Effect of Shared Decision-making on Decisional Conflict and Uptake of First-trimester Screening Tests

Introduction: Several factors influence women’s decision to take First Trimester Screening (FTS) tests. These factors are associated with the ambivalence of women toward undergoing screening tests. Objective: This study aimed to investigate the effect of Shared Decision-Making (SDM) about undergoing FTS on Decisional Conflict (DC) immediately after consultation and uptake of FTS. Materials and Methods: This quasi-experimental study was conducted on 200 pregnant women (100 women in the intervention and 100 in the control groups) referred to health centers for prenatal care in 2019. They were selected by the block randomization sampling method. The control group received the routine care and the intervention group, in addition to routine care, attended a 90-min long consultation session based on SDM. The women were contacted via phone at 14 weeks of pregnancy to collect data on their undertaking prenatal screening tests. The demographic characteristics form and O’Conner’s decisional conflict scale were filled out immediately after the consultation session for the intervention group. The obtained data were analyzed by the Chi-square, Fisher exact-test, Mann-Whitney U, and linear regression tests. The P value less than 0.05 was considered statistically significant. Results: There was no significant difference between the two groups regarding women’s demographic characteristics, except for education level, job, and insurance coverage. The Mean±SD DC score was significantly lower in the intervention group (7.35±8.55) compared to the control group (27.32±13.81) (95%CI; 16.80-24.19, P=0.001). In addition, there was a significant difference between the two groups in terms of undergoing the offered FTS (P=0.04). The DC scores ≥25 were associated with a decreased chance of undergoing FTS (P=0.02). Women were less likely to undergo FTS when they were self-employed (OR=0.15, 95%CI; 0.03-0.71, P=0.01). Conclusion: The SDM consultation can help women experience significantly lower levels of DC. Furthermore, factors such as self-employment can prevent women from undergoing FTS despite lower levels of DC.

Perbandingan Metode Certainty Factor dan Theorema Bayes dalam Mendiagnosa Penyakit Kandidiasis pada Manusia Menggunakan Metode Perbandingan Eksponensial

Candidiasis is an infectious disease caused by the fungus candida. Research on this fungus has been widely carried out until several types of candida fungi are found that can attack and cause infections in humans. Types of candidiasis also vary, but can be classified in general into three types, namely attacking the mouth (Candidiasis Thrush), vagina (Vulvoginal Candidiasis), and skin (Cutaneous Candidiasis). Candidiasis is very susceptible to infection and infection, therefore a study is needed to diagnose candidiasis. Today, expert systems are often used to diagnose diseases. There are several methods commonly used in expertise, including the Certainty Factor method and the Bayes Theorem. However, the problem faced in implementing an expert system in any field is uncertainty. This is caused by the user's hesitation in answering questions during the consultation session or even the inaccuracy of the methods used in building the system. Therefore, it is necessary to study and compare the methods that can be used to build the system. Exponential is a simple comparison that can reduce bias in the analysis process. This study aims to apply and analyze both methods and the results compare with an exponential comparison in detecting candidiasis in humans. The results of this study showed that both methods achieved the same results, namely the lowest percentage level was Candidiasis Truth, then Vuvoginal Candidiasis, and the highest was Candidiasis Cutaneous. Of these two methods, Certanty Factor is more accurate in diagnosing candidiasis.

A Glimpse into the “Black Box”: Which Elements of Consultation in an EBP are Associated with Client Symptom Change and Therapist Fidelity?

Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists’ CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients’ PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.

Factors Influencing Physicians' Clinical Decision-making at Upazila Health Complexes in Bangladesh

ABSTRACT Introduction Selecting the most appropriate treatment for each patient is the key activity in patient-physician encounters and providing healthcare services. Achieving desirable clinical goals mostly depends on making the right decision at the right time in any healthcare setting. But little is known about physicians' clinical decision-making in the primary care setting in Bangladesh. Therefore, this study explored the factors that influence decisions about prescribing medications, ordering pathologic tests, counseling patients, average length of patient visits in a consultation session, and referral of patients to other physicians or hospitals by physicians at Upazila Health Complexes (UHCs) in the country. It also explored the structure of physicians' social networks and their association with the decision-making process. Methods This was a cross-sectional descriptive study that used primary data collected from 85 physicians. The respondents, who work at UHCs in the Rajshahi Division, were selected purposively. The collected data were analyzed with descriptive statistics including frequency, percentage, one-way analysis of variance, and linear regression to understand relationships among the variables. Results The results of the study reveal that multiple factors influence physicians' decisions about prescribing medications, ordering pathologic tests, length of visits, counseling patients, and referring patients to other physicians or hospitals at the UHCs. Most physicians prescribe drugs to their patients, keeping in mind their purchasing capacity. Risk of violence by patients' relatives and better management are the two key factors that influence physicians' referral decisions. The physicians' professional and personal social networks also play an influential role in the decision-making process. It was found that physicians dedicate on average 16.17 minutes to a patient in a consultation session. The length of visits is influenced by various factors including the distance between the physicians' residence and their workplace, their level of education, and the number of colleagues with whom they have regular contact and from whom they can seek help. Conclusion The results of the study have yielded some novel insights about the complexity of physicians' everyday tasks at the UHCs in Bangladesh. The results would be of interest to public health researchers and policy makers.

Pharmacotherapy virtual attachment during COVID-19 pandemic: Use of online experiential assessment in a Malaysian pharmacy school

This case study aims to report the efforts made by International Islamic University Malaysia to pursue the experiential pharmacotherapy attachment for the final-year of pharmacy students via online mediums in the light of the COVID-19 restrictions on face-to-face clinical experiential learning. A four-week virtual pharmacotherapy experiential attachments were redesigned and conducted via an online platform (Google Meet). Students were required to have a two-hour virtual discussion and consultation session with their preceptors twice a week throughout the attachment period. In each week, students were provided with real-life clinical cases that were chosen by their preceptors from the Department of Pharmacy Practice’s clinical case repository. Students were assessed via clinical case reports, virtual seminar presentations, weekly virtual discussions with preceptors, and virtual objective structured clinical examinations. All the virtual sessions were conducted on a synchronous basis to assure students’ active participation. Alongside this, a revised online final assessment was also designed.

Integrasi Variable-Centered Intelligent Rule System dengan Teori Dempster-Shafer pada Sistem Pakar Infeksi Saluran Pernafasan Akut

Acute Respiratory Infection (ARI) is a disease caused by infections of the respiratory tract, larynx, pharynx, sinuses and nose. ARI often causes death because the sufferer who comes for treatment is underestimated is already suffering from severe ARI. In 2013 to 2015 ARI was one of the ten most common illnesses in the city of Kupang, where ARI ranked first, followed by other diseases of the upper respiratory tract and grastitis. This study produced an expert system to diagnose ARI using the Variable Centered-Rule System method which functions to facilitate knowledge development and Dempster-Shafer Theory which serves to overcome uncertainty by entering the density of each symptom of ARI in the system. The VCIRS method is a method of building knowledge and inference strategies on expert systems. This method is rigid in accommodating changes in inference strategies except for changes in knowledge structures. This study aims to make the VCIRS method dynamic in an inference process where the sequence of variables in inference is determined by the occurrence and density of the variable. System accuracy by using medical record data of 95% with the triggering sequence of symptoms becoming dynamic every time a consultation session occurs.

Consultation Session and General Treatment Session Procedures

Chapter 3 covers what happens during a consultation session. The therapist usually summarizes assessment results and provides recommendations to the family about treatment. Some general points are presented regarding treatment sessions such as how long treatment will last and how to handle missed sessions. The importance of completing homework between sessions is discussed as well as the importance of gradually increasing the child’s school attendance. Parents are encouraged to discuss any issues with the therapist and to rely on the therapist for support throughout the treatment process. Parents are also encouraged to read all the chapters in this workbook no matter what their child’s reason for school refusal may be.

Consultation Session and General Treatment Session Procedures

Chapter 3 provides an overview of the recommended procedures during the consultation session. Suggestions are provided for summarizing assessment results and making treatment recommendations to the family. General considerations for each treatment phase in this therapist guide are discussed. An outline of the eight treatment sessions is provided. Recommendations are made regarding immediate, generic suggestions that can apply to parents and youths with all types of school refusal behavior.

Objective measurement of effectiveness of psychological consulting services

We investigated whether or not physiological signals reflect the effectiveness of a psychological consultation. Participants (N = 108 college students) rated the quality of a consulting service. We recorded their vital signs before and after the consultation session, and eye-related signals during the consulting process. Results of paired samples t tests showed that body temperature, heart rate, and blood pressure had changed significantly after the consultation and degree of the changes was closely correlated with the participants' subjective ratings. Further, results of a 1-way analysis of variance showed that the change in eye-blinking rate and frequency of pupil size fluctuation were aligned with the consulting session outcome. Our results indicate that vital signs and eye-related signals are effective measures to evaluate the effectiveness of psychological consulting services.