Humans ; Decision Making ; Surgeons

Objective: To analysis the clinical characteristics of 400 fetuses with heart defects and the impactors of pregnancy decision making, and explore the influence of a multi-disciplinary team (MDT) cooperation approach on it. Methods: Clinical data of 400 fetuses with abnormal cardiac structure diagnosed at Peking University First Hospital from January 2012 to June 2021 were collected, which were divided into 4 groups according to the characteristics of fetal heart defects and the presence of extracardiac abnormalities or not: single cardiac defects without extracardiac abnormalities (122 cases), multiple cardiac defects without extracardiac abnormalities (100 cases), single cardiac defects with extracardiac abnormalities (115 cases), and multiple cardiac defects with extracardiac abnormalities (63 cases). The types of fetal cardiac structural abnormalities and genetic test results, and the detection rate of pathogenic genetic abnormalities, MDT consultation and management situation, and pregnancy decision of fetuses in each group were retrospectively analyzed. A logistics regression was used to analyze the influencing factors of fetal heart defects pregnancy decision. Results: (1) Among the 400 fetal heart defects, the four most common major types were ventricular septal defect 96 (24.0%, 96/400), tetralogy of Fallot 52 (13.0%, 52/400), coarctation of the aorta 34 (8.5%, 34/400), and atrioventricular septal defect 26 (6.5%, 26/400). (2) Among the 204 fetuses undergoing genetic examination, 44 (21.6%, 44/204) pathogenic genetic abnormalities were detected. (3) Detection rate of pathogenic genetic abnormalities (39.3%, 24/61) and pregnancy termination rate (86.1%, 99/115) in the single cardiac defects with extracardiac abnormalities group were significantly higher than those in the single cardiac defects without extracardiac abnormalities group [15.1% (8/53), 44.3% (54/122), respectively] and the multiple cardiac defects without extracardiac abnormalities group [6.1% (3/49), 70.0% (70/100), respectively, both P<0.05], and the pregnancy termination rate in the multiple cardiac defects without extracardiac abnormalities group and the multiple cardiac defects with extracardiac abnormalities group (82.5%,52/63) were significantly higher than that of the single cardiac abnormalities without extracardiac abnormalities group (both P<0.05). (4) After adjusting for age, gravity, parity and performed prenatal diagnosis, maternal age, the diagnosis of gestational age, prognosis grades, co-existence of extracardiac abnormalities, presence of pathogenic genetic abnormalities, and receiving MDT consultation and management were still independent influencing factors of termination of pregnancy of fetuses with cardiac defects (all P<0.05). A total of 29 (7.2%, 29/400) fetal cardiac defects received MDT consultation and management, and compared with those without MDT management, the pregnancy termination rate in the multiple cardiac defects without extracardiac abnormalities group [74.2%(66/89) vs 4/11] and the multiple cardiac defects with extracardiac abnormalities group [87.9%(51/58) vs 1/5] were lower, the differences were statistically significant respectively (all P<0.05). Conclusions: Maternal age, diagnosed gestational age, severity of cardiac defects, extracardiac abnormalities, pathogenic genetic abnormalities and MDT counseling and management are the influencing factors of fetal heart defects pregnancy decision. MDT cooperation approach influences pregnancy decision-making and should be recommended for the management of fetal cardiac defect to reduce unnecessary termination of pregnancy and improve pregnancy outcomes.
Pregnancy ; Female ; Humans ; Retrospective Studies ; Fetal Diseases/diagnosis* ; Heart Defects, Congenital/therapy* ; Fetus ; Decision Making ; Ultrasonography, Prenatal/methods*

When selecting implant guidance methods or judging whether the patient can be implanted, many doctors ignore or only use visual inspection to estimate a patient's mouth opening. This phenomenon often leads to failure to complete the implantation due to insufficient mouth opening or the deflection of the implant due to limited angle, resulting in the high incidence of corresponding complications. The main reason is that doctors lack accurate analysis and control of the overall geometric conditions of the intraoral surgical area, and three-dimensional position blocking of surgical instruments occurs during the operation. In the past, mouth opening was defined as the distance between the incisor edges of the upper and lower central incisors when the patient opens his mouth widely, and the implant area could be in any missing tooth position. When it is in the posterior tooth area, the specific measurement scheme of the mouth opening could not be simply equivalent to the previous measurement method in the anterior tooth area. However, how to measure quickly and conveniently the mouth opening of any surgical area to determine whether it could be implanted and meet the needs of the selected guidance method remains unclear. This paper introduces new concepts, establishes new classification and corresponding accurate measurement scheme of implant area, and establishes a decision tree of implant methods guided by the actually measured value. Results provide a quantitative basis for rational formulation and implementation of implant treatment.
Humans ; Mouth ; Dental Implantation, Endosseous/methods* ; Incisor ; Clinical Decision-Making ; Dental Implants

Interval timing is involved in a variety of cognitive behaviors such as associative learning and decision-making. While it has been shown that time estimation is adaptive to the temporal context, it remains unclear how interval timing behavior is influenced by recent trial history. Here we found that, in mice trained to perform a licking-based interval timing task, a decrease of inter-reinforcement interval in the previous trial rapidly shifted the time of anticipatory licking earlier. Optogenetic inactivation of the anterior lateral motor cortex (ALM), but not the medial prefrontal cortex, for a short time before reward delivery caused a decrease in the peak time of anticipatory licking in the next trial. Electrophysiological recordings from the ALM showed that the response profiles preceded by short and long inter-reinforcement intervals exhibited task-engagement-dependent temporal scaling. Thus, interval timing is adaptive to recent experience of the temporal interval, and ALM activity during time estimation reflects recent experience of interval.
Animals ; Mice ; Reward ; Time Factors ; Cognition ; Learning ; Decision Making ; Reinforcement, Psychology

Most patients want to play an active role in their own health care. There is now a movement from medical paternalism to patient-centered care in the consultation process that is based on the therapeutic alliance and negotiation between the doctor and patient, aptly named “shared decision-making” (SDM). It is a process where doctors work together with patients, including their families and caregivers, to select tests, treatments, management, or support packages, based on clinical evidence and personal informed preferences, health beliefs, and values. Successful implementation of SDM is associated with improved quality of consultations, favorable patient-reported health outcomes, and increased patient and doctor satisfaction. Patients are empowered to make proactive health decisions resulting in decreased anxiety, faster recovery, increased treatment compliance, and reduced unnecessary health care expenditure. There are multiple existing models in facilitating SDM. Two simple and easyto-follow models are the “three-talk model” and “S.H.A.R.E. approach.” The three-talk model endorsed by the NICE divides the SDM consultation into three steps, namely: team talk (explaining the need to consider treatment options as a team), option talk (describing the alternatives in more detail, and making use of patient decision aids [PDA] whenever appropriate), and decision talk (helping patients explore and form their personal preferences). On the other hand, the S.H.A.R.E. approach promoted by the Agency for Healthcare Research and Quality (AHRQ) is a five-step SDM consultation process that includes exploring and comparing the benefits, harms, and risks of each treatment option through meaningful dialogue about what matters most to patients.
Decision Making, Shared

Decision-making aid for cancer patients is of great significance in the diagnosis and treatment for diseases. Breast cancer is one of the most common malignant tumors in women all over the world, and breast cancer patients have become the main target population for decision-aided research. Application of decision-making assistance for patients in Western countries has developed to a certain extent, while relevant research in China is still at the early stage. There are kinds of intervention forms for patients' decision aids, including traditional brochures and videos, decision aids systems, decision coaching, multidisciplinary breast cancer teams, etc. The tools for decision-making quality evaluation include the patients' awareness for decision-making, participation, decision-making conflict, decision-making satisfaction, decision-making regret, which can provide important guidance for the application of decision-making aid treatment in breast cancer patients in the future.
Breast Neoplasms/therapy* ; China ; Decision Making ; Emotions ; Female ; Humans ; Personal Satisfaction

Adolescent ; Decision Making ; Emotions ; Humans

Intra-abdominal desmoid tumor (IADT) and gastrointestinal stromal tumor (GIST) are both mesenchymal tumors mostly found in gastrointestinal tracts and easily misdiagnosed, which would directly damage the survival prognosis and quality of life of patients. With the advent of the era of precision medicine, the understanding of the above two diseases is more in-depth, and the requirements for accurate diagnosis and individualized precision treatment are more stringent. Moreover, there seems to be some internal relationship between IADT and GIST, and the lack of systematic research and discussion makes clinical decision-making and patient management easy to fall into traps and misunderstandings. Therefore, this paper reviews the clinical characteristics, pathogenesis and treatments of the two, and explore their differences and internal relations, so as to provide research and practical reference for promoting more precise and individualized diagnosis and treatment regimens.
Clinical Decision-Making ; Fibromatosis, Aggressive/diagnosis* ; Gastrointestinal Stromal Tumors/diagnosis* ; Humans ; Prognosis ; Quality of Life

Background: Shared decision-making (SDM) is the active process of collaborative clinical decision making between patient and physician. Factors associated with use of shared decision making have been investigated previously, but few have explored this topic locally. Objective: To determine patient and physician characteristics associated with shared decision making of adult Filipino patients with type 2 diabetes mellitus. Methods: A cross sectional study was conducted from January to April 2020 among patients of the Family Medicine Clinic (FMC) of the Philippine General Hospital (PGH) with type 2 diabetes mellitus and all residents of the Department of Family and Community Medicine (DFCM). Sociodemographic characteristics and clinical characteristics were obtained using self-administered questionnaires, and shared decision making was measured using the SDM Q-9 Filipino Version. Responses were encoded using Microsoft Excel and analyzed using SPSS. Results: A total of 153 patients and 36 residents were recruited into the study. The patients had an average age of 59 (SD + 9.52) years, with the majority being female (68.6%), and a mean HbA1c level of 7.76% (SD + 2.53%). The physicians had an average age of 29.6 (SD + 4.59) years, and more than half were female (66.67%). The mean level of perceived shared decision making was 85.77% (SD + 14.12%). Patients who were not aware of the current HbA1c level were less likely to have high shared decision making, while having two or less comorbidities increased the likelihood of having a highly participative consultation. Conclusion The perceived mean shared decision making was 85.77%. Shared decision making was associated with lack of knowledge on HbA1c level and few comorbidities among adult Filipino patients with Type 2 diabetes mellitus at the Family Medicine Clinic of the Outpatient Department of the Philippine General Hospital. None of the physician characteristics were linked to patient participation.
Decision Making, Shared ; Patient Participation ; Diabetes Mellitus

OBJECTIVES: To verify the applicability and extensibility of the satisfaction index of basic medical insurance for rural and urban residents, and to explore the mechanism responsible for the satisfaction index in Kunming and Changsha City, and provide references for effective management and policy making. METHODS: A stratified cluster sampling method was conducted. A total of 560 familial decision makers were randomly selected in 24 classes of 14 schools of Kunming and Changsha City. Model reliability was tested by SPSS18.0. In addition, Smart PLS 3.0 was applied to conduct model validity test, calculate the satisfaction index, and to compare the model path coefficients of Kunming and Changsha by multi-group analysis. RESULTS: In the application of the satisfaction index of basic medical insurance for rural and urban residents in Kunming, Cronbach's α of the model was 0.93, split-half reliability coefficient was 0.90, and the latent variable composite reliability coefficient values were more than 0.86; the latent variable average variance extraction (AVE) values were greater than 0.66, and the square root of the AVE of each latent variable (all greater than 0.66) was larger than the correlation coefficient with other latent variables. The factor loading values were greater than 0.70, with statistical significance. The basic health insurance satisfaction index of Kunming and Changsha was 60.40 and 52.05, respectively. The difference between the path coefficient of Kunming and Changsha was not statistically significant except the path from public satisfaction to public loyalty. Perceived value had the largest direct and total effect on public satisfaction latent variable in Kunming City. While the perceived value had the largest direct effect on public satisfaction, and the perceived quality had the largest total effect on public satisfaction in Changsha City. CONCLUSIONS The satisfaction index model reflects the satisfaction of pupils' basic medical insurance for urban and rural residents, and it also shows good reliability and validity in Changsha and Kunming. What's more the model can be extended to the national level to evaluate the satisfaction of basic medical insurance for urban and rural residents for primary school students. The basic health insurance satisfaction index of familial decision makers in Kunming is higher than that of Changsha. There are differences between Kunming and Changsha in the influential mechanism of the satisfaction index of for Chinese pupils with basic medical insurance for rural and urban residents, and the measures taken by the government and relevant departments to improve the satisfaction of basic medical insurance should be based on local conditions.
China ; Decision Making ; Humans ; Personal Satisfaction ; Reproducibility of Results ; Rural Population ; Urban Population