The rights of psychiatric patients in China: a survey of medical staff and consumers' attitudes toward patient participation in clinical trials

How do people think about the implementation of speech and video recognition technology in emergency medical practice?

Background

Recently, speech and video information recognition technology (SVRT) has developed rapidly. Introducing SVRT into the emergency medical practice process may lead to improvements in health care. The purpose of this study was to evaluate the level of acceptance of SVRT among patients, caregivers and emergency medical staff.

Methods

Structured questionnaires were developed for the patient or caregiver group and the emergency medical staff group. The survey was performed in one tertiary academic hospital emergency department. Questions were optimized for each specific group, and responses were provided mostly using Likert 5-scales. Additional multivariable logistic regression analyses for the whole cohort and subgroups were conducted to calculate odds ratios (OR) and confidence intervals (CI) to examine the association between individual characteristics and SVRT acceptance.

Results

Of 264 participants, respondents demonstrated a positive attitude and acceptance toward SVRT and artificial intelligence (AI) in future; 179 (67.8%) for video recordings, and 190 (72.0%) for speech recordings. A multivariable logistic regression model revealed that several factors were associated with acceptance of SVRT in emergency medical practice: belief in health care improvement by signal analysis technology (OR, 95% CIs: 2.48 (1.15–5.42)) and AI (OR, 95% CIs: 1.70 (0.91–3.17)), reliability of AI application in emergency medicine (OR, 95% CIs: 2.36 (1.28–4.35)) and the security of personal information (OR, 95% CIs: 1.98 (1.10–3.63)).

Conclusion

A high level of acceptance toward SVRT has been shown in patients or caregivers, and it also appears to be associated with positive attitudes toward new technology, AI and security of personal information.

Attitudes of Chinese Patients with Non-alcoholic Fatty Liver Disease Toward Participation in Clinical Trials from a National Multicenter Survey

BACKGROUND

Many new therapies of non-alcoholic fatty liver disease are being evaluated in clinical trials (CTs), but few of these trials involved sites in China. We evaluated influencing factors of Chinese patients' perspectives in participation in CTs of non-alcoholic fatty liver disease.

METHODS

A questionnaire was designed to be completed by patients with non-alcoholic fatty liver disease at eight affiliated hospitals across China.

RESULTS

428 patients were included in this analysis, 63% were male and median age was 37.9 years (30.0-44.0). 54% patients rated "to help others" and 30% "to improve my health status" as the greatest benefit from CTs. The most important concerns were safety (43%) and patients' benefit (26%). Improving liver fibrosis or cirrhosis (53%) and reducing fat in liver (21%) were desired efficacy of new drugs. Possibility of being treated with a placebo for up to 2-6 years played an influential (21%) or very influential (73%) role on participation. Lower education level, lower body mass index, and cirrhosis were positively associated with acceptance of liver biopsies. Anxiety of adverse effects of the new drug and requirement of 2-3 liver biopsies were negatively associated with patients' attitudes toward participating in the trial.

CONCLUSION

More than one-third of Chinese patients with NAFLD in this survey are willing to participate in CTs of NASH. For CTs of NASH treatment, potential effects on reversing fibrosis or cirrhosis would positively influence, while adverse effects of the new drug and requirement of multiple liver biopsies would negatively influence participation in our study.

Changing of Chinese psychiatrists' attitudes toward consent process to treatment and its association with the China's National Mental Health Law

OBJECTIVE

Few studies have addressed informed consent in Chinese psychiatric practice. We wished to explore psychiatrists' attitudes toward informed consent in Shanghai after promulgation of the first national law for mental health care in China: the National Mental Health Law.

METHOD

A total of 398 psychiatrists were recruited from seven psychiatric hospitals in Shanghai. Their anthropometric data were collected. A confidential, self-report questionnaire addressing attitudes toward the informed consent process was completed by all participants.

RESULTS

Most respondents would like to inform patients/guardians of the diagnosis (95.2%), treatment plan (93.5%), treatment goals and potential adverse effects of prescribed medications (94.7%), and alternative treatment plans (71.9%). In addition, 58.4% of psychiatrists thought that the informed consent process for physical restraint was difficult to follow. According to logistic regression, psychiatrists not trained to use the National Mental Health Law were more likely to have a negative attitude toward the informed consent process compared with those trained (adjusted odds ratio = 0.21; 95% confidence interval: 0.07-0.59; p = 0.003).

CONCLUSIONS

Psychiatrists trained to use the National Mental Health Law had more positive attitudes toward the informed consent process. Lack of such training could affect the attitudes of psychiatrists toward the informed consent process in China.

Low level of knowledge regarding diagnosis and treatment among inpatients with schizophrenia in Shanghai

OBJECTIVE

The study was designed to measure the level of knowledge of the diagnosis of illness and its treatment among patients with schizophrenia in China, and to examine the association between the capacity to provide informed consent and participation in treatment.

PARTICIPANTS AND METHODS

A cross-sectional study was conducted at three clinical inpatient sites in Shanghai, China, during 2015. Patients' knowledge of the illness, as well as the knowledge of the patients' families and psychiatrists, was determined. Logistic regression was used to determine the factors associated with patients' knowledge of schizophrenia.

RESULTS

Out of 109 enrolled schizophrenic inpatients (mean age 42.46±1.29 years), 60.6% were aware of their diagnosis and 67.0% knew details of their treatment plan. The group with unimpaired capacity for giving informed consent had a greater knowledge of their diagnosis (χ²=5.002, p=0.038) and of their treatment plan (χ²=11.196, p<0.01) in comparison with patients who were regarded to be impaired. Using logistic regression analysis, it was found that patients' capacity to give informed consent to treatment was associated with the level of knowledge surrounding the diagnosis (odds ratio =3.230, p<0.05) and the level of knowledge of treatment (odds ratio =4.962, p<0.01).

CONCLUSION

The level of knowledge reported by inpatients with schizophrenia was low with respect to the diagnosis of schizophrenia and of the treatment associated with this illness. An association between patients' capacities for giving informed consent and knowledge of their illness was confirmed in the present study. The results suggest that, in clinical practice, the informed consent process should be strengthened to protect the interests of patients with schizophrenia.

A comparative study of patients' attitudes toward clinical research in the United States and urban and rural China

As the number of clinical trials conducted in China increases, understanding Chinese attitudes toward clinical research is critical for designing effective and ethical studies. Two survey studies were conducted in 2012 and 2013 to compare patient attitudes toward clinical research and factors affecting research participation in the United States and urban and rural China. We surveyed 525 patients in 2012 (186 US, 186 urban, 153 rural China) and 690 patients in 2013 (412 US, 206 urban, 72 rural China). US patients were more likely to have no concerns regarding research participation than Chinese patients. Most common concerns of US patients were safety, privacy and confidentiality, and time required. Safety was a top concern for many Chinese. Chinese patients, particularly rural Chinese, were more concerned about the likelihood of self-benefit, and receiving free medical care and financial incentive had greater influence on their participation. Being informed of the freedom to choose whether to participate or to leave a study was less important to Chinese patients. Our study provides important insights into Chinese patients' attitudes toward clinical research and the need to educate them about their rights. These findings help in designing cross-cultural clinical studies that maximize enrollment while upholding Western ethical standards.

Association between awareness of patient rights and patient's education, seeing bill, and age: a cross-sectional study

Background:

Considering the controversial results of previous reports on awareness of bill of patients’ rights in different regions, as well as the fact that no report is available on the awareness of patients of their rights in teaching hospitals of Sari, we conducted the present study.

Materials and Methods:

This is a cross-sectional Study conducted in teaching hospitals of Sari in 2011. The study population consisted of 336 patients recruited from 4 hospitals affiliated with Mazandaran University of Medical Sciences in Sari, through calculating the selection quota of each hospital. Data were collected through face-to-face interview on discharge, using a two-section questionnaire based on the bill of patient rights and with verified reliability and validity. Data analysis was accomplished on SPSS soft- ware version 10.

Results:

55.4% of patients were women and 44.6% were men. The patients’ mean age was 40.93 ± 15.04 years and the mean length of stay was 4.6 ± 3.34 days. Most patients had elementary education (36%) or were illiterate (25%). The majority (63.4%) had not seen the bill of patients’ rights. 58.9% had poor knowledge, 12% had intermediate knowledge, and 29.1% had good knowledge. As for the articles of the bill, the poorest awareness correlated to the 9^th article (the right to participate or refrain from participating in research). We found a significant relationship between awareness of the bill, and the patient’s education, seeing the bill, and age (p<0.0005).

Conclusion:

The results of the present study indicate that patients are not sufficiently aware of their rights, and this problem requires comprehensive planning to be resolved.