects treatment outcomes. To generate initial insights, we conducted a pilot doubly randomized preference trial to test whether offering individuals with binge-spectrum eating disorder a choice between two digital interventions is causally linked with superior outcomes than random assignment to these interventions. Participants with recurrent binge eating were randomized to either a choice (n = 77) or no-choice (n = 78) group. Those in the choice group could choose one of the two digital programs, while those in the no-choice group were assigned a program at random. The two digital interventions (a broad and a focused program) took 4 weeks to complete, were based on cognitive-behavioral principles and have demonstrated comparable efficacy, but differ in scope, content, and targeted change mechanisms. Most participants (79%) allocated to the choice condition chose the broad program. While both groups experienced improvements in primary (Eating Disorder Examination Questionnaire global scores and number of binge eating episodes over the past month) and secondary outcomes (dietary restraint, body image concerns, etc.), no significant between-group differences were observed. The two groups did not differ on dropout rates, nor on most indices of intervention engagement. Findings provide preliminary insights towards the role of client preferences in digital mental health interventions for eating disorders. Client preferences may not determine outcomes when digital interventions are based on similar underlying principles, although larger trials are needed to confirm this.     

妇产科教学如何应对新的医疗环境

近年来，患者维权意识增强，医患关系紧张，妇产科教学面临着缺乏实践教学对象，教学任务不能落实的尴尬局面。只有在教学中渗透医德教育，提高医疗风险意识，加强教师素质培训，尽力协调好医患关系，应用先进科学的教学方法，才能保证教学质量，从而使妇产科教学落到实处。