Name: e-patient counseling trial (e-paco): computer based education versus nurse counseling for patients to prepare for colonoscopy
Uploaded: 2019-08-01T12:30:00
Description: Watch this Scientific Journal Video about E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy at JoVE.com

作者感谢维茨克·基辅特博士对手稿的方法支持和评论。

这项研究得到了拉德布德大学医学中心(#2015-1742)伦理审查委员会的授权。随后,各参与机构的执行局获得批准(审判登记:荷兰审判登记处,NTR 5475)。
1. 让患者参加试验/随机化
<ol><li>通过全科医生、外科医生或内科专家接触所有转诊患者进行结肠镜检查,以获得多样化的样本。</li>
	<li>通过电话联系所有符合条件的患者,以便门诊部门诊助理通过电话或与患者进行面对?...

<ol>
	<li>Zauber, A. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Colonoscopic+polypectomy+and+long-term+prevention+of+colorectal-cancer+deaths.">Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.</a> New England Journal of Medicine. 366 (8), 687-696 (2012).</li><li>Chang, C. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Meta-analysis:+The+effect+of+patient+education+on+bowel+preparation+for+colonoscopy.">Meta-analysis: The effect of patient education on bowel preparation for colonoscopy.</a> Endoscopy Internation Open. 3 (6), E646-E652 (2015).</li><li>Yee, R., Manoharan, S., Hall, C., Hayashi, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optimizing+bowel+preparation+for+colonoscopy:+what+are+the+predictors+of+an+inadequate+preparation.">Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation.</a> American Journal of Surgery. 209 (5), 787-792 (2015).</li><li>Abuksis, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+patient+education+program+is+cost-effective+for+preventing+failure+of+endoscopic+procedures+in+a+gastroenterology+department.">A patient education program is cost-effective for preventing failure of endoscopic procedures in a gastroenterology department.</a> American Journal of Gastroenterology. 96 (6), 1786-1790 (2001).</li><li>Denberg, T. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+a+mailed+brochure+on+appointment-keeping+for+screening+colonoscopy:+a+randomized+trial.">Effect of a mailed brochure on appointment-keeping for screening colonoscopy: a randomized trial.</a> Annals of Internal Medicine. 145 (12), 895-900 (2006).</li><li>Morcom, J., Dunn, S. V., Luxford, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Establishing+an+Australian+nurse+practitioner-led+colorectal+cancer+screening+clinic.">Establishing an Australian nurse practitioner-led colorectal cancer screening clinic.</a> Gastroenterology Nursing. 28 (1), 33-42 (2005).</li><li>Fox, M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+the+literature+reporting+on+studies+that+examined+the+impact+of+interactive,+computer-based+patient+education+programs.">A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs.</a> Patient Education and Counseling. 77 (1), 6-13 (2009).</li><li>Veldhuijzen, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computer-assisted+instruction+before+colonoscopy+is+as+effective+as+nurse+counseling,+a+clinical+pilot+trial.">Computer-assisted instruction before colonoscopy is as effective as nurse counseling, a clinical pilot trial.</a> Endoscopy International Open. 5 (8), E792-E797 (2017).</li><li>Mittal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Boston+bowel+preparation+scale:+reliable+not+only+for+colonoscopy-oriented+research+but+clinical+practice+also.">The Boston bowel preparation scale: reliable not only for colonoscopy-oriented research but clinical practice also.</a> Gastrointestinal Endoscopy. 71 (1), 221 (2010).</li><li>Lai, E. J., Calderwood, A. H., Doros, G., Fix, O. K., Jacobson, B. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Boston+bowel+preparation+scale:+a+valid+and+reliable+instrument+for+colonoscopy-oriented+research.">The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research.</a> Gastrointestinal Endoscopy. 69, 620-625 (2009).</li><li>Bouwmans, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+iMTA+Productivity+Cost+Questionnaire:+A+Standardized+Instrument+for+Measuring+and+Valuing+Health-Related+Productivity+Losses.">The iMTA Productivity Cost Questionnaire: A Standardized Instrument for Measuring and Valuing Health-Related Productivity Losses.</a> Value in Health. 18 (6), 753-758 (2015).</li><li>Spielberger, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Manual for the State&#8208;Trait anxiety inventory (form Y). , (1987).</li><li>Krol, M. W., de Boer, D., Delnoij, D. M., Rademakers, J. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Net+Promoter+Score+-+an+asset+to+patient+experience+surveys?.">The Net Promoter Score - an asset to patient experience surveys?.</a> Health Expectactions. 18 (6), 3099-3109 (2015).</li><li>van der Vaart, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+Dutch+functional,+communicative+and+critical+health+literacy+scales.">Validation of the Dutch functional, communicative and critical health literacy scales.</a> Patient Education and Counseling. 89 (1), 82-88 (2012).</li><li>van der Vaart, R., Drossaert, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+Digital+Health+Literacy+Instrument:+Measuring+a+Broad+Spectrum+of+Health+1.0+and+Health+2.0+Skills.">Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills.</a> Journal of Medical Internet Research. 19 (1), e27 (2017).</li><li>Rademakers, J., Nijman, J., van der Hoek, L., Heijmans, M., Rijken, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+patient+activation+in+The+Netherlands:+translation+and+validation+of+the+American+short+form+Patient+Activation+Measure+(PAM13).">Measuring patient activation in The Netherlands: translation and validation of the American short form Patient Activation Measure (PAM13).</a> Biomed Central Public Health. 12, 577 (2012).</li><li>Ware, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=SF-36+health+survey+update.">SF-36 health survey update.</a> Spine (Phila Pa 1976). 25 (24), 3130-3139 (2000).</li><li>Rex, D. K., Imperiale, T. F., Latinovich, D. R., Bratcher, L. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+bowel+preparation+on+efficiency+and+cost+of+colonoscopy.">Impact of bowel preparation on efficiency and cost of colonoscopy.</a> American Journal of Gastroenterology. 97 (7), 1696-1700 (2002).</li><li>Rosenfeld, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+patient+education+on+the+quality+of+inpatient+bowel+preparation+for+colonoscopy.">The impact of patient education on the quality of inpatient bowel preparation for colonoscopy.</a> Canadian Journal of Gastroenterology. 24 (9), 543-546 (2010).</li><li>Clark, B. T., Rustagi, T., Laine, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+level+of+bowel+prep+quality+requires+early+repeat+colonoscopy:+systematic+review+and+meta-analysis+of+the+impact+of+preparation+quality+on+adenoma+detection+rate.">What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate.</a> American Journal of Gastroenterology. 109 (11), 1714-1723 (2014).</li><li>Liu, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Telephone-based+re-education+on+the+day+before+colonoscopy+improves+the+quality+of+bowel+preparation+and+the+polyp+detection+rate:+a+prospective,+colonoscopist-blinded,+randomised,+controlled+study.">Telephone-based re-education on the day before colonoscopy improves the quality of bowel preparation and the polyp detection rate: a prospective, colonoscopist-blinded, randomised, controlled study.</a> Gut. 63 (1), 125-130 (2014).</li><li>Tae, J. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+patient+education+with+cartoon+visual+aids+on+the+quality+of+bowel+preparation+for+colonoscopy.">Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy.</a> Gastrointestinal Endoscopy. 76 (4), 804-811 (2012).</li><li>Prakash, S. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+the+quality+of+colonoscopy+bowel+preparation+using+an+educational+video.">Improving the quality of colonoscopy bowel preparation using an educational video.</a> Canadian Journal of Gastroenteroly. 27 (12), 696-700 (2013).</li></ol>

与传统的护士咨询相比,电子患者咨询(E-PACO)试验旨在研究基于计算机的教育(CBE)的效用、实用性和患者感知的实用性。在本手稿中,CBE 与用于评估假设的方法一起演示。
已确定高质量的结肠镜检查是预防结肠直肠癌的黄金标准。肠准备不足与肿瘤缺失有关,增加重复检查的需要,增加患者18、19、20的费用和累积不适。<sup class="x...

完整的结肠镜检查是检测结肠1癌前病变的程序。为了充分检查结肠粘病,最佳的肠道清洁至关重要。准备不足的结肠导致腺瘤检测率不足,因此需要重复手术。在以前的研究中,更好的患者了解如何清楚地准备导致肠道制剂的更高质量2。为了达到一个干净的结肠,患者有限制饮食1-2天,并使用净化诱导腹泻。这会引起腹部不适,并中断日常活动。鉴于这些障碍,肠准备不足并不罕见是少见的3。患者对方案的最佳依从性可增强有效的肠制剂和结肠镜检查的后续疗效。
结肠镜检查给患者的信息管理方式有明显的差异4。有些患者在会诊期间直接从其保健专业人员处接收信息,或由辅助人员(护士、技术人员或行政人员)告知,而其他单位则通过印刷的传单5提供信息。任何信息传递的影响都因患者依赖因素而加剧,如教育水平、综合能力和文化方面。这导致对可能对指令合规性产生负面影响的信息的理解是复杂的。
患者准备中的一个关键要素是,每个患者都充分了解手术的风险和益处,包括结肠镜检查的肠准备步骤。此外,镇静剂和镇痛药的常规使用需要对患者个人进行风险评估。许多中心依靠护士咨询在手术前获得知情同意。这导致患者更好地遵守肠道准备说明。然而,虽然有效,它对于护士来说很耗时,重复,并且会导致患者对病人信息的可变性。更重要的是,它要求病人多去医院看病,这暗示病人没有工作6。总之,在注重成本的医疗保健环境中,这是一个经济上具有挑战性的做法。以往的研究表明,集中电子学习路径能促进良好的理解和学习,提高患者满意度。网络教育成功地用于增加患者的知识,并且已成为获得知情同意的公认机制。这导致了针对肠道准备的定制教学计划的发展,该计划结合了时间和环境灵活性的优势,同时在信息传递方面保持一致性。此前,作者开发了一种工具,允许计算机辅助教学(CAI)用于结肠镜检查8。此工具使用计算机动画,捕捉观看者的注意力,同时充分告知他/她结肠镜检查的目标。该模块以可理解的语言按逻辑顺序编写,对患者进行结肠镜检查的不同方面的教育。它提供了基本的解剖学教学点,并逐步指导患者如何进行肠准备。在我们的试验性研究中,我们表明,CAI的结肠镜检查增强肠准备水平,相当于护士咨询。
研究小组力求提高已开发的CAI的功效。其局限性是,它是一种单向工具,提供信息,但不允许获取患者有关病史和药物使用的具体信息。这是护士咨询访问的一个重要部分,因为它允许由护士判断镇前风险评估。因此,编制了一份专门的调查表,旨在收集数据点,以便进行结构化风险评估。此调查问卷由患者在 CAI 结束时完成。这样就不需要在这个时候与护士或医生进行面对面的会面。使用双向沟通(将CAI与问卷相结合)是实用的,为患者提供高质量的信息,同时满足内科对镇化风险信息的需求。这种综合教学和信息获取称为基于计算机的教育(CBE)7。
与传统的护士咨询相比,该试验的目的是测试CBE非中心化的效用、实用性和患者感知的实用性。假设CBE在结肠镜检查期间实现高质量的肠准备,不低于护士咨询。这个过程是独立于时间和空间,因此可以在患者家的舒适中观看。因此,选择的次要结果与患者相关的结果措施,如短暂休假、焦虑、满意度和理解信息,因为这些可能受益于通过这一数字渠道的交付。包括患者激活、健康和电子健康知识等过程措施,以确定哪些患者从这一工具中受益最大。
学习设计 该试验被设置为内分体盲多中心随机对照试验设计。纳入标准是成人年龄和选择性完全结肠镜检查的转诊。排除标准是荷兰语的文盲率和严重的视听障碍和精神残疾,这些障碍使CBE无法实施。此外,如果没有互联网接入或有互联网接入的亲属,患者被排除(见表1)。患者将由荷兰4个大型内窥镜中心的门诊部后台工作人员招募。所有患者接受基于聚乙烯乙二醇或皮苏酸钠的分量剂量泻药制度。经过训练有素的工作人员对排内和排除标准的评估后,使用随机化工具(在下面的协议中描述)对患者进行随机分布,每个试验站点的分布为 1:1。拒绝参加的原因被记录下来。试验流程图如图2所示。
成果措施 主要结果测量是内窥镜检查期间肠制剂的质量。内科医生经过培训,使用波士顿肠制剂量表 (BBPS) 对肠道准备进行评分。BBPS 是三个肠段的累积分数,从 0-1"不满意",2-3"差",4-5"公平",6-7"好",和 8-9"优秀"。分数+6被认为是足够的9,10。作为次要结果,重点是疾病缺勤、焦虑、满意度和信息重新调用。还收集了有关患者激活和健康知识的信息。
干预的成本最小化效应以两种方式计算。各组之间对内窥镜单位费用的比较将使用每次访问费用分析进行。疾病缺勤的宏观经济影响也得到评估,因为干预组的患者将需要较少的医院就诊。为此,使用经过调整的i生产力成本问卷11,对几个项目进行评估:社会经济地位、工作状态和病假时间。
预期侵入性医疗程序的患者经常经历焦虑,可能超过他们的应对机制。焦虑评估在T0和T1与状态-特崔焦虑清单(STAI)12。STAI 是一个广泛使用的 20 项自我报告仪器,分数从 20(没有焦虑)到 80(高焦虑)。患者满意度使用两种不同的衡量标准进行评分。患者经验会影响未来行为,因此在 T3 评估"返回意愿",从 1(非常不愿意返回)到 10(非常愿意返回)。此外,使用净提升者分数 (NPS) 的问题"您是否会向同行推荐此内窥镜单元？患者的分数范围从 1(根本不可能)到 10(极有可能)。NPS将在T0和T3进行评估,并计算为% 促进者(分数9-10) - % 解说器(分数1-6)13 。为了评估患者对CBE患者信息的理解,需要重现指令的元素。患者信息重新调用在 T1(结肠镜检查前)使用 10 项测试进行评估,问题用"是"或"否"回答。结肠镜检查中患者教育的效果受患者理解医疗信息的能力的影响。14项荷兰经验证的健康素养量表用于评估这个项目,分为3个子尺度,在T014。新增了21项问卷,作为电子健康素养15的衡量标准。其中包含有关患者处理在线医疗信息的技能和经验的问题。患者每天都要面对可能对其健康有重大影响的选择。有效管理他们的选择需要知识、技能和信心。为此,这些元素被映射在T0 13项患者激活测量量表(PAM-13)16 。患者目前的健康状况由T017的医学结果研究36项健康调查(RAND-36)进行评估。
统计分析 为了对主要结果的两个组进行统计比较,使用准备不足的冒号的相对风险(定义为 BBPS <6)。在文献中,90%的成功率(对于准备充分的结肠)很常见,10%的非劣质差值是临床上可接受的最大差值。非劣质能力计算导致每组180名患者,共360名患者。这需要排除对标准组超过 10% 的差异。根据早期研究,在完成协议之前,患者损失率为 60%,因此,接近的患者目标数设定为 1,000。除非劣质分析外,还将进行优势分析,以调查对次要结果措施的影响。

<table>
	<tbody>
		<tr>
			<td>Computer Based Education</td>
			<td>Medify BV</td>
			<td>n/a</td>
			<td>Computer Based Education tool for patient instruction prior to colonoscopy</td>
		</tr>
		<tr>
			<td>Computer / tablet</td>
			<td>Any</td>
			<td></td>
			<td>A computer or tablet should be used to complete the e-learning and fill out the questionnaires</td>
		</tr>
		<tr>
			<td>Medify Content Management System</td>
			<td>Medify BV</td>
			<td>n/a</td>
			<td>A content management system to process the e-learning content</td>
		</tr>
	</tbody>
</table>

e-patient counseling trial (e-paco): computer based education versus nurse counseling for patients to prepare for colonoscopy

改善患者教育,在结肠镜检查前专注于肠准备,导致更清洁的结肠。内窥镜检查单位必须获得知情同意,并在结肠镜检查前对镇静剂使用进行风险评估。荷兰目前为实现这些目标而采取的做法是在门诊场所进行护士咨询。这代价高昂,在患者和医院的均匀性和时间消耗方面都有缺点。假设是,使用视频和3D动画的计算机教育在大多数情况下可以取代护士咨询,而不会在结肠镜检查期间失去肠道清洁质量。
这个多中心,随机的,内窥镜盲的临床试验评估结肠镜检查期间的主要结果测量(肠制剂)。次要结果措施是缺病、指导后和结肠镜检查前的患者焦虑、患者满意度和信息重新调用。这项研究将在四个不同级别的内窥镜单位(农村、城市和三级)进行。纳入标准是成人年龄和转诊完全结肠镜检查。排除标准是荷兰文盲、视听障碍或精神残疾,以及没有(同龄人)上网。
这项试验旨在建立基于计算机的在线教育,作为在结肠镜检查前进行患者教育的工具。通过选择与护理标准(护士咨询)的直接比较,可以评估内窥镜质量措施和患者相关结果措施。

前面提到的试验性研究使用与本协议8相同的互动工具将护士指导与CAI进行比较。由于本研究的目标与本议定书中使用的结果相当,因此在此更详细地解释了试验结果。另见表28。
在这项试验研究中,有385名患者被登记。CAI小组包含188个受试者。接受护士咨询的对照组有197名患者。?...

Watch this Scientific Journal Video about E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy at JoVE.com

E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

这项试验的目的是确立在线计算机教育作为患者在结肠镜检查前准备的工具的地位。计算机教育与护理标准、护士咨询、内窥镜质量措施评价和患者相关结果措施进行比较。

电子患者咨询试验(E-PACO):基于计算机的教育与护士咨询,为患者准备结肠镜检查

Improving patient education focusing on bowel preparation before a colonoscopy leads to cleaner colons. Endoscopy units must obtain informed consent and ...

该协议解决了当前在线时代患者教育的问题。虽然现代生活以高速度实施基于网络的解决方案，但患者教育却滞后。基于计算机的教育在时间、地点和学习速度上赋予患者权力，对患者的满意度产生了积极影响，具有若干操作优势。演示这个程序的将是基里尔·帕夫洛夫，一个胃肠病学居民从我部门。他将扮演一个正在接受计算机教育的病人的角色，说明这个过程的每一步。所有转诊的结肠镜检查患者都被要求参加试验，并记录拒绝的理由。纳入标准是成人年龄和转诊完整的结肠镜检查。排斥标准是荷兰文盲、视听障碍或精神残疾，没有互联网接入的同龄人。患者在获得许可后，随机进入干预、计算机教育或控制、护士咨询组。患者接受教育后，将填写基线问卷。在结肠镜检查当天，患者和内窥镜医生在结肠镜检查前、检查和结肠镜检查后的几个时间点填写调查问卷。我们现在将详细展示我们审判中的干预。让患者阅读弹出窗口，其中包含如何使用 CBE 的说明，然后单击结肠镜检查程序说明"选项卡。病人读你准备考试了吗？然后单击下一步。让患者在检查前播放"视频"，然后继续。欢迎来到Radboudumc，在那里将检查你的大肠。接下来，播放检查准备"视频为病人，并继续。播放第二个考试准备"视频，然后单击下一步。播放内窥镜"视频，然后单击屏幕右侧。与医生一起播放会议"视频并继续。播放"退出过程"视频，然后单击下一步。播放镇静剂"视频和前进。最后一段视频后，让患者阅读肠子的位置"文本并继续。将出现小肠的自动三- D 动画。让患者在阅读小肠文本时拖动旋转三D图像。当患者完成文本后，让患者单击下一步并拖动以旋转大肠的三D图像。阅读大肠"文本后，患者应单击下一步并拖动以旋转下一个三D图像。让患者阅读《大肠检查继续》文本，然后单击屏幕右侧。新的自动三-D 动画将出现，以 Anus 为中心。让患者阅读替代检查"文本并提前。当显示结肠入口的三D动画出现时，让患者播放空气输液"视频。在视频的末尾，患者应单击下一步。考试技术"将出现。阅读后，让患者单击"下一步"。当息肉动画出现时，播放"删除息肉"视频并继续。在视频的末尾，让患者查看检查后的视频，然后单击下一步。现在播放检查报告和后续预约"视频为病人和继续。让患者阅读"有一个美好的旅程"文本给病人，然后单击下一步。让患者阅读检查的风险"，然后单击屏幕右侧。然后让患者在"问卷和知情同意"幻灯片上填写病史和用药使用问卷，并在表格填写后点击发送。该表格将促使内窥镜部门采取自动操作，如停止抗凝药物（如果指示）。协议中的两个关键步骤是：第一，患者填写调查问卷，第二，将问卷退回内窥镜科。将显示结肠镜检查的准备"选项卡。让患者按照步骤操作，以与刚才展示的相同步骤方式阅读有关泻药使用的所有信息。当患者完成结肠镜检查准备模块后，单击"路径到科室"选项卡以将数据路由到内窥镜检查单元。在一项试验性研究中，将护士指导与计算机辅助指导进行比较，在计算机辅助指导组观察到内窥镜检查前患者舒适度有了显著改善。由于这种评级在护士咨询后直接较高，因此必须考虑个人接触中人为因素的影响，并提供情感支持。患者焦虑与信息回忆分数之间没有显著差异。两组肠准备分数之间的差异也没有观察到，即使使用两个不同的尺度。患者返回调查问卷后，内窥镜科必须准确评估所提供的信息。如果需要，可以向患者发送额外的信息。本研究方案采用计算机教育，可应用于其他体检。例如，为患者准备手术。

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Unit 1

E-Patient Counseling Trial (E-PACO): Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

The Nursing Process II

SCIENTISTS IN ACTION

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科研

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癌症患者血浆样本中无细胞DNA检测

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Cutaneous T-cell lymphomas (CTCL) are derived from the transformation and uncontrolled proliferation of mature skin-homing T cells, and mycosis fungoides ...

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Breast cancer is a devastating malignancy, accounting for 40,000 female deaths and 30% of new female cancer diagnoses in the United States in 2019 alone. ...

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An understanding of drug resistance and the development of novel strategies to sensitize highly resistant cancers rely on the availability of suitable ...