PEC innovation最新文献_第10页

Learning from brilliant failures 从辉煌的失败中学习

PEC innovation

Pub Date : 2025-03-02 DOI: 10.1016/j.pecinn.2025.100383

Annemiek J Linn, Nanon Labrie

引用次数: 0

Patient counselling on opioids by pharmacy technicians: A mixed-method study to explore facilitators and barriers 由药学技术人员对阿片类药物进行患者咨询：一项探索促进因素和障碍的混合方法研究

PEC innovation

Pub Date : 2025-02-17 DOI: 10.1016/j.pecinn.2025.100382

Elsemiek A.W. Jansen-Groot Koerkamp , Irem Simsek , Eman Badawy , Mette Heringa , Marcel L. Bouvy

Objectives

This study investigates community pharmacy technicians' (PTs) counselling practices for patients prescribed opioids and identifies facilitators and barriers influencing their counselling behaviour.

Methods

A sequential exploratory mixed-method study involving interviews and a questionnaire was conducted among PTs, working in Dutch community pharmacies. PTs were recruited via professional networks, panels and social media. Inductive thematic analysis was performed for interviews. Descriptive statistics of questionnaires was performed and associations between behaviour of discussing dependency and background characteristics (1), barriers (2) and beliefs (3) were tested.

Results

Nineteen topics emerged from 18 interviews. Out of 252 questionnaire-respondents, most PTs consistently discussed dosage and common side effects during the first opioid dispense. Although 92 % considered discussing opioid dependency important, only 62 % frequently performed it. Barriers included a lack of information about the indication (p = 0.012), lack of work agreements (p = 0.017), time (p = 0.022), feeling insecure (p = 0.041), less work experience (p = 0.025) and the belief that prescribers are responsible for discussing opioid dependency with patients (p = 0.018).

Conclusion

The high importance that PTs place on counselling patients on opioid dependency does not match their behaviour. To close this gap and optimize the role of PTs in promoting safe opioid use, organizational and competency-related barriers must be addressed. This includes clear work protocols, communication training and including the indication on opioid prescriptions.

Innovation

This research focuses on an underexplored group involved in patients' opioid management, crucial for designing effective interventions, as PTs frequently have direct patient contact.

目的调查社区药学技术人员（PTs）对阿片类药物处方患者的咨询实践，并确定影响其咨询行为的因素和障碍。方法采用顺序探索性混合方法，对在荷兰社区药房工作的PTs进行访谈和问卷调查。PTs是通过专业网络、小组和社交媒体招募的。对访谈进行归纳主题分析。对问卷进行描述性统计，并检验讨论依赖行为与背景特征(1)、障碍(2)和信念(3)之间的关系。结果18次访谈共产生19个主题。在252名问卷调查对象中，大多数PTs在第一次阿片类药物分配期间一致讨论剂量和常见副作用。虽然92%的人认为讨论阿片类药物依赖很重要，但只有62%的人经常这样做。障碍包括缺乏有关适应症的信息（p = 0.012）、缺乏工作协议（p = 0.017）、时间（p = 0.022）、缺乏安全感（p = 0.041）、工作经验不足（p = 0.025）以及认为开处方者有责任与患者讨论阿片类药物依赖（p = 0.018）。结论精神科医师对患者阿片类药物依赖咨询的重视程度与其行为不匹配。为了缩小这一差距并优化PTs在促进阿片类药物安全使用方面的作用，必须解决与组织和能力相关的障碍。这包括明确的工作规程、沟通培训以及包括阿片类药物处方的适应症。创新本研究的重点是参与患者阿片类药物管理的一个未被充分开发的群体，这对于设计有效的干预措施至关重要，因为PTs经常与患者直接接触。

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引用次数: 0

Enhancing perinatal health patient information through ChatGPT – An accuracy study 通过ChatGPT增强围产期健康患者信息-准确性研究

PEC innovation

Pub Date : 2025-02-10 DOI: 10.1016/j.pecinn.2025.100381

P.L.M. de Vries , D. Baud , S. Baggio , M. Ceulemans , G. Favre , E. Gerbier , H. Legardeur , E. Maisonneuve , C. Pena-Reyes , L. Pomar , U. Winterfeld , A. Panchaud

Objectives

To evaluate ChatGPT's accuracy as information source for women and maternity-care workers on “nutrition” and “red flags” in pregnancy.

Methods

Accuracy of ChatGPT-generated recommendations was assessed by a 5-point Likert scale by eight raters for ten indicators per topic in four languages (French, English, German and Dutch). Accuracy and interrater agreement were calculated per topic and language.

Results

For both topics, median accuracy scores of ChatGPT-generated recommendations were excellent (5.0; IQR 4–5) independently of language. Median accuracy scores varied with a maximum of 1 on a 5-point Likert-scare according to question's framing. Overall accuracy scores were 83–89 % for ‘nutrition in pregnancy’ versus 96–98 % for ‘red flags in pregnancy’. Inter-rater agreement was good to excellent for both topics.

Conclusion

Although ChatGPT generated accurate recommendations regarding the tested indicators for nutrition and red flags during pregnancy, women should be aware of ChatGPT's limitations such as inconsistencies according to formulation, language and the woman's personal context.

Innovation

Despite a growing interest in the potential use of artificial intelligence in healthcare, this is, to the best of our knowledge, the first study assessing potential limitations that may impact accuracy of ChatGPT-generated recommendations such as language and question-framing in key domains of perinatal health.

目的评价ChatGPT作为妇女和妇幼保健工作者孕期“营养”和“危险信号”信息来源的准确性。方法chatgpt生成的推荐的准确性由8位评分者以4种语言（法语、英语、德语和荷兰语）对每个主题的10个指标进行5点李克特量表评估。准确度和译员一致性按主题和语言计算。结果对于这两个主题，chatgpt生成的推荐的中位数准确率得分都很好(5.0；IQR 4-5)独立于语言。根据问题的框架，5分Likert-scare的中位数准确度得分最高为1分。“孕期营养”的总体准确率为83 - 89%，而“孕期危险信号”的总体准确率为96 - 98%。评分者对这两个题目的一致意见都很好。结论：尽管ChatGPT对怀孕期间的营养和危险信号的测试指标给出了准确的建议，但女性应该意识到ChatGPT的局限性，例如根据配方、语言和女性的个人情况不一致。尽管人们对人工智能在医疗保健领域的潜在应用越来越感兴趣，但据我们所知，这是第一项评估可能影响chatgpt生成的建议准确性的潜在局限性的研究，例如围产期健康关键领域的语言和问题框架。

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引用次数: 0

Changes in community pharmacy communication – Towards emotional awareness at the pharmacy counter 社区药房沟通的变化——走向药房柜台的情感意识

PEC innovation

Pub Date : 2025-02-06 DOI: 10.1016/j.pecinn.2025.100380

Nanna Broch Mottelson , Gitte Reventlov Husted , Susanne Kaae , Charlotte Verner Rossing , Christina Fogtmann Fosgerau

Objective

To explore whether and how community pharmacy staff display an alteration in emotional awareness through interactional behavior during desk meetings after participating in a mentalizing education programme, and thereby to investigate if theoretical learnings, or offline social cognition, can be translated into actual communicative practice, or online social cognition.

Methods

As part of a larger feasibility study, we developed a methodological framework to categorize interactional contributions in relation to mentalizing communication and emotional awareness. The framework was applied to a total of 50 video recordings of community pharmacy desk interactions from 11 Danish community pharmacies who all participated in the mentalizing education programme. Through this, pharmacy staffs' interactional contributions from 25 video recordings before and 25 video recordings after participation were categorized and descriptively compared.

Results

Pharmacy staff appear to display an altered orientation towards patients post-education; they produce more questions when initiating interactions (first position talk-turns) and more responses to patients' utterances (third position talk-turns). Furthermore, the realizations of third position contributions in post-participation measures display heightened emotional awareness, rendering a greater orientation to patients' perspectives.

Conclusion

In post-participation measures pharmacy staff displayed an altered interactional approach to patients. This contributes to research concerning competency training of healthcare professionals and adds weight to the notion that online social cognitive skills can be affected through training of offline social cognitive skills.

Innovation

The methodological framework provides a novel and innovative approach to investigating changes in communicative practices. The framework is appropriate for all dialogical healthcare communication research.

目的探讨社区药房员工在参加心理化教育项目后，在案头会议中是否通过互动行为表现出情绪意识的改变，以及如何表现出情绪意识的改变，从而探讨理论学习或线下社会认知能否转化为实际交际实践或线上社会认知。方法作为一个更大的可行性研究的一部分，我们开发了一个方法框架来分类与心智化沟通和情感意识相关的互动贡献。该框架被应用于11个丹麦社区药房的50个社区药房柜台互动录像，这些药店都参加了心理教育方案。通过对参与前和参与后的25段视频中药学人员的互动贡献进行分类和描述性比较。结果药房工作人员对患者的教育后取向有所改变；他们在开始互动时产生更多的问题（第一个位置谈话转向），并对患者的话语做出更多的反应（第三个位置谈话转向）。此外，在参与后的措施中，第三位贡献的实现显示出更高的情感意识，使患者的观点更有针对性。结论在参与后测量中，药学人员对患者的互动方式发生了改变。这有助于医疗保健专业人员能力培训的研究，并增加了在线社会认知技能可以通过线下社会认知技能培训受到影响的概念的权重。创新方法框架提供了一种新颖和创新的方法来调查交际实践的变化。该框架适用于所有对话式卫生保健传播研究。

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引用次数: 0

Corrigendum to “Factors contributing to implementation of a father-friendly neonatal intensive care unit in Denmark” [PEC Innovation 5 (2024) 100353] “促成丹麦实施父亲友好型新生儿重症监护病房的因素”的勘误[PEC创新5 (2024)100353]

PEC innovation

Pub Date : 2025-02-05 DOI: 10.1016/j.pecinn.2025.100379

Betty Noergaard , Karin Yde Waidtløw , Poul-Erik Kofoed , Signe Vahlkvist

引用次数: 0

“It's hard to talk to a computer, I get it”: An exploratory analysis of clinician connection-building communication practices in rural telepalliative care encounters “和电脑交谈很困难，我明白了”：对农村远程护理接触中临床医生建立联系的沟通实践的探索性分析

PEC innovation

Pub Date : 2025-01-25 DOI: 10.1016/j.pecinn.2025.100377

Elise C. Tarbi , Natalie Ambrose , Eric C. Anderson , Rebecca N. Hutchinson , Paul K.J. Han , Maija Reblin , Robert Gramling

Context/Objectives

Establishing human connection is critical during serious illness conversations, however the sensory and relational environment of telehealth may require innovative communication practices for clinicians, patients, and families to do so effectively. We sought to explore if and how recommended in-person best practices for establishing human connection are adapted to the telehealth palliative care (telePC) setting, to enable discovery and description of practice innovations in this new care environment.

Methods

We analyzed data from the Northern New England Palliative Care TeleConsult Research Study – a formative mixed-methods pilot study at two academic medical centers in rural US states with patients with serious illness (2019–2020). We used a qualitative descriptive approach paired with directed content analysis to analyze video-recorded telePC consultations.

Results

Nine video-recorded telePC consultations were analyzed including 9 patients and 6 palliative care clinicians. Patient-participants had a mean age of 68 years, 56 % were women, and 38 % did not complete high school. Mean consultation duration was 52 min (standard deviation 10, range 40–70 min). Our qualitative analysis of visits resulted in three key themes describing clinician communication: 1) Practices for fostering human connection; 2) Practices for overcoming technical problems/difficulties; and 3) Practices for engaging in multi-participant tele-conversations.

Conclusion

Our study findings help to provide proof-of-concept evidence that clinicians can use recommended in-person connection-building communication practices in telePC. As palliative care clinicians naturally adapt to telehealth environments, more empirical research is needed to understand which innovative approaches most effectively foster human connection.

Innovation

TelePC represents an expanding, yet understudied, mode of palliative care delivery. This study is among the first to describe how the telePC context is catalyzing naturally-occurring communication innovations.

背景/目的在重症对话中建立人际关系是至关重要的，然而远程医疗的感官和关系环境可能需要临床医生、患者和家属创新的沟通实践来有效地做到这一点。我们试图探索建立人际关系的推荐的面对面最佳实践是否以及如何适应远程医疗姑息治疗（telePC）环境，以便在这种新的护理环境中发现和描述实践创新。方法：我们分析了新英格兰北部姑息治疗远程咨询研究的数据，这是一项形成性的混合方法试点研究，在美国农村州的两个学术医疗中心进行，患者患有严重疾病（2019-2020）。我们使用定性描述方法与直接内容分析相结合来分析视频记录的电话咨询。结果分析了9例姑息治疗患者和6名姑息治疗临床医生的视频会诊。患者参与者的平均年龄为68岁，56%为女性，38%未完成高中学业。平均会诊时间为52分钟（标准差10，范围40-70分钟）。我们对就诊的定性分析得出了描述临床医生沟通的三个关键主题：1)培养人际关系的实践；2)克服技术问题/困难的实践；3)进行多参与者远程对话的练习。结论我们的研究结果有助于为临床医生在远程诊疗中使用推荐的面对面建立联系的沟通实践提供概念验证证据。由于姑息治疗临床医生自然适应远程医疗环境，需要更多的实证研究来了解哪些创新方法最有效地促进人际关系。InnovationTelePC代表了一种正在扩大但尚未得到充分研究的姑息治疗提供模式。这项研究是第一批描述电信环境如何催化自然发生的通信创新的研究之一。

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引用次数: 0

“In some ways it feels like a specialism”: Exploring the lived experience of multilingual maternity professionals – A qualitative interview study “在某些方面，它感觉像是一种专业”：探索多语种产科专业人员的生活经验-一项定性访谈研究

PEC innovation

Pub Date : 2025-01-22 DOI: 10.1016/j.pecinn.2025.100378

Emma Brooks

Objective

This study aimed to investigate the experience of multilingual maternity staff working in UK NHS hospitals.

Methods

As part of an exploratory qualitative descriptive approach, semi-structured interviews were conducted with multilingual healthcare professionals, working in perinatal care in different NHS trusts across the United Kingdom. Interviews were audio-recorded, transcribed and subsequently analyzed using thematic analysis.

Results

Where practitioners were able to draw on their linguistic skills, they felt that multilingualism was a specialism and appreciated by colleagues. Practitioners also felt that the utilisation of shared languages could boost the confidence of women and birthing people, as well as improving their understanding and sense of wellbeing. Conversely, several practitioners felt an obligation to offer linguistic support, noting that it added to a workload burden, and fear of litigation, that was not experienced by monolingual colleagues.

Conclusion

Strategic utilisation of linguistically skilled NHS practitioners may hold the potential for advancing equity of care for migrant populations, who are regularly and disproportionately represented in data recording adverse outcomes.

Innovation

Investing in institutional support and formal accreditation for multilingual health professionals would enable them to be able to operate with confidence, redress (invisibilized) workloads and contribute to advancing parity of care for migrant patients.

目的本研究旨在调查在英国国民保健服务医院工作的多语种产科人员的经验。方法作为探索性定性描述方法的一部分，对在英国不同NHS信托机构从事围产期护理工作的多语种医疗保健专业人员进行了半结构化访谈。采访录音、抄写，然后利用专题分析进行分析。结果当从业者能够利用他们的语言技能时，他们觉得多语言是一种专长，并受到同事的赞赏。从业者还认为，使用共享语言可以增强妇女和分娩人员的信心，并提高他们的理解和幸福感。相反，一些从业人员感到有义务提供语言支持，注意到这增加了工作量负担和对诉讼的恐惧，这是单语同事所没有经历过的。战略性地利用语言熟练的NHS从业人员可能具有促进移民人口护理公平的潜力，移民人口经常不成比例地出现在记录不良结果的数据中。创新投资于多语种卫生专业人员的机构支持和正式认证，将使他们能够充满信心地开展工作，纠正（无形的）工作量，并有助于促进移徙患者的护理平等。

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引用次数: 0

Visuals versus textual scales: Optimizing reliability and user experience in observational assessment of parent-child interaction 视觉与文本量表：优化亲子互动观察性评估的可靠性和用户体验

PEC innovation

Pub Date : 2025-01-20 DOI: 10.1016/j.pecinn.2025.100376

Mirte L. Forrer , Carlo Schuengel , Mirjam Oosterman

Objective

Assessment of parent-child interaction by practitioners is of great importance but hindered by a lack of instruments that withstand the constraints daily practice places on usage. Visuals may offer an alternative format. Visualizations were tested on reliability, accuracy, and feasibility in observational assessment of parent-child interaction, as alternatives for textual rating scales.

Methods

In Study 1, 95 students rated parent-child interactions with a video or text anchor scale, and in Study 2, 217 professionals rated the same interactions with a decision tree including visual components or a text anchor scale.

Results

Students using the video anchor scale were less reliable and accurate, slower, and had a less positive user experience than students using the text anchor scale. Professionals using the decision tree did not differ in reliability and were comparable in user experience with professionals using the text anchor scale. Rater accuracy showed similar dependency on quality of parental behavior for both scales: ratings were less accurate when the quality of the parent-child interaction was low, and more accurate when the quality was high. However, professionals were less accurate and slower in using the decision tree than the text anchor scale.

Conclusion

With a first iteration of a decision tree performing the same to or only slightly worse, efforts to further develop decision trees might be worthwhile.

Innovation

These nonintuitive findings underscore the value of experimental testing in assessment design in daily practice.

目的：从业者对亲子互动的评估是非常重要的，但由于缺乏能够承受日常实践对使用的限制的工具而受到阻碍。视觉效果可能提供另一种格式。可视化测试的可靠性，准确性和可行性，在亲子互动的观察性评估，作为文本评定量表的替代品。方法在研究1中，95名学生用视频或文本锚量表对亲子互动进行评分，在研究2中，217名专业人员用包含视觉成分或文本锚量表的决策树对亲子互动进行评分。结果使用视频主播量表的学生与使用文本主播量表的学生相比，可靠性和准确性较低，速度较慢，用户体验较差。使用决策树的专业人员在可靠性方面没有差异，并且在用户体验方面与使用文本锚量表的专业人员相当。两种量表的评分准确度对父母行为质量的依赖性相似：当亲子互动质量较低时，评分准确性较低，而当亲子互动质量较高时，评分准确性较高。然而，专业人员使用决策树的准确性和速度比文本锚量表低。由于决策树的第一次迭代执行相同或仅略差，因此进一步开发决策树的努力可能是值得的。这些非直觉的发现强调了实验测试在日常实践评估设计中的价值。

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引用次数: 0

Patients' emotional expressions and clinicians' responses in oncology – From recognition to exploration of concerns 肿瘤患者的情绪表达和临床医生的反应——从认识到关注的探索

PEC innovation

Pub Date : 2025-01-17 DOI: 10.1016/j.pecinn.2025.100374

Fernanda Bittencourt Romeiro , Vanessa Garrido Pais , Gerry Humphris , Margarida Figueiredo-Braga

Objectives

The objective of this study was to analyze patient's emotional expressions during the consultations and the responses of their oncologists to these expressions.

Methods

The study employed a mixed-method, observational, descriptive, and explanatory design. A total of 31 adult patients at different clinical stages, undergoing cancer treatment and 8 oncologists were included. Thirty-one routine outpatient oncology consultations were analyzed, after being transcribed and coded, using the Portuguese version of the Verona Coding Definitions of Emotional Sequences (VR-CoDES).

Results

The oncologists elicited and recognized patients' emotional concerns but they did not explore them in a way that encouraged patients to continue verbalizing their feelings. Oncologists provided more directive and guidance-oriented responses, focusing on cues related to physical pain and symptoms. Multilevel logistic regression analysis modeled the probability of oncologists' responses showing reduction of space in relation to patients' emotional cues/concerns, controlling for clustering and patients' clinical and socio-demographic variables. The type of cue and treatment influenced the oncologists' responses.

Conclusions

Communication skills training focused on the ability to better explore patients' emotions may help oncologists to provide more explicit and empathetic responses that validate the emotional content expressed during consultations. Practice Implications: Oncologists do not use the same responses as a standard with patients, thus adjusting them individually.

目的本研究的目的是分析患者在会诊时的情绪表达以及肿瘤医生对这些情绪表达的反应。方法采用观察性、描述性和解释性设计相结合的方法。共纳入31名处于不同临床阶段、正在接受癌症治疗的成年患者和8名肿瘤学家。使用葡萄牙语版本的Verona编码定义的情感序列（VR-CoDES）进行转录和编码后，对31例常规门诊肿瘤会诊进行分析。结果肿瘤学家引起并认识到患者的情感担忧，但他们没有以鼓励患者继续用语言表达他们的感受的方式来探讨这些问题。肿瘤学家提供了更多的指导性和指导性的回应，重点关注与身体疼痛和症状相关的线索。在控制聚类和患者临床和社会人口变量的情况下，多水平逻辑回归分析模拟了肿瘤学家反应的概率，显示了与患者情绪线索/关注相关的空间减少。提示和治疗的类型影响肿瘤学家的反应。结论沟通技巧培训侧重于更好地了解患者情绪的能力，可以帮助肿瘤医生提供更明确、更感同身受的回应，从而验证患者在会诊时表达的情绪内容。实践意义：肿瘤学家不使用相同的反应作为患者的标准，因此单独调整它们。

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引用次数: 0

Are we offering palliative care and employing shared decision making in the neonatal intensive care unit? A 10-year retrospective chart review 我们是否提供姑息治疗，并在新生儿重症监护室采用共同决策？10年回顾性图表回顾

PEC innovation

Pub Date : 2025-01-16 DOI: 10.1016/j.pecinn.2025.100375

Sawyer Karabelas-Pittman , Helen Coo , Hannah Lee , Christine C. Moon , Gillian MacLean

Objective

Perinatal palliative care (PPC) supports families with a fetal diagnosis of a life-limiting condition or who are facing preterm labour at the limits of viability. Shared decision making (SDM) is the gold standard approach in PPC. The objectives of this study were to describe the Neonatal Intensive Care Unit (NICU) team's involvement in PPC and the extent of SDM at an academic hospital in southeastern Ontario, and the frequency with which PPC was offered, accepted and received for live births.

Methods

We retrospectively reviewed charts for births from January 2010–January 2020 where a life-limiting condition (LLC) had been prenatally diagnosed or there was threatened preterm labour (TPTL) at the limits of viability. Frequency distributions were used to summarize the NICU team's involvement, extent of SDM, and data related to PPC provision.

Results

The LLC group included 73 patients. The NICU team was consulted for 26 (36 %). Among the 10 consults that involved decision making, SDM was documented in 9 instances (90 %). PPC was offered to 9 of 60 LLC families (15 %) with a live birth and was accepted by 8 (89 %). The TPTL Group included 112 patients. Seventy (62 %) received a consult with the NICU team. SDM was documented in 34 of 39 consults (87 %) that involved decision making. PPC was offered to 28 of 90 families (31 %) who experienced a live birth and was accepted by 16 (57 %).

Conclusion

Our results demonstrate the need for standardized consultation and palliative care referral protocols to advance access to and quality of neonatal end-of-life care.

目的围产期姑息治疗（PPC）支持胎儿诊断为生命受限条件或面临生存能力极限的早产的家庭。共享决策（SDM）是PPC的黄金标准方法。本研究的目的是描述安大略省东南部一家学术医院新生儿重症监护病房（NICU）团队参与PPC和SDM的程度，以及为活产婴儿提供、接受和接受PPC的频率。方法回顾性分析2010年1月至2020年1月产前诊断为生命限制状况（LLC）或生存能力极限时存在威胁性早产（TPTL）的新生儿图表。频率分布用于总结NICU团队的参与、SDM的程度以及与PPC提供相关的数据。结果LLC组73例。NICU小组咨询26例（36%）。在涉及决策制定的10个咨询中，SDM在9个实例中被记录（90%）。60个活产的LLC家庭中有9个（15%）接受了PPC， 8个（89%）接受了PPC。TPTL组包括112例患者。70例（62%）接受了NICU小组的会诊。39例涉及决策的咨询中有34例（87%）记录了SDM。90个活产家庭中有28个（31%）接受了PPC， 16个（57%）接受了PPC。结论我们的研究结果表明，需要标准化的咨询和姑息治疗转诊协议，以提高新生儿临终关怀的可及性和质量。

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引用次数: 0