在心房的患者中,共享决策策略预防中风的有效性:集群随机对照试验
Elissa M Ozanne1, Geoffrey D Barnes2, Juan P Brito3
1Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA elissa.ozanne@hsc.utah.edu.
概括
在非膜动中预防中风的决策辅助工具显著改善了共享决策,患者知识,并减少了决策冲突. 使用这些辅助工具,单独或结合使用,比通常的护理提供了优势.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 患者的决策制定 患者的决策
背景情况:
- 非膜性心房动 (NVAF) 具有显著的中风风险.
- 在NVAF中有效预防中风需要患者和临床医生之间的共同决策.
- 现有的决策支持工具对共享决策质量的影响可能有所不同.
研究的目的:
- 评估患者决策辅助工具和临床医生遇到决策辅助工具的有效性,以提高NVAF患者中风预防的共享决策.
- 评估这些助决器对患者知识和决策冲突的影响.
主要方法:
- 一个集群随机对照试验,涉及6个美国学术医疗中心的1117名NVAF患者.
- 患者和临床医生被随机分配,接受决定辅助 (面向患者或面向临床医生) 或通常的护理.
- 主要结果包括共享决策的质量 (OPTION12),患者的知识和决策冲突.
主要成果:
- 与常规护理相比,患者和接触决策辅助器的联合使用显著改善了共享决策质量,患者知识,并减少了决策冲突.
- 单独使用的患者决策辅助工具和遭遇决策辅助工具都显示出对共享决策和知识的显著益处.
- 没有发现治疗选择或患者满意度的显著差异,也没有发现访问长度的显著差异.
结论:
- 无论是面向患者,面向临床医生还是组合的决策辅助工具,都提高了共享决策,患者知识,并减少了NVAF中风预防中的决策冲突.
- 该研究表明,比起通常的护理,使用访问前或访问期间的决策辅助工具具有优势.
- 这些发现支持将决策辅助工具纳入NVAF管理的临床实践.
更多相关视频
相关概念视频
Coronary Artery Disease IV: Preventive Measures
893
Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
893
Acute Coronary Syndrome IV: Interprofessional Care
528
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
528
Atherosclerosis III: Management
747
Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
747
Atherosclerosis IV: Nursing Management
621
Nursing management for a patient with arteriosclerosis involves a comprehensive approach focusing on lifestyle modification, disease monitoring, education, and symptomatic care. Here is an overview of effective nursing strategies:Assessment and Monitoring: Initial and ongoing assessments are crucial. Nurses must document the patient's medical history, including any hypertension, diabetes, hyperlipidemia, and other cardiovascular diseases. Assessments also cover family history and lifestyle...
621
Venous Thrombosis III: Interprofessional Care
482
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
482


