Medical Treatment Decisions Research Articles

Pediatric limbal stem cell deficiency: An overview of a rarely studied pathology.

The cornea is the outermost transparent layer of the eye, and the continuous renewal of the corneal epithelium is important for its transparency. This process is primarily facilitated by corneal stem cells, most of which are found at the limbus. However, any deterioration or damage in this region leads to corneal conjunctivalization and consequent limbal stem cell deficiency (LSCD), which compromises corneal transparency. LSCD is an important condition, especially in the pediatric population, as it can lead to corneal vascularization, opacity and ultimately loss of vision and subsequent amblyopia, unlike adults. Although pediatric LSCD is often due to chemical injuries, as in adults, it is also caused by conditions such as congenital aniridia, Steven Johnson Syndrome and various other immunological disorders. Appropriate and timely treatment in pediatric LSCD is of particular importance in preventing progression to amblyopia, unlike adults. Accurate staging of the disease is essential for the necessary medical and surgical treatment decision. While medical approaches are at the forefront to eliminate the causative agent and improve the ocular surface in reversible cases, it is essential to replace the limbal stem cells lost in advanced disease. For these replacement procedures, it is noteworthy that there is a tendency for minimally invasive methods compared to adults to avoid possible complications due to long life expectancy in children. In conclusion, although there are various reviews on limbal stem cell deficiency (LSCD) in adults, we believe that this review for childhood LSCD will make an important contribution to the literature, since the relevant literature currently reported for the pediatric population is limited.

Attitudes and awareness in autonomous decision on medical treatment or inclusion in clinical trials amongst Slovenian adolescents: an online survey

BackgroundIn Europe and elsewhere in the world, activities are taking place to improve the awareness of children and adolescents (hereinafter: adolescents) regarding their rights and obligations in autonomous decision-making about their own medical treatment and participation in clinical research.MethodsThe cross-sectional survey of adolescents was carried out using an anonymous online questionnaire. We obtained consent from the Commission of the Republic of Slovenia for Medical Ethics. Participating young people were invited through the network of primary and secondary schools, the Society of Dystrophy of Slovenia and through the dissemination of electronic messages. The online questionnaire was open from April 25 to May 6, 2023. Young people aged 13 to 20 joined the survey. The association between several factors and awareness of the minimum age limit was tested by univariate logistic regression. All statistical testing was performed at a significance level of 0.05.ResultsThe responses of 458 respondents were analysed, of which 281 were male. Only 8.3% of participating adolescents knew the age limit set by law for autonomous decision-making about medical treatment at 15 years old. Most answered that a medical institution should inform them about their rights (62.4%). Only 5.02% responded that they do not need their parents’ consent when making decisions; 2.6% of respondents answered that they autonomously decided to undergo treatment without their parents’ knowledge. The majority obtained information about treatment from a doctor (more than 70%); 42.8% were in favour of new forms of treatment, especially chronic patients (more than 70%); 44.8% had already heard about clinical research, most of them through the media (55.4%); 70% of the respondents answered correctly about making an autonomous decision about participation in research at the age of 18. About three-quarters (75.6%) of respondents who had heard of clinical research believe that an individual should be paid for participating.ConclusionsOur research showed insufficient awareness of the age limit of adolescents regarding medical treatment decisions and clinical research. The prevailing view is that health professionals should inform young people more about their rights. Most adolescents believe they should be paid to participate in clinical research.

Placebos in Healthcare: A Behavioral Study on How Treatment Responsiveness Affects Therapy Decisions in a Simulated Patient-Physician Interaction.

Treatment choice during clinical practice is crucial to best help each patient. One of the physicians' main goals is choosing a personalized effective treatment, but it also represents a challenging issue. Here, we explored different treatment choices in a simulated patient-physician interaction. Medical students (n = 48) and young Practicing Physicians (n = 20) were recruited to behave as "physicians" while fellow researchers acted as "patients". Participants were divided equally into a Belief Group, which received positive information about placebo efficacy, and a Non-Belief Group, which received negative information. Empathy traits and psychological variables were measured in both groups. During the task, participants were asked to choose between an active (TENS treatment) or a placebo treatment, to reduce patients' pain. Patients never underwent the painful stimulation but acted as if they had, simulating high or low pain responses to the placebo treatment (placebo-responders/placebo non-responders) and low pain to the TENS treatment. Behavioral results showed that the Belief Group gave significantly more placebo treatments when faced with a patient that simulated placebo responsiveness, while the Non-Belief group showed a mirrorlike behavior, administrating more believed TENS treatments when faced with a placebo non-responder. No differences were found between Medical Students and Practicing Physicians. This study constitutes a frame of reference for medical treatment decisions, indicating that physicians' treatment choices are influenced by patients' responsiveness to the treatments, as well as by their prior beliefs and empathy traits.

Assessing the Feasibility of a Cancer Biomarker Testing Navigator in the Laboratory

Abstract Introduction/Objective Cancer biomarker testing is a crucial component of precision oncology, as it can guide medical treatment decisions with targeted therapies and immune checkpoint inhibitors. However, complex, fragmented, and inefficient operational processes involved in biomarker testing lead to delays, errors, and variability in testing. One potential solution is to introduce a novel role in the pathology laboratory: the cancer biomarker testing navigator (BTN). Methods/Case Report The American Society for Clinical Pathology (ASCP) conducted a mixed-methods project to assess the current state of biomarker testing operations and explore how a BTN may improve biomarker testing processes. ASCP conducted an online survey, focus groups, and worked with two hospital-based cancer centers on a feasibility pilot. Results (if a Case Study enter NA) Survey and focus group insights reveal several operational challenges around the biomarker testing process. 47 completed the survey and 16 participated in the focus groups. Participants report that biomarker test orders may be incorrect or incomplete. 37% of survey respondents experience delays preparing tissue samples for send-out cancer biomarker testing. 42% of survey respondents are unable to track the processing status of send-out tests. Excessive time is required to coordinate and facilitate send-out tests, especially when multiple reference laboratories are used since each has its own portal, requisition form, specimen requirements, etc. 87% agree they would benefit significantly from having a dedicated person to coordinate and manage cancer biomarker tests. The cancer centers that piloted this role found that they could catch and correct defects such as incorrect test ordered, incorrect specimen types marked on the test order, outdated requisition used, etc. The BTN also found instances where the test report was incomplete or had not been uploaded into the EHR. The BTN role could be justified by evaluating metrics such as task efficiency, workplace satisfaction in the lab, and levels of service satisfaction from oncologists. Patient care can be improved by reducing delays in testing and by reviewing other metrics of quality care delivery. Conclusion The BTN role in the laboratory is a novel solution for ensuring the proper collection and triage of pathology samples for biomarker testing. This role could serve as a liaison between the laboratory and ordering clinicians, provide collection and testing guidance, and help with benchmarking and quality measurement initiatives.

Pediatric Obesity Pharmacotherapy: State of the Science, Research Gaps, and Opportunities.

Pediatric obesity is a major public health problem, affecting nearly 20% of children and adolescents living in the United States. In 2023, the American Academy of Pediatrics released its first clinical practice guideline for the evaluation and management of child and adolescent obesity and recommended integrating health behavior and lifestyle interventions with pharmacological treatment when medically indicated. However, there is a limited evidence base to guide antiobesity medication treatment decisions in clinical practice and limited data on long-term safety during this critical period of growth and development in youth. Thus, in November of 2023, the National Institute of Diabetes and Digestive and Kidney Diseases sponsored a workshop to identify knowledge gaps and opportunities for research on the use of pharmacotherapy for obesity in children and adolescents. Leading scientific and clinical experts in obesity pathophysiology and treatment, pharmacotherapy, clinical trial design, and health equity and disparities, among others, identified gaps in clinical trial design, guidance for clinical use of medications in children and adolescents, additional treatment outcomes beyond body fat or weight, and improvement in care delivery. Adolescent patients and caregivers with lived experience of obesity and weight management were also invited to participate in a panel discussion, providing personal perspectives on living with obesity, clinical care considerations, and research needs. This article summarizes the workshop proceedings on the state of the science and identifies gaps and opportunities for future research to inform optimal and equitable medical management of children and adolescents with obesity.

Assessment of pulmonary nodules using [18F]-FDG PET/CT in deep inspiration breath-hold

The characterization of pulmonary nodules (PN) is a primary indication for [18F]-FDG PET/CT. However, respiratory movements hinder this characterization, especially for PN located in the lower lobes. Various methods have been developed to improve image resolution. ObjectiveOur objective was to compare the diagnostic efficacy of [18F]-FDG PET/CT in deep inspiration breath-hold (DIBH) versus free-breathing corrected by software, in the evaluation of PN. MethodsWe prospectively analyzed 51 patients to assess PN using [18F]-FDG PET/CT in DIBH and free-breathing corrected by software. A total of 84 nodules with an average size of 10 mm were analyzed, with pathological anatomy or medical treatment decisions by a multidisciplinary tumor board used as reference. ResultsA total of 84 PN were evaluated, comparing those in DIBH versus free-breathing, finding statistically significant differences in SUVmax values (P < .05) (mean SUVmax 3.7 in free-breathing vs. 5.33 in DIBH). When analyzed by location in lobes, we did not find statistically significant differences, though there was a trend towards higher SUVmax values in the lower lobes. [18F]-FDG PET/CT in DIBH showed high sensitivity (95%) and negative predictive value (NPV) (92%), indicating it may be a promising tool for PN characterization. ConclusionsThe acquisition of [18F]-FDG PET/CT in DIBH significantly improves the sensitivity and diagnostic efficacy in the assessment of PN. Although no statistically significant differences were found based on location, there is a potential benefit for the lower lobes. These findings could support its use in clinical practice.

Acknowledgement and use of advance care directives and goals of care by emergency department staff: a mixed method post intervention study.

Advance Care Planning (ACP) refers to a process that includes Advance Care Directives (ACD) and Goals of Care (GOC), a practice widely used for over three decades. Following the findings of an audit and a cross-sectional study in 2019 and 2021 respectively, we implemented several educational and other interventional strategies aimed at enhancing staff awareness and emphasizing the importance of recognizing and documenting of ACD/GOC. The aim of this study was to evaluate the acknowledgement and use of ACD and GOC by Emergency Department (ED) staff following these interventions. We used a mixed methods approach, incorporating both observational and cross-sectional designs with reflexive thematic analysis. Data extraction for the observational study took place between 1st April and 30th June 2023 focusing on a target population of randomly sampled adults aged ≥ 65 years. Demographics and other ACD and GOC related patients' clinical data were collected. Data collection for the cross-sectional study occurred between 19th July and 13th September 2023 targeting all ED staff. Information gathered included demographics, awareness about ACD and GOC, including storage location and implementation, as well as knowledge of Medical Treatment decision Makers (MTDM), a jurisdictional term identifying a person legally appointed to make healthcare decisions on behalf of someone who lacks decision-making capacity and other Victorian State legislative requirements were collected. In the observational period, 22,335 patients attended the ED and 19% (n = 6546) qualified for inclusion from which a sample of 308 patients were randomly extracted. We found ACD documents were noted in the medical records of 6.5% of the sample, fewer than 8% identified in our previous study. There was no correlation between ACD record availability and age (p = 0.054; CI ranging from - 0.065 to 7.768). The response rate for the cross-sectional survey was 12% (n = 340) in contrast to earlier study with 28% (n = 476) respondents. Staff knowledge and familiarity with ACD was 25% and GOC 45%. After implementing interventions in staff education and ACP awareness, we found that ACD documentation did not improve. However, GOC documentation increased in the context of heightened institutional awareness and integration into the Electronic Medical Records (EMR).

Ethical boundary decisions in intensive care medicine

Ethical decision-making is acornerstone of intensive care and emergency medicine. In acute scenarios, clinicians often face rapid, high-stakes decisions concerning life and death, made more challenging by time constraints and incomplete information. These decisions are further complicated by economic constraints, limited resources, and evolving technological capabilities. What decision-making aids and factors can be employed in ethical borderline cases within intensive care medicine? Fundamental ethical principles such as patient autonomy, beneficence, non-maleficence, and justice form the basis for medical treatment decisions. Evaluating the patient's will through advanced directives or proxy consensus is crucial, although advanced directives can be ambiguous. Assessing quality of life is increasingly important, with instruments such as the Clinical Frailty Scale (CFS) being utilized. For older patients, aholistic approach is recommended, focusing on overall health rather than chronological age. In patients with advanced underlying diseases, amultidisciplinary dialogue is essential. Decision-making in intensive care medicine requires careful consideration of medical, ethical, and individual factors. Despite advances in artificial intelligence and prognostic models, human judgment remains crucial. During periods of resource scarcity, ethically sound triage protocols are required. The challenge lies in applying these principles and factors in clinical practice while respecting the individuality of each patient.

Validating older adult patient's Medical Treatment Decision Maker's (MTDM). A retrospective observational study with follow-up phone interview transcript

A Medical Treatment Decision Maker (MTDM), also referred to as surrogate decision maker, by law, is to be appointed to make medical treatment decisions on behalf of a person who cannot make such decisions for themselves. In the Emergency Department (ED) and acute healthcare services, the clinicians’ (nurses and doctors) ability to contact MTDMs is essential for patient care, particularly in time-critical situations. Our primary objective was to review the verification process and assess the accuracy of MTDM contact numbers in the Health Information System (HIS) to assess compliance with legislation. We used a quantitative method with retrospective observational study design and follow-up phone interview transcript. One hundred and fifty-nine participants were randomly selected of whom 76 % had MTDM. Patient advancing age had statistically significant association with the number of call attempts made to reach the listed MTDM (P = 0.043; CI, -3.541 to -0.057) and the MTDM's consent to participate (p = 0.023).

Management of BRCA-associated breast cancer patients in low and middle-income countries: a review.

Breast cancer poses a significant global health challenge, with higher incidence rates in developed countries. However, low- and middle-income countries (LMICs) suffer from higher mortality rates due to various factors, including limited screening programs, delayed diagnosis and inadequate access to healthcare and advanced treatments. Approximately 5%-10% of breast cancer cases stem from germline mutations in BRCA-1/2 genes. A positive BRCA1/2 status obtained through genetic testing significantly influences surgical and medical treatment decisions. Therefore, genetic counseling, proper surveillance and customized interventions for BRCA1/2 carriers are essential to maximizing the benefits of monitoring, chemoprevention and risk-reducing surgeries for breast and ovarian cancers. Identification of BRCA mutations also impacts treatment strategies, leading to the integration of chemotherapeutic agents like platinum-based chemotherapy and PARP inhibitors. However, implementing these advanced treatment guidelines in LMICs with complex, fragmented and underfunded healthcare systems presents numerous challenges. In this review, we explore the current status and obstacles associated with managing BRCA1/2-associated breast cancer in LMICs.

Knowledge Domain and Emerging Trends in Internet-based diagnosis and treatment services：A Scientometric Review Based on CiteSpace V Analysis

Background: In the battle against the COVID-19 pandemic, Internet-based diagnosis and treatment services offer a promising technological avenue for effective healthcare delivery. However, there remains a scarcity of bibliometric analyses on Internet-based diagnosis and treatment services within the healthcare domain. This study aims to address this gap by conducting a comprehensive examination of research advancements, highlighting prevalent themes, and delineating emerging trends in Internet-based diagnosis and treatment research using CiteSpace V. Methods: The Web of Science Core Collection (WoSCC) was utilized to gather literature on Internet-based diagnosis and treatment within the healthcare sector spanning from 2001 to 2021. CiteSpace V facilitated keyword analysis, created dual-map overlays of journals, generated timeline views of co-cited references, and analyzed literature information. This encompassed variables such as involved countries and institutions, journals publishing relevant research, authors and cited authors, cited references, highly cited works, H-index, average citations, prevalent subjects of interest, and emerging frontiers in the field. Results: WoSCC identified a total of 1259 papers on Internet-based diagnosis and treatment for bibliometric analysis. Annual publications generally exhibited an upward trend. The United States contributed the most publications (465 papers) and the highest number of highly cited papers (9). Poland had the highest average citations per item (42.12). Gerhard Andersson emerged as the most influential author, with 16 publications and a co-citation count of 216. The six primary topics in Internet-based diagnosis and treatment services were health anxiety, randomized controlled trials, IoT platforms, health-related quality, Chinese men, and Internet gaming disorder. The eight emerging topics were medical devices, artificial intelligence, health-related quality, breast cancer, prostate cancer, patient care, treatment decisions, and HIV. With the development of Internet-based diagnosis and treatment technology, major ongoing research trends include the deep application of artificial intelligence in the medical field, enhancing patient satisfaction in clinical practice, improving health-related quality, and treating breast cancer patients. Conclusions: This study provides a comprehensive examination of Internet-based diagnosis and treatment services within the healthcare sector, offering valuable insights that provide significant guidance for future development in the field.

Abstract PO4-25-09: HER2-Low and Ultra-Low expression in young women with luminal breast cancer in México

Abstract Background and objective HER2-Low in breast cancer is a biomarker with new approaches for prognosis and medical treatment decisions. However, HER2-Ultra-Low is an area of novel research. Our objective was to describe the clinicopathologic characteristics and HER2 expression status of a group of Mexican young patients with luminal breast cancer. Methods One hundred and fifty-seven young patients (&amp;lt; 40 years) with luminal breast cancer diagnosed from 2014 to 2020 were included. Clinicopathologic features, hormone receptors, HER2 expression, and tumor infiltrating lymphocytes (TILs) were assessed. We categorized patients in three groups: HER2 negative (n=95, 60.5%), HER2-Low (n=33, 21.0%), and HER2-Ultra-Low (n=29, 18.5%). Descriptive statistics were used to report demographic, clinical and histopathological characteristics. Kaplan-Meier curves and log-rank or Mantel-Cox tests were used to determine survival. Statistical significance was established using a P value &amp;lt; 0.05. This analysis was performed using R (version 4.0.4) through R Studio interface (version 1.4.1106). Results The median of age at diagnosis was 36.1 years [range 32.8-38.8], with a median of follow-up of 5.08 years [range 3.58-6.52]. The most frequent histologic type was ductal infiltrating carcinoma (81%), and 49.4% presented grade two of differentiation. T2, N0 and clinical stage II were the most common (45.2%, 44.5, and 48.1%, respectively), and fourteen patients (9.0%) presented clinical stage IV. We found statistically significant differences in Ki67 and total TILs quantification between HER2 negative and HER2-Low. Progesterone receptor levels were higher for HER2 negative and Ultra-Low in comparison to HER2-Low. The total population had a 5-year overall survival of 84.9%. We found statistically significant differences in the median of survival between HER2 groups, with a shorter survival for HER2-Low. Conclusion To date, there are no studies that describe the clinical profile and OS of HER2-Low and Ultra-Low in young patients with luminal breast cancer in México. These preliminary findings could indicate the need for further investigation in prognosis, outcomes, and specific treatment in these patients. This study contributes to better understand the clinicopathologic profile of the HER2-Ultra-Low group and its differences with the HER2-Low group. Citation Format: Jesus Edgardo Hernandez Hernandez, César Octavio Lara Torres, Bryan Moreno Moran, Cynthia Villareal Garza, Fany Iris Porras Reyes, Víctor Manuel Pérez Sánchez, Alejandro Mohar. HER2-Low and Ultra-Low expression in young women with luminal breast cancer in México [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-25-09.

The Influence of Internet-Derived Misinformation on Medical Treatment Decisions: A Social Learning Perspective

Purpose “Internet-Derived Information Obstructing Treatment” refers to the phenomenon where patients make their health decisions based on misinformation found online, leading to poor or harmful medical choices. DeGroot’s social learning model is used in this study to enquire at how false information spreads on the internet and influences people’s choices about treatment. We examine how likely patients will choose the wrong treatment, impacting their mental health, such as by making anxiety and depression symptoms worse. In addition, we examine the dynamics of low, high, and mixed levels of influence in the spread of false information. Methods We derived a mathematical framework to analyse the impact of peer-to-peer information sharing on medical decisions using DeGroot’s social learning model by modelling the process of belief updates in digital health networks. Each person’s decision-making is impacted by the views and information they encounter from others; this is known as the multiplier effect of social learning and is incorporated into the model. This method mimics the increasing likelihood that patients will encounter health-related disinformation as they engage with various online communities. Low misinformation influence, high misinformation influence, and mixed initial beliefs were the three scenarios that were modelled in the study. Treatment choices and mental health results were evaluated in light of each scenario. Based on patients’ exposure to false information through internet platforms, the odds ratios (ORs) for negative medical decisions, anxiety, and depression were computed. Results In all of these situations, people were much more likely to make a bad treatment choice when they had incorrect information. Repeated interactions with peers who had been influenced by online false information raised patients’ chances of making bad treatment choices by 50% in the high misinformation scenario (95% confidence interval [CI]: 1.25–1.80). Some patients who were given false information had 40% more anxiety and 35% more depression (OR: 1.40, 95% CI: 1.10–1.70 and OR: 1.35, 95% CI: 1.05–1.65, respectively). According to the model, social learning made false information more powerful, and this was most clear in situations where false information was common. Conclusion DeGroot’s social learning process is a good way to explain how false information found on the internet can affect a patient’s choice of treatment and mental health. Misinformation from the internet can lead to bad medical decisions and higher mental health risks, especially in networks where peers have a lot of power. The results stress the need for targeted interventions to improve digital health literacy and stop the spread of false information in online health communities. Future research should look into ways to stop the social learning processes that keep spreading false information.

Pruning the Way to Reliable Policies: A Multi-Objective Deep Q-Learning Approach to Critical Care.

Medical treatments often involve a sequence of decisions, each informed by previous outcomes. This process closely aligns with reinforcement learning (RL), a framework for optimizing sequential decisions to maximize cumulative rewards under unknown dynamics. While RL shows promise for creating data-driven treatment plans, its application in medical contexts is challenging due to the frequent need to use sparse rewards, primarily defined based on mortality outcomes. This sparsity can reduce the stability of offline estimates, posing a significant hurdle in fully utilizing RL for medical decision-making. We introduce a deep Q-learning approach to obtain more reliable critical care policies by integrating relevant but noisy frequently measured biomarker signals into the reward specification without compromising the optimization of the main outcome. Our method prunes the action space based on all available rewards before training a final model on the sparse main reward. This approach minimizes potential distortions of the main objective while extracting valuable information from intermediate signals to guide learning. We evaluate our method in off-policy and offline settings using simulated environments and real health records from intensive care units. Our empirical results demonstrate that our method outperforms common offline RL methods such as conservative Q-learning and batch-constrained deep Q-learning. By disentangling sparse rewards and frequently measured reward proxies through action pruning, our work represents a step towards developing reliable policies that effectively harness the wealth of available information in data-intensive critical care environments.

The Effects of Introducing a Harm Threshold for Medical Treatment Decisions for Children in the Courts of England & Wales: An (Inter)National Case Law Analysis

The case of Charlie Gard sparked an ongoing public and academic debate whether in court decisions about medical treatment for children in England & Wales the best interests test should be replaced by a harm threshold. However, the literature has scantly considered (1) what the impact of such a replacement would be on future litigation and (2) how a harm threshold should be introduced: for triage or as standard for decision-making. This article directly addresses these gaps, by first analysing reported cases in England & Wales about medical treatment in the context of a S31 order, thus using a harm threshold for triage and second comparing court decisions about medical treatment for children in England & Wales based on the best interest test with Dutch and German case law using a harm threshold. The investigation found that whilst no substantial increase of parental discretion can be expected an introduction of a harm threshold for triage would change litigation. In particular, cases in which harm is limited, currently only heard when there are concerns about parental decision-making, may be denied a court hearing as might cases in which the child has lost their capacity to suffer. Applying a harm threshold for triage in decisions about withholding or withdrawing life-sustaining treatment might lead to a continuation of medical treatment that could be considered futile.

Clinical Phenotyping with an Outcomes-driven Mixture of Experts for Patient Matching and Risk Estimation.

Observational medical data present unique opportunities for analysis of medical outcomes and treatment decision making. However, because these datasets do not contain the strict pairing of randomized control trials, matching techniques are to draw comparisons among patients. A key limitation to such techniques is verification that the variables used to model treatment decision making are also relevant in identifying the risk of major adverse events. This article explores a deep mixture of experts approach to jointly learn how to match patients and model the risk of major adverse events in patients. Although trained with information regarding treatment and outcomes, after training, the proposed model is decomposable into a network that clusters patients into phenotypes from information available before treatment. This model is validated on a dataset of patients with acute myocardial infarction complicated by cardiogenic shock. The mixture of experts approach can predict the outcome of mortality with an area under the receiver operating characteristic curve of 0.85 ± 0.01 while jointly discovering five potential phenotypes of interest. The technique and interpretation allow for identifying clinically relevant phenotypes that may be used both for outcomes modeling as well as potentially evaluating individualized treatment effects.

Pythagorean fuzzy cognitive analysis for medical care and treatment decisions

Pythagorean fuzzy cognitive analysis for medical care and treatment decisions

Wissensstand und Fehlvorstellungen zu Vorsorgedokumenten – Ergebnisse einer Bürgerbefragung

ZusammenfassungEinleitungVorsorgedokumente wie Patientenverfügung oder Vorsorgevollmacht sind bedeutsame Instrumente der Vorausplanung für Situationen, in denen ein Mensch nicht mehr für sich selbst entscheiden kann. Obwohl immer mehr Bürger:innen in Deutschland solche Dokumente erstellen, ist über ihr Wissen zu Zweck, Arten und Anwendung von Vorsorgedokumenten wenig bekannt. Nach über 10 Jahren seit der gesetzlichen Verankerung der Patientenverfügung soll diese Studie das Wissen von Bürger:innen erfassen und Wissenslücken detektieren.MethodenIn der Stadt und im Landkreis Würzburg wurde 2021 eine Querschnittsbefragung von volljährigen Bürger:innen u. a. zu Besitz, Umgang mit und Wissensstand zu Vorsorgedokumenten durchgeführt. Die Rekrutierung erfolgte über Werbeanzeigen und lokale Netzwerke.ErgebnisseVon den 282 Befragten (MAlter = 50 J., zu 2 Drittel weiblich) hatten 43,4 % nach Selbstangabe zumindest ein Vorsorgedokument verfasst. Im Wissenstest wurden im Mittel 22/34 Punkten erreicht. Fragen zur konkreten Anwendung von Vorsorgedokumenten anhand eines Fallbeispiels sowie zu Sterbehilfearten wurden häufig korrekt beantwortet, wohingegen beim Faktenwissen zu den einzelnen Dokumenttypen größere Wissensdefizite bestanden. Objektiv getestetes Wissen und Variablen zum subjektiven Wissensstand korrelieren positiv.DiskussionDie relativ hohe Quote an erstellten Dokumenten in dieser Stichprobe ist Ausdruck ihrer raschen Verbreitung in den letzten Jahren. Das Wissensniveau ist als niedrig einzuschätzen und zeigt Fehlvorstellungen zu Rechten und Pflichten der verfassenden Person sowie der beteiligten Akteure. Das gemessene Wissen der Bürger:innen steht in Diskrepanz zum häufig geäußerten Wunsch, durch informiertes Erstellen von Vorsorgedokumenten ihre Selbstbestimmung zu wahren.

Can mediation avoid litigation in conflicts about medical treatment for children? An analysis of previous litigation in England and Wales

ObjectiveTo investigate the reasons why parents disagree with their clinicians in cases reaching the court and to estimate the number of cases in which mediation might have avoided litigation.DesignAnalysis of...

Familiarity with and Dissemination of Advance Directives in Germany: Results of a Representative Survey of the General Population

With an advance directive, people can make provisions for the case of incapacity to give consent with regard to future medical and nursing treatment decisions. Currently, there are no data available on how well known and widespread advance directives are in the population in Germany. The aim of the study was, in addition to record awareness and dissemination, to find out more about the reasons for (not) writing an advance directive and about information and support used by people. An online survey of a representative sample of the general population (n=1000) was conducted. The data were analysed descriptively and by means of regression analysis. The survey showed that 92% of the sample knew about advance directives, and 37% had already created one. The probability of having already written an advance directive increases with increasing age. The reported reasons for (not) writing were heterogeneous. Almost 2/3 of all respondents had already accessed information on this topic, mainly via the Internet. The majority of those surveyed was not aware of any support available in drafting the advance directive. These findings provide suggestions for tailoring information and support services.