Proximal hamstring tendon avulsions: comparable clinical outcomes of operative and non-operative treatment at 1-year follow-up using a shared decision-making model

2022 ◽  
pp. bjsports-2021-104588
Author(s):  
Anne D van der Made ◽  
Rolf W Peters ◽  
Claire Verheul ◽  
Frank F Smithuis ◽  
Gustaaf Reurink ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Outcome ◽  
Shared Decision Making ◽  
Operative Treatment ◽  
Hamstring Tendon ◽  
Shared Decision ◽  
Model Of Care ◽  
Decision Making Model ◽  
Proximal Hamstring

ObjectiveTo prospectively evaluate 1-year clinical and radiological outcomes after operative and non-operative treatment of proximal hamstring tendon avulsions.MethodsPatients with an MRI-confirmed proximal hamstring tendon avulsion were included. Operative or non-operative treatment was selected by a shared decision-making process. The primary outcome was the Perth Hamstring Assessment Tool (PHAT) score. Secondary outcome scores were Proximal Hamstring Injury Questionnaire, EQ-5D-3L, Tegner Activity Scale, return to sports, hamstring flexibility, isometric hamstring strength and MRI findings including proximal continuity.ResultsTwenty-six operative and 33 non-operative patients with a median age of 51 (IQR: 37–57) and 49 (IQR: 45–56) years were included. Median time between injury and initial visit was 12 (IQR 6–19) days for operative and 21 (IQR 12–48) days for non-operative patients (p=0.004). Baseline PHAT scores were significantly lower in the operative group (32±16 vs 45±17, p=0.003). There was no difference in mean PHAT score between groups at 1 year follow-up (80±19 vs 80±17, p=0.97). Mean PHAT score improved by 47 (95% CI 39 to 55, p<0.001) after operative and 34 (95% CI 27 to 41, p<0.001) after non-operative treatment. There were no relevant differences in secondary clinical outcome measures. Proximal continuity on MRI was present in 20 (95%, 1 recurrence) operative and 14 (52%, no recurrences) non-operative patients (p=0.008).ConclusionIn a shared decision-making model of care, both operative and non-operative treatment of proximal hamstring tendon avulsions resulted in comparable clinical outcome at 1-year follow-up. Operative patients had lower pretreatment PHAT scores but improved substantially to reach comparable PHAT scores as non-operative patients. We recommend using this shared decision model of care until evidence-based indications in favour of either treatment option are available from high-level clinical trials.

scholarly journals Refusal to Travel in the National Ambulance Service. A Patient Care Report examination.

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Eamonn Byrne ◽  
Sasha Selby ◽  
Paul Gallen ◽  
Alan Watts
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Shared Decision Making ◽  
Vital Signs ◽  
Ambulance Service ◽  
Guidance Document ◽  
Shared Decision ◽  
Clinical Guidance ◽  
Decision Making Model

<p><strong>Introduction</strong></p><p>Every patient has the right to refuse treatment and, or transport (RTT) to hospital (1). The National Ambulance Service (NAS) has operated under a clinical guidance document that requires an assessment of patient capacity and a baseline amount of data to be gathered on every patient to facilitate the patient making an informed decision (2,3). An increase in the rate of non-conveyance of patients and refusal to travel calls as well as an increasing number of complaints prompted a quality improvement initiative based on improving and facilitating a shared decision-making model.</p><p><strong>Aim</strong></p><p>For patients who RTT, to establish a baseline quality of information collected and recorded on a Patient Care Report.</p><p><strong>Methods</strong></p><p>All NAS incidents closed with a refusal of treatment or transport, from 1<sup>st</sup> Jan 2017 to 9<sup>th</sup> November 2017 were identified from National Emergency Operation Centre (NEOC). A random selection of 75 Patient care reports (52 Paper and 23 Electronic) were identified and reviewed. Compliance with the refusal to travel guidance document was measured.</p><p><strong>Results</strong></p><p>31% of paper PCR’s reviewed were missing a complete set of vital signs. An average of 48.4 % (Median 48.4% Range 36.5% to 61.5%) were missing a complete second set of vital signs. 17.3% of combined forms were missing the patient’s chief complaint and 38.7% had no practitioner clinical impression entered. 24% had no capacity assessment completed.</p><p><strong>Conclusion</strong></p><p>Clinical information recorded by NAS staff did not meet the clinical guidance document requirements. It is impossible to assess what information was given to a patient to facilitate a shared decision-making model. The quality of NAS documentation can be improved for patients who refuse to travel.</p>

scholarly journals Provider Recommendations for Phase I Clinical Trials Within a Shared Decision-Making Model in Phase I Cancer Clinical Trial Discussions

2020 ◽  
Vol 16 (9) ◽  
pp. e859-e867
Author(s):  
Rachel S. Hianik ◽  
Gavin P. Campbell ◽  
Eli Abernethy ◽  
Colleen Lewis ◽  
Christina S. Wu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Decision Making ◽  
Clinical Trials ◽  
Phase I ◽  
Shared Decision Making ◽  
Phase I Trial ◽  
Performance Status ◽  
Shared Decision ◽  
Phase I Clinical Trials ◽  
Decision Making Model

PURPOSE: Debate continues over whether explicit recommendations for a clinical trial should be included as an element of shared decision making within oncology. We aimed to determine if and how providers make explicit recommendations in the setting of phase I cancer clinical trials. METHODS: Twenty-three patient/provider conversations about phase I trials were analyzed to determine how recommendations are made and how the conversations align with a shared decision-making framework. In addition, 19 providers (9 of whose patient encounters were observed) were interviewed about the factors they consider when deciding whether to recommend a phase I trial. RESULTS: We found that providers are comprehensive in the factors they consider when recommending clinical trials. The two most frequently stated factors were performance status (89%) and patient preferences (84%). Providers made explicit recommendations in 19 conversations (83%), with 12 of those being for a phase I trial (12 [63%] of 19). They made these recommendations in a manner consistent with a shared decision-making model; 18 (95%) of the 19 conversations during which a recommendation was made included all steps, or all but 1 step, of shared decision making, as did 11 of the 12 conversations during which a phase I trial was recommended. In 7 (58%) of these later conversations, providers also emphasized the importance of the patient’s opinion. CONCLUSION: We suggest that providers not hesitate to make explicit recommendations for phase I clinical trials, because they are able to do so in a manner consistent with shared decision making. With further research, these results can be applied to other clinical trial settings.

Interactive Media for Diabetes Self-Management: Issues in Maximizing Public Health Impact

2010 ◽  
Vol 30 (6) ◽  
pp. 745-758 ◽  
Author(s):  
Russell E. Glasgow
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Interactive Media ◽  
Health Impact ◽  
Self Management ◽  
Public Health Impact ◽  
Shared Decision

Background . Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. Methods . Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support. Results . Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results. Conclusions . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient’s care, and collection of cost-effectiveness data is a key need for future research.

scholarly journals Chinese international students travelling with friends: Group decision-making and disagreement prevention

2021 ◽  
Author(s):  
◽  
Hanru Zhu
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
International Students ◽  
Shared Decision Making ◽  
Group Decision Making ◽  
Group Decision ◽  
Chinese International Students ◽  
Decision Making Process ◽  
Shared Decision ◽  
Decision Making Model

<p>This thesis investigates the group decision-making process of Chinese international students travelling with friends in New Zealand. Focusing on groups of friends, a neglected decision-making unit, it explores models of group decision-making and disagreement prevention and resolution strategies of Chinese international students making travel-related decisions. Qualitative research method governed by the interpretive paradigm was adopted. Sixteen Chinese international students from Victoria University of Wellington were interviewed. They were from eleven travel groups and had experience of independent leisure travel in non-family groups in New Zealand. Given that Chinese independent visitor market to New Zealand keeps growing, and Chinese international students have been referred as “China's first wave of independent travellers” (King & Gardiner, 2015), this study adds knowledge to the understanding of the travel behaviours and decision-making process of this market travelling in New Zealand.  Tourism attractions were the most discussed travel-related decision during the group decision-making process, followed by decisions on travel activities, food and restaurants, accommodation and transportation. Three group decision-making models were identified: leadership, division of work, and shared decision-making. Leadership includes three roles of leaders, namely the travel initiator who has the initial idea for the trip and who gets potential members together, the main plan-provider who is responsible for collecting travel information and travel tips to make the whole travel plan and arrange travel schedules, and the main decision-maker who makes the final decision in the travel group. The former two roles are with less dominance, while the latter is with higher dominance in the decision-making process. The division of work model refers to dividing the tasks (e.g. organising accommodation or transport) within the travel group and includes two roles: the plan-provider who is responsible for making the plan for the allocated task, and the decision-maker who made the decision on the allocated task. In the shared decision-making model, the group members make the travel-related decisions collectively by discussion and voting.  Most travel groups were found to use multiple group decision-making models conjointly, with a few groups only using the shared decision-making model. Overall, the most used models were shared decision-making and leadership. Most travel group who adopted the leadership model tended to then use either shared decision-making model or the division of work model depending on the level of dominance of group leader.  Most interviewees indicated that there was lack of disagreement during the group decision-making process. Thus the research focus has shifted from the disagreement resolution to the disagreement prevention. Five disagreement prevention strategies and one influencing factor were identified: travelling with like-minded people, adequate preparation, empathy and mutual understanding, tolerance, compensation and external factors. If disagreements occurred, one or more of tight strategies were adopted by the interviewees to resolve them, namely making concessions, discussing and voting, looking for alternatives, persuasion, toleration, splitting up, accommodating and delaying. Implications and recommendation for industries and future studies are discussed.</p>

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