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Sample records for driven treatment decisions

  1. SU-E-J-04: A Data-Driven, Response-Based, Multi-Criteria Decision Support System for Personalized Lung Radiation Treatment Planning

    SciTech Connect

    Luo, Y; McShan, D; Schipper, M; Matuszak, M; Ten Haken, R; Kong, F

    2014-06-01

    Purpose: To develop a decision support tool to predict a patient's potential overall survival (OS) and radiation induced toxicity (RIT) based on clinical factors and responses during the course of radiotherapy, and suggest appropriate radiation dose adjustments to improve therapeutic effect. Methods: Important relationships between a patient's basic information and their clinical features before and during the radiation treatment are identified from historical clinical data by using statistical learning and data mining approaches. During each treatment period, a data analysis (DA) module predicts radiotherapy features such as time to local progression (TTLP), time to distant metastases (TTDM), radiation toxicity to different organs, etc., under possible future treatment plans based on patient specifics or responses. An information fusion (IF) module estimates intervals for a patient's OS and the probabilities of RIT from a treatment plan by integrating the outcomes of module DA. A decision making (DM) module calculates “satisfaction” with the predicted radiation outcome based on trade-offs between OS and RIT, and finds the best treatment plan for the next time period via multi-criteria optimization. Results: Using physical and biological data from 130 lung cancer patients as our test bed, we were able to train and implement the 3 modules of our decision support tool. Examples demonstrate how it can help predict a new patient's potential OS and RIT with different radiation dose plans along with how these combinations change with dose, thus presenting a range of satisfaction/utility for use in individualized decision support. Conclusion: Although the decision support tool is currently developed from a small patient sample size, it shows the potential for the improvement of each patient's satisfaction in personalized radiation therapy. The radiation treatment outcome prediction and decision making model needs to be evaluated with more patients and demonstrated for

  2. A Decision Fusion Framework for Treatment Recommendation Systems.

    PubMed

    Mei, Jing; Liu, Haifeng; Li, Xiang; Xie, Guotong; Yu, Yiqin

    2015-01-01

    Treatment recommendation is a nontrivial task--it requires not only domain knowledge from evidence-based medicine, but also data insights from descriptive, predictive and prescriptive analysis. A single treatment recommendation system is usually trained or modeled with a limited (size or quality) source. This paper proposes a decision fusion framework, combining both knowledge-driven and data-driven decision engines for treatment recommendation. End users (e.g. using the clinician workstation or mobile apps) could have a comprehensive view of various engines' opinions, as well as the final decision after fusion. For implementation, we leverage several well-known fusion algorithms, such as decision templates and meta classifiers (of logistic and SVM, etc.). Using an outcome-driven evaluation metric, we compare the fusion engine with base engines, and our experimental results show that decision fusion is a promising way towards a more valuable treatment recommendation. PMID:26262059

  3. Bayesian Decision Support for Adaptive Lung Treatments

    NASA Astrophysics Data System (ADS)

    McShan, Daniel; Luo, Yi; Schipper, Matt; TenHaken, Randall

    2014-03-01

    Purpose: A Bayesian Decision Network will be demonstrated to provide clinical decision support for adaptive lung response-driven treatment management based on evidence that physiologic metrics may correlate better with individual patient response than traditional (population-based) dose and volume-based metrics. Further, there is evidence that information obtained during the course of radiation therapy may further improve response predictions. Methods: Clinical factors were gathered for 58 patients including planned mean lung dose, and the bio-markers IL-8 and TGF-β1 obtained prior to treatment and two weeks into treatment along with complication outcomes for these patients. A Bayesian Decision Network was constructed using Netica 5.0.2 from Norsys linking these clinical factors to obtain a prediction of radiation induced lung disese (RILD) complication. A decision node was added to the network to provide a plan adaption recommendation based on the trade-off between the RILD prediction and complexity of replanning. A utility node provides the weighting cost between the competing factors. Results: The decision node predictions were optimized against the data for the 58 cases. With this decision network solution, one can consider the decision result for a new patient with specific findings to obtain a recommendation to adaptively modify the originally planned treatment course. Conclusions: A Bayesian approach allows handling and propagating probabilistic data in a logical and principled manner. Decision networks provide the further ability to provide utility-based trade-offs, reflecting non-medical but practical cost/benefit analysis. The network demonstrated illustrates the basic concept, but many other factors may affect these decisions and work on building better models are being designed and tested. Acknowledgement: Supported by NIH-P01-CA59827

  4. Data-Driven Decision Making 2016

    ERIC Educational Resources Information Center

    Ligon, Glynn D.

    2006-01-01

    Educators base many of their most significant decisions on what they think will happen in the future. This article on education technology begins by outlining six notable advances in education information technology that have already occurred. Ten predictions are made concerning general advances in education information technology for the next…

  5. Group decision support system for customer-driven product design

    NASA Astrophysics Data System (ADS)

    Lin, Zhihang; Chen, Hang; Chen, Kuen; Che, Ada

    2000-10-01

    This paper describes the work on the development of a group decision support system for customer driven product design. The customer driven is to develop products, which meet all customer requirements in whole life cycle of products. A process model of decision during product primary design is proposed to formulate the structured, semi-structured and unstructured decision problems. The framework for the decision support system is presented that integrated both advances in the group decision making and distributed artificial intelligent. The system consists of the product primary design tool kit and the collaborative platform with multi-agent structure. The collaborative platform of the system and the product primary design tool kit, including the VOC (Voice of Customer) tool, QFD (Quality Function Deployment) tool, the Conceptual design tool, Reliability analysis tool and the cost and profit forecasting tool, are indicated.

  6. Guarding against discriminatory treatment decisions.

    PubMed

    Griffith, Richard

    2013-10-01

    This article studies a case in which a 52-year-old male patient has early onset dementia, Down's syndrome and an associated heart condition, for which he is prescribed warfarin and digoxin. A district nurse, who is an independent prescriber, monitors and adjusts his medication and takes the required blood sample. The staff at the care home where the patient lives report that the patient is spitting out his medication and they have not been able to persuade him to swallow his tablets for a week. Despite the patient being assessed as lacking capacity to decide treatment decisions, the care home staff argue that his refusal to take medication should be respected and the medication discontinued. Although withdrawing the medication would make caring for the patient less challenging, the district nurse assesses the legal obligations that must be considered before this decision can be considered lawful. PMID:24471220

  7. Outcome-driven Evaluation Metrics for Treatment Recommendation Systems.

    PubMed

    Mei, Jing; Liu, Haifeng; Li, Xiang; Yu, Yiqin; Xie, Guotong

    2015-01-01

    Treatment recommendation systems aim to providing clinical decision supports, e.g. with integration of Computerized Physician Order Entry (CPOE). One of the most significant issue is the quality of recommendations which needs to be quantified, before getting the acceptance from physicians. In computer science, such evaluations are typically performed by applying appropriate metrics that provides a comparison of different systems. However, a big challenge for evaluating treatment recommendation systems is that ground truth is only partially observed. In this paper, we propose an outcome-driven evaluation methodology, and present five metrics (i.e. precision, recall, accuracy, relative risk and odds ratio) with highlight of their statistic meanings in clinical context. The experimental results are based on the comparison of two well-developed treatment recommendation systems (one is knowledge-driven and based on clinical practice guidelines, while the other is data-driven and based on patient similarity analysis), using our proposed evaluation metrics. As a conclusion, physicians are less prone to comply with clinical guidelines, but once following guideline recommendations, it is much more likely to get good outcomes than not following. PMID:25991128

  8. A Middle School Principal's and Teachers' Perceptions of Leadership Practices in Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Godreau Cimma, Kelly L.

    2011-01-01

    The purpose of this qualitative case study was to describe one Connecticut middle school's voluntary implementation of a data-driven decision making process in order to improve student academic performance. Data-driven decision making is a component of Connecticut's accountability system to assist schools in meeting the requirements of the No…

  9. Parental involvement in paediatric cancer treatment decisions

    PubMed Central

    McKenna, K; Collier, J; Hewitt, M; Blake, H

    2010-01-01

    This study investigated parents' information needs and involvement in decision-making processes affecting the care of children diagnosed with cancer. Interviews and questionnaires were used to assess parental satisfaction in 50 mothers and 16 fathers responsible for 58 children in an English Paediatric Oncology Unit. Parents reported that doctors contributed almost twice as much to the decision-making process as they did, but parental satisfaction was positively correlated with the amount of information provided when giving informed consent. Satisfaction about their involvement in this process relied heavily upon the level of support received from others. Parents consenting to their child's involvement in non-randomised trials perceived themselves to be under greater pressure from others during the decision-making process while those whose children were further along the treatment trajectory were more uncertain about decisions previously made. Findings indicate that the accessibility, support, information and degree of control afforded to parents by healthcare professionals impacts upon their satisfaction with both the decision-making process and their confidence in the decisions thus made. Information and support tailored to parents' specific needs may therefore enhance satisfaction with clinical decision making and reassure parents about decisions made in the long-term interest of their child's health. PMID:19807776

  10. SIDEKICK: Genomic data driven analysis and decision-making framework

    PubMed Central

    2010-01-01

    Background Scientists striving to unlock mysteries within complex biological systems face myriad barriers in effectively integrating available information to enhance their understanding. While experimental techniques and available data sources are rapidly evolving, useful information is dispersed across a variety of sources, and sources of the same information often do not use the same format or nomenclature. To harness these expanding resources, scientists need tools that bridge nomenclature differences and allow them to integrate, organize, and evaluate the quality of information without extensive computation. Results Sidekick, a genomic data driven analysis and decision making framework, is a web-based tool that provides a user-friendly intuitive solution to the problem of information inaccessibility. Sidekick enables scientists without training in computation and data management to pursue answers to research questions like "What are the mechanisms for disease X" or "Does the set of genes associated with disease X also influence other diseases." Sidekick enables the process of combining heterogeneous data, finding and maintaining the most up-to-date data, evaluating data sources, quantifying confidence in results based on evidence, and managing the multi-step research tasks needed to answer these questions. We demonstrate Sidekick's effectiveness by showing how to accomplish a complex published analysis in a fraction of the original time with no computational effort using Sidekick. Conclusions Sidekick is an easy-to-use web-based tool that organizes and facilitates complex genomic research, allowing scientists to explore genomic relationships and formulate hypotheses without computational effort. Possible analysis steps include gene list discovery, gene-pair list discovery, various enrichments for both types of lists, and convenient list manipulation. Further, Sidekick's ability to characterize pairs of genes offers new ways to approach genomic analysis that

  11. The structural basis for cancer treatment decisions

    PubMed Central

    Nussinov, Ruth; Jang, Hyunbum; Tsai, Chung-Jung

    2014-01-01

    Cancer treatment decisions rely on genetics, large data screens and clinical pharmacology. Here we point out that genetic analysis and treatment decisions may overlook critical elements in cancer development, progression and drug resistance. Two critical structural elements are missing in genetics-based decision-making: the mechanisms of oncogenic mutations and the cellular network which is rewired in cancer. These lay the foundation for the structural basis for cancer treatment decisions, which is rooted in the physical principles of the molecular conformational behavior of single molecules and their interactions. Improved tumor mutational analysis platforms and knowledge of the redundant pathways which can take over in cancer, may not only supplement known actionable findings, but forecast possible cancer progression and resistance. Such forward-looking can be powerful, endowing the oncologist with mechanistic insight and cancer prognosis, and consequently more informed treatment options. Examples include redundant pathways taking over after inhibition of EGFR constitutive activation, mutations in PIK3CA p110α and p85, and the non-hotspot AKT1 mutants conferring constitutive membrane localization. PMID:25277176

  12. Data-Driven Decision Making: Teachers' Use of Data in the Classroom

    ERIC Educational Resources Information Center

    Moriarty, Tammy Wu

    2013-01-01

    Data-driven decision making has become an important educational issue in the United States, primarily because of federal and state emphasis on school accountability and achievement. Data use has been highlighted as a key factor in monitoring student progress and informing decision making at various levels of the education system. Federal and state…

  13. Co-Constructing Distributed Leadership: District and School Connections in Data-Driven Decision-Making

    ERIC Educational Resources Information Center

    Park, Vicki; Datnow, Amanda

    2009-01-01

    The purpose of this paper is to examine leadership practices in school systems that are implementing data-driven decision-making employing the theory of distributed leadership. With the advent of No Child Left Behind Act of 2001 (NCLB) in the US, educational leaders are now required to analyse, interpret and use data to make informed decisions in…

  14. Decision support for redesigning wastewater treatment technologies.

    PubMed

    McConville, Jennifer R; Künzle, Rahel; Messmer, Ulrike; Udert, Kai M; Larsen, Tove A

    2014-10-21

    This paper offers a methodology for structuring the design space for innovative process engineering technology development. The methodology is exemplified in the evaluation of a wide variety of treatment technologies for source-separated domestic wastewater within the scope of the Reinvent the Toilet Challenge. It offers a methodology for narrowing down the decision-making field based on a strict interpretation of treatment objectives for undiluted urine and dry feces and macroenvironmental factors (STEEPLED analysis) which influence decision criteria. Such an evaluation identifies promising paths for technology development such as focusing on space-saving processes or the need for more innovation in low-cost, energy-efficient urine treatment methods. Critical macroenvironmental factors, such as housing density, transportation infrastructure, and climate conditions were found to affect technology decisions regarding reactor volume, weight of outputs, energy consumption, atmospheric emissions, investment cost, and net revenue. The analysis also identified a number of qualitative factors that should be carefully weighed when pursuing technology development; such as availability of O&M resources, health and safety goals, and other ethical issues. Use of this methodology allows for coevolution of innovative technology within context constraints; however, for full-scale technology choices in the field, only very mature technologies can be evaluated. PMID:25225855

  15. Patient age and general dentists' treatment decisions.

    PubMed

    Dolan, T A; McNaughton, C A; Davidson, S N; Mitchell, G S

    1992-01-01

    To test whether a patient's age plays a role in dentists' treatment planning decisions, a convenience sample of 159 general dentists attending a state dental society annual meeting was presented a vignette including intra-oral photographs, a brief case history and clinical diagnosis of a patient. The patient was partially dentate, and was described as having irreversible pulpitis of tooth #19. Three versions of the vignette were developed, with identical materials and information except for the patient's age (either 44, 65, or 84 years), and were randomly assigned to the participating dentists who were asked to develop a treatment plan for the patient's mandibular arch. The dentists planned limited therapy for the 84 year old because of their assumptions about the patient's brief life expectancy, cost, concern about the inability of the patient to tolerate extensive treatment, and a low cost/benefit ratio. These findings suggest that a patient's age influences general dentists' treatment planning decisions, perhaps limiting the treatment options offered to older adults. Additional research is necessary to further test these associations. PMID:10895734

  16. Data-Driven Decision-Making: Mission Accomplished

    ERIC Educational Resources Information Center

    Weinstock, Jeff

    2009-01-01

    When the author and his colleagues last left Chicago Public Schools (CPS) and Texas' Plano Independent School District in April 2008, both school districts were immersed in the long and labored advance toward becoming a fully matured data-driven operation, one that uses sophisticated technologies to gather data, sort and interpret it, and…

  17. Data-Driven Decision Making: The "Other" Data

    ERIC Educational Resources Information Center

    Villano, Matt

    2007-01-01

    Data is a daily reality for school systems. Between standardized tests and tools from companies that offer data warehousing services, educators and district superintendents alike are up to their eyeballs in facts and figures about student performance that they can use as the basis for curricular decisions. Still, there is more to assessment than…

  18. Data Use: Data-Driven Decision Making Takes a Big-Picture View of the Needs of Teachers and Students

    ERIC Educational Resources Information Center

    Bernhardt, Victoria L.

    2009-01-01

    Data-driven decision making is the process of using data to inform decisions to improve teaching and learning. Schools typically engage in two kinds of data-driven decision making--at the school level and at the classroom level. The first leads to the second. In this article, the author describes how Marylin Avenue Elementary School successfully…

  19. Data-Driven Decision Making in Practice: The NCAA Injury Surveillance System

    ERIC Educational Resources Information Center

    Klossner, David; Corlette, Jill; Agel, Julie; Marshall, Stephen W.

    2009-01-01

    Putting data-driven decision making into practice requires the use of consistent and reliable data that are easily accessible. The systematic collection and maintenance of accurate information is an important component in developing policy and evaluating outcomes. Since 1982, the National Collegiate Athletic Association (NCAA) has been collecting…

  20. Creating a System for Data-Driven Decision-Making: Applying the Principal-Agent Framework

    ERIC Educational Resources Information Center

    Wohlstetter, Priscilla; Datnow, Amanda; Park, Vicki

    2008-01-01

    The purpose of this article is to improve our understanding of data-driven decision-making strategies that are initiated at the district or system level. We apply principal-agent theory to the analysis of qualitative data gathered in a case study of 4 urban school systems. Our findings suggest educators at the school level need not only systemic…

  1. Design and Data in Balance: Using Design-Driven Decision Making to Enable Student Success

    ERIC Educational Resources Information Center

    Fairchild, Susan; Farrell, Timothy; Gunton, Brad; Mackinnon, Anne; McNamara, Christina; Trachtman, Roberta

    2014-01-01

    Data-driven approaches to school decision making have come into widespread use in the past decade, nationally and in New York City. New Visions has been at the forefront of those developments: in New Visions schools, teacher teams and school teams regularly examine student performance data to understand patterns and drive classroom- and…

  2. Data-Driven Decision-Making: Facilitating Teacher Use of Student Data to Inform Classroom Instruction

    ERIC Educational Resources Information Center

    Schifter, Catherine C.; Natarajan, Uma; Ketelhut, Diane Jass; Kirchgessner, Amanda

    2014-01-01

    Data-driven decision making is essential in K-12 education today, but teachers often do not know how to make use of extensive data sets. Research shows that teachers are not taught how to use extensive data (i.e., multiple data sets) to reflect on student progress or to differentiate instruction. This paper presents a process used in an National…

  3. Data-Driven Decision Making--Not Just a Buzz Word

    ERIC Educational Resources Information Center

    Kadel, Rob

    2010-01-01

    In education, data-driven decision making is a buzz word that has come to mean collecting absolutely as much data as possible on everything from attendance to zero tolerance, and then having absolutely no idea what to do with it. Most educational organizations with a plethora of data usually call in a data miner, or evaluator, to make some sense…

  4. A Perfect Time for Data Use: Using Data-Driven Decision Making to Inform Practice

    ERIC Educational Resources Information Center

    Mandinach, Ellen B.

    2012-01-01

    Data-driven decision making has become an essential component of educational practice across all levels, from chief state school officers to classroom teachers, and has received unprecedented attention in terms of policy and financial support. It was included as one of the four pillars in the American Recovery and Reinvestment Act (2009),…

  5. A communication model of shared decision making: accounting for cancer treatment decisions.

    PubMed

    Siminoff, Laura A; Step, Mary M

    2005-07-01

    The authors present a communication model of shared decision making (CMSDM) that explicitly identifies the communication process as the vehicle for decision making in cancer treatment. In this view, decision making is necessarily a sociocommunicative process whereby people enter into a relationship, exchange information, establish preferences, and choose a course of action. The model derives from contemporary notions of behavioral decision making and ethical conceptions of the doctor-patient relationship. This article briefly reviews the theoretical approaches to decision making, notes deficiencies, and embeds a more socially based process into the dynamics of the physician-patient relationship, focusing on cancer treatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that have potential to influence communication, (b) jointly constructed communication climate, and (c) treatment preferences established by the physician and the patient. PMID:16045427

  6. What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

    PubMed Central

    Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

    2013-01-01

    Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

  7. Visualization-based decision support for value-driven system design

    NASA Astrophysics Data System (ADS)

    Tibor, Elliott

    In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations

  8. Cognitive Imaging in Visual Data-Driven Decision-Support Systems

    NASA Astrophysics Data System (ADS)

    Gorohov, V.; Vitkovskiy, V.

    2010-12-01

    Within data-driven types of decision-support systems (DDDSS, DSS), visual decision-support systems are those that try to inspire operator to find solution (decision) by producing visual representation of the data. Traditional approaches, that utilize traditional scientific visualization techniques such as 2D and 3D plots, vector fields, surface maps etc, works well when subject to represent is relatively simply structured data, low-dimensioned and weak interconnected. However, modern scientific experiments, as those in astrophysics observations, generate huge volumes of multidimensional complicated data. More sophisticated approach for visualizing of big volumes of multidimensional data is that based on the cognitive machine graphics techniques, which, for example, are used in visualization system Space Walker (SW). In contrast to illustrative ones, the cognitive images are aimed to make clear and evident some difficult scientific concepts and promote us with a new knowledge.

  9. Projection in surrogate decisions about life-sustaining medical treatments.

    PubMed

    Fagerlin, A; Ditto, P H; Danks, J H; Houts, R M; Smucker, W D

    2001-05-01

    To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed. PMID:11403214

  10. Dubious delegation: Article III limits on mental health treatment decisions.

    PubMed

    Teitelbaum, Adam

    2012-06-01

    A common condition of supervised release requires a defendant, post-incarceration, to participate in a mental health treatment program. Federal district courts often order probation officers to make certain decisions ancillary to these programs. However, Article III delegation doctrine places limits on such actions. This Note addresses the constitutionality of delegating the "treatment program" decision, in which a probation officer decides which type of treatment the defendant must undergo; the choice is often between inpatient treatment and other less restrictive alternatives. The resolution of this issue ultimately depends on whether this decision constitutes a "judicial act." Finding support in lower court case law, this Note argues that a "judicial act" encompasses decisions affecting the defendant's significant liberty interests. The Supreme Court case law and the mental health literature make clear that significant liberty interests are at stake in these "treatment program" decisions. Thus, delegating the "treatment program" decision to probation officers is unconstitutional under Article III. The Note concludes by suggesting a constitutionally permissible scheme whereby the judge orders a maximally intrusive treatment while giving the probation officer the discretion to choose a less restrictive program. PMID:22708137

  11. Model-driven decision support for monitoring network design: methods and applications

    NASA Astrophysics Data System (ADS)

    Vesselinov, V. V.; Harp, D. R.; Mishra, P. K.; Katzman, D.

    2012-12-01

    A crucial aspect of any decision-making process for environmental management of contaminated sites and protection of groundwater resources is the identification of scientifically defensible remediation scenarios. The selected scenarios are ranked based on both their protective and cost effectiveness. The decision-making process is facilitated by implementation of site-specific data- and model-driven analyses for decision support (DS) taking into account existing uncertainties to evaluate alternative characterization and remedial activities. However, due to lack of data and/or complex interdependent uncertainties (conceptual elements, model parameters, measurement/computational errors, etc.), the DS optimization problem is ill posed (non unique) and the model-prediction uncertainties are difficult to quantify. Recently, we have developed and implemented several novel theoretical approaches and computational algorithms for model-driven decision support. New and existing DS tools have been employed for model analyses of the fate and extent of a chromium plume in the regional aquifer at Sandia Canyon Site, LANL. Since 2007, we have performed three iterations of DS analyses implementing different models, decision-making tools, and data sets providing guidance on design of a subsurface monitoring network for (1) characterization of the flow and transports processes, and (2) protection of the water users. The monitoring network is augmented by new wells at locations where acquired new data can effectively reduce uncertainty in model predicted contaminant concentrations. A key component of the DS analyses is contaminant source identification. Due to data and conceptual uncertainties, subsurface processes controlling the contaminant arrival at the top of the regional aquifer are not well defined. Nevertheless, the model-based analyses of the existing data and conceptual knowledge, including respective uncertainties, provide constrained probabilistic estimates of the

  12. Integrating complex business processes for knowledge-driven clinical decision support systems.

    PubMed

    Kamaleswaran, Rishikesan; McGregor, Carolyn

    2012-01-01

    This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS. PMID:23366138

  13. Sim•TwentyFive: An Interactive Visualization System for Data-Driven Decision Support

    PubMed Central

    Stubbs, Brendan; Kale, David C.; Das, Amar

    2012-01-01

    Clinicians at the bedside are increasingly overwhelmed by an inundation of information and must rely largely on pattern recognition and professional experience to comprehend complex clinical data and treat their patients in a timely manner. Traditional decision support systems are based on rules and predictive models and often fail to take advantage of increasingly large digital clinical data stores available in real-time. We propose an alternative approach to delivering data-driven decision support based on an interactive system for exploring and visualizing a context of physiologically similar patients from a database. Here we present Sim•TwentyFive, a highly flexible, responsive, intuitive prototype with a comprehensive set of interaction techniques that effectively reduces the cognitive burden of querying, exploring, analyzing and comparing similar past patient episodes. Quantitative performance tests and anonymous summative evaluations from PICU physicians indicated that Sim•TwentyFive is an efficient, intuitive and clinically-useful tool. PMID:23304364

  14. Medulloblastoma development: tumor biology informs treatment decisions.

    PubMed

    Gopalakrishnan, Vidya; Tao, Rong-Hua; Dobson, Tara; Brugmann, William; Khatua, Soumen

    2015-01-01

    Medulloblastoma is the most common malignant pediatric brain tumor. Current treatments including surgery, craniospinal radiation and high-dose chemotherapy have led to improvement in survival. However, the risk for recurrence as well as significant long-term neurocognitive and endocrine sequelae associated with current treatment modalities underscore the urgent need for novel tumor-specific, normal brain-sparing therapies. It has also provided the impetus for research focused on providing a better understanding of medulloblastoma biology. The expectation is that such studies will lead to the identification of new therapeutic targets and eventually to an increase in personalized treatment approaches. PMID:25768332

  15. Development and initial evaluation of a treatment decision dashboard

    PubMed Central

    2013-01-01

    Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2

  16. Becoming Data Driven: The Influence of Teachers' Sense of Efficacy on Concerns Related to Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Dunn, Karee E.; Airola, Denise T.; Lo, Wen-Juo; Garrison, Mickey

    2013-01-01

    Data-driven decision-making (DDDM) reform has proven to be an effective means for improving student learning. However, little DDDM reform has happened at the classroom level, and little research has explored variables that influence teacher adoption of DDDM. The authors propose a model in which teachers' sense of efficacy for the skills that…

  17. Patients' and parents' concerns and decisions about orthodontic treatment

    PubMed Central

    Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    Objective Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level. Methods One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents. Results Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients. Conclusions The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment. PMID:26877979

  18. Japanese physicians’ preferences for decision making in rheumatoid arthritis treatment

    PubMed Central

    Aoki, Akiko; Ohbu, Sadayoshi

    2016-01-01

    Background Rheumatoid arthritis (RA) is a complex chronic illness requiring continued medical care. During the past decade, the therapeutic options for RA have increased significantly; these often have a higher risk of adverse effects and are more expensive than traditional drugs. Rheumatologists may hence face difficulties when deciding on the optimal modality in initiating or changing treatment. The aim of this study was to explore the Japanese physicians’ usual style of and preferences for decision making regarding RA treatment. Methods This was a cross-sectional study conducted using an Internet survey. Respondents were asked about their usual style of making treatment decisions (perceived style), and their perception of the importance of physicians’ actions and patients’ attitudes. Results Of the 485 physicians who were sent the questionnaire, 157 responded completely (response rate: 32.3%). Ninety-two percent of the respondents were men, and 57% were clinicians with more than 20 years of experience. Their specialties were general medicine (29%), rheumatology (27%), orthopedics (31%), and rehabilitation (12%). Sixty-one (39%) stated that they usually presented multiple treatment options to their patients and selected a decision for them, 42 (27%) shared the decision making with their patients, 34 (22%) let their patients choose the treatment, and 20 (13%) made the treatment decision for the patients. Physicians using the shared decision making (SDM) style desired for their patients to have supportive family and friends, to discuss with nurses, and to follow the doctors’ directions more strongly compared with physicians using the other styles. There were no significant differences in sex, duration of clinical experience, major place of clinical work, and number of patients per month by the styles. More number of rheumatologists and physicians with specialist qualifications stated that they practiced SDM. Conclusion To enhance patient participation

  19. Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions.

    PubMed

    Ubel, Peter A

    2016-05-01

    Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments. PMID:27226516

  20. Treatment Decisions for Children with Speech-Sound Disorders

    ERIC Educational Resources Information Center

    Kamhi, Alan G.

    2006-01-01

    PURPOSE: In this article, I consider how research, clinical expertise, client values, a clinician's theoretical perspective, and service delivery considerations affect the decisions that clinicians make to treat children with speech-sound disorders (SSD). METHOD: After reviewing the research on phonological treatment, I discuss how a clinician's…

  1. Decision Support System Development for the Treatment of Maladaptive Behaviors.

    ERIC Educational Resources Information Center

    Hile, Matthew G.; Desrochers, Marcie N.

    The Mental Retardation-Expert (MR-E) is a microcomputer based expert decision support system that provides practitioners with state of the art assistance in the treatment of aggressive, self injurious, and destructive behaviors displayed by individuals with mental retardation or developmental disabilities. This system, based on human experts and…

  2. Redefining self: patients' decision making about treatment for multiple sclerosis.

    PubMed

    Lowden, Diane; Lee, Virginia; Ritchie, Judith A

    2014-08-01

    The treatment of multiple sclerosis (MS) has become possible with the advent of disease-modifying therapies, but little is known about patients' experiences when faced with a complex array of treatment options. The purpose of this phenomenological study was to explore the lived experience of making a first decision about treatment with disease-modifying therapies for relapsing-remitting MS. Nine participants shared their perspectives on negotiating the decision to accept, refuse, or delay treatment. All individuals described a core theme in which decision making about treatment was part of a process of coming to a "redefined self." This core theme included reflections about self-image, quality of life, goals, and being a person with MS. Six common themes supporting this core theme were (a) weighing and deciding what's important, (b) acknowledging the illness as part of oneself, (c) playing the mental game, (d) seeking credible resources, (e) evaluating symptoms and fit with quality of life, and (f) managing the roles and involvement of family. The findings of this study provide a greater understanding about the experience of making a therapeutic choice for those with MS and offer insights for nurses when supporting patients faced with options about treatment. PMID:24875289

  3. Online Produced Water Treatment Catalog and Decision Tool

    SciTech Connect

    J. Arthur

    2012-03-31

    The objective of this project was to create an internet-based Water Treatment Technology Catalog and Decision Tool that will increase production, decrease costs and enhance environmental protection. This is to be accomplished by pairing an operator's water treatment cost and capacity needs to specific water treatments. This project cataloged existing and emerging produced water treatment technologies and allows operators to identify the most cost-effective approaches for managing their produced water. The tool captures the cost and capabilities of each technology and the disposal and beneficial use options for each region. The tool then takes location, chemical composition, and volumetric data for the operator's water and identifies the most cost effective treatment options for that water. Regulatory requirements or limitations for each location are also addressed. The Produced Water Treatment Catalog and Decision Tool efficiently matches industry decision makers in unconventional natural gas basins with: 1) appropriate and applicable water treatment technologies for their project, 2) relevant information on regulatory and legal issues that may impact the success of their project, and 3) potential beneficial use demands specific to their project area. To ensure the success of this project, it was segmented into seven tasks conducted in three phases over a three year period. The tasks were overseen by a Project Advisory Council (PAC) made up of stakeholders including state and federal agency representatives and industry representatives. ALL Consulting has made the catalog and decision tool available on the Internet for the final year of the project. The second quarter of the second budget period, work was halted based on the February 18, 2011 budget availability; however previous project deliverables were submitted on time and the deliverables for Task 6 and 7 were completed ahead of schedule. Thus the application and catalog were deployed to the public Internet

  4. Treatment limitation decisions under uncertainty: the value of subsequent euthanasia.

    PubMed

    Savulescu, Julian

    1994-01-01

    This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty. PMID:11657375

  5. Examining Data Driven Decision Making via Formative Assessment: A Confluence of Technology, Data Interpretation Heuristics and Curricular Policy

    ERIC Educational Resources Information Center

    Swan, Gerry; Mazur, Joan

    2011-01-01

    Although the term data-driven decision making (DDDM) is relatively new (Moss, 2007), the underlying concept of DDDM is not. For example, the practices of formative assessment and computer-managed instruction have historically involved the use of student performance data to guide what happens next in the instructional sequence (Morrison, Kemp, &…

  6. Teacher Capacity for and Beliefs about Data-Driven Decision Making: A Literature Review of International Research

    ERIC Educational Resources Information Center

    Datnow, Amanda; Hubbard, Lea

    2016-01-01

    Data-driven decision making continues to be a growing educational reform initiative across the globe. The effective use of data requires that teachers develop the knowledge and skills to analyze and use data to improve instruction. The purpose of this article is to examine teachers' capacity for and beliefs about data use. These issues are…

  7. Data-Driven Decision Making: Vision to Know and Do. Backgrounder Brief. CoSN Essential Leadership Skills Series

    ERIC Educational Resources Information Center

    Consortium for School Networking (NJ1), 2005

    2005-01-01

    This Backgrounder Brief is an executive summary of "Data-Driven Decision Making: Vision to Know and Do," a component of CoSN's Essential Leadership Skills Series. Collecting student achievement data is nothing new in schools. But for all of the data gathered, many schools remain information poor. Educators are challenged to understand how to best…

  8. Educational Psychology's Instructional Challenge: Pre-Service Teacher Concerns Regarding Classroom-Level Data-Driven Decision-Making

    ERIC Educational Resources Information Center

    Dunn, Karee E.

    2016-01-01

    Data-driven decision-making (DDDM) is a difficult topic to cover, but typically required, in the applied educational psychology course or other courses required for teacher licensure in the United States. While a growing body of literature indicates in-service teachers are resistant to DDDM and underprepared to engage in it, little has been done…

  9. Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration.

    PubMed

    Pieterse, A H; Baas-Thijssen, M C M; Marijnen, C A M; Stiggelbout, A M

    2008-09-16

    Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, > or = 81% thought not all patients are able to participate and > or = 74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points. PMID:18781148

  10. Breast cancer diagnosis and factors influencing treatment decisions in Ghana.

    PubMed

    Aziato, Lydia; Clegg-Lamptey, Joe Nat A

    2015-01-01

    Researchers in this study explored the reactions of women with breast cancer and identified factors influencing treatment decisions. A qualitative exploratory approach was employed. Participants were recruited from a tertiary hospital and a breast cancer support group. Purposive sampling recruited 12 women. It was found that women identified breast lesions accidentally or intentionally and that diagnosis was delayed. Emotional reactions to diagnosis included shock and sadness. Factors that influenced treatment were the influence of other people, alternative sources of treatment, faith and support, knowledge, "tuning the mind," and effects on intimacy. Health professionals should develop effective communication and counseling skills for clients. PMID:24750095

  11. Data-Driven Geospatial Visual Analytics for Real-Time Urban Flooding Decision Support

    NASA Astrophysics Data System (ADS)

    Liu, Y.; Hill, D.; Rodriguez, A.; Marini, L.; Kooper, R.; Myers, J.; Wu, X.; Minsker, B. S.

    2009-12-01

    Urban flooding is responsible for the loss of life and property as well as the release of pathogens and other pollutants into the environment. Previous studies have shown that spatial distribution of intense rainfall significantly impacts the triggering and behavior of urban flooding. However, no general purpose tools yet exist for deriving rainfall data and rendering them in real-time at the resolution of hydrologic units used for analyzing urban flooding. This paper presents a new visual analytics system that derives and renders rainfall data from the NEXRAD weather radar system at the sewershed (i.e. urban hydrologic unit) scale in real-time for a Chicago stormwater management project. We introduce a lightweight Web 2.0 approach which takes advantages of scientific workflow management and publishing capabilities developed at NCSA (National Center for Supercomputing Applications), streaming data-aware semantic content management repository, web-based Google Earth/Map and time-aware KML (Keyhole Markup Language). A collection of polygon-based virtual sensors is created from the NEXRAD Level II data using spatial, temporal and thematic transformations at the sewershed level in order to produce persistent virtual rainfall data sources for the animation. Animated color-coded rainfall map in the sewershed can be played in real-time as a movie using time-aware KML inside the web browser-based Google Earth for visually analyzing the spatiotemporal patterns of the rainfall intensity in the sewershed. Such system provides valuable information for situational awareness and improved decision support during extreme storm events in an urban area. Our further work includes incorporating additional data (such as basement flooding events data) or physics-based predictive models that can be used for more integrated data-driven decision support.

  12. Ontology driven decision support for the diagnosis of mild cognitive impairment.

    PubMed

    Zhang, Xiaowei; Hu, Bin; Ma, Xu; Moore, Philip; Chen, Jing

    2014-03-01

    In recent years, mild cognitive impairment (MCI) has attracted significant attention as an indicator of high risk for Alzheimer's disease (AD), and the diagnosis of MCI can alert patient to carry out appropriate strategies to prevent AD. To avoid subjectivity in diagnosis, we propose an ontology driven decision support method which is an automated procedure for diagnosing MCI through magnetic resonance imaging (MRI). In this approach, we encode specialized MRI knowledge into an ontology and construct a rule set using machine learning algorithms. Then we apply these two parts in conjunction with reasoning engine to automatically distinguish MCI patients from normal controls (NC). The rule set is trained by MRI data of 187 MCI patients and 177 normal controls selected from Alzheimer's Disease Neuroimaging Initiative (ADNI) using C4.5 algorithm. By using a 10-fold cross validation, we prove that the performance of C4.5 with 80.2% sensitivity is better than other algorithms, such as support vector machine (SVM), Bayesian network (BN) and back propagation (BP) neural networks, and C4.5 is suitable for the construction of reasoning rules. Meanwhile, the evaluation results suggest that our approach would be useful to assist physicians efficiently in real clinical diagnosis for the disease of MCI. PMID:24468160

  13. Three-dimensional brain magnetic resonance imaging segmentation via knowledge-driven decision theory

    PubMed Central

    Verma, Nishant; Muralidhar, Gautam S.; Bovik, Alan C.; Cowperthwaite, Matthew C.; Burnett, Mark G.; Markey, Mia K.

    2014-01-01

    Abstract. Brain tissue segmentation on magnetic resonance (MR) imaging is a difficult task because of significant intensity overlap between the tissue classes. We present a new knowledge-driven decision theory (KDT) approach that incorporates prior information of the relative extents of intensity overlap between tissue class pairs for volumetric MR tissue segmentation. The proposed approach better handles intensity overlap between tissues without explicitly employing methods for removal of MR image corruptions (such as bias field). Adaptive tissue class priors are employed that combine probabilistic atlas maps with spatial contextual information obtained from Markov random fields to guide tissue segmentation. The energy function is minimized using a variational level-set-based framework, which has shown great promise for MR image analysis. We evaluate the proposed method on two well-established real MR datasets with expert ground-truth segmentations and compare our approach against existing segmentation methods. KDT has low-computational complexity and shows better segmentation performance than other segmentation methods evaluated using these MR datasets. PMID:26158060

  14. A systematic review of decision aids for patients making a decision about treatment for early breast cancer.

    PubMed

    Nicholas Zdenkowski; Butow, Phyllis; Tesson, Stephanie; Boyle, Frances

    2016-04-01

    Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted. PMID:27017240

  15. Comprehensive Risk-Based Diagnostically Driven Treatment Planning: Developing Sequentially Generated Treatment.

    PubMed

    Kois, Dean E; Kois, John C

    2015-07-01

    The clinical example presented in this article demonstrates a risk-based, diagnostically driven treatment planning approach by focusing on 4 key categories: periodontal, biomechanical, functional, dentofacial. In addition, our unique approach allowed the comprehensive clinical management of a patient with complex restorative needs. A full-mouth rehabilitation was completed sequentially without sacrificing the amount of dentistry necessary to restore health, comfort, function, and esthetics. The result exceeded the patient's expectation and was made financially possible by extending treatment over numerous years. PMID:26140967

  16. Unbiased estimation in seamless phase II/III trials with unequal treatment effect variances and hypothesis-driven selection rules.

    PubMed

    Robertson, David S; Prevost, A Toby; Bowden, Jack

    2016-09-30

    Seamless phase II/III clinical trials offer an efficient way to select an experimental treatment and perform confirmatory analysis within a single trial. However, combining the data from both stages in the final analysis can induce bias into the estimates of treatment effects. Methods for bias adjustment developed thus far have made restrictive assumptions about the design and selection rules followed. In order to address these shortcomings, we apply recent methodological advances to derive the uniformly minimum variance conditionally unbiased estimator for two-stage seamless phase II/III trials. Our framework allows for the precision of the treatment arm estimates to take arbitrary values, can be utilised for all treatments that are taken forward to phase III and is applicable when the decision to select or drop treatment arms is driven by a multiplicity-adjusted hypothesis testing procedure. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd. PMID:27103068

  17. Data Science and its Relationship to Big Data and Data-Driven Decision Making.

    PubMed

    Provost, Foster; Fawcett, Tom

    2013-03-01

    Companies have realized they need to hire data scientists, academic institutions are scrambling to put together data-science programs, and publications are touting data science as a hot-even "sexy"-career choice. However, there is confusion about what exactly data science is, and this confusion could lead to disillusionment as the concept diffuses into meaningless buzz. In this article, we argue that there are good reasons why it has been hard to pin down exactly what is data science. One reason is that data science is intricately intertwined with other important concepts also of growing importance, such as big data and data-driven decision making. Another reason is the natural tendency to associate what a practitioner does with the definition of the practitioner's field; this can result in overlooking the fundamentals of the field. We believe that trying to define the boundaries of data science precisely is not of the utmost importance. We can debate the boundaries of the field in an academic setting, but in order for data science to serve business effectively, it is important (i) to understand its relationships to other important related concepts, and (ii) to begin to identify the fundamental principles underlying data science. Once we embrace (ii), we can much better understand and explain exactly what data science has to offer. Furthermore, only once we embrace (ii) should we be comfortable calling it data science. In this article, we present a perspective that addresses all these concepts. We close by offering, as examples, a partial list of fundamental principles underlying data science. PMID:27447038

  18. Capturing Treatment Decision Making Among Patients With Solid Tumors and Their Caregivers

    PubMed Central

    Jones, Randy A.; Steeves, Richard; Ropka, Mary E.; Hollen, Patricia

    2013-01-01

    Purpose/Objectives To examine the feasibility and acceptability of using a decision aid with an interactive decision-making process in patients with solid tumors and their caregivers during cancer-related treatment. Research Approach A phenomenologic approach was used to analyze qualitative data, with a focus on the meaning of participants’ lived experiences. Interviews were conducted by telephone or in person. Setting Outpatient clinics at two regional cancer centers. Participants 160 total individuals; 80 patients with newly diagnosed breast (n = 22), advanced-stage prostate (n = 19), or advanced-stage lung (n = 39) cancer, and their caregivers (n = 80). Methodologic Approach Twenty-seven of the 80 pairs engaged in audio recorded interviews that were conducted using a semistructured interview guide. Continuous text immersion revealed themes. Validity of qualitative analysis was achieved by member checking. Findings Significant findings included three themes: (a) the decision aid helped patients and caregivers understand treatment decisions better, (b) the decision aid helped patients and caregivers to be more involved in treatment decisions, and (c) frequent contact with the study nurse was valuable. Conclusions Decision making was more complex than participants expected. The decision aid helped patients and caregivers make satisfying treatment decisions and become integral in a shared treatment decision-making process. Interpretation Decision aids can help patients and their caregivers make difficult treatment decisions affecting quantity and quality of life during cancer treatment. The findings provide valuable information for healthcare providers helping patients and their caregivers make treatment decisions through a shared, informed, decision-making process. Knowledge Translation Decision aids can be helpful with treatment choices. Caregivers’ understanding about treatment is just as important in the decision-making process as the patients

  19. Dental caries: A complete changeover, PART III: Changeover in the treatment decisions and treatments

    PubMed Central

    Carounanidy, Usha; Sathyanarayanan, R

    2010-01-01

    Comprehensive management of dental caries should involve the management of disease as well as the lesion. Current decision making process in cariology is influenced by numerous factors such as the size/ depth/ activity of the carious lesion and age/ the caries risk status of the patient. Treatment decisions should involve planning the non-operative/ preventive treatment for non-cavitated or early cavitated lesions and also formulating operative treatment for cavitated lesions. Apart from these two responsibilities, a clinician should also be knowledgeable enough to decide when not to interfere in the caries dynamics and how frequently to recall the patient for follow-ups. The non-operative treatment prescriptions vary in dose, intensity and mode of delivery according to the caries risk status. Minimal invasion and maximal conservation of tooth structure has become the essence of current operative treatments. This part of the series elaborates on the paradigm shift in the management of dental caries. PMID:21217948

  20. Emotion and decision-making: affect-driven belief systems in anxiety and depression

    PubMed Central

    Paulus, Martin P.; Yu, Angela J.

    2012-01-01

    Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches to the link between emotion and decision-making, and focus on research with anxious or depressed individuals that reveals how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We then discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression and outline the broader implications of this approach. PMID:22898207

  1. In Light of the Limitations of Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Loeb, Susanna

    2012-01-01

    Students' experiences and the opportunities they have to learn rest on the quality of education decisions made in each classroom, in each school, in each district, and in each state, federal legislature, and department of education. The role of research and scholarship more broadly in education finance and policy is to inform these decisions for…

  2. Generalized Tumor Dose for Treatment Planning Decision Support

    NASA Astrophysics Data System (ADS)

    Zuniga, Areli A.

    Modern radiation therapy techniques allow for improved target conformity and normal tissue sparing. These highly conformal treatment plans have allowed dose escalation techniques increasing the probability of tumor control. At the same time this conformation has introduced inhomogeneous dose distributions, making delivered dose characterizations more difficult. The concept of equivalent uniform dose (EUD) characterizes a heterogeneous dose distribution within irradiated structures as a single value and has been used in biologically based treatment planning (BBTP); however, there are no substantial validation studies on clinical outcome data supporting EUD's use and therefore has not been widely adopted as decision-making support. These highly conformal treatment plans have also introduced the need for safety margins around the target volume. These margins are designed to minimize geometrical misses, and to compensate for dosimetric and treatment delivery uncertainties. The margin's purpose is to reduce the chance of tumor recurrence. This dissertation introduces a new EUD formulation designed especially for tumor volumes, called generalized Tumor Dose (gTD). It also investigates, as a second objective, margins extensions for potential improvements in local control while maintaining or minimizing toxicity. The suitability of gTD to rank LC was assessed by means of retrospective studies in a head and neck (HN) squamous cell carcinoma (SCC) and non-small cell lung cancer (NSCLC) cohorts. The formulation was optimized based on two datasets (one of each type) and then, model validation was assessed on independent cohorts. The second objective of this dissertation was investigated by ranking the probability of LC of the primary disease adding different margin sizes. In order to do so, an already published EUD formula was used retrospectively in a HN and a NSCLC datasets. Finally, recommendations for the viability to implement this new formulation into a routine treatment

  3. Nonadjunctive Use of Continuous Glucose Monitoring for Diabetes Treatment Decisions.

    PubMed

    Castle, Jessica R; Jacobs, Peter G

    2016-09-01

    While self-monitoring of blood glucose (SMBG) is the current standard used by people with diabetes to manage glucose levels, recent improvements in accuracy of continuous glucose monitoring (CGM) technology are making it very likely that diabetes-related treatment decisions will soon be made based on CGM values alone. Nonadjunctive use of CGM will lead to a paradigm shift in how patients manage their glucose levels and will require substantial changes in how care providers educate their patients, monitor their progress, and provide feedback to help them manage their diabetes. The approval to use CGM nonadjunctively is also a critical step in the pathway toward FDA approval of an artificial pancreas system, which is further expected to transform diabetes care for people with type 1 diabetes. In this article, we discuss how nonadjunctive CGM is expected to soon replace routine SMBG and how this new usage scenario is expected to transform health outcomes and patient care. PMID:26880390

  4. Exploring Data-Driven Decision-Making in the Field: How Faculty Use Data and Other Forms of Information to Guide Instructional Decision-Making. WCER Working Paper No. 2014-3

    ERIC Educational Resources Information Center

    Hora, Matthew T.; Bouwma-Gearhart, Jana; Park, Hyoung Joon

    2014-01-01

    A defining characteristic of current U.S. educational policy is the use of data to inform decisions about resource allocation, teacher hiring, and curriculum and instruction. Perhaps the biggest challenge to data-driven decision making (DDDM) is that data use alone does not automatically result in improved teaching and learning. Research indicates…

  5. Federal Policy to Local Level Decision-Making: Data Driven Education Planning in Nigeria

    ERIC Educational Resources Information Center

    Iyengar, Radhika; Mahal, Angelique R.; Felicia, Ukaegbu-Nnamchi Ifeyinwa; Aliyu, Balaraba; Karim, Alia

    2015-01-01

    This article discusses the implementation of local level education data-driven planning as implemented by the Office of the Senior Special Assistant to the President of Nigeria on the Millennium Development Goals (OSSAP-MDGs) in partnership with The Earth Institute, Columbia University. It focuses on the design and implementation of the…

  6. An MPEG-21-driven multimedia adaptation decision-taking engine based on constraint satisfaction problem

    NASA Astrophysics Data System (ADS)

    Feng, Xiao; Tang, Rui-chun; Zhai, Yi-li; Feng, Yu-qing; Hong, Bo-hai

    2013-07-01

    Multimedia adaptation decision-taking techniques based on context are considered. Constraint satisfaction problem-Based Content Adaptation Algorithm (CBCAA) is proposed. First the algorithm obtains and classifies context information using MPEG-21; then it builds the constraint model according to different types of context information, constraint satisfaction method is used to acquire Media Description Decision Set (MDDS); finally a bit-stream adaptation engine performs the multimedia transcoding. Simulation results prove that the presented algorithm offers an efficient solution for personalized multimedia adaptation in heterogeneous environments.

  7. The Call for Data-Driven Decision Making in the Midwest's Schools: NCREL's Response.

    ERIC Educational Resources Information Center

    Cromey, Allison; van der Ploeg, Arie; Masini, Blase

    This report describes the efforts of the North Central Regional Educational Laboratory (NCREL) during the last several years to respond to direct requests from educational stakeholders to help integrate data into their decision-making processes related to school improvement. In some cases, NCREL cooperated in the development of educational…

  8. Data-Driven Decision Making in Community Colleges: An Integrative Model for Institutional Effectiveness

    ERIC Educational Resources Information Center

    Callery, Claude Adam

    2012-01-01

    This qualitative study identified the best practices utilized by community colleges to achieve systemic and cultural agreement in support of the integration of institutional effectiveness measures (key performance indicators) to inform decision making. In addition, the study identifies the relevant motives, organizational structure, and processes…

  9. Keeping Teachers in the Center: A Framework of Data-Driven Decision-Making

    ERIC Educational Resources Information Center

    Light, Daniel; Wexler, Dara H.; Heinze, Juliette

    2004-01-01

    The Education Development Center's Center for Children and Technology (CCT) conducted a three year study of a large-scale data reporting system, developed by the Grow Network for New York City's Department of Education. This paper presents a framework based on two years of research exploring the intersection of decision-support technologies,…

  10. Data-Driven Decision-Making: It's a Catch-Up Game

    ERIC Educational Resources Information Center

    Briggs, Linda L.

    2006-01-01

    Having an abundance of data residing in individual silos across campus, but little decision-ready information, is a typical scenario at many institutions. One problem is that the terms "data warehousing" and "business intelligence" refer to very different things, although the two often go hand-in-hand. "Data warehousing" describes an architecture…

  11. A multi-agent-based, semantic-driven system for decision support in epidemic management.

    PubMed

    Li, Sen; Mackaness, William A

    2015-09-01

    Issues in epidemiology are truly multidisciplinary, requiring knowledge from diverse disciplines such as sociology, medicine, biology, geography and information science. Such inherent complexity has led to a challenge in developing decision support systems for epidemic information management, especially when data are from heterogeneous origins. In order to achieve a solution, an integrative framework is proposed. The Semantic Web is introduced in the context of enriching meaningful and machine-readable descriptions of epidemiological data. Software agents are utilised to achieve automation in semantic discovery, composition of data and process services. The objective is to enhance the performance in information retrieval in a dynamic decision-making environment while concealing technical complexity from inexperienced users. We illustrate how a prototype system can be developed by considering an epidemiology management scenario in which spatio-temporal analysis is undertaken of a specified epidemic. PMID:24448277

  12. Perturbations in Effort-Related Decision-Making Driven by Acute Stress and Corticotropin-Releasing Factor.

    PubMed

    Bryce, Courtney A; Floresco, Stan B

    2016-07-01

    Acute stress activates numerous systems in a coordinated effort to promote homeostasis, and can exert differential effects on mnemonic and cognitive functions depending on a myriad of factors. Stress can alter different forms of cost/benefit decision-making, yet the mechanisms that drive these effects, remain unclear. In the present study, we probed how corticotropin-releasing factor (CRF) may contribute to stress-induced alterations in cost/benefit decision-making, using an task where well-trained rats chose between a low effort/low reward lever (LR; two pellets) and a high effort/high reward lever (HR; four pellets), with the effort requirement increasing over a session (2, 5, 10, and 20 presses). One-hour restraint stress markedly reduced preference for the HR option, but this effect was attenuated by infusions of the CRF antagonist, alpha-helical CRF. Conversely, central CRF infusion mimicked the effect of stress on decision-making, as well as increased decision latencies and reduced response vigor. CRF infusions did not alter preference for larger vs smaller rewards, but did reduce responding for food delivered on a progressive ratio, suggesting that these treatments may amplify perceived effort costs that may be required to obtain rewards. CRF infusions into the ventral tegmental area recapitulated the effect of central CRF treatment and restraint on choice behavior, suggesting that these effects may be mediated by perturbations in dopamine transmission. These findings highlight the involvement of CRF in regulating effort-related decisions and suggest that increased CRF activity may contribute to motivational impairments and abnormal decision-making associated with stress-related psychiatric disorders such as depression. PMID:26830960

  13. Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis.

    PubMed

    Violette, Philippe D; Agoritsas, Thomas; Alexander, Paul; Riikonen, Jarno; Santti, Henrikki; Agarwal, Arnav; Bhatnagar, Neera; Dahm, Philipp; Montori, Victor; Guyatt, Gordon H; Tikkinen, Kari A O

    2015-01-01

    Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making. PMID:25772796

  14. 76 FR 3077 - Notice of Decision To Revise a Heat Treatment Schedule for Emerald Ash Borer

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-19

    ... accordance with Sec. 305.3(a)(1), we published a notice \\2\\ in the Federal Register on August 25, 2010 (75 FR... Animal and Plant Health Inspection Service Notice of Decision To Revise a Heat Treatment Schedule for... are advising the public of our decision to revise a heat treatment schedule for the emerald ash...

  15. Virtual support for paediatric HIV treatment decision making

    PubMed Central

    Le Doare, Kirsty; Mackie, N E; Kaye, S; Bamford, A; Walters, S; Foster, C

    2015-01-01

    Objective The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network. Design A retrospective review of the clinical outcomes of paediatric and adolescent (0–21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013. Results 234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10–15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input. Conclusions Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network. PMID:25549664

  16. Data Driven Farming: Delivering the Benefits of Remotely Sensed Data and Decision Support Tools to Farmers

    NASA Astrophysics Data System (ADS)

    Shriver, J.; Soloff, J. A.; Molen, N.

    2014-12-01

    Web-based agricultural management software allows for the delivery of previously hard to access soil, weather and remotely sensed data to growers. While access to these data sources is beneficial, growers can realize large gains by leveraging field level data and integrating decision support tools that have been presented in the literature. Using a previously developed model for estimating the growth stage of maize (Sakamoto et al. 2010), we examine how remotely sensed data can be integrated into a web-based agricultural management tool, informing grower management decisions by providing near real-time estimates of crop growth stage and sub-field level variability in growing conditions. When combined with field-level soil and weather data, growers can use remote sensing based models to tailor management activities, taking variable (climate related) and invariant (site characteristic) yield determining factors into account.Time series of Wide Dynamic Range Vegetation Index (WDRVI) derived from Landsat observations were linked to 97 fields growing maize across the Mid-western region of the United States in 2013. Crop growth stage day of year (DOY) estimates (V2.5, R1, R5, and R6) were predicted for each field based on the WDRVI profile and compared to a growing degree day based estimate. These estimates aid in scheduling growth stage specific management activities and allow farmers to more efficiently monitor geographically remote fields. Within-field variation in growing conditions is presented on an ordinal scale (below average, average, above average) based on the field-level distribution of WDRVI values at each observation. Monitoring of sub-field level conditions allows growers to calibrate field-level yield estimates, prioritize field scouting activities and plan targeted interventions. Integration of these tools into existing web-based agricultural management tools allows growers to easily incorporate remotely sensed data into their decision making process

  17. Demand driven decision support for efficient water resources allocation in irrigated agriculture

    NASA Astrophysics Data System (ADS)

    Schuetze, Niels; Grießbach, Ulrike Ulrike; Röhm, Patric; Stange, Peter; Wagner, Michael; Seidel, Sabine; Werisch, Stefan; Barfus, Klemens

    2014-05-01

    Due to climate change, extreme weather conditions, such as longer dry spells in the summer months, may have an increasing impact on the agriculture in Saxony (Eastern Germany). For this reason, and, additionally, declining amounts of rainfall during the growing season the use of irrigation will be more important in future in Eastern Germany. To cope with this higher demand of water, a new decision support framework is developed which focuses on an integrated management of both irrigation water supply and demand. For modeling the regional water demand, local (and site-specific) water demand functions are used which are derived from the optimized agronomic response at farms scale. To account for climate variability the agronomic response is represented by stochastic crop water production functions (SCWPF) which provide the estimated yield subject to the minimum amount of irrigation water. These functions take into account the different soil types, crops and stochastically generated climate scenarios. By applying mathematical interpolation and optimization techniques, the SCWPF's are used to compute the water demand considering different constraints, for instance variable and fix costs or the producer price. This generic approach enables the computation for both multiple crops at farm scale as well as of the aggregated response to water pricing at a regional scale for full and deficit irrigation systems. Within the SAPHIR (SAxonian Platform for High Performance Irrigation) project a prototype of a decision support system is developed which helps to evaluate combined water supply and demand management policies for an effective and efficient utilization of water in order to meet future demands. The prototype is implemented as a web-based decision support system and it is based on a service-oriented geo-database architecture.

  18. Towards a climate-driven dengue decision support system for Thailand

    NASA Astrophysics Data System (ADS)

    Lowe, Rachel; Cazelles, Bernard; Paul, Richard; Rodó, Xavier

    2014-05-01

    Dengue is a peri-urban mosquito-transmitted disease, ubiquitous in the tropics and the subtropics. The geographic distribution of dengue and its more severe form, dengue haemorrhagic fever (DHF), have expanded dramatically in the last decades and dengue is now considered to be the world's most important arboviral disease. Recent demographic changes have greatly contributed to the acceleration and spread of the disease along with uncontrolled urbanization, population growth and increased air travel, which acts as a mechanism for transporting and exchanging dengue viruses between endemic and epidemic populations. The dengue vector and virus are extremely sensitive to environmental conditions such as temperature, humidity and precipitation that influence mosquito biology, abundance and habitat and the virus replication speed. In order to control the spread of dengue and impede epidemics, decision support systems are required that take into account the multi-faceted array of factors that contribute to increased dengue risk. Due to availability of seasonal climate forecasts, that predict the average climate conditions for forthcoming months/seasons in both time and space, there is an opportunity to incorporate precursory climate information in a dengue decision support system to aid epidemic planning months in advance. Furthermore, oceanic indicators from teleconnected areas in the Pacific and Indian Ocean, that can provide some indication of the likely prevailing climate conditions in certain regions, could potentially extend predictive lead time in a dengue early warning system. In this paper we adopt a spatio-temporal Bayesian modelling framework for dengue in Thailand to support public health decision making. Monthly cases of dengue in the 76 provinces of Thailand for the period 1982-2012 are modelled using a multi-layered approach. Environmental explanatory variables at various spatial and temporal resolutions are incorporated into a hierarchical model in order to

  19. Information technology and decision support tools for stakeholder-driven river basin salinity management

    SciTech Connect

    Quinn, N.W.T; Cozad, D.B.; Lee, G.

    2010-01-01

    Innovative strategies for effective basin-scale salinity management have been developed in the Hunter River Basin of Australia and more recently in the San Joaquin River Basin of California. In both instances web-based stakeholder information dissemination has been a key to achieving a high level of stakeholder involvement and the formulation of effective decision support salinity management tools. A common element to implementation of salinity management strategies in both river basins has been the concept of river assimilative capacity for controlling export salt loading and the potential for trading of the right to discharge salt load to the river - the Hunter River in Australia and the San Joaquin River in California. Both rivers provide basin drainage and the means of exporting salt to the ocean. The paper compares and contrasts the use of monitoring, modeling and information dissemination in the two basins to achieve environmental compliance and sustain irrigated agriculture in an equitable and socially and politically acceptable manner.

  20. A Requirements-Driven Optimization Method for Acoustic Treatment Design

    NASA Technical Reports Server (NTRS)

    Berton, Jeffrey J.

    2016-01-01

    Acoustic treatment designers have long been able to target specific noise sources inside turbofan engines. Facesheet porosity and cavity depth are key design variables of perforate-over-honeycomb liners that determine levels of noise suppression as well as the frequencies at which suppression occurs. Layers of these structures can be combined to create a robust attenuation spectrum that covers a wide range of frequencies. Looking to the future, rapidly-emerging additive manufacturing technologies are enabling new liners with multiple degrees of freedom, and new adaptive liners with variable impedance are showing promise. More than ever, there is greater flexibility and freedom in liner design. Subject to practical considerations, liner design variables may be manipulated to achieve a target attenuation spectrum. But characteristics of the ideal attenuation spectrum can be difficult to know. Many multidisciplinary system effects govern how engine noise sources contribute to community noise. Given a hardwall fan noise source to be suppressed, and using an analytical certification noise model to compute a community noise measure of merit, the optimal attenuation spectrum can be derived using multidisciplinary systems analysis methods. The subject of this paper is an analytical method that derives the ideal target attenuation spectrum that minimizes noise perceived by observers on the ground.

  1. The decision to engage cognitive control is driven by expected reward-value: neural and behavioral evidence.

    PubMed

    Dixon, Matthew L; Christoff, Kalina

    2012-01-01

    Cognitive control is a fundamental skill reflecting the active use of task-rules to guide behavior and suppress inappropriate automatic responses. Prior work has traditionally used paradigms in which subjects are told when to engage cognitive control. Thus, surprisingly little is known about the factors that influence individuals' initial decision of whether or not to act in a reflective, rule-based manner. To examine this, we took three classic cognitive control tasks (Stroop, Wisconsin Card Sorting Task, Go/No-Go task) and created novel 'free-choice' versions in which human subjects were free to select an automatic, pre-potent action, or an action requiring rule-based cognitive control, and earned varying amounts of money based on their choices. Our findings demonstrated that subjects' decision to engage cognitive control was driven by an explicit representation of monetary rewards expected to be obtained from rule-use. Subjects rarely engaged cognitive control when the expected outcome was of equal or lesser value as compared to the value of the automatic response, but frequently engaged cognitive control when it was expected to yield a larger monetary outcome. Additionally, we exploited fMRI-adaptation to show that the lateral prefrontal cortex (LPFC) represents associations between rules and expected reward outcomes. Together, these findings suggest that individuals are more likely to act in a reflective, rule-based manner when they expect that it will result in a desired outcome. Thus, choosing to exert cognitive control is not simply a matter of reason and willpower, but rather, conforms to standard mechanisms of value-based decision making. Finally, in contrast to current models of LPFC function, our results suggest that the LPFC plays a direct role in representing motivational incentives. PMID:23284730

  2. The Decision to Engage Cognitive Control Is Driven by Expected Reward-Value: Neural and Behavioral Evidence

    PubMed Central

    Dixon, Matthew L.; Christoff, Kalina

    2012-01-01

    Cognitive control is a fundamental skill reflecting the active use of task-rules to guide behavior and suppress inappropriate automatic responses. Prior work has traditionally used paradigms in which subjects are told when to engage cognitive control. Thus, surprisingly little is known about the factors that influence individuals' initial decision of whether or not to act in a reflective, rule-based manner. To examine this, we took three classic cognitive control tasks (Stroop, Wisconsin Card Sorting Task, Go/No-Go task) and created novel ‘free-choice’ versions in which human subjects were free to select an automatic, pre-potent action, or an action requiring rule-based cognitive control, and earned varying amounts of money based on their choices. Our findings demonstrated that subjects' decision to engage cognitive control was driven by an explicit representation of monetary rewards expected to be obtained from rule-use. Subjects rarely engaged cognitive control when the expected outcome was of equal or lesser value as compared to the value of the automatic response, but frequently engaged cognitive control when it was expected to yield a larger monetary outcome. Additionally, we exploited fMRI-adaptation to show that the lateral prefrontal cortex (LPFC) represents associations between rules and expected reward outcomes. Together, these findings suggest that individuals are more likely to act in a reflective, rule-based manner when they expect that it will result in a desired outcome. Thus, choosing to exert cognitive control is not simply a matter of reason and willpower, but rather, conforms to standard mechanisms of value-based decision making. Finally, in contrast to current models of LPFC function, our results suggest that the LPFC plays a direct role in representing motivational incentives. PMID:23284730

  3. Landfill leachate treatment by solar-driven AOPs

    SciTech Connect

    Rocha, Elisangela M.R.; Vilar, Vitor J.P.; Boaventura, Rui A.R.; Fonseca, Amelia; Saraiva, Isabel

    2011-01-15

    Sanitary landfill leachate resulting from the rainwater percolation through the landfill layers and waste material decomposition is a complex mixture of high-strength organic and inorganic compounds which constitutes serious environmental problems. In this study, different heterogeneous (TiO{sub 2}/UV, TiO{sub 2}/H{sub 2}O{sub 2}/UV) and homogenous (H{sub 2}O{sub 2}/UV, Fe{sup 2+}/H{sub 2}O{sub 2}/UV) photocatalytic processes were investigated as an alternative for the treatment of a mature landfill leachate. The addition of H{sub 2}O{sub 2} to TiO{sub 2}/UV system increased the reduction of the aromatic compounds from 15% to 61%, although mineralization was almost the same. The DOC and aromatic content abatement is similar for the H{sub 2}O{sub 2}/UV and TiO{sub 2}/H{sub 2}O{sub 2}/UV processes, although the H{sub 2}O{sub 2} consumption is three times higher in the H{sub 2}O{sub 2}/UV system. The low efficiency of TiO{sub 2}/H{sub 2}O{sub 2}/UV system is presumably due to the alkaline leachate solution, for which the H{sub 2}O{sub 2} becomes highly unstable and self-decomposition of H{sub 2}O{sub 2} occurs. The efficiency of the TiO{sub 2}/H{sub 2}O{sub 2}/UV system increased 10 times after a preliminary pH correction to 4. The photo-Fenton process is much more efficient than heterogeneous (TiO{sub 2}, TiO{sub 2}/H{sub 2}O{sub 2}/UV) or homogeneous (H{sub 2}O{sub 2}/UV) photocatalysis, showing an initial reaction rate more than 20 times higher, and leading to almost complete mineralization of the wastewater. However, when compared with TiO{sub 2}/H{sub 2}O{sub 2}/UV with acidification, the photo-Fenton reaction is only two times faster. The optimal initial iron dose for the photo-Fenton treatment of the leachate is 60 mg Fe{sup 2+} L{sup -1}, which is in agreement with path length of 5 cm in the photoreactor. The kinetic behaviour of the process (60 mg Fe{sup 2+} L{sup -1}) comprises a slow initial reaction, followed by a first-order kinetics (k = 0.020 LkJ{sub UV

  4. Data-driven modeling of hydroclimatic trends and soil moisture: Multi-scale data integration and decision support

    NASA Astrophysics Data System (ADS)

    Coopersmith, Evan Joseph

    -identical topography. This cross-application of parametric calibrations and LiDAR-driven disaggregation facilitates decision-support at locations without proximally-located soil moisture sensors.

  5. Agricultural Management Decision Aids Driven by Real-Time Satellite Data.

    NASA Astrophysics Data System (ADS)

    Diak, George R.; Anderson, Martha C.; Bland, William L.; Norman, John M.; Mecikalski, John M.; Aune, Robert M.

    1998-07-01

    In a NASA-sponsored program entitled Use of Earth and Space Science Data Over the Internet, scientists at the University of Wisconsin-Madison have developed a suite of products for agriculture that are based in satellite and conventional observations, as well as state-of-the-art forecast models of the atmosphere and soil_canopy environments. These products include an irrigation scheduling product based in satellite estimates of daily solar energy, a frost protection product that relies on prediction models and satellite estimates of clouds, and a product for the prediction of foliar disease that is based in satellite net radiation, rainfall measured by NEXRAD, and a detailed model of the soil_canopy environment. During the growing season, the first two products are available in near-real time on the Internet. The last product involving foliar disease depends on a decision support system named WISDOM developed by the University of Wisconsin-Extension, which resides locally on growers' home computers. Growers interface WISDOM with a server to obtain the rainfall, meteorological data, surface radiation inputs, and canopy model output required by WISDOM for the blight models.

  6. Predictive decision making driven by multiple time-linked reward representations in the anterior cingulate cortex

    PubMed Central

    Wittmann, Marco K.; Kolling, Nils; Akaishi, Rei; Chau, Bolton K. H.; Brown, Joshua W.; Nelissen, Natalie; Rushworth, Matthew F. S.

    2016-01-01

    In many natural environments the value of a choice gradually gets better or worse as circumstances change. Discerning such trends makes predicting future choice values possible. We show that humans track such trends by comparing estimates of recent and past reward rates, which they are able to hold simultaneously in the dorsal anterior cingulate cortex (dACC). Comparison of recent and past reward rates with positive and negative decision weights is reflected by opposing dACC signals indexing these quantities. The relative strengths of time-linked reward representations in dACC predict whether subjects persist in their current behaviour or switch to an alternative. Computationally, trend-guided choice can be modelled by using a reinforcement-learning mechanism that computes a longer-term estimate (or expectation) of prediction errors. Using such a model, we find a relative predominance of expected prediction errors in dACC, instantaneous prediction errors in the ventral striatum and choice signals in the ventromedial prefrontal cortex. PMID:27477632

  7. Predictive decision making driven by multiple time-linked reward representations in the anterior cingulate cortex.

    PubMed

    Wittmann, Marco K; Kolling, Nils; Akaishi, Rei; Chau, Bolton K H; Brown, Joshua W; Nelissen, Natalie; Rushworth, Matthew F S

    2016-01-01

    In many natural environments the value of a choice gradually gets better or worse as circumstances change. Discerning such trends makes predicting future choice values possible. We show that humans track such trends by comparing estimates of recent and past reward rates, which they are able to hold simultaneously in the dorsal anterior cingulate cortex (dACC). Comparison of recent and past reward rates with positive and negative decision weights is reflected by opposing dACC signals indexing these quantities. The relative strengths of time-linked reward representations in dACC predict whether subjects persist in their current behaviour or switch to an alternative. Computationally, trend-guided choice can be modelled by using a reinforcement-learning mechanism that computes a longer-term estimate (or expectation) of prediction errors. Using such a model, we find a relative predominance of expected prediction errors in dACC, instantaneous prediction errors in the ventral striatum and choice signals in the ventromedial prefrontal cortex. PMID:27477632

  8. What Teachers Think about What They Can Do with Data: Development and Validation of the Data Driven Decision-Making Efficacy and Anxiety Inventory

    ERIC Educational Resources Information Center

    Dunn, Karee E.; Airola, Denise T.; Lo, Wen-Juo; Garrison, Mickey

    2013-01-01

    Classroom level data driven decision-making (DDDM) involves the use of data to identify patterns of performance that reveal students' academic strengths and weaknesses relative to established learning goals, and the planning of instructional practices to support academic success for all students. Although DDDM is not a new paradigm in education,…

  9. Teachers' Experiences with the Data-Driven Decision Making Process in Increasing Students' Reading Achievement in a Title I Elementary Public School

    ERIC Educational Resources Information Center

    Atkinson, Linton

    2015-01-01

    This paper is a research dissertation based on a qualitative case study conducted on Teachers' Experiences within a Data-Driven Decision Making (DDDM) process. The study site was a Title I elementary school in a large school district in Central Florida. Background information is given in relation to the need for research that was conducted on the…

  10. Data-Driven Decision Making and Its Effects on Leadership Practices and Student Achievement in K-5 Public Elementary Schools in California

    ERIC Educational Resources Information Center

    Ceja, Rafael, Jr.

    2012-01-01

    The enactment of the NCLB Act of 2001 and its legislative mandates for accountability testing throughout the nation brought to the forefront the issue of data-driven decision making. This emphasis on improving education has been spurred due to the alleged failure of the public school system. As a result, the role of administrators has evolved to…

  11. Operative Versus Nonoperative Treatment of Jones Fractures: A Decision Analysis Model.

    PubMed

    Bishop, Julius A; Braun, Hillary J; Hunt, Kenneth J

    2016-01-01

    Optimal management of metadiaphyseal fifth metatarsal fractures (Jones fractures) remains controversial. Decision analysis can optimize clinical decision-making based on available evidence and patient preferences. We conducted a study to establish the determinants of decision-making and to determine the optimal treatment strategy for Jones fractures using a decision analysis model. Probabilities for potential outcomes of operative and nonoperative treatment of Jones fractures were determined from a review of the literature. Patient preferences for outcomes were obtained by questionnaire completed by 32 healthy adults with no history of foot fracture. Derived values were used in the model as a measure of utility. A decision tree was constructed, and fold-back and sensitivity analyses were performed to determine optimal treatment. Nonoperative treatment was associated with a value of 7.74, and operative treatment with an intramedullary screw was associated with a value of 7.88 given the outcome probabilities and utilities studied, making operative treatment the optimal strategy. When parameters were varied, nonoperative treatment was favored when the likelihood of healing with nonoperative treatment rose above 82% and when the probability of healing after surgery fell below 92%. In this decision analysis model, operative fixation is the preferred management strategy for Jones fractures. PMID:26991586

  12. An ontology-driven, case-based clinical decision support model for removable partial denture design.

    PubMed

    Chen, Qingxiao; Wu, Ji; Li, Shusen; Lyu, Peijun; Wang, Yong; Li, Miao

    2016-01-01

    We present the initial work toward developing a clinical decision support model for specific design of removable partial dentures (RPDs) in dentistry. We developed an ontological paradigm to represent knowledge of a patient's oral conditions and denture component parts. During the case-based reasoning process, a cosine similarity algorithm was applied to calculate similarity values between input patients and standard ontology cases. A group of designs from the most similar cases were output as the final results. To evaluate this model, the output designs of RPDs for 104 randomly selected patients were compared with those selected by professionals. An area under the curve of the receiver operating characteristic (AUC-ROC) was created by plotting true-positive rates against the false-positive rate at various threshold settings. The precision at position 5 of the retrieved cases was 0.67 and at the top of the curve it was 0.96, both of which are very high. The mean average of precision (MAP) was 0.61 and the normalized discounted cumulative gain (NDCG) was 0.74 both of which confirmed the efficient performance of our model. All the metrics demonstrated the efficiency of our model. This methodology merits further research development to match clinical applications for designing RPDs. This paper is organized as follows. After the introduction and description of the basis for the paper, the evaluation and results are presented in Section 2. Section 3 provides a discussion of the methodology and results. Section 4 describes the details of the ontology, similarity algorithm, and application. PMID:27297679

  13. An ontology-driven, case-based clinical decision support model for removable partial denture design

    PubMed Central

    Chen, Qingxiao; Wu, Ji; Li, Shusen; Lyu, Peijun; Wang, Yong; Li, Miao

    2016-01-01

    We present the initial work toward developing a clinical decision support model for specific design of removable partial dentures (RPDs) in dentistry. We developed an ontological paradigm to represent knowledge of a patient’s oral conditions and denture component parts. During the case-based reasoning process, a cosine similarity algorithm was applied to calculate similarity values between input patients and standard ontology cases. A group of designs from the most similar cases were output as the final results. To evaluate this model, the output designs of RPDs for 104 randomly selected patients were compared with those selected by professionals. An area under the curve of the receiver operating characteristic (AUC-ROC) was created by plotting true-positive rates against the false-positive rate at various threshold settings. The precision at position 5 of the retrieved cases was 0.67 and at the top of the curve it was 0.96, both of which are very high. The mean average of precision (MAP) was 0.61 and the normalized discounted cumulative gain (NDCG) was 0.74 both of which confirmed the efficient performance of our model. All the metrics demonstrated the efficiency of our model. This methodology merits further research development to match clinical applications for designing RPDs. This paper is organized as follows. After the introduction and description of the basis for the paper, the evaluation and results are presented in Section 2. Section 3 provides a discussion of the methodology and results. Section 4 describes the details of the ontology, similarity algorithm, and application. PMID:27297679

  14. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients.

    PubMed

    Schiphorst, A H W; Ten Bokkel Huinink, D; Breumelhof, R; Burgmans, J P J; Pronk, A; Hamaker, M E

    2016-05-01

    Treatment decisions for elderly cancer patients can be challenging. A geriatric assessment may identify unknown medical conditions, give insight on patients' ability to tolerate treatment and guide treatment decisions. Our aim was to study the value of a geriatric consultation in oncological decision-making. Data on cancer patients referred for geriatric consultation for clinical optimisation or due to uncertainty regarding their optimal treatment strategy were prospectively analysed. Outcome of geriatric evaluations, non-oncological interventions and suggested adaptations of oncological treatment proposals were evaluated. Seventy-two patients were referred for consultation, over half of which in a curative treatment setting. Prevalence of geriatric syndromes was 93%, previously undiagnosed conditions were identified in 49% of patients and non-oncological interventions were initiated in 56%. Time was spent discussing patients' priorities (53% of consultations), expectations on treatment (50%) and advance care planning (14%). For 82% of patients, suggestions were made regarding the optimal treatment decision: a more intensive treatment was recommended in 39%, a less intensive therapy for 42% and in 19% only supportive care was suggested. The results demonstrate that a geriatric consultation can aid in complex treatment decisions and may allow for a reduction in over- and undertreatment of elderly cancer patients. PMID:26211484

  15. onlineDeCISion.org: a web-based decision aid for DCIS treatment.

    PubMed

    Ozanne, Elissa M; Schneider, Katharine H; Soeteman, Djøra; Stout, Natasha; Schrag, Deborah; Fordis, Michael; Punglia, Rinaa S

    2015-11-01

    Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.​org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.​org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions. PMID:26475704

  16. Older Adults Newly Diagnosed with Symptomatic Myeloma Want to Participate in Treatment Decision Making

    PubMed Central

    Tariman, Joseph D.; Doorenbos, Ardith; Schepp, Karen G.; Singhal, Seema; Berry, Donna L.

    2014-01-01

    Purpose/Objectives The purpose of the study was to describe the preferences for participation in decision making of older patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Design Descriptive, cross sectional design Setting Subjects’ homes and two large academic cancer centers. Sample The convenience sample consisted of 20 older adults (60 years of age and above) with symptomatic myeloma diagnosed within the past 6 months. Methods The Control Preferences Scale was administered followed by an in-person one-time semi-structured interview. Main Research Variables Role preferences for participation in treatment decision-making, age, gender, race, work status, personal relationship status, education, and income. Findings 55% (n=11) of the subjects had preferred a shared role with the physician and 40% (n=8) had preferred to make the decisions after seriously considering the opinion of their physicians. Only one subject preferred to leave the decision to the doctor as long as the doctor considered the patient’s treatment preferences. Sociodemographic characteristics had no impact on preferences for participation in treatment decision-making. Conclusions The study findings indicate that older adults newly diagnosed with myeloma wanted to participate during treatment decision-making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow them to be autonomous in making treatment decisions if the patient so desire such control in the decision-making process. A culture of equipoise between the patient and the clinician during TDM must be cultivated in order to achieve the patient's desired level of participation. More studies that focus on supporting and involving patients diagnosed with myeloma in the decision-making process are needed in order to influence clinical practice and policy. Practice

  17. The Appleton Consensus: suggested international guidelines for decisions to forgo medical treatment.

    PubMed

    1989-03-13

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forgo Medical Treatment. The guidelines deal with four specific decision-making circumstances. 1. Five guidelines were created for decisions involving competent patients or patients who executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom "no substituted judgment" can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities given the reality of scarce health resources. PMID:2929046

  18. Integrating Strategic and Operational Decision Making Using Data-Driven Dashboards: The Case of St. Joseph Mercy Oakland Hospital.

    PubMed

    Jack Weiner; Balijepally, Venugopal; Tanniru, Mohan

    2015-01-01

    Hospitals have invested and continue to invest heavily in building information systems to support operations at various levels of administration. These systems generate a lot of data but fail to effectively convert these data into actionable information for decision makers. Such ineffectiveness often is attributed to a lack of alignment between strategic planning and information technology (IT) initiatives supporting operational goals. We present a case study that illustrates how the use of digital dashboards at St. Joseph Mercy Oakland (SJMO) Hospital in Pontiac, Michigan, was instrumental in supporting such an alignment. Driven by a focus on key performance indicators (KPIs), dashboard applications also led to other tangible and intangible benefits. An ability to track KPIs over time and against established targets, with drill-down capabilities, allowed leadership to hold staff members accountable for achieving their performance targets. By displaying the dashboards in prominent locations (such as operational unit floors, the physicians' cafeteria, and nursing stations), SJMO ushered in transparency in the planning and monitoring processes. The need to develop KPI metrics and drive data collection efforts became ingrained in the work ethos of people at every level of the organization. Although IT-enabled dashboards have been instrumental in supporting this cultural transformation, the focus of investment was the ability of technology to make collective vision and action the responsibility of all stakeholders. PMID:26554142

  19. SLUDGE TREATMENT PROJECT KOP CONCEPTUAL DESIGN CONTROL DECISION REPORT

    SciTech Connect

    CARRO CA

    2010-03-09

    This control decision addresses the Knock-Out Pot (KOP) Disposition KOP Processing System (KPS) conceptual design. The KPS functions to (1) retrieve KOP material from canisters, (2) remove particles less than 600 {micro}m in size and low density materials from the KOP material, (3) load the KOP material into Multi-Canister Overpack (MCO) baskets, and (4) stage the MCO baskets for subsequent loading into MCOs. Hazard and accident analyses of the KPS conceptual design have been performed to incorporate safety into the design process. The hazard analysis is documented in PRC-STP-00098, Knock-Out Pot Disposition Project Conceptual Design Hazard Analysis. The accident analysis is documented in PRC-STP-CN-N-00167, Knock-Out Pot Disposition Sub-Project Canister Over Lift Accident Analysis. Based on the results of these analyses, and analyses performed in support of MCO transportation and MCO processing and storage activities at the Cold Vacuum Drying Facility (CVDF) and Canister Storage Building (CSB), control decision meetings were held to determine the controls required to protect onsite and offsite receptors and facility workers. At the conceptual design stage, these controls are primarily defined by their safety functions. Safety significant structures, systems, and components (SSCs) that could provide the identified safety functions have been selected for the conceptual design. It is anticipated that some safety SSCs identified herein will be reclassified based on hazard and accident analyses performed in support of preliminary and detailed design.

  20. A Pathway to Personalization of Integrated Treatment: Informatics and Decision Science in Psychiatric Rehabilitation

    PubMed Central

    Spaulding, William; Deogun, Jitender

    2011-01-01

    Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome. PMID:21860042

  1. Treatment decisions based on scalar and functional baseline covariates.

    PubMed

    Ciarleglio, Adam; Petkova, Eva; Ogden, R Todd; Tarpey, Thaddeus

    2015-12-01

    The amount and complexity of patient-level data being collected in randomized-controlled trials offer both opportunities and challenges for developing personalized rules for assigning treatment for a given disease or ailment. For example, trials examining treatments for major depressive disorder are not only collecting typical baseline data such as age, gender, or scores on various tests, but also data that measure the structure and function of the brain such as images from magnetic resonance imaging (MRI), functional MRI (fMRI), or electroencephalography (EEG). These latter types of data have an inherent structure and may be considered as functional data. We propose an approach that uses baseline covariates, both scalars and functions, to aid in the selection of an optimal treatment. In addition to providing information on which treatment should be selected for a new patient, the estimated regime has the potential to provide insight into the relationship between treatment response and the set of baseline covariates. Our approach can be viewed as an extension of "advantage learning" to include both scalar and functional covariates. We describe our method and how to implement it using existing software. Empirical performance of our method is evaluated with simulated data in a variety of settings and also applied to data arising from a study of patients with major depressive disorder from whom baseline scalar covariates as well as functional data from EEG are available. PMID:26111145

  2. Development of instruments to measure the quality of breast cancer treatment decisions

    PubMed Central

    Lee, Clara N.; Dominik, Rosalie; Levin, Carrie A.; Barry, Michael J.; Cosenza, Carol; O’Connor, Annette M.; Mulley, Albert G.; Sepucha, Karen R.

    2010-01-01

    Background Women with early stage breast cancer face a multitude of decisions. The quality of a decision can be measured by the extent to which the treatment reflects what’s most important to an informed patient. Reliable and valid measures of patients’ knowledge and their goals and concerns related to breast cancer treatments are needed to assess decision quality. Objective To identify a set of key facts and goals relevant to each of three breast cancer treatment decisions (surgery, reconstruction, and adjuvant chemotherapy and hormone therapy) and to evaluate the validity of the methods used to identify them. Methods Candidate facts and goals were chosen based on evidence review and qualitative studies with breast cancer patients and providers. Cross-sectional surveys of patients and providers were conducted for each decision. The accuracy, importance, and completeness of the items were examined. Results 38 facts (11–14 per decision) and 27 goals (8–10 per decision) were identified. An average of 17 patients and 21 providers responded to each survey. The sets of facts were accurate and complete for all three decisions. The sets of goals and concerns were important for surgery and reconstruction, but not chemotherapy/hormone therapy. Patients and providers disagreed about the relative importance of several key facts and goals. Conclusion Overall, breast cancer patients and providers found the sets of facts and goals accurate, important, and complete for three treatment decisions. Because patients’ and providers’ perspectives are different, it is vital that instrument development should include items reflecting both views. PMID:20550591

  3. Intergenerational Differences and Similarities in Life-Sustaining Treatment Attitudes and Decision Factors.

    ERIC Educational Resources Information Center

    Mills, Terry L.; Wilmoth, Janet M.

    2002-01-01

    A cross-sectional sample of three-generation families was used to evaluate life-sustaining medical treatment attitudes and decision factors. Results show that the older generation perceived mental capacity, family burden, and pain as most important considerations. Among the middle generation the type of life-sustaining treatment was important. The…

  4. The Role of Culture in Families' Treatment Decisions for Children with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Mandell, David S.; Novak, Maytali

    2005-01-01

    There is little information available about how and why parents of children with autism spectrum disorders (ASD) make decisions regarding which of the many available treatments to implement with their children. Given the lack of available information regarding treatment efficacy, it is likely that parents' beliefs about child development,…

  5. The Effects of Treatment Needs and Prior Social Services Use on Juvenile Court Decision Making

    ERIC Educational Resources Information Center

    Schwalbe, Craig S.; Hatcher, Schnavia Smith; Maschi, Tina

    2009-01-01

    Every year, juvenile court judges commit large numbers of delinquent youths to institutional placements. Prior research indicates that both legal and extra-legal factors influence this decision-making process. Less frequently examined is the role of treatment needs and prior social services use. This study examined the influence of treatment needs…

  6. Reducing Aversion to Side Effects in Preventive Medical Treatment Decisions

    ERIC Educational Resources Information Center

    Waters, Erika A.; Weinstein, Neil D.; Colditz, Graham A.; Emmons, Karen M.

    2007-01-01

    Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by…

  7. Neural correlates of decision making after unfair treatment

    PubMed Central

    Wu, Yan; Zang, Yufeng; Yuan, Binke; Tian, Xuehong

    2015-01-01

    Empirical evidence indicates that people are inequity averse. However, it is unclear whether and how suffering unfairness impacts subsequent behavior. We investigated the consequences of unfair treatment in subsequent interactions with new interaction partners and the associated neural mechanisms. Participants were experimentally manipulated to experience fair or unfair treatment in the ultimatum game (UG), and subsequently, they were given the opportunity to retaliate in the dictator game (DG) in their interactions with players who had not played a role in the previous fair or unfair treatment. The results showed that participants dictated less money to unrelated partners after frequently receiving unfair offers in the previous UG (vs. frequently receiving fair offers in the previous UG), but only when they were first exposed to unfair UG/DG. Stronger activation in the right dorsal anterior insula was found during receiving unfair offers and during the subsequent offer-considering phase. The regional homogeneity (ReHo), a measure of the local synchronization of neighboring voxels in resting-state brain activity, in the left ventral anterior insula and left superior temporal pole was positively correlated with the behavior change. These findings suggest that unfair treatment may encourage a spread of unfairness, and that the anterior insula may be not only engaged in signaling social norm violations, but also recruited in guiding subsequent adaptive behaviors. PMID:25798102

  8. The influence of family ties on men's prostate cancer screening, biopsy, and treatment decisions.

    PubMed

    Shaw, Eric K; Scott, John G; Ferrante, Jeanne M

    2013-11-01

    Extensive research has focused on understanding family dynamics of men with prostate cancer. However, little qualitative work has examined the role of family ties on men's prostate cancer decisions across the spectrum of screening, diagnosis, and treatment. Using data from a larger study, we qualitatively explored the influence of family ties on men's prostate cancer decisions. Semistructured interviews were conducted with men ages ≥50 (N = 64), and data were analyzed using a grounded theory approach and a series of immersion/crystallization cycles. Three major themes of spousal/family member influence were identified: (a) spousal/family member alliance marked by open communication and shared decision making, (b) men who actively opposed spouse/family member pressure and made final decisions themselves, and (c) men who yielded to spouse/family member pressure. Our findings provide insights into men's relational dynamics that are important to consider for the shared decision-making process across the prostate cancer spectrum. PMID:23459024

  9. Physician, Patient and Contextual Factors Affecting Treatment Decisions in Older Adults with Cancer: A Literature Review

    PubMed Central

    Tariman, J. D.; Berry, D. L.; Cochrane, B.; Doorenbos, A.; Schepp, K.

    2010-01-01

    Purpose/Objectives To review physician, patient, and contextual factors that affect treatment decision-making in older adults diagnosed with cancer and relate these factors to theoretical models of decision-making. Data Sources PubMed (1966-April 2010), PsycINFO (1967-April 2010) and CINAHL (1982-April 2010) databases were searched to access relevant medical, psychological and nursing literature. Data Synthesis Physician factors in treatment decisions include physician personal beliefs and values, expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors include personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors include availability of caregiver, lack of insurance, poor financial status, and geographical barrier. The interplay of physician, patient, and contextual factors are not well understood. Existing models of decision-making are not sufficient to explicate TDM process in older adults diagnosed with cancer. Conclusions Clinical studies in older adult patient population using a longitudinal and prospective design are needed to examine real-time interplay of patient, physician, and contextual factors and to better understand how these divergent factors influenced actual treatment decisions. Implications for Nursing Oncology nurses can advocate for a patient’s autonomy during TDM by coaching them to seek evidence-based discussion of various treatment options, benefits and risks assessments, and truthful discussion of the probability of success for each treatment option from their physicians. Oncology nurses must promote an informed treatment decisions that are consistent with a patient’s personal preference and values within the limits of the patient’s personal contexts. PMID:22201670

  10. Management of hypertensive crises: the scientific basis for treatment decisions.

    PubMed

    Blumenfeld, J D; Laragh, J H

    2001-11-01

    The spectrum of disorders associated with an elevated blood pressure (BP) encompasses chronic uncomplicated hypertension and the hypertensive crises, including hypertensive urgencies and emergencies. Although these syndromes vary widely in their presentations, clinical courses, and outcomes they share pathophysiologic mechanisms and, consequently, therapeutic responses to specifically targeted antihypertensive drug types. Nevertheless, hypertensive crises are often treated with drugs which, in that setting are either unsafe or are of unsubstantiated efficacy. The purpose of this review is to examine the pathophysiology of commonly encountered hypertensive crises, including stroke, hypertensive encephalopathy, aortic dissection, acute pulmonary edema, and preeclampsia-eclampsia and to provide a rational approach to their treatment based upon relevant pathophysiologic and pharmacologic principles. Measurement of plasma renin activity (PRA) level often provides insight regarding pathophysiology and predicts efficacy of antihypertensive treatments in the individual patient. However, in hypertensive crises, drug therapy is initiated before the PRA level is known. Nevertheless, the renin-angiotensin dependence (R-type) or volume dependence (V-type) of hypertension can often be deduced by the BP response to drugs that interrupt the renin system (R-drugs) or that decrease body volume (V-drugs). Based upon these considerations, a treatment algorithm is provided to guide drug selection in patients presenting with a hypertensive crisis. PMID:11724216

  11. Physiology-driven adaptive virtual reality stimulation for prevention and treatment of stress related disorders.

    PubMed

    Cosić, Kresimir; Popović, Sinisa; Kukolja, Davor; Horvat, Marko; Dropuljić, Branimir

    2010-02-01

    The significant proportion of severe psychological problems related to intensive stress in recent large peacekeeping operations underscores the importance of effective methods for strengthening the prevention and treatment of stress-related disorders. Adaptive control of virtual reality (VR) stimulation presented in this work, based on estimation of the person's emotional state from physiological signals, may enhance existing stress inoculation training (SIT). Physiology-driven adaptive VR stimulation can tailor the progress of stressful stimuli delivery to the physiological characteristics of each individual, which is indicated for improvement in stress resistance. Following an overview of physiology-driven adaptive VR stimulation, its major functional subsystems are described in more detail. A specific algorithm of stimuli delivery applicable to SIT is outlined. PMID:20528296

  12. Removal of fluorine from contaminated soil by electrokinetic treatment driven by solar energy.

    PubMed

    Zhou, Ming; Zhu, Shufa; Liu, Yana; Wang, Xuejian

    2013-08-01

    Instead of direct current power supply, a series of electrokinetic remediation experiments driven by solar energy on fluorine-contaminated soil were conducted in a self-made electrolyzer, in order to reduce energy expenditure of electrokinetic remediation. After the 12-day electrokinetic remediation driven by solar energy, the removal efficiency of fluorine was 22.3%, and electrokinetic treatment had an impact on changes in partitioning of fluorine in soil. It proved that the combination of electrokinetics and solar energy was feasible and effective to some extent for the remediation of fluorine-contaminated soil. Meanwhile, the experimental results also indicated that the electromigration was a more dominant transport mechanism for the removal of fluorine from contaminated soil than electroosmosis, and the weather condition was the important factor in affecting the removal efficiency. PMID:23475445

  13. Decision regret following treatment for localized breast cancer: is regret stable over time?

    PubMed Central

    Martinez, Kathryn A.; Li, Yun; Resnicow, Ken; Graff, John J.; Hamilton, Ann S.; Hawley, Sarah T

    2015-01-01

    Background While studies suggest most women have little regret regarding their breast cancer treatment decisions immediately following treatment, to date no studies have evaluated how regret may change over time. Objective To measure the stability of post-treatment decision regret over time among women with breast cancer. Methods Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan or Los Angeles County Surveillance Epidemiology and End Results (SEER) registry completed surveys at 9 months following diagnosis (Time 1) and again approximately 4 years later (Time 2). A decision regret scale consisting of 5 items was summed to create two decision regret scores at both Time 1 and Time 2 (range: 0 to 20). Multivariable linear regression was used to examine change in regret from 9 months to 4 years. Independent variables included surgery type, receipt of reconstruction, and recurrence status at follow-up. The model controlled for demographic and clinical factors. Results The analytic sample included 1,536 women. Mean regret in the overall sample was 4.9 at Time 1 and 5.4 at Time 2 (p<0.001). In the multivariable linear model, we found no difference in change in decision regret over time by surgery type. Reporting a new diagnosis of breast cancer at Time 2 was associated with 2.6 point increase in regret over time, compared to women without an additional diagnosis (p=0.003). Receipt of reconstruction was not associated with change in decision regret over time. Conclusions Decision regret following treatment was low and relatively stable over time for most women. Those facing an additional diagnosis of breast cancer following treatment may be at risk for elevated regret-related distress. PMID:25532824

  14. Confidentiality and treatment decisions of minor clients: a health professional's dilemma & policy makers challenge.

    PubMed

    Jackson, Margot Karen; Burns, Katharina Kovacs; Richter, Magdalena S

    2014-01-01

    Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children's Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented. PMID:25032089

  15. Conflict and user involvement in drug misuse treatment decision-making: a qualitative study

    PubMed Central

    Fischer, Jan; Neale, Joanne; Bloor, Michael; Jenkins, Nicholas

    2008-01-01

    Background This paper examines client/staff conflict and user involvement in drug misuse treatment decision-making. Methods Seventy-nine in-depth interviews were conducted with new treatment clients in two residential and two community drug treatment agencies. Fifty-nine of these clients were interviewed again after twelve weeks. Twenty-seven interviews were also conducted with staff, who were the keyworkers for the interviewed clients. Results Drug users did not expect, desire or prepare for conflict at treatment entry. They reported few actual conflicts within the treatment setting, but routinely discussed latent conflicts – that is, negative experiences and problematic aspects of current or previous treatment that could potentially escalate into overt disputes. Conflict resulted in a number of possible outcomes, including the premature termination of treatment; staff deciding on the appropriate outcome; the client appealing to the governance structure of the agency; brokered compromise; and staff skilfully eliciting client consent for staff decisions. Conclusion Although the implementation of user involvement in drug treatment decision-making has the potential to trigger high levels of staff-client conflict, latent conflict is more common than overt conflict and not all conflict is negative. Drug users generally want to be co-operative at treatment entry and often adopt non-confrontational forms of covert resistance to decisions about which they disagree. Staff sometimes deploy user involvement as a strategy for managing conflict and soliciting client compliance to treatment protocols. Suggestions for minimising and avoiding harmful conflict in treatment settings are given. PMID:18837989

  16. Inflammation (or synovitis)-driven osteoarthritis: an opportunity for personalizing prognosis and treatment?

    PubMed

    Siebuhr, A S; Bay-Jensen, A C; Jordan, J M; Kjelgaard-Petersen, C F; Christiansen, C; Abramson, S B; Attur, M; Berenbaum, F; Kraus, V; Karsdal, M A

    2016-03-01

    The disabling and painful disease osteoarthritis (OA) is the most common form of arthritis. Strong evidence suggests that a subpopulation of OA patients has a form of OA driven by inflammation. Consequently, understanding when inflammation is the driver of disease progression and which OA patients might benefit from anti-inflammatory treatment is a topic of intense research in the OA field. We have reviewed the current literature on OA, with an emphasis on inflammation in OA, biochemical markers of structural damage, and anti-inflammatory treatments for OA. The literature suggests that the OA patient population is diverse, consisting of several subpopulations, including one associated with inflammation. This inflammatory subpopulation may be identified by a combination of novel serological inflammatory biomarkers. Preliminary evidence from small clinical studies suggests that this subpopulation may benefit from anti-inflammatory treatment currently reserved for other inflammatory arthritides. PMID:26484849

  17. Combine or Separate Future Pain? The Impact of Current Pain on Decisions about Future Dental Treatments

    PubMed Central

    Andrade, Eduardo B.; Bianchini, Marco Aurélio; Lucchiari, Newton

    2013-01-01

    Patients are often given the option of undergoing future painful treatments in one or multiple sessions (e.g., extracting two wisdom teeth on one or two different days). In a randomized controlled field experiment, we investigated the impact of transient pain on patients’ decision to combine or separate future periodontal treatments. The main results show that most patients preferred to have the future treatments take place in one session when they made their choice after a painless examination (i.e., general clinical exam). However, the patients’ preference for combining the future treatments did not differ from chance when the choice was made immediately following a painful examination (i.e., pocketing and bleeding on probing exam). The impact of pain on decision making is observed within and between participants. Current pain seems to lead patients to question their ability to endure future painful treatments in one session. PMID:23704972

  18. The nurse's role in treatment decisions for the child with neurological impairment.

    PubMed

    Duffy, Lisa V

    2009-10-01

    Healthcare providers are often faced with ethical dilemmas when making treatment decisions for a child with neurological impairment. Problems may stem from the fact that the wishes of the family may be in opposition to what the healthcare team feels is in the best interest of the child. There are many factors that need to be considered when determining treatment options for the child with neurological impairment. Nurses are in a unique position to advocate for the involvement of the child's family in making these difficult decisions. PMID:19835240

  19. The medical visit context of treatment decision-making and the therapeutic relationship.

    PubMed

    Roter, Debra

    2000-03-01

    The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals. Failures of this kind, have been largely attributed to the psychological dynamics of the patients, physicians, illnesses, and contexts that characterize the medical decision. There has been little attempt to provide a framework for accommodating or understanding the larger social context and social influences that contribute to this variation. Applying Paulo Freire's participatory social orientation model to the context of the medical visit suggests a framework for viewing the impact of physicians' communication behaviours on patients' capacity for treatment decision-making. Physicians' use of communication strategies can act to reinforce an experience of patient dependence or self-reliance in regard to the patient-physician relationship generally and treatment decision-making, in particular. Certain communications enhance patient participation in the medical visit's dialogue, contribute to patient engagement in problem posing and problem-solving, and finally, facilitate patient confidence and competence to undertake autonomous action. The purpose of this essay is to place treatment decision-making within the broader context of the therapeutic relationship, and to describe ways in which routine medical visit communication can accommodate individual patient preferences and help develop and further patient capacity for autonomous decision-making. PMID:11281908

  20. Understanding decisions made about hepatitis C treatment by couples who inject drugs.

    PubMed

    Treloar, C; Rance, J; Bryant, J; Fraser, S

    2016-02-01

    Efforts to increase the number of people having hepatitis C virus (HCV) treatment require understanding how to best deliver services to meet consumers' needs. The general health literature has examined the role that partners can play in supporting health outcomes. This study examines the experiences of couples who inject drugs in relation to knowledge of, decisions about and management of HCV treatment. This is a qualitative interview study of people who inject drugs in couples. Participants were recruited from harm reduction services in two major Australian cities. Couples were interviewed separately. Data were examined using the couple as the unit of analysis and to identify patterns of experience related to the HCV serostatus of couples. Knowledge of HCV and HCV treatment was low and variable but showed some relationship to serostatus. Decisions about HCV treatment were deeply informed by concerns regarding treatment side effects. Positive concordant couples considered 'staging' treatment to ensure that each partner could (in turn) care for the other. People with HCV in serodiscordant relationships may need specific support regarding HCV treatment information. Within positive concordant partnerships, our data indicated the need to support the HCV-positive 'carer' during their partner's treatment. Changing treatment regimens, and their anticipated lower side effect profiles, will need to be actively promoted to ensure that couples understand how these changes affect their treatment options. PMID:26305873

  1. Prophylactic treatment with the BH3 mimetic ABT-737 impedes Myc-driven lymphomagenesis in mice.

    PubMed

    Kelly, P N; Grabow, S; Delbridge, A R D; Adams, J M; Strasser, A

    2013-01-01

    As many oncogenic changes, such as Myc overexpression, promote apoptosis, the survival of emerging neoplastic clones may often initially depend upon endogenous levels of particular pro-survival members of the Bcl-2 protein family. Pertinently, we recently showed that in lymphoma-prone Eμ-myc transgenic mice, which overexpress Myc in all B-lymphoid cells, endogenous Bcl-x(L) is critical for the survival, as well as the expansion of preneoplastic B-lymphoid cells and the development of malignant disease. This discovery raised the possibility that pharmacological blockade of Bcl-x(L) might impede Myc-driven lymphoma development. Indeed, we report here that treatment of preleukaemic Eμ-myc transgenic mice with the Bcl-2 homology (BH)3 mimetic drug ABT-737, which inhibits Bcl-x(L), as well as Bcl-2 and Bcl-w, augmented apoptosis of preneoplastic B-lymphoid cells, reduced their numbers and greatly prolonged lymphoma-free survival. These findings reveal that BH3 mimetic drugs may provide a prophylactic strategy to prevent the development of certain tumours, particularly those driven by deregulated Myc expression. Moreover, such treatment may help in the management of patients with hereditary cancer syndromes and perhaps also in the prevention of tumour relapses. PMID:22814621

  2. Ontology-Driven Hypothesis Generation to Explain Anomalous Patient Responses to Treatment

    NASA Astrophysics Data System (ADS)

    Moss, Laura; Sleeman, Derek; Sim, Malcolm; Booth, Malcolm; Daniel, Malcolm; Donaldson, Lyndsay; Gilhooly, Charlotte; Hughes, Martin; Kinsella, John

    Within the medical domain there are clear expectations as to how a patient should respond to treatments administered. When these responses are not observed it can be challenging for clinicians to understand the anomalous responses. The work reported here describes a tool which can detect anomalous patient responses to treatment and further suggest hypotheses to explain the anomaly. In order to develop this tool, we have undertaken a study to determine how Intensive Care Unit (ICU) clinicians identify anomalous patient responses; we then asked further clinicians to provide potential explanations for such anomalies. The high level reasoning deployed by the clinicians has been captured and generalised to form the procedural component of the ontology-driven tool. An evaluation has shown that the tool successfully reproduced the clinician’s hypotheses in the majority of cases. Finally, the paper concludes by describing planned extensions to this work.

  3. Decision making for HIV prevention and treatment scale up: Bridging the gap between theory and practice

    PubMed Central

    Alistar, Sabina S.; Brandeau, Margaret L.

    2011-01-01

    Background Effectively controlling the HIV epidemic will require efficient use of limited resources. Despite ambitious global goals for HIV prevention and treatment scale up, few comprehensive practical tools exist to inform such decisions. Methods We briefly summarize modeling approaches for resource allocation for epidemic control, and discuss the practical limitations of these models. We describe typical challenges of HIV resource allocation in practice and some of the tools used by decision makers. We identify the characteristics needed in a model that can effectively support planners in decision making about HIV prevention and treatment scale up. Results An effective model to support HIV scale-up decisions will be flexible, with capability for parameter customization and incorporation of uncertainty. Such a model needs certain key technical features: it must capture epidemic effects; account for how intervention effectiveness depends on the target population and the level of scale up; capture benefit and cost differentials for packages of interventions versus single interventions, including both treatment and prevention interventions; incorporate key constraints on potential funding allocations; identify optimal or near-optimal solutions; and estimate the impact of HIV interventions on the health care system and the resulting resource needs. Additionally, an effective model needs a user-friendly design and structure, ease of calibration and validation, and accessibility to decision makers in all settings. Conclusions Resource allocation theory can make a significant contribution to decision making about HIV prevention and treatment scale up. What remains now is to develop models that can bridge the gap between theory and practice. PMID:21191118

  4. Decision-Making in Prostate Cancer: Active Surveillance Over Other Treatment Options.

    PubMed

    Bayliss, David; Duff, Jed; Stricker, Phil; Walker, Kim

    2016-01-01

    A qualitative-descriptive study of four patients with prostate cancer used the Cognitive-Social Health Information Processing framework to understand how and why men diagnosed with prostate cancer choose active surveillance over other treatment options. In accordance with the literature, it was found that the surgeon or general practitioner's recommendation was the most influential factor when patients are making a treatment decision. PMID:27501595

  5. Lay Referral Patterns Involved in Cardiac Treatment Decision Making among Middle-Aged and Older Adults

    ERIC Educational Resources Information Center

    Schoenberg, Nancy E.; Amey, Cheryl H.; Stoller, Eleanor Palo; Muldoon, Susan B.

    2003-01-01

    Purpose: This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. Design and Methods: A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors.…

  6. Dentist-Patient Interactions in Treatment Decision-Making: A Qualitative Study.

    ERIC Educational Resources Information Center

    Redford, Maryann; Gift, Helen C.

    1997-01-01

    A University of North Carolina study using focus groups of dentists and patients found dentist-patient interactions play an important role in treatment decision-making, and are predicated on non-clinical factors, including dentists' intuition and judgment and patient impressions of dentists' examination styles, personalities, and interpersonal…

  7. Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

    ERIC Educational Resources Information Center

    Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

    2006-01-01

    In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

  8. The Impact of Reading a Clinical Study on Treatment Decisions of Physicians and Residents.

    ERIC Educational Resources Information Center

    Bergman, David A.; Pantell, Robert H.

    1986-01-01

    A study of the effect of reading a recent clinical study on pediatricians', pediatric residents', and family practitioners' decisions concerning treatment of a common, potentially serious problem revealed a considerable influence but physician difficulty in using probability data and reliance on intuition rather than calculation. (MSE)

  9. Linking scientists, decision makers, and organizations to improve understanding of climate-driven changes in coastal storms and their impacts in Western Alaska

    NASA Astrophysics Data System (ADS)

    Reynolds, J. H.; Murphy, K.

    2012-12-01

    The coastal zones of Western Alaska are expected to experience a nexus of climate-driven changes in landform processes resulting from the impacts of sea ice loss; sea level change; permafrost thaw; and changes in frequency, intensity, and direction of coastal storms, etc. These climate-driven changes will cascade through the near-shore and coastal physical systems, ecological systems, and human communities, and thus present major sources of uncertainty for a wide variety of the region's decision makers. To effectively and efficiently address some of the information needs of these decision makers, the Western Alaska Landscape Conservation Cooperative created a two-year program of applied science focused on 'Changes in Coastal Storms and their Impacts'. We summarize program components that successfully advanced applied science to address these decision maker information needs. All the components share a common feature of promoting linkages: (i) among resource decision makers, stakeholders and scientists, to identify and address key areas of uncertainty associated with coastal storms and thus align the science activities with decision maker needs for a variety of climate vulnerability assessments; (ii) among researchers, to mutually advance their science efforts; and (iii) among organizations, to efficiently address shared science needs. Resulting applied science benefits include (i) integrative projects using very fine resolution surge modeling to assess impacts of saltwater inundation on migratory waterfowl breeding populations and habitat; (ii) coordinating the selection of historic storms for reanalysis by two surge modeling efforts of differing resolution and domain, thus allowing for cross-model comparisons of performance over their shared spatial domain and future regional-scale application of the higher resolution model; and (iii) collaborative, cross-agency efforts to establish a water level network that meets multiple purposes (from model calibration to

  10. The Appleton Consensus: suggested international guidelines for decisions to forego medical treatment.

    PubMed

    Stanley, J M

    1989-09-01

    Thirty-three physicians, bioethicists, and medical economists from ten different countries met at Lawrence University, Appleton, Wisconsin, to create The Appleton Consensus: International Guidelines for Decisions to Forego Medical Treatment. The guidelines deal with four specific decision-making circumstances: 1. Five guidelines were created for decisions involving competent patients or patients who have executed an advance directive before becoming incompetent, and those guidelines fell into three categories. 2. Thirteen guidelines were created for decisions involving patients who were once competent, but are not now competent, who have not executed an advance directive. 3. Seven guidelines were created for decisions involving patients who are not now and never have been competent, for whom 'no substituted judgement' can be rendered. 4. Eleven guidelines were created for decisions involving the scarcity of medical resources, which exists in all communities. Five concepts were identified as being critical in the establishment of priorities, given the reality of scarce health resources (1). The term 'physician' is used in the American sense, synonymous with 'medical practitioner'. PMID:2677379

  11. Risky Decision-Making but Not Delay Discounting Improves during Inpatient Treatment of Polysubstance Dependent Alcoholics

    PubMed Central

    De Wilde, Bieke; Bechara, Antoine; Sabbe, Bernard; Hulstijn, Wouter; Dom, Geert

    2013-01-01

    Background: High levels of impulsivity, characteristics of addicted patients, are known to be important predictors of relapse. However, so far, little is known about the stability or variability of two main components of impulsivity (delay discounting and decision-making). The present study examined the changes in impulsivity during the first week of an abstinence based, behavioral orientated inpatient treatment program. Method: Thirty-seven polysubstance dependent alcoholics completed the Delay Discounting Task (DDT), and the Iowa Gambling Task (IGT) using the original version with decks A′B′C′D′, and an alternative version with decks K′L′M′N′, for measuring decision-making, after 2 and 6 weeks of active treatment. Results: It was found that performances on the IGT changed during treatment while performances on the DDT did not (test-retest period: 4 weeks). Conclusion: The results provide preliminary evidence that improvements in decision-making might be related to treatment effects. All patients followed a highly structured cognitive-behavioral treatment program, which might have enhanced their executive functioning (coping skills training). PMID:24027538

  12. Cancer treatment decision-making processes for older patients with complex needs: a qualitative study

    PubMed Central

    Hughes, Jane; Farrington, Naomi; Richardson, Alison

    2015-01-01

    Objectives Although older people can experience complex health and social care needs alongside a primary cancer diagnosis, little is understood about how cancer treatment decisions are made for this population. This study aimed to investigate how cancer treatment decisions are formulated for older people with complex health and social care needs and the factors that shape these processes. Design Qualitative study involving semistructured interviews and non-participant observations. Framework approach used for data analysis. Setting Breast and colorectal cancer services in five English NHS hospital trusts. Participants Interviews: purposive sample of 22 clinicians directly involved in a face-to-face clinical role with patients regarding cancer treatment and care, maximising variation across clinical roles, tumour types and trusts. Observations: purposive sample of five cancer multidisciplinary meetings, maximising variation across location, team size and tumour type. Results The initial stages of cancer treatment decision-making are team-based, medically dominated and focused on the cancer. For patients with complex health and social care needs that extend beyond cancer pathology, later and less visible stages in the decision-making process are more haphazard and may result in less effective and workable treatment plans, as individual clinicians struggle to devise and deliver these plans without breaching time-based targets. Conclusions Service targets that focus resources solely on the presenting disease can disadvantage older patients with complex health and social care needs that extend beyond this primary diagnosis. Care should be taken to ensure time-based targets do not disincentivise thorough and timely assessment that can lead to the formulation of treatment plans tailored to individual needs and circumstances. PMID:26667015

  13. Provider and patient correlates of provider decisions to recommend HCV treatment to HIV co-infected patients.

    PubMed

    Wagner, Glenn; Osilla, Karen Chan; Garnett, Jeffrey; Ghosh-Dastidar, Bonnie; Bhatti, Laveeza; Witt, Mallory; Goetz, Matthew Bidwell

    2012-01-01

    Despite low uptake of hepatitis C virus (HCV) treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at 3 HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one's provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake. PMID:22564797

  14. Use of ultrasound in treatment decisions for patients with rheumatoid arthritis: an observational study in Italy.

    PubMed

    Epis, Oscar; Scioscia, Crescenzio; Locaputo, Antonia; Cappelli, Antonella; Maier, Armin; Rocchetta, Pier Andrea; Tomietto, Paola; Perin, Antonella; Rigon, Chiara; Santo, Leonardo; Casilli, Oriana; Lapadula, Giovanni; Bruschi, Eleonora

    2016-08-01

    In rheumatoid arthritis (RA), treatment response is generally assessed using standard clinical disease activity measures. However, ultrasound has become increasingly popular among rheumatologists to monitor disease activity and response. The purpose of this analysis of ECOgraphic evaluation for STaging ARthritis (ECOSTAR) study data was to determine how ultrasound affects clinicians' decisions about changing treatment in RA. ECOSTAR was an observational, cohort study conducted between March 2010 and December 2012 at nine clinical centers in Italy in RA patients being considered for treatment change. After clinical evaluation of each patient, patients underwent diagnostic ultrasound (US) investigations and each patient was given a total echography score using a combination of scores for joint effusion, synovial hypertrophy, and power Doppler. The US results were provided to the clinicians and the influence of US on the clinicians' treatment choices were recorded. Ninety-five patients screened for study inclusion had confirmed RA (mean age 53.9 years; mean disease duration 8.9 years). Therapy changes were made by clinicians according to the hand and wrist joint US scores: score 0 appeared to have no influence on clinicians' decision to modify treatment, scores >0-3 were associated with a numerically higher estimated probability of not changing therapy than changing therapy, and scores >3 had a greater influence on the clinician to modify therapy and an increased probability of the clinician changing therapy versus not changing therapy. Ultrasonography scores appear to influence treatment decisions in patients with RA, with clinicians appearing less likely to alter treatment regimens in patients with low ultrasound scores and more likely to change treatment regimens when higher scores are obtained. Further research is warranted. PMID:27320945

  15. HIV Treatment as Prevention: Models, Data, and Questions—Towards Evidence-Based Decision-Making

    PubMed Central

    2012-01-01

    Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention. PMID:22802739

  16. [Patients in pre-dialysis: decision taking and free choice of treatment].

    PubMed

    Sarrias Lorenz, X; Bardón Otero, E; Vila Paz, M L

    2008-01-01

    Predialysis is a clinical situation in which the patient has significant impairment of kidney function that will ultimately lead to either death or inclusion in kidney replacement therapy (dialysis and/or transplantation). Since a practical and effective dialysis technique was introduced, the length and quality of survival of patients with end-stage renal failure has constantly increased. Contraindications for dialysis are almost never of a renal origin. The obstacles are the concomitant diseases of the patient. The age of the patient may be one of these obstacles. The average age at initiation of dialysis in our country is currently 67 years and over 50% of patients are 60 years old or older. Decision making: From an ethical viewpoint, there is a consensus in stating that anything that can technically be done, should be done. The principle of nonmaleficence and respect for the autonomy of the patients are "prima facie" principles when the physician has doubts as to whether dialysis provides a benefit to the patient. The principle of autonomy, which makes the patient a competent subject of treatment, allows a framework of shared decisions to be created in which the physician uses his knowledge and experiences in assessing the risk and benefits of dialysis including the alternative of no dialysis. The competent patient, duly informed, will chose the option that is best for him and take the decision. Principle of treatment proportionality: This principle states that there is a moral obligation to implement all therapeutic measures that show a relationship of due proportion between the resources used and the expected result. Dialysis is in principle a proportional treatment for end-stage renal failure. However, it may become a disproportional treatment because of the physical and mental conditions of the elderly patient. The good that is sought with institution of treatment can cause a harm to the patient that justifies noninclusion of the patient in dialysis

  17. Sufficiency of care in disasters: ventilation, ventilator triage, and the misconception of guideline-driven treatment.

    PubMed

    Trotter, Griffin

    2010-01-01

    This essay examines the management of ventilatory failure in disaster settings where clinical needs overwhelm available resources. An ethically defensible approach in such settings will adopt a "sufficiency of care" perspective that is: (1) adaptive, (2) resource-driven, and (3) responsive to the values of populations being served. Detailed, generic, antecedently written guidelines for "ventilator triage" or other management issues typically are of limited value, and may even impede ethical disaster response if they result in rescuers' clumsily interpreting events through the lens of the guideline, rather than customizing tactics to the actual context. Especially concerning is the tendency of some expert planners to mistakenly assume that medical treatment of respiratory failure: (1) always requires full-feature mechanical ventilators, (2) will always occur in hospitals, and (3) can be planned in advance without sophisticated public consultation about likely ethical dilemmas. PMID:21313863

  18. Intra-household relations and treatment decision-making for childhood illness: a Kenyan case study.

    PubMed

    Molyneux, C S; Murira, G; Masha, J; Snow, R W

    2002-01-01

    This study, conducted on the Kenyan coast, assesses the effect of intra-household relations on maternal treatment-seeking. Rural and urban Mijikenda mothers' responses to childhood fevers in the last 2 weeks (n=317), and to childhood convulsions in the previous year (n=43), were documented through survey work. The intra-household relations and decision-making dynamics surrounding maternal responses were explored through in-depth individual and group interviews, primarily with women (n=223). Responses to convulsions were more likely than responses to fevers to include a healer consultation (p<0.0001), and less likely to include the purchase of over-the-counter medications (p<0.0001). Mothers received financial or advisory assistance from others in 71% (n=236) of actions taken outside the household in response to fevers. In-depth interviews suggested that general agreement on appropriate therapy results in relatively few intra-household conflicts over the treatment of fevers. Disputes over perceived cause and appropriate therapy of convulsions, however, highlighted the importance of age, gender and relationship to household head in intra-household relations and treatment decision-making. Although mothers' treatment-seeking preferences are often circumscribed by these relations, a number of strategies can be drawn upon to circumvent 'inappropriate' decisions, sometimes with implications for future household responses to similar syndromes. The findings highlight the complexity of intra-household relations and treatment decision-making dynamics. Tentative implications for interventions aimed at improving the home management of malaria, and for further research, are presented. PMID:11814209

  19. Withholding treatment and intellectual disability: Second survey on end-of-life decisions in Switzerland

    PubMed Central

    Wicki, Monika T

    2016-01-01

    Background: As people live longer, they are more likely to die over a prolonged period from incurable, chronic illnesses that occur more frequently in old age. Therefore, people will experience an increase in end-of-life discussions and decisions. Aim: The aim of this study was to explore the prevalence and nature of end-of-life decisions for people with disabilities in Swiss residential homes. Design: A cross-sectional survey in the three biggest German-speaking regions in Switzerland (N = 209) was conducted. Setting: All of the residential homes for adults with disabilities (N = 209) were invited to participate in a cross-sectional survey. The response quote was 76.7%. Directors provided information on 82 deaths. Chi-square and t-tests were used to study differences in prevalence and nature of end-of-life decisions between people with intellectual disability (ID) and people with other disabilities. Results: An end-of-life decision was taken in 53.7% of the cases (n = 44). For people with ID, the decision to withhold treatment had been taken more often (28.9%, 13 cases) than for people with other disabilities (8.1%, 3 cases) (χ2 (1, N = 82) = 5.58, p = 0.017). Conclusion: The study provides insight in end-of-life decision-making for people with disabilities in Switzerland. The results have implications on surrogate decision-making for people with ID living in residential homes. As the study partly confirms the results of previous studies, further studies will be necessary. PMID:27408720

  20. Treatment decision-making and information-seeking preferences in women with pelvic floor disorders

    PubMed Central

    Raker, Christina A.; Myers, Deborah L.; Clark, Melissa A.

    2010-01-01

    Introduction and hypothesis The Autonomy Preference Index (API) and Control Preferences Scale (CPS) measure information-seeking and decision-making preferences. Our objective was to validate these scales in women with pelvic floor disorders (PFDs) and identify variables associated with decision-making preferences. Methods Women seeking care for PFDs completed the API and the CPS. Psychometric properties were determined. Multivariable analyses were used to identify correlates of information-seeking and decision-making preferences. Results One hundred ten women were recruited. Both scales demonstrated good psychometric properties (intraclass correlation coefficient=0.5 to 0.7; Cronbach’s alpha = 0.8 for the API, and r=−0.3 between the API and CPS). Based on scores, women had strong preferences to be well informed, but were more neutral in their decision-making preferences. In multivariable analyses, higher education levels were associated with a stronger desire for seeking medical information. Conclusions Women seeking care for PFDs vary in their preferences for participating in treatment decisions. PMID:20424822

  1. Radiation Treatment in Older Patients: A Framework for Clinical Decision Making

    PubMed Central

    Smith, Grace L.; Smith, Benjamin D.

    2014-01-01

    In older patients, radiation treatment plays a vital role in curative and palliative cancer therapy. Radiation treatment recommendations should be informed by a comprehensive, personalized risk-benefit assessment that evaluates treatment efficacy and toxicity. We review several clinical factors that distinctly affect efficacy and toxicity of radiation treatment in older patients. First, locoregional tumor behavior may be more indolent in older patients for some disease sites but more aggressive for other sites. Assessment of expected locoregional relapse risk informs the magnitude and timeframe of expected radiation treatment benefits. Second, assessment of the competing cancer versus noncancer mortality and morbidity risks contextualizes cancer treatment priorities holistically within patients' entire spectrum and time course of health needs. Third, assessment of functional reserve helps predict patients' acute treatment tolerance, differentiating those patients who are unlikely to benefit from treatment or who are at high risk for treatment complications. Potential radiation treatment options include immediate curative treatment, delayed curative treatment, and no treatment, with additional consideration given to altered radiation target, dose, or sequencing with chemotherapy and/or surgery. Finally, when cure is not feasible, palliative radiation therapy remains valuable for managing symptoms and achieving meaningful quality-of-life improvements. Our proposed decision-making framework integrates these factors to help radiation oncologists formulate strategic treatment recommendations within a multidisciplinary context. Future research is still needed to identify how advanced technologies can be judiciously applied in curative and palliative settings to enhance risk-benefit profiles of radiation treatment in older patients and more accurately quantify treatment efficacy in this group. PMID:25071132

  2. Treatment of envenomation by Echis coloratus (mid-east saw scaled viper): a decision tree.

    PubMed

    Gilon, D; Shalev, O; Benbassat, J

    1989-01-01

    Envenomation by Echis coloratus causes a transient hemostatic failure. Systemic symptoms, hypotension and evident bleeding are rare, with only one reported fatality. In this paper, we examine the decision to treat victims of Echis coloratus by a specific horse antiserum. The decision model considers the mortality of treated and untreated envenomation, and the side effects of antiserum treatment: fatal anaphylaxis, serum sickness and increased risk of death after a possible repeated exposure to horse antiserum in the future. The results of the analysis are not sensitive to variations in the probability of side effects of antiserum treatment. They are sensitive to variations in the risk of bleeding after envenomation, in the degree of reduction of this risk by antiserum treatment and in the risk of dying after an event of bleeding. Prompt administration of antiserum appears to be the treatment of choice if it reduces the risk of bleeding from 23.6% to 20.3% and if 1.6% or more of the bleeding events are fatal. We conclude that presently available data support antiserum treatment of victims of Echis coloratus who present with hemostatic failure, even though the advantage imparted by this treatment appears to be small. PMID:2683230

  3. Applying the least restrictive alternative principle to treatment decisions: A legal and behavioral analysis

    PubMed Central

    Johnston, J. M.; Sherman, Robert A.

    1993-01-01

    The least restrictive alternative concept is widely used in mental health law. This paper addresses how the concept has been applied to treatment decisions. The paper offers both a legal and a behavioral analysis to some problems that have emerged in recent years concerning the selection of behavioral procedures used to change client behavior. The paper also offers ways of improving the application of the concept, which involve developing a more behaviorally functional perspective toward restrictiveness. PMID:22478138

  4. Justifying medication decisions in mental health care: Psychiatrists’ accounts for treatment recommendations

    PubMed Central

    Angell, Beth; Bolden, Galina B.

    2015-01-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients’ concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists’ orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  5. Justifying medication decisions in mental health care: Psychiatrists' accounts for treatment recommendations.

    PubMed

    Angell, Beth; Bolden, Galina B

    2015-08-01

    Psychiatric practitioners are currently encouraged to adopt a patient centered approach that emphasizes the sharing of decisions with their clients, yet recent research suggests that fully collaborative decision making is rarely actualized in practice. This paper uses the methodology of Conversation Analysis to examine how psychiatrists justify their psychiatric treatment recommendations to clients. The analysis is based on audio-recordings of interactions between clients with severe mental illnesses (such as, schizophrenia, bipolar disorders, etc.) in a long-term, outpatient intensive community treatment program and their psychiatrist. Our focus is on how practitioners design their accounts (or rationales) for recommending for or against changes in medication type and dosage and the interactional deployment of these accounts. We find that psychiatrists use two different types of accounts: they tailor their recommendations to the clients' concerns and needs (client-attentive accounts) and ground their recommendations in their professional expertise (authority-based accounts). Even though psychiatrists have the institutional mandate to prescribe medications, we show how the use of accounts displays psychiatrists' orientation to building consensus with clients in achieving medical decisions by balancing medical authority with the sensitivity to the treatment relationship. PMID:26046726

  6. Foreign accent syndrome: a multimodal evaluation in the search of neuroscience-driven treatments.

    PubMed

    Moreno-Torres, Ignacio; Berthier, Marcelo L; Del Mar Cid, Maria; Green, Cristina; Gutiérrez, Antonio; García-Casares, Natalia; Froudist Walsh, Seán; Nabrozidis, Alejandro; Sidorova, Julia; Dávila, Guadalupe; Carnero-Pardo, Cristóbal

    2013-02-01

    Foreign accent syndrome (FAS) is a rare condition which is placed in the mildest end of the spectrum of speech disorders. The impairment, not severe enough to elicit phonological errors, is associated with various alterations in the fine execution of speech sounds which cause the impression of foreignness. There is a growing interest in the study of linguistic and paralinguistic components, psychosocial aftermaths, and neural basis of FAS, but there are not yet neuroscience-driven treatments for this condition. A multimodal evaluation was conducted in a single patient with the aim of searching for clues which may assist to design neuroscience-driven therapies. The patient was a middle-aged bilingual woman who had chronic FAS. She had segmental deficits, abnormal production of linguistic and emotional prosody, impaired verbal communication, and reduced motivation and social engagement. Magnetic resonance imaging showed bilateral small lesions mainly affecting the left deep frontal operculum and dorsal anterior insula. Diffusion tensor tractography suggested disrupted left deep frontal operculum-anterior insula connectivity. Metabolic activity measured with positron emission tomography was primarily decreased in key components of networks implicated in planning and execution of speech production, cognitive control and emotional communication (Brodmann's areas 4/6/9/10/13/25/47, basal ganglia, and anterior cerebellar vermis). Compensatory increases of metabolic activity were found in cortical areas (left anterior cingulate gyrus, left superior temporal gyrus and right prefrontal cortex) associated with feedback and focal attention processes critical for monitoring and adjustment of verbal utterances. Moreover, bilateral structural and functional abnormalities probably interrupted the trajectory of the lateral and medial cholinergic pathways causing region-specific hypoactivity. The results from this study provide targets for further investigation and some clues to

  7. Shared Treatment Decision Making Improves Adherence and Outcomes in Poorly Controlled Asthma

    PubMed Central

    Wilson, Sandra R.; Strub, Peg; Buist, A. Sonia; Knowles, Sarah B.; Lavori, Philip W.; Lapidus, Jodi; Vollmer, William M.

    2010-01-01

    Rationale: Poor adherence to asthma controller medications results in poor treatment outcomes. Objectives: To compare controller medication adherence and clinical outcomes in 612 adults with poorly controlled asthma randomized to one of two different treatment decision-making models or to usual care. Methods: In shared decision making (SDM), nonphysician clinicians and patients negotiated a treatment regimen that accommodated patient goals and preferences. In clinician decision making, treatment was prescribed without specifically eliciting patient goals/preferences. The otherwise identical intervention protocols both provided asthma education and involved two in-person and three brief phone encounters. Measurements and Main Results: Refill adherence was measured using continuous medication acquisition (CMA) indices—the total days' supply acquired per year divided by 365 days. Cumulative controller medication dose was measured in beclomethasone canister equivalents. In follow-up Year 1, compared with usual care, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.46; P < 0.0001) and long-acting β-agonist adherence (CMA, 0.51 vs. 0.40; P = 0.0225); higher cumulative controller medication dose (canister equivalent, 10.9 vs. 5.2; P < 0.0001); significantly better clinical outcomes (asthma-related quality of life, health care use, rescue medication use, asthma control, and lung function). In Year 2, compared with usual care, SDM resulted in significantly lower rescue medication use, the sole clinical outcome available for that year. Compared with clinician decision making, SDM resulted in: significantly better controller adherence (CMA, 0.67 vs. 0.59; P = 0.03) and long-acting β-agonist adherence (CMA, 0.51 vs. 0.41; P = 0.0143); higher cumulative controller dose (CMA, 10.9 vs. 9.1; P = 0.005); and quantitatively, but not significantly, better outcomes on all clinical measures. Conclusions: Negotiating patients' treatment decisions

  8. SU-D-BRD-05: Decision Opportunities in Radiation Therapy Treatments

    SciTech Connect

    Watkins, W.T.; Siebers, J.V.

    2014-06-01

    Purpose: A method to reveal tradeoffs in radiation therapy treatments is introduced in order to aid in clinical, patient-specific decision making. Methods: A clinically acceptable treatment plan was varied for two patients, a stereotactic body radiation therapy (SBRT) lung cancer case and a pituitary case, in order to reveal decision opportunities. Plans were optimized such that non-zero dose-volume objectives were defined for all organs at risk (OARS). At fixed planning target volume (PTV) dose, a single OAR is sacrificed, i.e. the weight of the dose volume objective is deceased, and potential dosimetric benefits in other regions of interest are identified. If tradeoffs are identified, plans are stored and presented as decision opportunities. Results: Clinically relevant tradeoffs were revealed by sacrificing individual OARs. The SBRT lung case was planned according to the Radiotherapy-Oncology Group (RTOG) 0813 protocol, but by violating the high-dose protocol objective (>2 cm from the PTV) in the patient's lung, mean heart dose was reduced by 1.7 Gy and the great vessel V20 was reduced from 42% to 2%. Tradeoffs in dose to the chestwall and heart were also revealed, an increase of 6 Gy in chestwall-Dmax reduces heart mean dose by 0.9 Gy and mean dose to the great vessels by 2.6 Gy. For the pituitary tumor, sacrificing the right parotid gland (increasing mean dose from 7.8 Gy to 14.1 Gy) spares the temporal lobes bilaterally (V20 is reduced by 4%) and left parotid mean dose is reduced from 6.4 Gy to 5.2 Gy. Conclusion: Clinical tradeoffs in radiation therapy treatment planning are revealed by sacrificing individual OARS. By revealing these tradeoffs, decision making in plan selection is simplified and can be considered in the context of patient-specific quality of life.

  9. Young Breast Cancer Survivors: Their Perspectives on Treatment Decisions and Fertility Concerns

    PubMed Central

    Gorman, Jessica R.; Usita, Paula; Madlensky, Lisa; Pierce, John P.

    2010-01-01

    Background Younger women diagnosed with breast cancer are more likely to have survival concerns related to fertility, which may influence their treatment decisions. Objective This qualitative study explores how young women make cancer treatment decisions and the role of fertility concerns in that process. Intervention/Methods We used purposeful sampling to identify a diverse group of 20 young breast cancer survivors, half of whom had a child after breast cancer. We conducted open-ended telephone interviews and used cross-case, inductive analysis to identify themes. Results The main themes were: 1) I was young, I wanted to do everything possible to move forward with my life and not to have the cancer come back, 2) Fertility concerns are different for every woman 3) My oncologist was great… a huge part of my survivorship, and 4) They didn’t tell me about my options and I didn’t think about fertility until it was too late. Conclusions While fertility was important to many participants, treatment decisions were mainly motivated by survival concerns. Fertility concerns depended on life circumstances and the timing in relation to diagnosis varied. There is a need for improved information regarding the impact of treatment on fertility and fertility preservation options, even if concerns are not expressed at diagnosis. Implications for Practice It is critical that cancer care providers provide timely information regarding fertility. Oncology nurses are particularly well-positioned to serve this role by communicating with patients about their fertility concerns and reproductive planning prior to treatment and throughout the course of survivorship. PMID:20697269

  10. [Human body meridian spatial decision support system for clinical treatment and teaching of acupuncture and moxibustion].

    PubMed

    Wu, Dehua

    2016-01-01

    The spatial position and distribution of human body meridian are expressed limitedly in the decision support system (DSS) of acupuncture and moxibustion at present, which leads to the failure to give the effective quantitative analysis on the spatial range and the difficulty for the decision-maker to provide a realistic spatial decision environment. Focusing on the limit spatial expression in DSS of acupuncture and moxibustion, it was proposed that on the basis of the geographic information system, in association of DSS technology, the design idea was developed on the human body meridian spatial DSS. With the 4-layer service-oriented architecture adopted, the data center integrated development platform was taken as the system development environment. The hierarchical organization was done for the spatial data of human body meridian via the directory tree. The structured query language (SQL) server was used to achieve the unified management of spatial data and attribute data. The technologies of architecture, configuration and plug-in development model were integrated to achieve the data inquiry, buffer analysis and program evaluation of the human body meridian spatial DSS. The research results show that the human body meridian spatial DSS could reflect realistically the spatial characteristics of the spatial position and distribution of human body meridian and met the constantly changeable demand of users. It has the powerful spatial analysis function and assists with the scientific decision in clinical treatment and teaching of acupuncture and moxibustion. It is the new attempt to the informatization research of human body meridian. PMID:26946752

  11. The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others.

    PubMed

    Lafrance Robinson, Adele; Kosmerly, Stacey

    2015-01-01

    Eating disorder clinicians from various disciplines participated in one of two surveys: the "self" group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the "other" group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent. PMID:25401960

  12. Effects of Temperature and Acidic Pre-Treatment on Fenton-Driven Oxidation of MTBE-Spent Granular Activated Carbon

    EPA Science Inventory

    Temperature-dependent mechanisms in the Fenton-driven chemical oxidation of methyl tert-butyl ether (MTBE)-spent granular activated carbon (GAC) was investigated. Prior to iron (Fe) amendment to the GAC, acid-treatment altered the surface chemistry of the GAC and lowered the pH ...

  13. Effects on temperature and acidic pre-treatment on Fenton-driven oxidation of MTBE-spent granular activated carbon

    EPA Science Inventory

    Temperature-dependent mechanisms in the Fenton-driven chemical oxidation of methyl tert-butyl ether (MTBE)-spent granular activated carbon (GAC) was investigated. Prior to iron (Fe) amendment to the GAC, acid-treatment altered the surface chemistry of the GAC and lowered the p...

  14. Assessing the Value of New Treatments for Hepatitis C: Are International Decision Makers Getting this Right?

    PubMed

    Woods, Beth; Faria, Rita; Griffin, Susan

    2016-05-01

    Health systems worldwide are facing difficult choices about the use of a series of highly effective but costly new treatments for hepatitis C. In this paper we discuss how the National Institute for Health and Care Excellence in England and Wales, the Common Drug Review in Canada and the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia have approached the appraisal of these drugs. We argue that with the exception of the PBAC, assessments of the new drugs have not adequately accounted for their large financial burden. Given the potential health system impact of reimbursing these drugs, the use of lower cost-effectiveness thresholds should be considered. None of the decision-making processes included a comparison of the full range of treatment pathways. In particular, comparisons of using the new drugs as first- versus second-line drugs were omitted from all appraisals, as were comparisons with delayed treatment strategies whereby treatment is withheld until more severe disease stages. Omission of comparators leads to inaccurate estimates of cost effectiveness and potentially sub-optimal decision making. Lessons learned from these appraisals should be considered in future appraisals, particularly the upcoming assessments of the 'blockbuster' PCSK9 inhibitors for hypercholesterolaemia. PMID:26714687

  15. Clinical impact of treatment timing for chronic hepatitis C infection: a decision model

    PubMed Central

    Pho, M T; Jensen, D M; Meltzer, D O; Kim, A Y; Linas, B P

    2015-01-01

    Recent advances in the treatment of hepatitis C virus (HCV) infection have led to the availability of both highly efficacious interferon-containing and interferon-sparing regimens. However, the use of such therapies faces restrictions due to high costs. For patients who are medically eligible to receive interferon, the choice between the two will likely be impacted by preferences surrounding interferon, severity of disease, coverage policies and out-of-pocket costs. We developed a decision model to quantify the trade-offs between immediate, interferon-containing therapy and delayed, interferon-free therapy for patients with chronic, genotype 1 HCV infection. We projected the quality-adjusted life expectancy stratified by the presence or absence of cirrhosis for four strategies: (i) no treatment; (ii) immediate, one-time treatment with an interferon-containing regimen; (iii) immediate treatment as above with the opportunity for retreatment in patients who fail to achieve sustained virologic response with interferon-free therapy in 1 year; and (iv) delayed therapy with interferon-free therapy in 1 year. When compared to one-time immediate treatment with the interferon-containing regimen, delayed treatment with the interferon-free regimen in 1 year resulted in longer life expectancy, with a 0.2 quality-adjusted life year (QALY) increase in noncirrhotic patients, and a 1.1 QALY increase in patients with cirrhosis. This superiority in health benefits was lost when wait time for interferon-free therapy was greater than 3–3.2 years. In this modelling analysis, interferon-free therapy resulted in superior health benefits compared to immediate therapy with interferon until wait time exceeded 3–3.2 years. Such data can inform decision-making regarding treatment initiation for HCV as healthcare financing evolves. PMID:26135026

  16. Staging laparoscopy improves treatment decision-making for advanced gastric cancer

    PubMed Central

    Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin

    2016-01-01

    AIM: To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). METHODS: Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ2 test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. RESULTS: Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P < 0.05) for staging laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P < 0.05) for staging laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed. CONCLUSION: Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy. PMID:26855545

  17. Data-driven decision support for radiologists: re-using the National Lung Screening Trial dataset for pulmonary nodule management.

    PubMed

    Morrison, James J; Hostetter, Jason; Wang, Kenneth; Siegel, Eliot L

    2015-02-01

    Real-time mining of large research trial datasets enables development of case-based clinical decision support tools. Several applicable research datasets exist including the National Lung Screening Trial (NLST), a dataset unparalleled in size and scope for studying population-based lung cancer screening. Using these data, a clinical decision support tool was developed which matches patient demographics and lung nodule characteristics to a cohort of similar patients. The NLST dataset was converted into Structured Query Language (SQL) tables hosted on a web server, and a web-based JavaScript application was developed which performs real-time queries. JavaScript is used for both the server-side and client-side language, allowing for rapid development of a robust client interface and server-side data layer. Real-time data mining of user-specified patient cohorts achieved a rapid return of cohort cancer statistics and lung nodule distribution information. This system demonstrates the potential of individualized real-time data mining using large high-quality clinical trial datasets to drive evidence-based clinical decision-making. PMID:24965276

  18. Multicriteria decision approaches to support sustainable drainage options for the treatment of highway and urban runoff.

    PubMed

    Ellis, J B; Deutsch, J-C; Mouchel, J-M; Scholes, L; Revitt, M D

    2004-12-01

    The control and treatment of urban and highway runoff involves a variety of stakeholders in the selection of sustainable drainage systems (SUDS) as the design process needs to consider not only water quantity but also water quality and amenity. Thus, technical, environmental/ecological, social/community and economic cost factors become prime potential sustainability criteria in terms of assessing long-term, cost-effective drainage options. The paper develops a multicriteria analysis methodology for the evaluation and accreditation of SUDS structures within the context of an overall decision-support framework. Approaches independently developed in the UK and France are outlined with the common multicriteria structures defining generic performance criteria together with supporting benchmark standards and exclusion thresholds. A French case study is presented to illustrate the approach and to highlight the inherent constraints and subjectivity embedded in the decision-making process. PMID:15504512

  19. To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles

    PubMed Central

    Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

    2015-01-01

    Aim To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment. Methods Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture. Conclusions A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa. PMID:26559947

  20. A Social Approach to Decision-Making Capacity: Exploratory Research with People with Experience of Mental Health Treatment

    ERIC Educational Resources Information Center

    McDaid, Shari; Delaney, Sarah

    2011-01-01

    This paper reports on exploratory, qualitative research conducted with eight people with experience of mental health treatment about their understanding of decision-making capacity. While acknowledging that there are times when mental or emotional distress can interfere with the capacity to make decisions, participants described how their capacity…

  1. Reducing microplastics from facial exfoliating cleansers in wastewater through treatment versus consumer product decisions.

    PubMed

    Chang, Michelle

    2015-12-15

    Microplastics (<5mm) have been discovered in fresh and saltwater ecosystems, sediments, and wastewater effluent around the world. Their ability to persist and accumulate up food chains should be a concern as research is still experimenting with techniques to assess their long-term effects on the environment. I sought to characterize the microbeads found in facial exfoliating cleansers so as to better understand how to reduce this source of pollution through consumer use and wastewater treatment solutions. By sampling products from national-grossing cosmetic personal care brands, I was able to gather information on the size, color, volume, mass, and concentration of polyethylene beads in the cleansers. From that data, I modeled onto a consumer survey the estimated volume of microplastics entering a wastewater stream. Through inquiry, I learned the practices of two local wastewater treatment facilities. My findings show that consumer decisions and treatment protocols both play crucial parts in minimizing microplastic pollution. PMID:26563542

  2. Innovation Attributes and Adoption Decisions: Perspectives from Leaders of a National Sample of Addiction Treatment Organizations

    PubMed Central

    Knudsen, Hannah K.; Roman, Paul M

    2014-01-01

    Drawing on diffusion theory to further knowledge about evidence-based practices (EBPs) in the treatment of substance use disorders (SUDs), this study describes the perceived importance of innovation attributes in adoption decisions within a national sample of SUD treatment organizations. Face-to-face interviews were conducted with leaders of 307 organizations. A typology differentiated organizations reporting: (1) adoption of a treatment innovation in the past year (“recent adoption”), (2) plans to adopt an innovation in the upcoming year (“planned adoption”), or (3) no actual or planned adoption (“non-adoption”). About 30.7% of organizations reported recent adoption, 20.5% indicated planned adoption, and 48.8% were non-adopters. Leaders of organizations reporting recent adoption (n = 93) or planned adoption (n = 62) rated the importance of innovation attributes, including relative advantage, compatibility, complexity, and observability, on these adoption decisions using a Likert scale that ranged from 0 to 5. Innovation attributes most strongly endorsed were consistency with the program's treatment philosophy (mean = 4.47, SD = 1.03), improvement in the program's reputation with referral sources (mean = 4.00, SD = 1.33), reputational improvement with clients and their families (mean = 3.98, SD = 1.31), and reductions in treatment dropout (mean = 3.75, SD = 1.54). Innovation characteristics reflecting organizational growth and implementation costs were less strongly endorsed. Adopters and planners were generally similar in their importance ratings. There were modest differences in importance ratings when pharmacological innovations were compared to psychosocial interventions. These findings are consistent with diffusion theory and suggest that efforts to link EBPs with client satisfaction and potential reputational benefits may enhance the diffusion of EBPs. Attention to these attributes when developing and evaluating SUD treatment interventions may

  3. CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.

    PubMed

    Chow, Grant V; Czarny, Matthew J; Hughes, Mark T; Carrese, Joseph A

    2010-02-01

    The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event. PMID:20133288

  4. Shared Decision-Making in the Primary Care Treatment of Late-Life Major Depression: A Needed New Intervention?

    PubMed Central

    Raue, Patrick J.; Schulberg, Herbert C.; Lewis-Fernandez, Roberto; Boutin-Foster, Carla; Hoffman, Amy S.; Bruce, Martha L.

    2010-01-01

    Objective We suggest that clinicians consider models of shared decision-making for their potential ability to improve the treatment of major depression in the primary care setting and overcome limitations of collaborative care and other interventions. Methods We explore the characteristics and techniques of patient-clinician shared decision-making, with particular emphasis on this model’s relevance to the unique treatment concerns of depressed older adults. Results We describe a shared decision-making intervention to engage older adults in depression treatment in the primary care sector. Conclusions It is timely to examine shared decision-making models for elderly depressed primary care patients given their potential ability to improve treatment adherence and clinical outcomes. PMID:19946872

  5. The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care

    PubMed Central

    2014-01-01

    Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

  6. Laboratory Medicine in the Clinical Decision Support for Treatment of Hypercholesterolemia: Pharmacogenetics of Statins.

    PubMed

    Ruaño, Gualberto; Seip, Richard; Windemuth, Andreas; Wu, Alan H B; Thompson, Paul D

    2016-09-01

    Statin responsiveness is an area of great research interest given the success of the drug class in the treatment of hypercholesterolemia and in primary and secondary prevention of cardiovascular disease. Interrogation of the patient's genome for gene variants will eventually guide anti-hyperlipidemic intervention. In this review, we discuss methodological approaches to discover genetic markers predictive of class-wide and drug-specific statin efficacy and safety. Notable pharmacogenetic findings are summarized from hypothesis-free genome wide and hypothesis-led candidate gene association studies. Physiogenomic models and clinical decision support systems will be required for DNA-guided statin therapy to reach practical use in medicine. PMID:27514463

  7. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

    PubMed Central

    Heggland, Liv-Helen; Øgaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

    2012-01-01

    The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation. PMID:22830010

  8. Data and Model-Driven Decision Support for Environmental Management of a Chromium Plume at Los Alamos National Laboratory - 13264

    SciTech Connect

    Vesselinov, Velimir V.; Broxton, David; Birdsell, Kay; Reneau, Steven; Harp, Dylan; Mishra, Phoolendra; Katzman, Danny; Goering, Tim; Vaniman, David; Longmire, Pat; Fabryka-Martin, June; Heikoop, Jeff; Ding, Mei; Hickmott, Don; Jacobs, Elaine

    2013-07-01

    A series of site investigations and decision-support analyses have been performed related to a chromium plume in the regional aquifer beneath the Los Alamos National Laboratory (LANL). Based on the collected data and site information, alternative conceptual and numerical models representing governing subsurface processes with different complexity and resolution have been developed. The current conceptual model is supported by multiple lines of evidence based on comprehensive analyses of the available data and modeling results. The model is applied for decision-support analyses related to estimation of contaminant- arrival locations and chromium mass flux reaching the regional aquifer, and to optimization of a site monitoring-well network. Plume characterization is a challenging and non-unique problem because multiple models and contamination scenarios are consistent with the site data and conceptual knowledge. To solve this complex problem, an advanced methodology based on model calibration and uncertainty quantification has been developed within the computational framework MADS (http://mads.lanl.gov). This work implements high-performance computing and novel, efficient and robust model analysis techniques for optimization and uncertainty quantification (ABAGUS, Squads, multi-try (multi-start) techniques), which allow for solving problems with large degrees of freedom. (authors)

  9. Avoidant decision-making in social anxiety disorder: A laboratory task linked to in vivo anxiety and treatment outcome.

    PubMed

    Pittig, Andre; Alpers, Georg W; Niles, Andrea N; Craske, Michelle G

    2015-10-01

    Recent studies on reward-based decision-making in the presence of anxiety-related stimuli demonstrated that approach-avoidance conflicts can be assessed under controlled laboratory conditions. However, the clinical relevance of these decision conflicts has not been demonstrated. To this end, the present study investigated avoidant decisions in treatment-seeking individuals with social anxiety disorder (SAD). In a gambling task, advantageous choices to maximize gains were associated with task-irrelevant angry faces and disadvantageous choices with happy faces. The clinical relevance of avoidant decisions for in vivo anxiety in a social stress situation (public speaking) were examined (n = 44). In a subsample (n = 20), the predictive value for a reduction of avoidance following behavioral therapy was also evaluated. Results indicated a close link between more frequent avoidant decisions and elevated in vivo anxiety. Moreover, individuals who showed a deficit in the goal-directed adjustment of their decisions also showed higher and sustained distress during the social stressor and reported less decrease of avoidance following treatment. The findings highlight the importance of an avoidant decision-making style for the experience of acute distress and the maintenance of avoidance in SAD. Assessing avoidant decision-making may help to predict the response to behavioral treatments. PMID:26301755

  10. Parent Perspectives on the Decision to Initiate Medication Treatment of Attention-Deficit/Hyperactivity Disorder

    PubMed Central

    Pappadopulos, Elizabeth; Katsiotas, Nikki J.; Berest, Alison; Jensen, Peter S.; Kafantaris, Vivian

    2012-01-01

    Abstract Objectives Despite substantial evidence supporting the efficacy of stimulant medication for children with attention-deficit/hyperactivity disorder (ADHD), adherence to stimulant treatment is often suboptimal. Applying social/cognitive theories to understanding and assessing parent attitudes toward initiating medication may provide insight into factors influencing parent decisions to follow ADHD treatment recommendations. This report describes results from formative research that used focus groups to obtain parent input to guide development of a provider-delivered intervention to improve adherence to stimulants. Methods Participants were caregivers of children with ADHD who were given a stimulant treatment recommendation. Focus groups were recorded and transcribed verbatim. Data were analyzed by inductive, grounded theory methods as well as a deductive analytic strategy using an adapted version of the Unified Theory of Behavior Change to organize and understand parent accounts. Results Five groups were conducted with 27 parents (mean child age=9.35 years; standard deviation [SD]=2.00), mean time since diagnosis=3.33 years (SD=2.47). Most parents (81.5%) had pursued stimulant treatment. Inductive analysis revealed 17 attitudes facilitating adherence and 25 barriers. Facilitators included parent beliefs that medication treatment resulted in multiple functional gains and that treatment was imperative for their children's safety. Barriers included fears of personality changes and medication side effects. Complex patterns of parent adherence to medication regimens were also identified, as well as preferences for psychiatrists who were diagnostically expert, gave psychoeducation using multiple modalities, and used a chronic illness metaphor to explain ADHD. Theory-based analyses revealed conflicting expectancies about treatment risks and benefits, significant family pressures to avoid medication, guilt and concern that their children required medication, and

  11. Effect of a perspective-taking intervention on the consideration of pain assessment and treatment decisions

    PubMed Central

    Wandner, Laura D; Torres, Calia A; Bartley, Emily J; George, Steven Z; Robinson, Michael E

    2015-01-01

    Objectives Pain is often poorly managed, highlighting the need to better understand and treat patients’ pain. Research suggests that pain is assessed and treated differently depending on patient sex, race, and/or age. Perspective-taking, whereby one envisions the perspective of another, has been found to reduce racial disparities in pain management. This study used virtual human (VH) technology to examine whether a perspective-taking intervention impacts pain management decisions. Methods Ninety-six participants were randomized to an online treatment or control group and viewed 16 video clips of VHs with standardized levels of pain. Participants provided ratings on the VHs’ pain intensity and their willingness to administer opioids to them. The intervention group received a brief perspective-taking intervention that consisted of having participants imagine how the patient’s suffering could affect his/her life, whereas the control group was asked to wait for the next VH videos to load. A LENS model analysis was used to investigate both group level (nomothetic) and individual level (idiographic) decision policies. A LENS model of analysis is typically used as an analog method for capturing how groups of people and individuals use information in their environment to form judgments. Results Nomothetic results found that participants rated pain higher and were more likely to prescribe opioids to VHs postintervention, irrespective of group. Idiographic results, however, found that the use of cues to make pain management decisions was mitigated by the perspective-taking group. The participants in the perspective-taking group were more likely to think about pain and the patients’ perspective during the intervention, while control participants were more likely to reflect on the VHs’ sex, race, or age. Conclusion A brief intervention may alter participants’ pain management decisions. These results indicate that a brief intervention might be an initial step toward

  12. Behaviours and attitudes influencing treatment decisions for menopausal symptoms in five European countries

    PubMed Central

    Graham, Shelli; Clerinx, Cathy; Bernick, Brian A; Krassan, Mitchell; Mirkin, Sebastian; Currie, Heather

    2016-01-01

    Objective To assess women’s behaviours and attitudes regarding the treatment of menopausal symptoms in five European countries. Study design Women aged ≥45 years in France, Germany, Italy, Spain, and the United Kingdom participated in an internet survey. Completers were those who reported menopausal symptoms and had treated their symptoms. Women were equally stratified by age (45–54 years, 55–64 years, ≥65 years). Main outcome measures Behaviours, attitudes, and experiences regarding treatment of menopausal symptoms. Results Of 3890 peri- to postmenopausal women screened, 67% experienced symptoms and 54% sought either medical input or some treatment concerning their symptoms. Hot flushes, the most common symptom, decreased with age but remained prevalent after age 64. Roughly 75% of women who sought relief consulted a physician, mostly a gynaecologist or a general practitioner (GP) as in the United Kingdom. The decision to seek treatment was influenced by age, number, and severity of symptoms. Approximately 79% visiting a physician received prescription therapy. Of the women who received non-hormone therapy (HT) treatment instead of HT: patients refused HT (20–44%), physicians did not discuss HT (32–46%), or advised against HT (24–43%). Women in the United Kingdom were most familiar with and favorable to HT. Interest in a new HT (34–50%) was higher than use (19–28%). Conclusions Menopausal symptoms are common, persistent, and bothersome, but many fail to seek treatment. Sources and types of treatment vary among age groups and countries. Education regarding women’s attitudes toward treatment should be provided to those physicians who treat menopausal symptoms in each country. PMID:26895640

  13. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

    PubMed Central

    Mardani-Kivi, Mohsen; Zohrevandi, Behzad; Saheb-Ekhtiari, Khashayar; Hashemi-Motlagh, Keyvan

    2016-01-01

    Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1±3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education. PMID:26894221

  14. Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

    PubMed Central

    Ahn, Henry; Bailey, Christopher S.; Rivers, Carly S.; Noonan, Vanessa K.; Tsai, Eve C.; Fourney, Daryl R.; Attabib, Najmedden; Kwon, Brian K.; Christie, Sean D.; Fehlings, Michael G.; Finkelstein, Joel; Hurlbert, R. John; Townson, Andrea; Parent, Stefan; Drew, Brian; Chen, Jason; Dvorak, Marcel F.

    2015-01-01

    Background: Older people are at increased risk of traumatic spinal cord injury from falls. We evaluated the impact of older age (≥ 70 yr) on treatment decisions and outcomes. Methods: We identified patients with traumatic spinal cord injury for whom consent and detailed data were available from among patients recruited (2004–2013) at any of the 31 acute care and rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry. Patients were assessed by age group (< 70 v. ≥ 70 yr). The primary outcome was the rate of acute surgical treatment. We used bivariate and multivariate regression models to assess patient and injury-related factors associated with receiving surgical treatment and with the timing of surgery after arrival to a participating centre. Results: Of the 1440 patients included in our study cohort, 167 (11.6%) were 70 years or older at the time of injury. Older patients were more likely than younger patients to be injured by falling (83.1% v. 37.4%; p < 0.001), to have a cervical injury (78.0% v. 61.6%; p = 0.001), to have less severe injuries on admission (American Spinal Injury Association Impairment Scale grade C or D: 70.5% v. 46.9%; p < 0.001), to have a longer stay in an acute care hospital (median 35 v. 28 d; p < 0.005) and to have a higher in-hospital mortality (4.2% v. 0.6%; p < 0.001). Multivariate analysis did not show that age of 70 years or more at injury was associated with a decreased likelihood of surgical treatment (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI] 0.22–1.07). An unplanned sensitivity analysis with different age thresholds showed that a threshold of 65 years was associated with a decreased chance of surgical treatment (OR 0.39, 95% CI 0.19–0.80). Older patients who underwent surgical treatment had a significantly longer wait time from admission to surgery than younger patients (37 v. 19 h; p < 0.001). Interpretation: We found chronological age to be a factor influencing

  15. Operator decision support system for integrated wastewater management including wastewater treatment plants and receiving water bodies.

    PubMed

    Kim, Minsoo; Kim, Yejin; Kim, Hyosoo; Piao, Wenhua; Kim, Changwon

    2016-06-01

    An operator decision support system (ODSS) is proposed to support operators of wastewater treatment plants (WWTPs) in making appropriate decisions. This system accounts for water quality (WQ) variations in WWTP influent and effluent and in the receiving water body (RWB). The proposed system is comprised of two diagnosis modules, three prediction modules, and a scenario-based supporting module (SSM). In the diagnosis modules, the WQs of the influent and effluent WWTP and of the RWB are assessed via multivariate analysis. Three prediction modules based on the k-nearest neighbors (k-NN) method, activated sludge model no. 2d (ASM2d) model, and QUAL2E model are used to forecast WQs for 3 days in advance. To compare various operating alternatives, SSM is applied to test various predetermined operating conditions in terms of overall oxygen transfer coefficient (Kla), waste sludge flow rate (Qw), return sludge flow rate (Qr), and internal recycle flow rate (Qir). In the case of unacceptable total phosphorus (TP), SSM provides appropriate information for the chemical treatment. The constructed ODSS was tested using data collected from Geumho River, which was the RWB, and S WWTP in Daegu City, South Korea. The results demonstrate the capability of the proposed ODSS to provide WWTP operators with more objective qualitative and quantitative assessments of WWTP and RWB WQs. Moreover, the current study shows that ODSS, using data collected from the study area, can be used to identify operational alternatives through SSM at an integrated urban wastewater management level. PMID:26893178

  16. eHealth-as-a-Service (eHaaS): a data-driven decision making approach in Australian context.

    PubMed

    Black, Alofi; Sahama, Tony; Gajanayake, Randike

    2014-01-01

    A commitment in 2010 by the Australian Federal Government to spend $466.7 million dollars on the implementation of personally controlled electronic health records (PCEHR) heralded a shift to a more effective and safer patient centric eHealth system. However, deployment of the PCEHR has met with much criticism, emphasised by poor adoption rates over the first 12 months of operation. An indifferent response by the public and healthcare providers largely sceptical of its utility and safety speaks to the complex sociotechnical drivers and obstacles inherent in the embedding of large (national) scale eHealth projects. With government efforts to inflate consumer and practitioner engagement numbers giving rise to further consumer disillusionment, broader utilitarian opportunities available with the PCEHR are at risk. This paper discusses the implications of establishing the PCEHR as the cornerstone of a holistic eHealth strategy for the aggregation of longitudinal patient information. A viewpoint is offered that the real value in patient data lies not just in the collection of data but in the integration of this information into clinical processes within the framework of a commoditised data-driven approach. Consideration is given to the eHealth-as-a-Service (eHaaS) construct as a disruptive next step for co-ordinated individualised healthcare in the Australian context. PMID:25160321

  17. Making decisions about treatment for young people diagnosed with depressive disorders: a qualitative study of clinicians’ experiences

    PubMed Central

    2013-01-01

    Background The imperative to provide effective treatment for young people diagnosed with depressive disorders is complicated by several factors including the unclear effectiveness of treatment options. Within this context, little is known about how treatment decisions are made for this population. Methods In order to explore the experiences and beliefs of clinicians about treatment decision making for this population, semi-structured, qualitative interviews were conducted with 22 psychiatrists, general practitioners and allied health professionals from health care settings including specialist mental health services and primary health care. Interviews were audio taped, transcribed verbatim and analysed using thematic analysis. Results Clinicians largely reported and endorsed a collaborative model of treatment decision making for youth depression, although several exceptions to this approach were also described (e.g. when risk issues were present), highlighting a need to adapt the decision-making style to the characteristics and needs of the client. A differentiation was made between the decision-making processes (e.g. sharing of information) and who makes the decision. Caregiver involvement was seen as optional, especially in situations where no caregivers were involved, but ideal and useful if the caregivers were supportive. Gaps between the type and amount of information clinicians wanted to give their clients and what they actually gave them were reported (e.g. having fact sheets on hand). A broad range of barriers to involving clients and caregivers in decision-making processes were described relating to four levels (client and caregiver, clinician, service and broader levels) and suggestions were given to help overcome these barriers, including up-to-date, accessible and relevant information. Conclusions The current data support a collaborative model of treatment decision making for youth depression which: 1) focuses on the decision-making processes rather

  18. Management of frontal sinus fractures--treatment decision based on metric dislocation extent.

    PubMed

    Dalla Torre, Daniel; Burtscher, Doris; Kloss-Brandstätter, Anita; Rasse, Michael; Kloss, Frank

    2014-10-01

    The treatment of frontal sinus fractures is still a matter of research in neurosurgical and craniofacial surgery. The present study aimed to determine new criteria regarding surgical or observational treatment, especially concerning the fracture dislocation. Clinical information on 164 consecutive patients with fractures of the frontal sinus, treated at the Department of Craniomaxillofacial Surgery of the Medical University of Innsbruck from 2006 to 2010, have been evaluated. 23 female (14%) and 141 male (86%) patients suffered mainly from traffic (31.7%) and sports accidents (28.0%), followed by work accidents (20.1%), violence (3.7%) and accidents at home (3.1%). 51.8% presented an isolated fracture of the anterior wall, 47.6% both anterior and posterior wall fracture, 0.6% an isolated posterior wall fracture. Injury of the nasofrontal duct was found in 29.2%, CSF liquorrhoea in 15.9%. In total, 44.5% of the patients underwent surgical therapy, 55.5% were treated conservatively by observation. Treatment decision depended significantly on concomitant injuries of the nasofrontal duct and the presence of rhinoliquorrhoea as well as on the fracture dislocation. A new classification of frontal sinus fractures depending on their maximum dislocation is proposed. In addition, a treatment algorithm considering displacement, liquorrhoea and injury of the nasofrontal duct is presented. PMID:24942098

  19. Primary Care Providers’ Initial Treatment Decisions and Antidepressant Prescribing for Adolescent Depression

    PubMed Central

    Radovic, Ana; Farris, Coreen; Reynolds, Kerry; Reis, Evelyn C.; Miller, Elizabeth; Stein, Bradley D.

    2014-01-01

    OBJECTIVE Adolescent depression is a serious and undertreated public health problem. Nonetheless, pediatric primary care providers (PCPs) may have low rates of antidepressant prescribing due to structural and training barriers. We examined the impact of symptom severity and provider characteristics on initial depression treatment decisions in a setting with fewer structural barriers, an integrated behavioral health network. METHOD We administered a cross sectional survey to 58 PCPs within a large pediatric practice network. We compared PCP reports of initial treatment decisions in response to two vignettes describing depressed adolescents with either moderate or severe symptoms. We measured PCP depression knowledge, attitudes toward addressing psychosocial concerns, demographics, and practice characteristics. RESULTS Few PCPs (25% for moderate, 32% for severe) recommended an antidepressant. Compared with treatment recommendations for moderate depression, severe depression was associated with a greater likelihood of child psychiatry referral (OR 5.50[95% CI 2.47-12.2] p<.001). Depression severity did not affect the likelihood of antidepressant recommendation (OR 1.58[95% CI 0.80-3.11] p=.19). Antidepressants were more likely to be recommended by PCPs with greater depression knowledge (OR 1.72[95% CI 1.14-2.59] p=.009) and access to an on-site mental health provider (OR 5.13[95% CI 1.24-21.2] p=.02) and less likely to be recommended by PCPs who reported higher provider burden when addressing psychosocial concerns (OR 0.85[95% CI 0.75-0.98] p=.02). CONCLUSION PCPs infrequently recommended antidepressants for adolescents, regardless of depression severity. Continued PCP support through experiential training, accounting for provider burden when addressing psychosocial concerns, and co-management with mental health providers may increase PCPs’ antidepressant prescribing. PMID:24336091

  20. Data: Mining with a Mission- Data-Driven Decision Making Is the Buzz Phrase of Choice for the New Decade. but Once We've Got the Information, How Do We Use It to Yield Results?

    ERIC Educational Resources Information Center

    Salpeter, Judy

    2004-01-01

    For some districts, the current obsession with data grows out of the need to comply with No Child Left Behind and additional accountability-related mandates. For others, it dates way back before the phrase "data-driven decision making" rolled so frequently off the tongues of educators. In either case, there is no denying that an integral part of…

  1. Perspectives of parents on making decisions about the care and treatment of a child with cancer: a review of literature.

    PubMed

    Markward, Martha J; Benner, Kalea; Freese, Rebekah

    2013-12-01

    This review focuses on parental decision making regarding the care and treatment of children with cancer. Articles were abstracted from the following sources: Ovid Databases (Cochrane Database of Systematic Reviews, Database of Abstracts of Review of Effects, Medline, and Social Work Abstracts) and EBSCOhost (Academic Search Premier and Academic Search Complete) using smart text. The criteria for the search were publications between 2005 and 2012 and publication in peer-review journals. The descriptors used were parents of children with cancer, decision making, decisions about childhood cancer, and parents. The search yielded 59 references, but after duplicates, as well as dated and irrelevant articles were removed, 17 articles were identified that focused specifically on the decisions parents make regarding the care and treatment of children with cancer. Coders agreed that the child's quality of life/well-being, parental hope/expectations, support/supportive care, communication, and information were important themes in considering the decisions parents made regarding the care and treatment of children with cancer. These themes provide insight into the needs of parents in making decisions about the care and treatment of children with cancer. PMID:24377769

  2. Actual and Perceived Gender Differences in the Accuracy of Surrogate Decisions about Life-Sustaining Medical Treatment among Older Spouses

    ERIC Educational Resources Information Center

    Zettel-Watson, Laura; Ditto, Peter H.; Danks, Joseph H.; Smucker, William D.

    2008-01-01

    This study examined the influence of surrogate gender on the accuracy of substituted judgments about the use of life-sustaining treatment in a sample of 249 older adults and their self-selected surrogate decision-makers. Overall, wives were more accurate than husbands at predicting their spouses' treatment wishes. Surrogates' perceptions of their…

  3. SU-D-BRE-05: Feasibility and Limitations of Laser-Driven Proton Therapy: A Treatment Planning Study

    SciTech Connect

    Hofmann, K; Wilkens, J; Masood, U; Pawelke, J

    2014-06-01

    Purpose: Laser-acceleration of particles may offer a cost- and spaceefficient alternative for future radiation therapy with particles. Laser-driven particle beams are pulsed with very short bunch times, and a high number of particles is delivered within one laser shot which cannot be portioned or modulated during irradiation. The goal of this study was to examine whether good treatment plans can be produced for laser-driven proton beams and to investigate the feasibility of a laser-driven treatment unit. Methods: An exponentially decaying proton spectrum was tracked through a gantry and energy selection beam line design to produce multiple proton spectra with different energy widths centered on various nominal energies. These spectra were fed into a treatment planning system to calculate spot scanning proton plans using different lateral widths of the beam and different numbers of protons contained in the initial spectrum. The clinical feasibility of the resulting plans was analyzed in terms of dosimetric quality and the required number of laser shots as an estimation of the overall treatment time. Results: We were able to produce treatment plans with plan qualities of clinical relevance for a maximum initial proton number per laser shot of 6*10{sup 8}. However, the associated minimum number of laser shots was in the order of 10{sup 4}, indicating a long delivery time in the order of at least 15 minutes, when assuming an optimistic repetition rate of the laser system of 10 Hz. Conclusion: With the simulated beam line and the assumed shape of the proton spectrum it was impossible to produce clinically acceptable treatment plans that can be delivered in a reasonable time. The situation can be improved by a method or a device in the beam line which can modulate the number of protons from shot to shot. Supported by DFG Cluster of Excellence: Munich-Centre for Advanced Photonics.

  4. What Can Parents Do? A Review of State Laws Regarding Decision Making for Adolescent Drug Abuse and Mental Health Treatment

    PubMed Central

    Kerwin, MaryLouise E.; Kirby, Kimberly C.; Speziali, Dominic; Duggan, Morgan; Mellitz, Cynthia; Versek, Brian; McNamara, Ashley

    2013-01-01

    This study examined US state laws regarding parental and adolescent decision-making for substance use and mental health inpatient and outpatient treatment. State statues for requiring parental consent favored mental health over drug abuse treatment and inpatient over outpatient modalities. Parental consent was sufficient in 53%–61% of the states for inpatient treatment, but only for 39% – 46% of the states for outpatient treatment. State laws favored the rights of minors to access drug treatment without parental consent, and to do so at a younger age than for mental health treatment. Implications for how these laws may impact parents seeking help for their children are discussed. PMID:25870511

  5. [The role of PET/CT in decision-making during cancer treatment. Clinical experience].

    PubMed

    Sinkó, Dániel; Landherr, László

    2012-12-01

    Nowadays PET/CT examinations have got more and more important role during cancer treatment. It has importance not only in diagnostic examination and staging but also in the radiation planning process and measuring the therapeutic effect. From November 2006 to November 2010 there were 153 PET/CT examinations requested by the Oncology Outpatient Clinic, Uzsoki Hospital. Nine patients were excluded from the examination. In the clinical trial we have aimed to measure what the correlation between the oncologists' questions and the PET/CT results was, in how many cases the PET/CT had influence on therapeutic decision-making. In the case of the patients waiting for the operation we compared the results of the pathological examinations to the results of the PET/CT. The oncologists got the expected answers in 79 cases, while in 45 cases the answers were negative. In 10 cases there were no definite answers. Ten cases proved to be false negative or false positive based on the later pathological examination. As a result of the PET/CT findings the originally planned therapeutic decisions or the therapies in process have been modified in 77 cases. To sum up, the PET/CT gave the expected answers to the oncologists' questions in more than half of the cases (54.9%) and modified the originally prescribed therapy in 53.5% of the cases. PMID:23236592

  6. The vexing problem of defining the meaning, role and measurement of values in treatment decision-making.

    PubMed

    Charles, Cathy; Gafni, Amiram

    2014-03-01

    Two international movements, evidence-based medicine (EBM) and shared decision-making (SDM) have grappled for some time with issues related to defining the meaning, role and measurement of values/preferences in their respective models of treatment decision-making. In this article, we identify and describe unresolved problems in the way that each movement addresses these issues. The starting point for this discussion is that at least two essential ingredients are needed for treatment decision-making: research information about treatment options and their potential benefits and risks; and the values/preferences of participants in the decision-making process. Both the EBM and SDM movements have encountered difficulties in defining the meaning, role and measurement of values/preferences in treatment decision-making. In the EBM model of practice, there is no clear and consistent definition of patient values/preferences and no guidance is provided on how to integrate these into an EBM model of practice. Methods advocated to measure patient values are also problematic. Within the SDM movement, patient values/preferences tend to be defined and measured in a restrictive and reductionist way as patient preferences for treatment options or attributes of options, while broader underlying value structures are ignored. In both models of practice, the meaning and expected role of physician values in decision-making are unclear. Values clarification exercises embedded in patient decision aids are suggested by SDM advocates to identify and communicate patient values/preferences for different treatment outcomes. Such exercises have the potential to impose a particular decision-making theory and/or process onto patients, which can change the way they think about and process information, potentially impeding them from making decisions that are consistent with their true values. The tasks of clarifying the meaning, role and measurement of values/preferences in treatment decision

  7. Decision support tools for proton therapy ePR: intelligent treatment planning navigator and radiation toxicity tool for evaluating of prostate cancer treatment

    NASA Astrophysics Data System (ADS)

    Le, Anh H.; Deshpande, Ruchi; Liu, Brent J.

    2010-03-01

    The electronic patient record (ePR) has been developed for prostate cancer patients treated with proton therapy. The ePR has functionality to accept digital input from patient data, perform outcome analysis and patient and physician profiling, provide clinical decision support and suggest courses of treatment, and distribute information across different platforms and health information systems. In previous years, we have presented the infrastructure of a medical imaging informatics based ePR for PT with functionality to accept digital patient information and distribute this information across geographical location using Internet protocol. In this paper, we present the ePR decision support tools which utilize the imaging processing tools and data collected in the ePR. The two decision support tools including the treatment plan navigator and radiation toxicity tool are presented to evaluate prostate cancer treatment to improve proton therapy operation and improve treatment outcomes analysis.

  8. A Clinical Decision Support System for Femoral Peripheral Arterial Disease Treatment

    PubMed Central

    Yurtkuran, Alkın; Tok, Mustafa

    2013-01-01

    One of the major challenges of providing reliable healthcare services is to diagnose and treat diseases in an accurate and timely manner. Recently, many researchers have successfully used artificial neural networks as a diagnostic assessment tool. In this study, the validation of such an assessment tool has been developed for treatment of the femoral peripheral arterial disease using a radial basis function neural network (RBFNN). A data set for training the RBFNN has been prepared by analyzing records of patients who had been treated by the thoracic and cardiovascular surgery clinic of a university hospital. The data set includes 186 patient records having 16 characteristic features associated with a binary treatment decision, namely, being a medical or a surgical one. K-means clustering algorithm has been used to determine the parameters of radial basis functions and the number of hidden nodes of the RBFNN is determined experimentally. For performance evaluation, the proposed RBFNN was compared to three different multilayer perceptron models having Pareto optimal hidden layer combinations using various performance indicators. Results of comparison indicate that the RBFNN can be used as an effective assessment tool for femoral peripheral arterial disease treatment. PMID:24382983

  9. The ethics of forgoing life-sustaining treatment: theoretical considerations and clinical decision making.

    PubMed

    Welie, Jos Vm; Ten Have, Henk Amj

    2014-01-01

    Withholding or withdrawing a life-sustaining treatment tends to be very challenging for health care providers, patients, and their family members alike. When a patient's life seems to be nearing its end, it is generally felt that the morally best approach is to try a new intervention, continue all treatments, attempt an experimental course of action, in short, do something. In contrast to this common practice, the authors argue that in most instances, the morally safer route is actually to forgo life-sustaining treatments, particularly when their likelihood to effectuate a truly beneficial outcome has become small relative to the odds of harming the patient. The ethical analysis proceeds in three stages. First, the difference between neglectful omission and passive acquiescence is explained. Next, the two necessary conditions for any medical treatment, i.e., that it is medically indicated and that consent is obtained, are applied to life-sustaining interventions. Finally, the difference between withholding and withdrawing a life-sustaining treatment is discussed. In the second part of the paper the authors show how these theoretical-ethical considerations can guide clinical-ethical decision making. A case vignette is presented about a patient who cannot be weaned off the ventilator post-surgery. The ethical analysis of this case proceeds through three stages. First, it is shown that and why withdrawal of the ventilator in this case does not equate assistance in suicide or euthanasia. Next, the question is raised whether continued ventilation can be justified medically, or has become futile. Finally, the need for the health care team to obtain consent for the continuation of the ventilation is discussed. PMID:24618004

  10. Precedent autonomy should be respected in life-sustaining treatment decisions.

    PubMed

    Hebron, Allison Leslie; McGee, Summer

    2014-10-01

    In the 2011 landmark case of W v M, the English Court of Protection ruled that it was unlawful to withdraw artificial nutrition and hydration from a woman who had been in a minimally conscious state for 8 years. From the perspective of the court, the absence of a written advance directive negated the woman's previous, autonomous interests and, consequently, emphasis was given to her current welfare and well-being. While life itself is a moral good, prolonging life for a person in regular pain with no hope of recovering to a more complete state of awareness simply because that person only verbalized her wishes about her treatment decisions seems to drastically undervalue the principle of autonomy. We refute the notion that it is the role of the court to prolong life insofar as it can and argue that withholding and withdrawing life sustaining technologies from patients in a minimally conscious state can be ethically justified. PMID:24567422

  11. An Initial Comparison of Collaborative and Expert-Driven Consultation on Treatment Integrity

    ERIC Educational Resources Information Center

    Kelleher, Constance; Riley-Tillman, T. Chris; Power, Thomas J.

    2008-01-01

    Although over 15 years have passed since Witt (1990) noted that no empirical evidence exists to support the contention that a collaborative approach to consultation leads to more positive outcomes than a hierarchical or expert driven approach, this issue generally remains unaddressed (Schulte & Osborne, 2003). While the literature documenting the…

  12. Selection of an appropriate wastewater treatment technology: a scenario-based multiple-attribute decision-making approach.

    PubMed

    Kalbar, Pradip P; Karmakar, Subhankar; Asolekar, Shyam R

    2012-12-30

    Many technological alternatives for wastewater treatment are available, ranging from advanced technologies to conventional treatment options. It is difficult to select the most appropriate technology from among a set of available alternatives to treat wastewater at a particular location. Many factors, such as capital costs, operation and maintenance costs and land requirement, are involved in the decision-making process. Sustainability criteria must also be incorporated into the decision-making process such that appropriate technologies are selected for developing economies such as that of India. A scenario-based multiple-attribute decision-making (MADM) methodology has been developed and applied to the selection of wastewater treatment alternative. The four most commonly used wastewater treatment technologies for treatment of municipal wastewater in India are ranked for various scenarios. Six scenarios are developed that capture the regional and local societal priorities of urban, suburban and rural areas and translate them into the mathematical algorithm of the MADM methodology. The articulated scenarios depict the most commonly encountered decision-making situations in addressing technology selection for wastewater treatment in India. A widely used compensatory MADM technique, TOPSIS, has been selected to rank the alternatives. Seven criteria with twelve indicators are formulated to evaluate the alternatives. Different weight matrices are used for each scenario, depending on the priorities of the scenario. This study shows that it is difficult to select the most appropriate wastewater treatment alternative under the "no scenario" condition (equal weights given to each attribute), and the decision-making methodology presented in this paper effectively identifies the most appropriate wastewater treatment alternative for each of the scenarios. PMID:23023038

  13. Competence to make treatment decisions in anorexia nervosa: thinking processes and values

    PubMed Central

    Tan, Dr. Jacinta O. A.; Hope, Professor Tony; Stewart, Dr. Anne; Fitzpatrick, Professor Raymond

    2005-01-01

    This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence. PMID:18066393

  14. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    PubMed

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. PMID:26947301

  15. Primary care professional’s perspectives on treatment decision making for depression with African Americans and Latinos in primary care practice

    PubMed Central

    Patel, Sapana R.; Schnall, Rebecca; Little, Virna; Lewis-Fernández, Roberto; Pincus, Harold Alan

    2013-01-01

    Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to shared decision making included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression. PMID:24104206

  16. Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents.

    PubMed

    Birkeland, K; Katle, A; Løvgreen, S; Bøe, O E; Wisth, P J

    1999-01-01

    The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need. PMID:10546413

  17. Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature

    PubMed Central

    Friedrichs, Anke; Spies, Maren; Härter, Martin; Buchholz, Angela

    2016-01-01

    Background Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients’ preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. Methods An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. Results N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. Discussion Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients’ preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding

  18. The Application of Climate Risk Informed Decision Analysis to the Ioland Water Treatment Plant in Lusaka, Zambia

    NASA Astrophysics Data System (ADS)

    Kucharski, John; Tkach, Mark; Olszewski, Jennifer; Chaudhry, Rabia; Mendoza, Guillermo

    2016-04-01

    This presentation demonstrates the application of Climate Risk Informed Decision Analysis (CRIDA) at Zambia's principal water treatment facility, The Iolanda Water Treatment Plant. The water treatment plant is prone to unacceptable failures during periods of low hydropower production at the Kafue Gorge Dam Hydroelectric Power Plant. The case study explores approaches of increasing the water treatment plant's ability to deliver acceptable levels of service under the range of current and potential future climate states. The objective of the study is to investigate alternative investments to build system resilience that might have been informed by the CRIDA process, and to evaluate the extra resource requirements by a bilateral donor agency to implement the CRIDA process. The case study begins with an assessment of the water treatment plant's vulnerability to climate change. It does so by following general principals described in "Confronting Climate Uncertainty in Water Resource Planning and Project Design: the Decision Tree Framework". By utilizing relatively simple bootstrapping methods a range of possible future climate states is generated while avoiding the use of more complex and costly downscaling methodologies; that are beyond the budget and technical capacity of many teams. The resulting climate vulnerabilities and uncertainty in the climate states that produce them are analyzed as part of a "Level of Concern" analysis. CRIDA principals are then applied to this Level of Concern analysis in order to arrive at a set of actionable water management decisions. The principal goals of water resource management is to transform variable, uncertain hydrology into dependable services (e.g. water supply, flood risk reduction, ecosystem benefits, hydropower production, etc…). Traditional approaches to climate adaptation require the generation of predicted future climate states but do little guide decision makers how this information should impact decision making. In

  19. Development of a theory-driven rehabilitation treatment taxonomy: conceptual issues.

    PubMed

    Whyte, John; Dijkers, Marcel P; Hart, Tessa; Zanca, Jeanne M; Packel, Andrew; Ferraro, Mary; Tsaousides, Theodore

    2014-01-01

    Many rehabilitation treatment interventions, unlike pharmacologic treatments, are not operationally defined, and the labels given to such treatments do not specify the active ingredients that produce the intended treatment effects. This, in turn, limits the ability to study and disseminate treatments, to communicate about them clearly, or to train new clinicians to administer them appropriately. We sought to begin the development of a system of classification of rehabilitation treatments and services that is based on their active ingredients. To do this, we reviewed a range of published descriptions of rehabilitation treatments and treatments that were familiar to the authors from their clinical and research experience. These treatment examples were used to develop preliminary rules for defining discrete treatments, identifying the area of function they directly treat, and identifying their active ingredients. These preliminary rules were then tested against additional treatment examples, and problems in their application were used to revise the rules in an iterative fashion. The following concepts, which emerged from this process, are defined and discussed in relation with the development of a rehabilitation treatment taxonomy: rehabilitation treatment taxonomy; treatment and enablement theory; recipient (of treatment); essential, active, and inactive ingredients; mechanism of action; targets and aims of treatment; session; progression; dosing parameters; and social and physical environment. It is hoped that articulation of the conceptual issues encountered during this project will be useful to others attempting to promote theory-based discussion of rehabilitation effects and that multidisciplinary discussion and research will further refine these rules and definitions to advance rehabilitation treatment classification. PMID:24370322

  20. Using Linked Models to Study Interactions Between Water Use Decisions and Climate Change-Driven Watershed Processes in the Pacific Northwest Region

    NASA Astrophysics Data System (ADS)

    Orr, C. H.; Adam, J. C.; Beall, A. M.; Barber, M. E.; Nguyen, T. T.

    2012-12-01

    . Stakeholder processes that openly discuss the range of potential futures are helpful for mitigating the paralysis of water management policy caused by scientific and social uncertainty. The Palouse Basin bordering SE Washington and NW Idaho used collaborative modeling as to explore scientific uncertainty and potential futures in a sole source aquifer system with negligible recharge. In the Spokane Coeur D'Alene basin, a stakeholder exercise revealed that measurement uncertainty inclined stakeholders were inclined to pass up a costly Total Maximum Daily Load (TMDL) process and go directly to mitigation. Both cases revealed feedbacks to the physical system that are the result of decisions, preferences, and beliefs. This modeling framework is part of a larger development effort Watershed Integrated Systems Dynamics Model or "WISDM" to construct linked models to study interactions between water use decisions and climate change-driven watershed processes, and then to explore how participant / stakeholder involvement in the modeling could both improve understanding of the systems and lay the groundwork for adaptive changes in institutional arrangements.

  1. The Involvement of Parents in Healthcare Decisions Where Adult Children Are at Risk of Lacking Decision-Making Capacity: A Qualitative Study of Treatment Decisions in Epilepsy

    ERIC Educational Resources Information Center

    Redley, M.; Prince, E.; Bateman, N.; Pennington, M.; Wood, N.; Croudace, T.; Ring, H.

    2013-01-01

    Background: Patients with intellectual disabilities (ID) receive health care by proxy. It is family members and/or paid support staff who must recognise health problems, communicate with clinicians, and report the benefits, if any, of a particular treatment. At the same time international and national statutes protect and promote the right of…

  2. International and cross-cultural dimensions of treatment decisions for neonates.

    PubMed

    Lantos, John D

    2015-10-01

    Neonatal mortality rates vary widely among countries. According to data from the World Health Organization, neonatal mortality in low- and low-middle-income countries is ∼30 per 1000 babies. In upper middle-income countries, that number was just 10 per 1000. In the highest-income countries, it was <5 per 1000. These data may not be accurate. Many countries do not report the tiniest babies as live births. Thus, their reported infant mortality rates are much lower than their actual infant mortality rates. Another big difference between countries is in the rate at which congenital anomalies are diagnosed prenatally and the rate at which pregnancies are terminated by induced abortion. International comparisons therefore reflect differences in the way countries define live birth, the comprehensiveness of the reporting of live births even by their own definitions, differences in the prevalence of congenital anomalies, the rate at which those congenital anomalies are diagnosed prenatally, and the percentage of pregnancies with congenital anomalies that end in abortion. This article reviews these differences and discusses the implications for the ways in which we think about international differences in decisions about life-sustaining treatment. PMID:26072059

  3. Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions.

    PubMed

    Pang, M C

    1999-06-01

    The first part of this paper examines the practice of informed treatment decisions in the protective medical system in China today. The second part examines how health care professionals in China perceive and carry out their responsibilities when relaying information to vulnerable patients, based on the findings of an empirical study that I had undertaken to examine the moral experience of nurses in practice situations. In the Chinese medical ethics tradition, refinement [jing] in skills and sincerity [cheng] in relating to patients are two cardinal virtues that health care professionals are required to possess. This notion of absolute sincerity carries a strong sense of parental protectiveness. The empirical findings reveal that most nurses are ambivalent about telling the truth to patients. Truth-telling would become an insincere act if a patient were to lose hope and confidence in life after learning of his or her disease. In this system of protective medical care, it is arguable as to whose interests are being protected: the patient, the family or the hospital. I would suggest that the interests of the hospital and the family members who legitimately represent the patient's interests are being honoured, but at the expense of the patient's right to know. PMID:10390681

  4. A natural driven membrane process for brackish and wastewater treatment: photovoltaic powered ED and FO hybrid system.

    PubMed

    Zhang, Yang; Pinoy, Luc; Meesschaert, Boudewijn; Van der Bruggen, Bart

    2013-09-17

    In isolated locations, remote areas, or islands, potable water is precious because of the lack of drinking water treatment facilities and energy supply. Thus, a robust and reliable water treatment system based on natural energy is needed to reuse wastewater or to desalinate groundwater/seawater for provision of drinking water. In this work, a hybrid membrane system combining electrodialysis (ED) and forward osmosis (FO), driven by renewable energy (solar energy), denoted as EDFORD (ED-FO Renewable energy Desalination), is proposed to produce high-quality water (potable) from secondary wastewater effluent or brackish water. In this hybrid membrane system, feedwater (secondary wastewater effluent or synthetic brackish water) was drawn to the FO draw solution while the organic and inorganic substances (ions, compounds, colloids and particles) were rejected. The diluted draw solution was then pumped to the solar energy driven ED. In the ED unit, the diluted draw solution was desalted and high-quality water was produced; the concentrate was recycled to the FO unit and reused as the draw solution. Results show that the water produced from this system contains a low concentration of total organic carbon (TOC), carbonate, and cations derived from the feedwater; had a low conductivity; and meets potable water standards. The water production cost considering the investment for membranes and solar panel is 3.32 to 4.92 EUR m(-3) (for 300 days of production per year) for a small size potable water production system. PMID:23957893

  5. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    PubMed Central

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  6. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    PubMed

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  7. Inter-Institutional Variation in Management Decisions for Treatment of Four Common Cancers: A Multi-Institutional Cohort Study

    PubMed Central

    Weeks, Jane C.; Uno, Hajime; Taback, Nathan; Ting, Gladys; Cronin, Angel; D’Amico, Thomas A.; Friedberg, Jonathan W.; Schrag, Deborah

    2015-01-01

    Background When clinical practice is governed by evidenced-based guidelines and there is consensus regarding their validity, practice variation should be minimal. Where evidence gaps exist, greater variation is expected. Objective To systematically assess inter-institutional variation in management decisions for 4 common cancers. Design Multi-institutional observational cohort study of cancer patients diagnosed between July 2006 through May 2011 and observed through December 31, 2011. Setting 18 cancer centers participating in the formulation of treatment guidelines and systematic outcomes assessment through the National Comprehensive Cancer Network. Patients 25,589 patients with incident cancer of the breast, colorectum, lung, or non-Hodgkin’s lymphoma (NHL). Measurements Inter-institutional variation for 171 binary management decisions with varying levels of supporting evidence. For each decision, variation was characterized by the median absolute deviation (MAD) of the center-specific proportions. Results Inter-institutional variation was high (MAD >10%) for 35/171 (20%) oncology management decisions. This included: 9/22 (41%) for NHL, 16/76 (21%) for breast, 7/47 (15%) for lung, and 3/26 (12%) for colorectal. Decisions involving imaging and/or diagnostic procedures accounted for 46% and chemotherapy regimen choice for 37% of high variance decisions. The evidence grade underpinning the 35 high variance decisions was level I for 0%, 2A for 49% and 2B/other for 51%. Limitations Physician identifiers were unavailable, and results may not generalize outside of major cancer centers. Conclusions The substantial variation in institutional practice manifest among cancer centers reveals a lack of consensus about optimal management for common clinical scenarios. For clinicians, awareness of management decisions with high variation should prompt attention to patient preferences. For health systems, high variation can be used to prioritize comparative effectiveness

  8. Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid

    PubMed Central

    Westmacott, Robin; Walker, John R; Vardanyan, Gohar

    2016-01-01

    Background Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. Objective The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Methods Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Results Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Conclusions Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers’ messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet. PMID:27277709

  9. The relationship between cancer patient treatment decision-making roles and quality of life

    PubMed Central

    Atherton, Pamela J.; Smith, Tenbroeck; Singh, Jasvinder A.; Huntington, Jef; Diekmann, Brent B.; Huschka, Mashele; Sloan, Jeff A.

    2013-01-01

    Background This study's objective was to explore relationships between patient role preferences during the cancer treatment decision-making process and quality of life (QOL). Methods As part of a larger survey conducted by the American Cancer Society, 1-year cancer survivors completed a survey in 2000. This paper is based upon respondents from Minnesota (response rate 37.4%). Standardized measures included the Profile of Mood States (scores converted to have a range, 0-100; 100 is the best mood), the Short Form (SF)-36 (standardized scores), and the Control Preferences Scale. Patients' actual and preferred role preference distributions and concordance between the roles were compared to QOL scores using two-sample t-test methodology. Results Survivors (n=594) actual role in cancer care was 33% active, 50% collaborative and 17% passive. Their preferred role was 35% active, 53% collaborative, and 13% passive. 88% of survivors had concordant preferred and actual roles. Survivors with concordant roles had higher SF-36 Physical Component Scores (PCS) (p<0.01), higher vitality (p=0.01), less fatigue (p<0.01), less confusion (p=0.01), less anger (p=0.046) and better overall mood (p=0.01). These results were similar in both the female and the younger (age <60) cohorts. Survivors with active actual roles had higher PCS (p<0.01), less tension (p=0.04), and higher vitality (p=0.04) than those being collaborative or passive. No differences existed in QOL scores by preferred role. Conclusions Survivors who experienced discordance between their actual role and preferred role reported substantial QOL deficits in both physical and emotional domains. These results are indicative of the need to support patient preferences. PMID:23558408

  10. Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making.

    PubMed Central

    Behets, F. M.; Miller, W. C.; Cohen, M. S.

    2001-01-01

    The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders. PMID:11731816

  11. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    PubMed

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109

  12. Competing priorities in treatment decision-making: a US national survey of individuals with depression and clinicians who treat depression

    PubMed Central

    Barr, Paul J; Forcino, Rachel C; Mishra, Manish; Blitzer, Rachel; Elwyn, Glyn

    2016-01-01

    Objective To identify information priorities for consumers and clinicians making depression treatment decisions and assess shared decision-making (SDM) in routine depression care. Design 20 questions related to common features of depression treatments were provided. Participants were initially asked to select which features were important, and in a second stage they were asked to rank their top 5 ‘important features’ in order of importance. Clinicians were asked to provide rankings according to both consumer and clinician perspectives. Consumers completed CollaboRATE, a measure of SDM. Multiple logistic regression analysis identified consumer characteristics associated with CollaboRATE scores. Setting Online cross-sectional surveys fielded in September to December 2014. Participants We administered surveys to convenience samples of US adults with depression and clinicians who treat depression. Consumer sampling was targeted to reflect age, gender and educational attainment of adults with depression in the USA. Primary outcome measures Information priority rankings; CollaboRATE, a 3-item consumer-reported measure of SDM. Results 972 consumers and 244 clinicians completed the surveys. The highest ranked question for both consumers and clinicians was ‘Will the treatment work?’ Clinicians were aware of consumers’ priorities, yet did not always prioritise that information themselves, particularly insurance coverage and cost of treatment. Only 18% of consumers reported high levels of SDM. Working with a psychiatrist (OR 1.87; 95% CI 1.07 to 3.26) and female gender (OR 2.04; 95% CI 1.25 to 3.34) were associated with top CollaboRATE scores. Conclusions While clinicians know what information is important to consumers making depression treatment decisions, they do not always address these concerns. This mismatch, coupled with low SDM, adversely affects the quality of depression care. Development of a decision support intervention based on our findings can improve

  13. Heart valve disease in elderly Chinese population: effect of advanced age and comorbidities on treatment decision-making and outcomes

    PubMed Central

    Hu, Kui; Li, Jun; Wan, Yun; Hong, Tao; Lu, Shu-Yang; Guo, Chang-Fa; Wang, Chun-Sheng

    2016-01-01

    Background A considerable proportion of elderly patients with symptomatic severe heart valve disease are treated conservatively despite clear indications for surgical intervention. However, little is known about how advanced age and comorbidities affect treatment decision-making and therapeutic outcomes. Methods Patients (n = 234, mean age: 78.5 ± 3.7 years) with symptomatic severe heart valve disease hospitalized in our center were included. One hundred and fifty-one patients (65%) were treated surgically (surgical group) and 83 (35%) were treated conservatively (conservative group). Factors that affected therapeutic decision-making and treatment outcomes were investigated and long-term survival was explored. Results Isolated aortic valve disease, female sex, chronic renal insufficiency, aged ≥ 80 years, pneumonia, and emergent status were independent factors associated with therapeutic decision-making. In-hospital mortality for the surgical group was 5.3% (8/151). Three patients (3.6%) in the conservative group died during initial hospitalization. Low cardiac output syndrome and chronic renal insufficiency were identified as predictors of in-hospital mortality in the surgical group. Conservative treatment was identified as the single risk factor for late death in the entire study population. The surgical group had better 5-year (77.2% vs. 45.4%, P < 0.0001) and 10-year (34.5% vs. 8.9%, P < 0.0001) survival rates than the conservative group, even when adjusted by propensity score-matched analysis. Conclusions Advanced age and geriatric comorbidities profoundly affect treatment decision-making for severe heart valve disease. Valve surgery in the elderly was not only safe but was also associated with good long-term survival while conservative treatment was unfavorable for patients with symptomatic severe valve disease.

  14. The Effect of Emotion and Physician Communication Behaviors on Surrogates’ Life-Sustaining Treatment Decisions: A Randomized Simulation Experiment

    PubMed Central

    Barnato, Amber E.; Arnold, Robert M.

    2013-01-01

    Objective Surrogate decision makers for critically ill patients experience strong negative emotional states. Emotions influence risk perception, risk preferences, and decision making. We sought to explore the effect of emotional state and physician communication behaviors on surrogates’ life-sustaining treatment (LST) decisions. Design 5×2 between-subject randomized factorial experiment. Setting Web-based simulated interactive video meeting with an intensivist to discuss code status. Subjects Community-based participants 35 and older who self-identified as the surrogate for a parent or spouse recruited from 8 US cities through public advertisements. Interventions Block random assignment to emotion arousal manipulation and each of 4 physician communication behaviors. Measurements and Main Results Surrogate’s code status decision (CPR vs. DNR/AND). 256/373 (69%) respondents logged-in and were randomized: average age 50, 70% were surrogates for a parent, 63.5% were women, 76% were white, 11% black, and 9% Asian, and 81% were college educated. When asked about code status, 56% chose CPR. The emotion arousal manipulation increased depression-dejection (β=1.76 [0.58 – 2.94]), but did not influence CPR choice. Physician emotion handling and framing the decision as the patient’s rather than the surrogate’s did not influence CPR choice. Framing no CPR as the default rather than CPR resulted in fewer surrogates choosing CPR (48% vs. 64%, OR=0.52 [0.32-0.87]), as did framing the alternative to CPR as “allow natural death” rather than DNR (49% vs. 61%, OR=0.58 [95% CI 0.35-0.96]). Conclusions Experimentally-induced emotional state did not influence code status decisions, although small changes in physician communication behaviors substantially influenced this decision. PMID:23660727

  15. Diagnosis, referral, and primary treatment decisions in newly diagnosed prostate cancer patients in a multidisciplinary diagnostic assessment program

    PubMed Central

    Guy, David; Ghanem, Gabriella; Loblaw, Andrew; Buckley, Roger; Persaud, Beverly; Cheung, Patrick; Chung, Hans; Danjoux, Cyril; Morton, Gerard; Noakes, Jeff; Spevack, Les; Hajek, David; Flax, Stanley

    2016-01-01

    Introduction: We aimed to report on data from the multidisciplinary diagnostic assessment program (DAP) at the Gale and Graham Wright Prostate Centre (GGWPC) at North York General Hospital (NYGH). We assessed referral, diagnosis, and treatment decisions for newly diagnosed prostate cancer (PCa) patients as seen over time, risk stratification, and clinic type to establish a deeper understanding of current decision-making trends. Methods: From June 2007 to April 2012, 1277 patients who were diagnosed with PCa at the GGWPC were included in this study. Data was collected and reviewed retrospectively using electronic patient records. Results: 1031 of 1260 patients (81.8%) were seen in a multidisciplinary clinic (MDC). Over time, a decrease in low-risk (LR) diagnoses and an increase intermediate-risk (IR) diagnoses was observed (p<0.0001). With respect to overall treatment decisions 474 (37.1%) of patients received primary radiotherapy, 340 (26.6%) received surgical therapy, and 426 (33.4%) had conservative management; 57% of patients who were candidates for active surveillance were managed this way. No significant treatment trends were observed over time (p=0.8440). Significantly, different management decisions were made in those who attended the MDC compared to those who only saw a urologist (p<0.0001). Conclusions: In our DAP, the vast majority of patients presented with screen-detected disease, but there was a gradual shift from low- to intermediate-risk disease over time. Timely multidisciplinary consultation was achievable in over 80% of patients and was associated with different management decisions. We recommend that all patients at risk for prostate cancer be worked up in a multi-disciplinary DAP. PMID:27217859

  16. Treatment decisions for newborns at the threshold of viability: an ethical dilemma.

    PubMed

    Doroshow, R W; Hodgman, J E; Pomerance, J J; Ross, J W; Michel, V J; Luckett, P M; Shaw, A

    2000-09-01

    The major ethical issues involved in decision-making in the care of extremely low birth weight newborns are analyzed here. We propose a schema for assessment and management of these infants that is consistent with ethical principles broadly accepted by the pediatric community, and which takes into account mortality risk at any given institution rather than arbitrary weight limits, with a major decision-making role for the infant's parents. When possible, the decision of whether or not to resuscitate should be made before delivery; when not possible, delivery room resuscitation is recommended, and the decision to continue or withdraw care should be made subsequently based on likelihood of survival and the wishes of the parents. PMID:11002878

  17. Decision-making capacity for treatment in psychiatric and medical in-patients: cross-sectional, comparative study†

    PubMed Central

    Owen, Gareth S.; Szmukler, George; Richardson, Genevra; David, Anthony S.; Raymont, Vanessa; Freyenhagen, Fabian; Martin, Wayne; Hotopf, Matthew

    2013-01-01

    Background Is the nature of decision-making capacity (DMC) for treatment significantly different in medical and psychiatric patients? Aims To compare the abilities relevant to DMC for treatment in medical and psychiatric patients who are able to communicate a treatment choice. Method A secondary analysis of two cross-sectional studies of consecutive admissions: 125 to a psychiatric hospital and 164 to a medical hospital. The MacArthur Competence Assessment Tool - Treatment and a clinical interview were used to assess decision-making abilities (understanding, appreciating and reasoning) and judgements of DMC. We limited analysis to patients able to express a choice about treatment and stratified the analysis by low and high understanding ability. Results Most people scoring low on understanding were judged to lack DMC and there was no difference by hospital (P = 0.14). In both hospitals there were patients who were able to understand yet lacked DMC (39% psychiatric v. 13% medical in-patients, P<0.001). Appreciation was a better ‘test’ of DMC in the psychiatric hospital (where psychotic and severe affective disorders predominated) (P<0.001), whereas reasoning was a better test of DMC in the medical hospital (where cognitive impairment was common) (P = 0.02). Conclusions Among those with good understanding, the appreciation ability had more salience to DMC for treatment in a psychiatric setting and the reasoning ability had more salience in a medical setting. PMID:23969482

  18. Implementation of a "learner-driven" curriculum: an screening, brief intervention, and referral to treatment (SBIRT) interdisciplinary primary care model.

    PubMed

    Stanton, Marina R; Atherton, W Leigh; Toriello, Paul J; Hodgson, Jennifer L

    2012-01-01

    Although screening, brief intervention, and referral to treatment (SBIRT) has been a popular model to address potential substance abuse issues in primary care, there is a need for innovative approaches for training providers and staff on SBIRT protocols. An interdisciplinary approach to SBIRT training, named ICARE, was implemented at 3 different medical settings. The ICARE team trained 85 employees at an academic family medicine residency center and 37 employees across 2 rural community health care clinics. Using an innovative "learner-driven" approach, the authors implemented a combination of didactic and interactive training strategies that included on-site coaching, patient simulation exercises, as well as large- and small-group learning. PMID:22738012

  19. Redefining Residential: Family-Driven Care in Residential Treatment--Family Members Speak

    ERIC Educational Resources Information Center

    Residential Treatment for Children & Youth, 2009

    2009-01-01

    This is the sixth in a series of papers issued by the American Association of Children's Residential Centers (AACRC) regarding emerging and best practices in the field of residential treatment for children, youth, and families. AACRC is a long standing national association focused exclusively on practice and policy issues related to the provision…

  20. Microwave-driven asbestos treatment and its scale-up for use after natural disasters.

    PubMed

    Horikoshi, Satoshi; Sumi, Takuya; Ito, Shigeyuki; Dillert, Ralf; Kashimura, Keiichiro; Yoshikawa, Noboru; Sato, Motoyasu; Shinohara, Naoki

    2014-06-17

    Asbestos-containing debris generated by the tsunami after the Great East Japan Earthquake of March 11, 2011, was processed by microwave heating. The analysis of the treated samples employing thermo gravimetry, differential thermal analysis, X-ray diffractometry, scanning electron microscopy, and phase-contrast microscopy revealed the rapid detoxification of the waste by conversion of the asbestos fibers to a nonfibrous glassy material. The detoxification by the microwave method occurred at a significantly lower processing temperature than the thermal methods actually established for the treatment of asbestos-containing waste. The lower treatment temperature is considered to be a consequence of the microwave penetration depth into the waste material and the increased intensity of the microwave electric field in the gaps between the asbestos fibers resulting in a rapid heating of the fibers inside the debris. A continuous treatment plant having a capacity of 2000 kg day(-1) of asbestos-containing waste was built in the area affected by the earthquake disaster. This treatment plant consists of a rotary kiln to burn the combustible waste (wood) and a microwave rotary kiln to treat asbestos-containing inorganic materials. The hot flue gas produced by the combustion of wood is introduced into the connected microwave rotary kiln to increase the energy efficiency of the combined process. Successful operation of this combined device with regard to asbestos decomposition is demonstrated. PMID:24856876

  1. Control policies for a water-treatment system using the Markov Decision Process.

    NASA Astrophysics Data System (ADS)

    Chiam, Tze; Mitchell, Cary; Yih, Yuehwern

    In order to build a decision-making tool for choosing a control policy from a set of predefined policies for a water-treatment system, a simulation was developed. This technology-independent simulation focuses on the functions of a simplified representation of the water system based on documentation by NASA in the Baseline Value and Assumption Documents (BVAD). The clean-water requirement (consumption) and dirty-water generation (production) are based on crewmember demographics, activity schedules, and intensity of each activity. The water system consists of hygiene and potable-water subsystems. The hygiene-water subsystem supplies water for purposes such as laundry, urinal flush, dish wash, oral hygiene, and shower. The potable-water subsystem supplies water for drinking and re-hydration of food. Due to a lack of stochastic property descriptions for a real-world system in the BVAD, stochastic variables are introduced in this research to reflect a more realistic system. These variables describe the magnitude of deviation of system variables from their theoretical values through predetermined statistical distributions. These variables include hygiene and potable-water-treatment efficiencies, amounts of hygiene and potable water consumed, and amount of dirty water produced following potable-water consumption. Conditions of the system occurring hourly result from the intricate interaction of crewmembers and the water system. The primary measure of the condition of the system is the "state" representation of the system, assessed at the beginning of every hour. Conditions of the system examined include the amount of clean water available for consumption, amount of overflow (in excess of storage capacity) of clean and dirty water, amount of hourly water deficiency, amount of accumulated water deficiency, etc. State transitions of the system based on these assessments are affected by the stochastic properties of the system described above. The transitions also depend on

  2. Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey

    PubMed Central

    Ozmen, Vahit; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, Pinar

    2016-01-01

    Introduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX® 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score® (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57% had low RS, 35% had intermediate RS, and 8% had high RS, respectively. The overall rate of change in treatment decision was 33%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56%) of all patients, which decreased to 61 (37%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.  PMID:27081583

  3. Decision-Making in the Surgical Treatment of Breast Cancer: Factors Influencing Women’s Choices for Mastectomy and Breast Conserving Surgery

    PubMed Central

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

    One of the most difficult decisions a woman can be faced with when choosing breast cancer treatment is whether or not to undergo breast conserving surgery or mastectomy. The factors that influence these treatment decisions are complex and involve issues regarding access to health care, concerns for cancer recurrence, and the impact of surgery on body image and sexuality. Understanding these factors will help practitioners to improve patient education and to better guide patients through this decision-making process. Although significant scientific and societal advances have been made in improving women’s choices for the breast cancer treatment, there are still deficits in the decision-making processes surrounding the surgical treatment of breast cancer. Further research is needed to define optimal patient education and shared decision-making practices in this area. PMID:27066455

  4. Easing the burden of surrogate decision making: the role of a do-not-escalate-treatment order.

    PubMed

    Jacobsen, Juliet; Billings, Andrew

    2015-03-01

    We present a case illustrating the common problem of a surrogate decision maker who is psychologically distressed over the medical team's recommendation to withdraw life-sustaining treatment. We suggest how a do-not-escalate-treatment (DNET) order can be helpful in such situations when the usual approaches to withholding or withdrawing care are not acceptable to the surrogate. We define a DNET order, explain when it might be useful, and discuss how it can facilitate a humane, negotiated resolution of differences. PMID:25671289

  5. A decision aid for considering indomethacin prophylaxis vs. symptomatic treatment of PDA for extreme low birth weight infants

    PubMed Central

    2011-01-01

    Background Decision Aids (DA) are well established in various fields of medicine. It can improve the quality of decision-making and reduce decisional conflict. In neonatal care, and due to scientific equipoise, neonatologists caring for extreme low birth weight (ELBW) infants are in need to elicit parents' preferences with regard to the use of indomethacin therapy in ELBW infants. We aimed to develop a DA that elicits parents' preferences with regard to indomethacin therapy in ELBW infants. Methods We developed a DA for the use of the indomethacin therapy in ELBW infants according to the Ottawa Decision Support Framework. The development process involved parents, neonatologists, DA developers and decision making experts. A pilot testing with healthy volunteers was conducted through an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale. Results The DA is a computer-based interactive tool. In the first part, the DA provides information about patent ductus arteriosus (PDA) as a disease, the different treatment options, and the benefits and downsides of using indomethacin therapy in preterm infants. In the second part, it coaches the parent in the decision making process through clarifying values and preferences. Volunteers rated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008). Conclusion We have developed a computer based DA to assess parental preferences with regard to indomethacin therapy in preterm infants. Future research will involve measurement of parental preferences to guide and augment the clinical decisions in current neonatal practice. PMID:21888665

  6. Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation

    PubMed Central

    van der Veeken, Frida C. A.

    2016-01-01

    Background Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE). Methods Two-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders. Results and Conclusions Results tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients’ personal risk factors, strengths and other information sources. PMID:27517721

  7. Refining the ammonia hypothesis: a physiology-driven approach to the treatment of hepatic encephalopathy.

    PubMed

    Tapper, Elliot B; Jiang, Z Gordon; Patwardhan, Vilas R

    2015-05-01

    Hepatic encephalopathy (HE) is one of the most important complications of cirrhosis and portal hypertension. Although the etiology is incompletely understood, it has been linked to ammonia directly and indirectly. Our goal is to review for the clinician the mechanisms behind hyperammonemia and the pathogenesis of HE to explain the rationale for its therapy. We reviewed articles collected through a search of MEDLINE/PubMed, Cochrane Database of Systematic Reviews, and Google Scholar between October 1, 1948, and December 8, 2014, and by a manual search of citations within retrieved articles. Search terms included hepatic encephalopathy, ammonia hypothesis, brain and ammonia, liver failure and ammonia, acute-on-chronic liver failure and ammonia, cirrhosis and ammonia, portosytemic shunt, ammonia and lactulose, rifaximin, zinc, and nutrition. Ammonia homeostatsis is a multiorgan process involving the liver, brain, kidneys, and muscle as well as the gastrointestinal tract. Indeed, hyperammonemia may be the first clue to poor functional reserves, malnutrition, and impending multiorgan dysfunction. Furthermore, the neuropathology of ammonia is critically linked to states of systemic inflammation and endotoxemia. Given the complex interplay among ammonia, inflammation, and other factors, ammonia levels have questionable utility in the staging of HE. The use of nonabsorbable disaccharides, antibiotics, and probiotics reduces gut ammoniagenesis and, in the case of antibiotics and probiotics, systemic inflammation. Nutritional support preserves urea cycle function and prevents wasting of skeletal muscle, a significant site of ammonia metabolism. Correction of hypokalemia, hypovolemia, and acidosis further assists in the reduction of ammonia production in the kidney. Finally, early and aggressive treatment of infection, avoidance of sedatives, and modification of portosystemic shunts are also helpful in reducing the neurocognitive effects of hyperammonemia. Refining the

  8. Engagement with HIV Prevention Treatment and Care among Female Sex Workers in Zimbabwe: a Respondent Driven Sampling Survey

    PubMed Central

    Cowan, Frances M.; Mtetwa, Sibongile; Davey, Calum; Fearon, Elizabeth; Dirawo, Jeffrey; Wong-Gruenwald, Ramona; Ndikudze, Theresa; Chidiya, Samson; Benedikt, Clemens; Busza, Joanna; Hargreaves, James R.

    2013-01-01

    Objective(S) To determine the HIV prevalence and extent of engagement with HIV prevention and care among a representative sample of Zimbabwean sex workers working in Victoria Falls, Hwange and Mutare. Design Respondent driven sampling (RDS) surveys conducted at each site. Methods Sex workers were recruited using respondent driven sampling with each respondent limited to recruiting 2 peers. Participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Statistical analysis took account of sampling method. Results 870 women were recruited from the three sites. HIV prevalence was between 50 and 70%. Around half of those confirmed HIV positive were aware of their HIV status and of those 50-70% reported being enrolled in HIV care programmes. Overall only 25-35% of those with laboratory-confirmed HIV were accessing antiretroviral therapy. Among those reporting they were HIV negative, 21-28% reported having an HIV test in the last 6 months. Of those tested HIV negative, most (65-82%) were unaware of their status. Around two-thirds of sex workers reported consistent condom use with their clients. As in other settings, sex workers reported high rates of gender based violence and police harassment. Conclusions This survey suggests that prevalence of HIV is high among sex workers in Zimbabwe and that their engagement with prevention, treatment and care is sub-optimal. Intensifying prevention and care interventions for sex workers has the potential to markedly reduce HIV and social risks for sex workers, their clients and the general population in Zimbabwe and elsewhere in the region. PMID:24143203

  9. Success and Failure in Dynamic Decision Environments: Understanding Treatment Strategies for Patients with a Chronic Disease

    ERIC Educational Resources Information Center

    Ramsey, Gregory W.

    2010-01-01

    This dissertation proposes and tests a theory explaining how people make decisions to achieve a goal in a specific task environment. The theory is represented as a computational model and implemented as a computer program. The task studied was primary care physicians treating patients with type 2 diabetes. Some physicians succeed in achieving…

  10. Perceived need for information among patients with a haematological malignancy: associations with information satisfaction and treatment decision-making preferences.

    PubMed

    Rood, Janneke A J; van Zuuren, Florence J; Stam, Frank; van der Ploeg, Tjeerd; Eeltink, Corien; Verdonck-de Leeuw, Irma M; Huijgens, Peter C

    2015-06-01

    For patients with haematological malignancies, information on disease, prognosis, treatment and impact on quality of life is of the utmost importance. To gain insight into the perceived need for information in relation to sociodemographic and clinical parameters, comorbidity, quality of life (QoL) and information satisfaction, we compiled a questionnaire based on existing validated questionnaires. A total of 458 patients diagnosed with a haematological malignancy participated. The perceived need for information was moderate to high (40-70%). Multivariate regression analyses showed that a higher need for information was related to younger age, worse QoL, being member of a patient society and moderate comorbidity. The need for disease and treatment-related information was higher than the need for psychosocial information. A higher need for disease and treatment-related information was associated to being diagnosed with multiple myeloma. A higher need for psychosocial information was related to a lower educational level. The information provision could be improved according to 41% of the patients. Higher satisfaction with provided information was associated with better QoL. Most patients (62%) reported that they wanted to be fully informed about their illness and actively involved in treatment decision-making. The results contribute to improving patient-tailored information provision and shared decision-making in clinical practice. PMID:24811073

  11. Chronic heat-shock treatment driven differentiation induces apoptosis in Leishmania donovani.

    PubMed

    Raina, Puneet; Kaur, Sukhbir

    2006-09-01

    The present study investigates the role of apoptosis in the regulation of cell numbers of Leishmania donovani during the in vitro differentiation of promastigote stage to amastigote stage in axenic conditions. We report that apoptosis is induced in Leishmania donovani due to chronic heat-shock treatment of 37 ( degrees )C that also mediates the differentiation of promastigotes to amastigotes. This is characterized by the fragmentation of DNA, blebbing in the parasite cell membrane, nuclear condensation, formation of preapoptotic bodies and involvement of Ca(++) in the apoptotic process. The flowcytometric analysis shows an early and steep rise in percentage apoptotic nuclei till 48-hour stage of differentiation and then a gradual decline, suggesting synergistic action of Ca(++) ATPase and probably Hsp70. Hsp70 might be rescuing cells from apoptosis in the death signaling pathway. Incubation of the culture with Ca(++) chelator EGTA (1 mM) brings down the percentage of apoptotic nuclei considerably showing thereby that calcium is needed for the process of cell death here that occurs by apoptosis. The survival of the infective individuals appears to be decided by the parasite in the early stages of its differentiation. Our studies show the potential of the physiological temperature of 37 ( degrees )C in inducing apoptosis in Leishmania donovani and the therapeutic use it can be put to. PMID:16718376

  12. Effects of Viewing an Evidence-Based Video Decision Aid on Patients’ Treatment Preferences for Spine Surgery

    PubMed Central

    Lurie, Jon D.; Spratt, Kevin F.; Blood, Emily A.; Tosteson, Tor D.; Tosteson, Anna N. A.; Weinstein, James N.

    2011-01-01

    Study Design Secondary analysis within a large clinical trial Objective To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process. Summary of Background Data A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known. Methods Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation (IDH), spinal stenosis (SPS), or degenerative spondylolisthesis (DS) at thirteen multidisciplinary spine centers across the US were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent. Results Of the 2505 patients, 86% (n=2151) watched the video and 14% (n=354) did not. Watchers shifted their preference more often than non-watchers(37.9% vs. 20.8%, p < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, p < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (p=0.003). Among the 617 who started with no preference, after the video 27% preferred non-operative care, 22% preferred surgery, and 51% remained uncertain. Conclusion After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery. PMID:21358485

  13. Aging Prisoners' Treatment Selection: Does Prospect Theory Enhance Understanding of End-of-Life Medical Decisions?

    ERIC Educational Resources Information Center

    Phillips, Laura L.; Allen, Rebecca S.; Harris, Grant M.; Presnell, Andrew H.; DeCoster, Jamie; Cavanaugh, Ronald

    2011-01-01

    Purpose: With the rapid growth in the older inmate population and the economic impact of end-of-life treatments within the cash-strapped prison system, consideration should be given to inmate treatment preferences. We examined end-of-life treatment preferences and days of desired life for several health scenarios among male inmates incarcerated…

  14. Treatment of human-computer interface in a decision support system

    SciTech Connect

    Heger, A.S.; Duran, F.A.; Frysinger, S.; Cox, R.G.

    1992-11-01

    One of the most challenging applications facing the computer community is development of effective adaptive human-computer interface. This challenge stems from the complex nature of the human part of this symbiosis. The application of this discipline to the environmental restoration and waste management is further complicated due to the nature of environmental data. The information that is required to manage environmental impacts of human activity is fundamentally complex. This paper will discuss the efforts at Sandia National Laboratories in developing the adaptive conceptual model manager within the constraint of the environmental decision-making. A computer workstation, that hosts the Conceptual Model Manager and the Sandia Environmental Decision Support System will also be discussed.

  15. Developing a model based decision support tool for the identification of sustainable treatment options for domestic wastewater.

    PubMed

    Balkema, A J; Preisig, H A; Otterpohl, R; Lambert, A J; Weijers, S R

    2001-01-01

    To enable decision makers to select sustainable wastewater treatment systems, insight into the sustainability of a wide variety of systems should be provided in a transparent way leaving room for adaptation and interpretation according to the local situation. To provide this insight a structured methodology comparing wastewater treatment systems with respect to sustainability is defined. Similar to life cycle assessment (LCA) three phases can be distinguished: (1) goal and scope definition, (2) inventory analysis, and (3) optimisation and results. In the goal and scope definition we set the system boundaries to include most of the water cycle and part of the food cycle. Furthermore, we defined a multi-disciplinary set of sustainability indicators including technical, economic, environmental, and socio-cultural aspects. In the inventory analysis these sustainability indicators are quantified using simple static models of wastewater unit operations. Selection of unit operations results in a model of a complete wastewater treatment system. In the optimisation phase the decision maker can weigh the different sustainability indicators and select sustainable options through integer programming. PMID:11385856

  16. NKT cell adjuvant-based tumor vaccine for treatment of myc oncogene-driven mouse B-cell lymphoma

    PubMed Central

    West, Alison C.; Steegh, Kim; Duret, Helene; Paget, Christophe; Martin, Ben; Matthews, Geoffrey M.; Shortt, Jake; Chesi, Marta; Bergsagel, P. Leif; Bots, Michael; Zuber, Johannes; Lowe, Scott W.; Johnstone, Ricky W.

    2012-01-01

    Immunomodulators are effective in controlling hematologic malignancy by initiating or reactivating host antitumor immunity to otherwise poorly immunogenic and immune suppressive cancers. We aimed to boost antitumor immunity in B-cell lymphoma by developing a tumor cell vaccine incorporating α-galactosylceramide (α-GalCer) that targets the immune adjuvant properties of NKT cells. In the Eμ-myc transgenic mouse model, single therapeutic vaccination of irradiated, α-GalCer–loaded autologous tumor cells was sufficient to significantly inhibit growth of established tumors and prolong survival. Vaccine-induced antilymphoma immunity required NKT cells, NK cells, and CD8 T cells, and early IL-12–dependent production of IFN-γ. CD4 T cells, gamma/delta T cells, and IL-18 were not critical. Vaccine treatment induced a large systemic spike of IFN-γ and transient peripheral expansion of both NKT cells and NK cells, the major sources of IFN-γ. Furthermore, this vaccine approach was assessed in several other hematopoietic tumor models and was also therapeutically effective against AML-ETO9a acute myeloid leukemia. Replacing α-GalCer with β-mannosylceramide resulted in prolonged protection against Eμ-myc lymphoma. Overall, our results demonstrate a potent immune adjuvant effect of NKT cell ligands in therapeutic anticancer vaccination against oncogene-driven lymphomas, and this work supports clinical investigation of NKT cell–based immunotherapy in patients with hematologic malignancies. PMID:22932803

  17. Self-Driven Desalination and Advanced Treatment of Wastewater in a Modularized Filtration Air Cathode Microbial Desalination Cell.

    PubMed

    Zuo, Kuichang; Wang, Zhen; Chen, Xi; Zhang, Xiaoyuan; Zuo, Jiaolan; Liang, Peng; Huang, Xia

    2016-07-01

    Microbial desalination cells (MDCs) extract organic energy from wastewater for in situ desalination of saline water. However, to desalinate salt water, traditional MDCs often require an anolyte (wastewater) and a catholyte (other synthetic water) to produce electricity. Correspondingly, the traditional MDCs also produced anode effluent and cathode effluent, and may produce a concentrate solution, resulting in a low production of diluate. In this study, nitrogen-doped carbon nanotube membranes and Pt carbon cloths were utilized as filtration material and cathode to fabricate a modularized filtration air cathode MDC (F-MDC). With real wastewater flowing from anode to cathode, and finally to the middle membrane stack, the diluate volume production reached 82.4%, with the removal efficiency of salinity and chemical oxygen demand (COD) reached 93.6% and 97.3% respectively. The final diluate conductivity was 68 ± 12 μS/cm, and the turbidity was 0.41 NTU, which were sufficient for boiler supplementary or industrial cooling. The concentrate production was only 17.6%, and almost all the phosphorus and salt, and most of the nitrogen were recovered, potentially allowing the recovery of nutrients and other chemicals. These results show the potential utility of the modularized F-MDC in the application of municipal wastewater advanced treatment and self-driven desalination. PMID:27269411

  18. Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems?

    PubMed

    Garland, Ann F; Taylor, Robin; Brookman-Frazee, Lauren; Baker-Ericzen, Mary; Haine-Schlagel, Rachel; Liu, Yi Hui; Wong, Sarina

    2015-06-01

    Race/ethnic disparities in utilization of children's mental health care have been well documented and are particularly concerning given the long-term risks of untreated mental health problems (Institute of Medicine, 2003; Kessler et al. Am J Psychiatry 152:10026-1032, 1995). Research investigating the higher rates of unmet need among race/ethnic minority youths has focused primarily on policy, fiscal, and individual child or family factors that can influence service access and use. Alternatively, this study examines provider behavior as a potential influence on race/ethnic disparities in mental health care. The goal of the study was to examine whether patient (family) race/ethnicity influences physician diagnostic and treatment decision-making for childhood disruptive behavior problems. The study utilized an internet-based video vignette with corresponding survey of 371 randomly selected physicians from across the USA representing specialties likely to treat these patients (pediatricians, family physicians, general and child psychiatrists). Participants viewed a video vignette in which only race/ethnicity of the mother randomly varied (non-Hispanic White, Hispanic, and African American) and then responded to questions about diagnosis and recommended treatments. Physicians assigned diagnoses such as oppositional defiant disorder (48 %) and attention deficit disorder (63 %) to the child, but there were no differences in diagnosis based on race/ethnicity. The majority of respondents recommended psychosocial treatment (98 %) and/or psychoactive medication treatment (60 %), but there were no significant differences based on race/ethnicity. Thus, in this study using mock patient stimuli and controlling for other factors, such as insurance coverage, we did not find major differences in physician diagnostic or treatment decision-making based on patient race/ethnicity. PMID:26863339

  19. Treatment of uncertainties associated with PRAs in risk-informed decision making (NUREG1855).

    SciTech Connect

    Wheeler, Timothy A.

    2010-06-01

    This document provides guidance on how to treat uncertainties associated with probabilistic risk assessment (PRA) in risk-informed decisionmaking. The objectives of this guidance include fostering an understanding of the uncertainties associated with PRA and their impact on the results of PRA and providing a pragmatic approach to addressing these uncertainties in the context of the decisionmaking. In implementing risk-informed decisionmaking, the U.S. Nuclear Regulatory Commission expects that appropriate consideration of uncertainty will be given in the analyses used to support the decision and in the interpretation of the findings of those analyses. To meet the objective of this document, it is necessary to understand the role that PRA results play in the context of the decision process. To define this context, this document provides an overview of the risk-informed decisionmaking process itself. With the context defined, this document describes the characteristics of a risk model and, in particular, a PRA. This description includes recognition that a PRA, being a probabilistic model, characterizes aleatory uncertainty that results from randomness associated with the events of the model. Because the focus of this document is epistemic uncertainty (i.e., uncertainties in the formulation of the PRA model), it provides guidance on identifying and describing the different types of sources of epistemic uncertainty and the different ways that they are treated. The different types of epistemic uncertainty are parameter, model, and completeness uncertainties. The final part of the guidance addresses the uncertainty in PRA results in the context of riskinformed decisionmaking and, in particular, the interpretation of the results of the uncertainty analysis when comparing PRA results with the acceptance criteria established for a specified application. In addition, guidance is provided for addressing completeness uncertainty in risk-informed decision making. Such

  20. Attitudes towards informed consent, confidentiality, and substitute treatment decisions in southern African medical students: a case study from Zimbabwe.

    PubMed

    Hipshman, L

    1999-08-01

    This study explored the attitudes of biomedical science students (medical students) in a non-Western setting towards three medical ethics concepts that are based on fundamental Western culture ethical principles. A dichotomous (agree/disagree) response questionnaire was constructed using Western ethnocentric culture (WEC) based perspectives of informed consent, confidentiality, and substitute decision-making. Hypothesized WEC-Biased responses were assigned to the questionnaire's questions or propositions. A number of useful responses (169) were obtained from a large, cross-sectional, convenience sample of the MBChB students at the University of Zimbabwe Medical School. Statistical analysis described the differences in response patterns between the student's responses compared to the hypothesized WEC-Biased response. The effect of the nine independent variables on selected dependent variables (responses to certain questionnaire questions) was analyzed by stepwise logistic regression. Students concurred with the hypothesized WEC-Biased responses for two-thirds of the questionnaire items. This agreement included support for the role of legal advocacy in the substitute decision-making process. The students disagreed with the hypothesized WEC-Biased responses in several important medical ethics aspects. Most notably, the students indicated that persons with mental dysfunctions, as a class, were properly considered incompetent to make treatment decisions. None of the studied independent variables was often associated with students' responses, but training year was more frequently implicated than either ethnicity or gender. In order to develop internationally and culturally relevant medical ethics standards, non-Western perspectives ought to be acknowledged and incorporated. Two main areas for further efforts include: curriculum development in ethics reasoning and related clinical (medico-legal) decision-making processes that would be relevant to medical students from

  1. Clinical Decision-Making in Community Children’s Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

    PubMed Central

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2014-01-01

    Background Mental health professionals’ decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective The present study explored the role of prior training in evidence-based treatments on clinicians’ assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making. Methods Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog “think aloud” method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory. Results MANOVA results were significant for EBT training status such that EBT trained clinicians’ displayed cognitive processes more closely aligned with “expert” decision-makers and non-EBT trained clinicians’ decision processes were more similar to “novice” decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making. Conclusion This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians’ decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice. PMID:25892901

  2. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions.

    PubMed

    Johns, Claire; Seav, Susan M; Dominick, Sally A; Gorman, Jessica R; Li, Hongying; Natarajan, Loki; Mao, Jun James; Su, H Irene

    2016-04-01

    Patient-centered decision making about hot flash treatments often incorporates a balance of efficacy and side effects in addition to patient preference. This systematic review examines randomized controlled trials (RCTs) comparing at least two non-hormonal hot flash treatments in breast cancer survivors. In July 2015, PubMed, SCOPUS, CINAHL, Cochrane, and Web of Science databases were searched for RCTs comparing active, non-hormonal hot flash treatments in female breast cancer survivors. Thirteen trials were included after identifying 906 potential studies. Four trials were dose comparison studies of pharmacologic treatments citalopram, venlafaxine, gabapentin, and paroxetine. Hot flash reduction did not differ by tamoxifen or aromatase inhibitor use. Citalopram 10, 20, and 30 mg daily had comparable outcomes. Venlafaxine 75 mg daily improved hot flashes without additional side effects from higher dosing. Gabapentin 900 mg daily improved hot flashes more than 300 mg. Paroxetine 10 mg daily had fewer side effects than 20 mg. Among four trials comparing different pharmacologic treatments, venlafaxine alleviated hot flash symptoms faster than clonidine; participants preferred venlafaxine over gabapentin. Five trials compared pharmacologic to non-pharmacologic treatments. Acupuncture had similar efficacy to venlafaxine and gabapentin but may have longer durability after completing treatment and fewer side effects. We could not perform a pooled meta-analysis because outcomes were not reported in comparable formats. Clinical trial data on non-hormonal hot flash treatments provide comparisons of hot flash efficacy and other patient important outcomes to guide clinical management. Clinicians can use the information to help patients select hot flash interventions. PMID:27015968

  3. Comparison of Cone-Beam Computed Tomography and Periapical Radiography in Predicting Treatment Decision for Periapical Lesions: A Clinical Study

    PubMed Central

    Balasundaram, Ashok; Shah, Punit; Hoen, Michael M.; Wheater, Michelle A.; Bringas, Josef S.; Gartner, Arnold; Geist, James R.

    2012-01-01

    Objectives. To compare the ability of endodontists to determine the size of apical pathological lesions and select the most appropriate choice of treatment based on lesions' projected image characteristics using 2 D and 3 D images. Study Design. Twenty-four subjects were selected. Radiographic examination of symptomatic study teeth with an intraoral periapical radiograph revealed periapical lesions equal to or greater than 3 mm in the greatest diameter. Cone-beam Computed tomography (CBCT) images were made of the involved teeth after the intraoral periapical radiograph confirmed the size of lesion to be equal to greater than 3 mm. Six observers (endodontists) viewed both the periapical and CBCT images. Upon viewing each of the images from the two imaging modalities, observers (1) measured lesion size and (2) made decisions on treatment based on each radiograph. Chi-square test was used to look for differences in the choice of treatment among observers. Results. No significant difference was noted in the treatment plan selected by observers using the two modalities (χ2(3) = .036, P > 0.05). Conclusion. Lesion size and choice of treatment of periapical lesions based on CBCT radiographs do not change significantly from those made on the basis of 2 D radiographs. PMID:23056050

  4. Are more endodontic consultations needed in dental school clinic settings? A study of treatment decisions at one school.

    PubMed

    Aminoshariae, Anita; Tulunoglu, Ibrahim; Demko, Catherine; Galsterer, Mark; Montagnese, Thomas A; Mickel, Andre

    2015-04-01

    With no previous studies of the occurrence of interdisciplinary consultations for tooth extraction in a dental school clinic setting, the aim of this cross-sectional descriptive investigation was to measure and compare the consultation process that occurred among departments at one U.S. dental school for making treatment decisions on tooth extraction. A comprehensive computerized retrieval (Crystal Reports) was used to identify and gather data from patient records from July 1, 2007, to July 1, 2011. Treatment plans and progress notes were analyzed to determine why each tooth had been extracted and which department had recommended the extraction. Results showed that the clinical departments involved in treatment planning decisions were the DMD dental student clinic, Department of Periodontics, and Department of Endodontics. The narrative records of 227 patients who had 516 teeth extracted were examined. About three-fourths (73.26%) of the extracted teeth were extracted based on the recommendation of only one department. Of these extracted teeth, 22.0% (n=114) were previously endodontically treated, and only four were recommended for endodontic consultation prior to extraction. The study found that most extractions were performed without specialty consultations and that the Department of Endodontics was consulted the least of all departments. To foster interdisciplinary collaboration in dental school clinics and help students develop expertise in such collaborations, more specialty consultations are needed for teeth that are treatment planned for extraction in order to preclude needless extraction of potentially salvageable teeth. Doing so will provide benefits for both patient care and students' education. PMID:25838010

  5. Decision support system for the optimal location of electrical and electronic waste treatment plants: a case study in greece.

    PubMed

    Achillas, Ch; Vlachokostas, Ch; Moussiopoulos, Nu; Banias, G

    2010-05-01

    Environmentally sound end-of-life management of Electrical and Electronic Equipment has been realised as a top priority issue internationally, both due to the waste stream's continuously increasing quantities, as well as its content in valuable and also hazardous materials. In an effort to manage Waste Electrical and Electronic Equipment (WEEE), adequate infrastructure in treatment and recycling facilities is considered a prerequisite. A critical number of such plants are mandatory to be installed in order: (i) to accommodate legislative needs, (ii) decrease transportation cost, and (iii) expand reverse logistics network and cover more areas. However, WEEE recycling infrastructures require high expenditures and therefore the decision maker need to be most precautious. In this context, special care should be given on the viability of infrastructure which is heavily dependent on facilities' location. To this end, a methodology aiming towards optimal location of Units of Treatment and Recycling is developed, taking into consideration economical together with social criteria, in an effort to interlace local acceptance and financial viability. For the decision support system's needs, ELECTRE III is adopted as a multicriteria analysis technique. The methodology's applicability is demonstrated with a real-world case study in Greece. PMID:20031385

  6. Industrial experience of process identification and set-point decision algorithm in a full-scale treatment plant.

    PubMed

    Yoo, Changkyoo; Kim, Min Han

    2009-06-01

    This paper presents industrial experience of process identification, monitoring, and control in a full-scale wastewater treatment plant. The objectives of this study were (1) to apply and compare different process-identification methods of proportional-integral-derivative (PID) autotuning for stable dissolved oxygen (DO) control, (2) to implement a process monitoring method that estimates the respiration rate simultaneously during the process-identification step, and (3) to propose a simple set-point decision algorithm for determining the appropriate set point of the DO controller for optimal operation of the aeration basin. The proposed method was evaluated in the industrial wastewater treatment facility of an iron- and steel-making plant. Among the process-identification methods, the control signal of the controller's set-point change was best for identifying low-frequency information and enhancing the robustness to low-frequency disturbances. Combined automatic control and set-point decision method reduced the total electricity consumption by 5% and the electricity cost by 15% compared to the fixed gain PID controller, when considering only the surface aerators. Moreover, as a result of improved control performance, the fluctuation of effluent quality decreased and overall effluent water quality was better. PMID:19428173

  7. Decision support system for the optimal location of electrical and electronic waste treatment plants: A case study in Greece

    SciTech Connect

    Achillas, Ch.; Vlachokostas, Ch.; Moussiopoulos, N.; Banias, G.

    2010-05-15

    Environmentally sound end-of-life management of Electrical and Electronic Equipment has been realised as a top priority issue internationally, both due to the waste stream's continuously increasing quantities, as well as its content in valuable and also hazardous materials. In an effort to manage Waste Electrical and Electronic Equipment (WEEE), adequate infrastructure in treatment and recycling facilities is considered a prerequisite. A critical number of such plants are mandatory to be installed in order: (i) to accommodate legislative needs, (ii) decrease transportation cost, and (iii) expand reverse logistics network and cover more areas. However, WEEE recycling infrastructures require high expenditures and therefore the decision maker need to be most precautious. In this context, special care should be given on the viability of infrastructure which is heavily dependent on facilities' location. To this end, a methodology aiming towards optimal location of Units of Treatment and Recycling is developed, taking into consideration economical together with social criteria, in an effort to interlace local acceptance and financial viability. For the decision support system's needs, ELECTRE III is adopted as a multicriteria analysis technique. The methodology's applicability is demonstrated with a real-world case study in Greece.

  8. A Systematic Examination of Data-Driven Decision-Making within a School Division: The Relationships among Principal Beliefs, School Characteristics, and Accreditation Status

    ERIC Educational Resources Information Center

    Teigen, Beth N.

    2009-01-01

    This non-experimental, census survey included the elementary, middle, and high school principals at the comprehensive schools within a large, suburban school division in Virginia. The focus of this study was the factors that influence building administrators in using data to make instructional decisions. The purpose was to discover if there is a…

  9. Challenges in Measuring a New Construct: Perception of Voluntariness for Research and Treatment Decision Making

    PubMed Central

    Miller, Victoria A.; Reynolds, William W.; Ittenbach, Richard F.; Luce, Mary Frances; Beauchamp, Tom L.; Nelson, Robert M.

    2010-01-01

    RELIABLE AND VALID MEASURES OF RELEVANT constructs are critical in the developing field of the empirical study of research ethics. The early phases of scale development for such constructs can be complex. We describe the methodological challenges of construct definition and operationalization and how we addressed them in our study to develop a measure of perception of voluntariness. We also briefly present our conceptual approach to the construct of voluntariness, which we defined as the perception of control over decision making. Our multifaceted approach to scale development ensured that we would develop a construct definition of sufficient breadth and depth, that our new measure of voluntariness would be applicable across disciplines, and that there was a clear link between our construct definition and items. The strategies discussed here can be adapted by other researchers who are considering a scale development study related to the empirical study of ethics. PMID:19754231

  10. [Cataracts in dogs--overview and guideline for decision making in treatment].

    PubMed

    Fischer, M-C; Meyer-Lindenberg, A

    2014-01-01

    Cataract is the leading cause of impaired vision and vision loss in dogs. Because of the considerable progress in cataract surgery in recent decades, lens opacities can now be operated on with very good short-term success (90-95%), taking into account that proper patient selection is essential to maximize the probability of a successful surgical outcome. Following a description of anatomical and physiological lens characteristics, the etiology and complications of untreated cataracts are discussed. Furthermore, specific criteria for patient selection are addressed while delineating essential steps of the examination. This article aims to aid decision making in cataract therapy on the basis of diagnostic guidance and to facilitate the selection of an appropriate point of time for surgery. PMID:25422865