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Patient Education and Counseling Jul 2024To describe the role of patients with a chronic disease, healthcare professionals (HCPs) and technology in shared decision making (SDM) and the use of clinical decision... (Review)
Review
OBJECTIVES
To describe the role of patients with a chronic disease, healthcare professionals (HCPs) and technology in shared decision making (SDM) and the use of clinical decision support systems (CDSSs), and to evaluate the effectiveness of SDM and CDSSs interventions.
METHODS
Randomized controlled studies published between 2011 and 2021 were identified and screened independently by two reviewers, followed by data extraction and analysis. SDM elements and interactive styles were identified to shape the roles of patients, HCPs and technology.
RESULTS
Forty-three articles were identified and reported on 21 SDM-studies, 15 CDSS-studies, 2 studies containing both an SDM-tool and a CDSS, and 5 studies with other decision support components. SDM elements were mostly identified in SDM-tools and interactions styles were least common in the other decision support components.
CONCLUSIONS
Patients within the included RCTs mainly received information from SDM-tools and occasionally CDSSs when it concerns treatment strategies. HCPs provide and clarify information using SDM-tools and CDSSs. Technology provides interactions, which can support more active SDM. SDM-tools mostly showed evidence for positive effects on SDM outcomes, while CDSSs mostly demonstrated positive effects on clinical outcomes.
PRACTICE IMPLICATIONS
Technology-supported SDM has potential to optimize SDM when patients, HCPs and technology collaborate well together.
Topics: Humans; Decision Making, Shared; Randomized Controlled Trials as Topic; Chronic Disease; Patient Participation; Decision Support Systems, Clinical; Decision Support Techniques; Health Personnel
PubMed: 38547638
DOI: 10.1016/j.pec.2024.108267 -
The Science of the Total Environment Dec 2023Water and food security are constantly on the sustainable development agenda since they are interrelated with anthropogenic and ecosystemic issues present in the... (Review)
Review
Water and food security are constantly on the sustainable development agenda since they are interrelated with anthropogenic and ecosystemic issues present in the economic, environmental, and social spheres. The non-integrative management of these issues points to unsustainable futures. In this context, nexus approaches deserve considerable attention in the search for integrative management solutions capable of contributing to leveraging synergies that increase agricultural productivity, while simultaneously reducing environmental impacts, including water resources. This systematic literature review article aims to analyze the integration factors from the perspective of the water - food - environment nexus in the context of water and agricultural sustainability. The systematic methodology, including a content analysis, allowed the identification of analytical categories composed of the most present integrating factors and discussed in the scientific scope and how they are correlated from the perspective of the nexus. Among the extensive number of factors, the systemic management inserted in the integrated management of watersheds, the sustainable intensification from the perspective of food security and the demand for water resources, categorized in water security, presented higher frequency of occurrence when compared with the other factors. It is proposed that these factors can be considered as indicators of sustainability in the context of integrated water resources management and agricultural food production, since their synergistic effects have consequences in the water, agricultural and environmental management sectors. Thus, this study stands out for identifying trends and gaps in the water - food - environment nexus that can contribute to the development of innovative decision-making tools, in order to assist in the management of the watershed, where agriculture plays a key role in socio-environmental issues.
Topics: Water Supply; Food; Sustainable Development; Agriculture; Food Supply; Water
PubMed: 37678519
DOI: 10.1016/j.scitotenv.2023.166866 -
Health Promotion Perspectives 2023ChatGPT is an artificial intelligence based tool developed by OpenAI (California, USA). This systematic review examines the potential of ChatGPT in patient care and its...
BACKGROUND
ChatGPT is an artificial intelligence based tool developed by OpenAI (California, USA). This systematic review examines the potential of ChatGPT in patient care and its role in medical research.
METHODS
The systematic review was done according to the PRISMA guidelines. Embase, Scopus, PubMed and Google Scholar data bases were searched. We also searched preprint data bases. Our search was aimed to identify all kinds of publications, without any restrictions, on ChatGPT and its application in medical research, medical publishing and patient care. We used search term "ChatGPT". We reviewed all kinds of publications including original articles, reviews, editorial/ commentaries, and even letter to the editor. Each selected records were analysed using ChatGPT and responses generated were compiled in a table. The word table was transformed in to a PDF and was further analysed using ChatPDF.
RESULTS
We reviewed full texts of 118 articles. ChatGPT can assist with patient enquiries, note writing, decision-making, trial enrolment, data management, decision support, research support, and patient education. But the solutions it offers are usually insufficient and contradictory, raising questions about their originality, privacy, correctness, bias, and legality. Due to its lack of human-like qualities, ChatGPT's legitimacy as an author is questioned when used for academic writing. ChatGPT generated contents have concerns with bias and possible plagiarism.
CONCLUSION
Although it can help with patient treatment and research, there are issues with accuracy, authorship, and bias. ChatGPT can serve as a "clinical assistant" and be a help in research and scholarly writing.
PubMed: 37808939
DOI: 10.34172/hpp.2023.22 -
Journal of Endovascular Therapy : An... Nov 2023Our objective was to investigate whether patients who receive anticoagulation therapy have different outcomes after endovascular aneurysm repair (EVAR) from those who do... (Review)
Review
PURPOSE
Our objective was to investigate whether patients who receive anticoagulation therapy have different outcomes after endovascular aneurysm repair (EVAR) from those who do not.
MATERIALS AND METHODS
We conducted a systematic review of studies that compared outcomes of EVAR in patients who were on therapeutic anticoagulation vs those who were not. We developed and reported the review in accordance with the PRISMA guidelines with a registered protocol (CRD42022375894). The Ovid interface was used to search Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) up to November 2022. The quality of studies was assessed with the Newcastle-Ottawa Scale (NOS) (maximum score=9), and the evidence was appraised with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. The hazard ratio (HR) and 95% confidence interval (CI) was the effect estimate in time-to-event meta-analyses, calculated using the inverse-variance statistical method and random-effects models.
RESULTS
Sixteen studies qualified for inclusion reporting a total of 35 739 individuals. Anticoagulated patients had a statistically significantly higher hazard of death (HR=1.93, 95% CI=1.03-3.63), endoleak (HR=2.13, 95% CI=1.55-2.93), reintervention (HR=1.79, 95% CI=1.27-2.52), and aneurysm sac expansion (HR=2.72, 95% CI=1.57-4.72) than patients not receiving anticoagulation therapy. The median score on the NOS was 7 (range=4-9). The certainty of evidence was very low for mortality and reintervention and low for endoleak and sac expansion.
CONCLUSIONS
Anticoagulation is a poor prognostic factor after standard EVAR and should be considered in decision-making, consent processes, and surveillance strategies.
CLINICAL IMPACT
The number of individuals who take anticoagulation treatment has been rapidly increasing over the recent years. We aimed to investigate the effect of such treatment on outcomes after endovascular aneurysm repair (EVAR). Anticoagulated patients were found to have increased mortality, endoleak, and reintervention rates after EVAR compared to their non-anticoagulated counterparts. Anticoagulation therapy has a prognostic role in EVAR and should be considered in decision making and EVAR surveillance. Anticoagulated patients need to be informed of the higher failure rates of EVAR, and intensified surveillance strategies may need to be implemented in this patient cohort.
PubMed: 38031419
DOI: 10.1177/15266028231214761 -
Behavioural Brain Research Aug 2023In clinical research, aberrant avoidance behavior and inhibitory control deficit have a high comorbidity in different psychopathological disorders. Therefore, avoidance... (Review)
Review
In clinical research, aberrant avoidance behavior and inhibitory control deficit have a high comorbidity in different psychopathological disorders. Therefore, avoidance and impulsive and/or compulsive behaviors might be classified as transdiagnostic traits, where the assessment through animal models could address evidence of their contribution as neurobehavioral mechanisms in psychopathology. The objective of the present review has been to assess the avoidance trait and the implication of inhibitory control behaviors, through studies using passive and active avoidance tests in rodents, and a preclinical model using selective breeding of high- or low-avoidance Roman rats (RHA, RLA). A systematic search strategy was carried out in the PubMed and Web of Science databases, where a total of 40 studies were accepted in the qualitative synthesis. The results of the different studies reviewed pointed to a relation between a reduced avoidance profile in passive avoidance (PA) with impulsive decision making and novelty-seeking behaviors; an increased avoidance profile in PA with compulsive drinking; a high active avoidance profile, including RHA rats, with different types of impulsivity and novelty- seeking behaviors; and regarding compulsivity depending on its measure, a low active avoidance profile, including RLA rats, has been associated with increased anxiety in the EPM and increased grooming, while a high active avoidance profile, including RHA rats, has been associated with increased rearing, compulsive drinking including alcohol, and cognitive inflexibility. The results have been discussed in terms of environmental factors and the underlying mechanisms between these possible transdiagnostic traits in psychopathology.
Topics: Rats; Animals; Avoidance Learning; Exploratory Behavior; Models, Animal; Phenotype; Ethanol; Behavior, Animal
PubMed: 37207979
DOI: 10.1016/j.bbr.2023.114500 -
Australian Critical Care : Official... Apr 2024Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must... (Review)
Review
BACKGROUND
Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must better understand decision-making processes and factors influencing them.
AIM
The aim of this study was to explore factors influencing decision-making processes about implementing and limiting intensive care therapies.
DESIGN
Systematic integrative review, synthesising quantitative, qualitative, and mixed-methods studies.
METHODS
Five databases were searched (Medline, The Cochrane central register of controlled trials, Embase, PsycINFO, and CINAHL plus) for peer-reviewed, primary research published in English from 2010 to Oct 2022. Quantitative, qualitative, or mixed-methods studies focussing on intensive care decision-making were included for appraisal. Full-text review and quality screening included the Critical Appraisal Skills Program tool for qualitative and mixed methods and the Medical Education Research Quality Instrument for quantitative studies. Papers were reviewed by two authors independently, and a third author resolved disagreements. The primary author developed a thematic coding framework and performed coding and pattern identification using NVivo, with regular group discussions.
RESULTS
Of the 83 studies, 44 were qualitative, 32 quantitative, and seven mixed-methods studies. Seven key themes were identified: what the decision is about; who is making the decision; characteristics of the decision-maker; factors influencing medical prognostication; clinician-patient/surrogate communication; factors affecting decisional concordance; and how interactions affect decisional concordance. Substantial thematic overlaps existed. The most reported decision was whether to withhold therapies, and the most common decision-maker was the clinician. Whether a treatment recommendation was concordant was influenced by multiple factors including institutional cultures and clinician continuity.
CONCLUSION
Decision-making relating to intensive care unit therapy goals is complicated. The current review identifies that breadth of decision-makers, and the complexity of intersecting factors has not previously been incorporated into interventions or considered within a single review. Its findings provide a basis for future research and training to improve decisional concordance between clinicians and patients/surrogates with regards to intensive care unit therapies.
PubMed: 38609749
DOI: 10.1016/j.aucc.2024.02.007 -
Preferences for Palliative and End-of-Life Care: A Systematic Review of Discrete Choice Experiments.Value in Health : the Journal of the... Dec 2023Understanding what matters most to patients and their caregivers is fundamental to delivering high-quality care. This systematic review aimed to characterize and... (Review)
Review
OBJECTIVES
Understanding what matters most to patients and their caregivers is fundamental to delivering high-quality care. This systematic review aimed to characterize and appraise the evidence from discrete choice experiments eliciting preferences for palliative care.
METHODS
A systematic literature search was undertaken for publications up until August 2022. Data were synthesized narratively. Thematic analysis was applied to categorize attributes into groups. Attribute development, frequency, and relative importance were analyzed. Subgroup analyses were conducted to compare outcomes between patient and proxy respondents.
RESULTS
Seventeen studies spanning 11 countries were included; 59% of studies solely considered preferences for patients with cancer. A range of respondent groups were represented including patients (76%) and proxies (caregivers [35%], health providers [12%], and the public [18%]). A total of 117 individual attributes were extracted and thematically grouped into 8 broad categories and 21 subcategories. Clinical outcomes including quality of life, length of life, and pain control were the most frequently reported attributes, whereas attributes relating to psychosocial components were largely absent. Both patients and proxy respondents prioritized pain control over additional survival time. Nevertheless, there were differences between respondent cohorts in the emphasis on other attributes such as access to care, timely information, and low risk of adverse effects (prioritized by patients), as opposed to cost, quality, and delivery of care (prioritized by proxies).
CONCLUSIONS
Our review underscores the vital role of pain control in palliative care; in addition, it shed light on the complexity and relative strength of preferences for various aspects of care from multiple perspectives, which is useful in developing personalized, patient-centered models of care for individuals nearing the end of life.
Topics: Humans; Quality of Life; Patient Preference; Terminal Care; Palliative Care; Pain; Choice Behavior
PubMed: 37543206
DOI: 10.1016/j.jval.2023.07.005 -
Journal of Palliative Medicine Dec 2023Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled... (Review)
Review
Parental Ethical Decision Making and Implications for Advance Care Planning: A Systematic Review and Secondary Analysis of Qualitative Literature from England and Wales, Germany, and the Netherlands.
Clinicians and parents are expected to make medical treatment decisions in the child's best interests. To reach their decisions, clinicians typically apply a principled approach outlined by Beauchamp and Childress. How parents make ethical decisions is an under-researched area. A possible model for parental decision making is the Ethics of Care (EoC) theory. Ethical decision making within this framework aims to preserve the caring relationship. What is right or wrong depends on the circumstances at the time. To identify the parental ethical values and determine whether parental decision making is consistent with EoC, a systematic review and secondary analysis of qualitative research from England and Wales, the Netherlands, and Germany was performed. As part of a larger project investigating conflicts between parents and clinicians about children's medical treatment, the choice of countries was determined by differences in litigation. Eight databases were searched for articles published between 2010 and 2020 reporting on at least one medical treatment decision made by parents of a child with any life-limiting condition and analyzed using reflexive thematic analysis. Twelve included articles directly addressing advance care planning (ACP) were reanalyzed to investigate whether this specific decision parents are increasingly being asked to make is also consistent with EoC. Forty-three articles were included. Parents use the same 6 ethical values which, consistent with EoC, are mostly in the context of their relationship with the child. All values contributed to the previously identified theme of "being a good parent/person." Analysis of parental decision making in ACP confirmed consistency with EoC. The parental decision-making process is consistent with EoC. That parental decisions aim to maintain the caring relationship and are dependent on the circumstances at the time has implications for parental decision making in ACP and should be reflected in future policies.
Topics: Child; Humans; Netherlands; Wales; Decision Making; Parents; Advance Care Planning
PubMed: 37262127
DOI: 10.1089/jpm.2022.0520 -
Nursing Ethics Apr 2024Interventions to improve ethical decision-making are available in nursing education. Evidence of its effectiveness is essential. (Review)
Review
BACKGROUND
Interventions to improve ethical decision-making are available in nursing education. Evidence of its effectiveness is essential.
OBJECTIVE
This review examined the effectiveness of interventions to improve nursing students' ethical decision-making skills.
METHODS
A structured search was performed in Google Scholar, Web of Science, Science Direct, Pubmed, Scopus, Cochrane Library, Elsevier, CINAHL EBSCO, and ULAKBIM. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) was used to assess the quality of studies.
ETHICAL CONSIDERATIONS
Ethical approval was not required for this systematic review.
FINDINGS
The final review was composed of six studies of published between January 2013 and 2023. Nine different teaching methods applied to students. Although the importance of ethical decision-making skills in solving ethical problems that nurses may encounter at any time is known, it is thought that there is a lack of data in the literature in the last 10 years. The last 10 years were chosen as this aims to provide a review based on the most current, relevant and quality information. The review indicated that all of the teaching methods improved ethical decision-making.
CONCLUSION
Different teaching methods can be used in the nursing education curriculum to meet the learning needs of nursing students in ethical decision-making.
PubMed: 38576333
DOI: 10.1177/09697330241239917 -
Minerva Anestesiologica Jun 2024Decision-making about organ donation (OD) is influenced by interrelated cognitive and non-cognitive factors. The identification of these factors in the general...
INTRODUCTION
Decision-making about organ donation (OD) is influenced by interrelated cognitive and non-cognitive factors. The identification of these factors in the general population and among healthcare professionals (HCP) in Italy are key ethical and scientific requirements to inform targeted communication and policy-making interventions, and to promote decision-making processes that are truly informed.
EVIDENCE ACQUISITION
A systematic review of articles published between January 1, 1999, and January 31, 2024 was performed by searching four databases using these terms: "organ donation" AND (attitude OR opinion OR knowledge OR awareness OR intention OR beliefs OR norms OR perception) AND (Italy OR Italian). The reference sections of included articles were scrutinized for additional references.
EVIDENCE SYNTHESIS
Most respondents (lay citizens and HCPs) were in favor of OD, but many (mainly but not exclusively lay citizens) would not authorize OD in the event of death of a family member. Lack of knowledge about OD and the gap between demand and supply of organs, fear of body mutilation, doubts about the criteria for brain death diagnosis, doubts about the wishes of the deceased family member, and distrust towards medical doctors and the healthcare system were the most commonly reported reasons, confirming that cognitive and non-cognitive factors are at play.
CONCLUSIONS
The majority of the Italian population supports OD, but cognitive and non-cognitive barriers are present even among HCPs. Communication campaigns, encouraging family discussions about OD, providing better education for HCPs (including medical and nursing students), and making it easier to sign OD cards may promote informed decision-making and possibly increase consent rates.
PubMed: 38922284
DOI: 10.23736/S0375-9393.24.18098-4