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To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids). Scale development study, involving construct, item and scale development, validation and reliability testing. There has been increasing use of decision support technologies--adjuncts to the discussions clinicians have with patients about difficult decisions. A global interest in developing these interventions exists among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation. Scale development study, involving construct, item and scale development, validation and reliability testing. Twenty-five researcher-members of the International Patient Decision Aid Standards Collaboration worked together to develop the instrument (IPDASi). In the fourth Stage (reliability study), eight raters assessed thirty randomly selected decision support technologies. IPDASi measures quality in 10 dimensions, using 47 items, and provides an overall quality score (scaled from 0 to 100) for each intervention. Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sampled (n = 30), enabling discrimination. The inter-rater intraclass correlation for the overall quality score was 0.80. Correlations of dimension scores with the overall score were all positive (0.31 to 0.68). Cronbach's alpha values for the 8 raters ranged from 0.72 to 0.93. Cronbach's alphas based on the dimension means ranged from 0.50 to 0.81, indicating that the dimensions, although well correlated, measure different aspects of decision support technology quality. A short version (19 items) was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 (CI 0.79 to 0.92). This work demonstrates that IPDASi has the ability to assess the quality of decision support technologies. The existing IPDASi provides an assessment of the quality of a DST's components and will be used as a tool to provide formative advice to DSTs developers and summative assessments for those who want to compare their tools against an existing benchmark.

HintergrundImmer wieder wird diskutiert, inwiefern Stress bzw. Stresserleben (akut oder chronisch) sich auf die Ergebnisse (Outcome) von Reproduktionsmedizin (artifizielle Reproduktionstechnologien, ART) auswirkt.FragestellungGibt es anhand bisheriger wissenschaftlicher Studien Beweise für die Hypothese „Stress hat einen negativen Einfluss auf den Erfolg der ART“?Material und MethodeEin Review aktueller Literatur zum möglichen Zusammenhang zwischen Stress und ART-Outcome wurde erstellt.ErgebnisseDie meisten aktuellen Studien, insbesondere Metaanalysen, zeigen keinen eindeutigen Zusammenhang zwischen Stress und ART-Outcome. Allerdings verursacht ART bei den Betroffenen Stress, der wiederum mit ein Grund für die hohen Drop-out-Raten bei IVF (In-vitro-Fertilisation) und ICSI (intrazytoplasmatische Spermieninjektion) darstellt. Als medizinisch sinnvoll erachtete Therapien werden dadurch nicht selten vorzeitig beendet, und Paare können nicht von der kumulativen Schwangerschaftsrate profitieren.SchlussfolgerungEine Beratung der Patientinnen bzw. der Paare über die o. g. Ergebnisse sind außerordentlich wichtig, um den Erfolgsdruck und den Stress der Therapie nicht noch zu erhöhen. Psychosoziale Beratungs- und spezifische Therapieangebote sollten aktiv empfohlen und bereitgestellt werden, um Stress und Drop-out-Raten zu reduzieren.

Embryos in cryo-storage accumulate worldwide with conservative estimates suggesting that over 180,000 embryos are currently in storage in the United Kingdom. Couples keep their embryos in storage despite having satisfied their family building needs and evidence suggests that a proportion of couples will need decisional support in resolving the embryo disposition decision. The aim of the studies presented in this thesis was to better understand the embryo disposition decision context, establish factors associated with the decision (facilitators and impediments) and identify targets for decision support to improve patient experiences. The work presented in this thesis demonstrates that the embryo disposition decision is embedded in a complex and distressing decision context that makes it difficult for couples to choose a disposition option. The complexity and difficulty of the decision context emerges from couples' affective forecasting, their representation of embryos, their treatment experience, reproductive life stage and personality characteristics. An affective and cognitive embryo representation measure was developed allowing a multifaceted assessment of how couples feel and think about their embryos. It was suggested that the difficulty and complexity of the decision context emerges because in order to make a disposition decision couples need to achieve integration of their embryo representations with their disposition intentions. Embryo representations as well as embryo disposition preferences may change as a function of treatment experience, especially treatment success which makes the integration process even more difficult. The new measures offer the opportunity to integrate findings from cross-cultural settings, and are hoped to be used to support patients during treatment.

Background Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany. Methods Data sets from 221 organisations from a prior online survey were separated into two sub-groups divided by their estimated sedation rate A) lower/equal to 16% ( n  = 187; 90.8%) and B) higher than 16% ( n  = 19; 9.2%) for secondary analysis. Demographic factors and characteristics of PS treatment practices between the two groups were compared using T-Tests and Chi 2 / Fisher Exact Tests and considered significant (*) at two-sided p  < .05. Results Organisations in group B report that they discuss PS for a higher proportion of patients (38.5%/10.2%, p  < 0.000**), rate agitation more often as an indications for PS (78.9%/ 53.5%, p  = 0.050*), and are more likely to use Lorazepam (63.2%/ 37.4%, p  = 0.047*), Promethazin (26.3%/ 9.6%, p  = 0.044*), and (Es-)Ketamin (31.6%/ 12.8%, p  = 0.039*) than representatives in group A. Both groups differ significantly in their allocation of three case scenarios to different types of PS. Conclusions Both definitions and patterns of clinical practice between palliative and hospice care representatives show divergence, which may be influenced one by another. A comprehensive framework considering conceptual, clinical, ethical, and legal aspects of different definitions of PS could help to better distinguish between different types and nuances of PS.