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Sample records for driven treatment decisions

  1. Data-Driven-Decision Making

    ERIC Educational Resources Information Center

    T.H.E. Journal, 2004

    2004-01-01

    The data defined in this article encompasses a range of topics, including data definitions, data management systems, infrastructure (both local and statewide), and the actual use of data to make decisions on either the administrative or instructional side. This emphasis on data has grown as technology has made the access and use of data easier.…

  2. Making Data-Driven Decisions: Silent Reading

    ERIC Educational Resources Information Center

    Trudel, Heidi

    2007-01-01

    Due in part to conflicting opinions and research results, the practice of sustained silent reading (SSR) in schools has been questioned. After a frustrating experience with SSR, the author of this article began a data-driven decision-making process to gain new insights on how to structure silent reading in a classroom, including a comparison…

  3. Treatment decisions under ambiguity.

    PubMed

    Berger, Loïc; Bleichrodt, Han; Eeckhoudt, Louis

    2013-05-01

    Many health risks are ambiguous in the sense that reliable and credible information about these risks is unavailable. In health economics, ambiguity is usually handled through sensitivity analysis, which implicitly assumes that people are neutral towards ambiguity. However, empirical evidence suggests that people are averse to ambiguity and react strongly to it. This paper studies the effects of ambiguity aversion on two classical medical decision problems. If there is ambiguity regarding the diagnosis of a patient, ambiguity aversion increases the decision maker's propensity to opt for treatment. On the other hand, in the case of ambiguity regarding the effects of treatment, ambiguity aversion leads to a reduction in the propensity to choose treatment.

  4. 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

  5. Central Office Data-Driven Decision Making in Public Education

    ERIC Educational Resources Information Center

    Scheikl, Oskar F.

    2009-01-01

    Data-driven decision making has become part of the lexicon for educational reform efforts. Supported by the federal No Child Left Behind legislation, the use of data to inform educational decisions has become a common-place practice across the country. Using an online survey administered to central office data leaders in all Virginia public school…

  6. 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.

  7. 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.

  8. 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

  9. Data-Driven Decision Making. Information Capsule. Volume 0605

    ERIC Educational Resources Information Center

    Blazer, Christie

    2006-01-01

    The federal No Child Left Behind Act and its mandate for adequate yearly progress has placed unprecedented demands on districts to use evidence to support their school improvement efforts. Research has not yet determined if data-driven decision making leads to improvements in teaching and learning since most outcomes reported to date are based on…

  10. Counterpoint: the treatment decision design.

    PubMed

    Brookhart, M Alan

    2015-11-15

    The comparative new-user design is a principled approach to learning about the relative risks and benefits of starting different treatments in patients who have no history of use of the treatments being studied. Vandenbroucke and Pearce (Am J Epidemiol. 2015;182(10):826-833) discuss some problems inherent in incident exposure designs and argue that epidemiology may be harmed by a rigid requirement that follow-up can only begin at first exposure. In the present counterpoint article, a range of problems in pharmacoepidemiology that do not necessarily require that observation begin at first exposure are discussed. For example, among patients who are past or current users of a medication, we might want to know whether treatment should be augmented, switched, restarted, or discontinued. To answer these questions, a generalization of the new-user design, the treatment decision design, which identifies cohorts anchored at times when treatment decisions are being made, such as the evaluation of laboratory parameters, is discussed. The design aims to provide estimates that are directly relevant to physicians and patients, helping them to better understand the risks and benefits of the different treatment choices that they are considering. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Counterpoint: The Treatment Decision Design

    PubMed Central

    Brookhart, M. Alan

    2015-01-01

    The comparative new-user design is a principled approach to learning about the relative risks and benefits of starting different treatments in patients who have no history of use of the treatments being studied. Vandenbroucke and Pearce (Am J Epidemiol. 2015;182(10):826–833) discuss some problems inherent in incident exposure designs and argue that epidemiology may be harmed by a rigid requirement that follow-up can only begin at first exposure. In the present counterpoint article, a range of problems in pharmacoepidemiology that do not necessarily require that observation begin at first exposure are discussed. For example, among patients who are past or current users of a medication, we might want to know whether treatment should be augmented, switched, restarted, or discontinued. To answer these questions, a generalization of the new-user design, the treatment decision design, which identifies cohorts anchored at times when treatment decisions are being made, such as the evaluation of laboratory parameters, is discussed. The design aims to provide estimates that are directly relevant to physicians and patients, helping them to better understand the risks and benefits of the different treatment choices that they are considering. PMID:26507307

  12. Workflow-driven clinical decision support for personalized oncology.

    PubMed

    Bucur, Anca; van Leeuwen, Jasper; Christodoulou, Nikolaos; Sigdel, Kamana; Argyri, Katerina; Koumakis, Lefteris; Graf, Norbert; Stamatakos, Georgios

    2016-07-21

    The adoption in oncology of Clinical Decision Support (CDS) may help clinical users to efficiently deal with the high complexity of the domain, lead to improved patient outcomes, and reduce the current knowledge gap between clinical research and practice. While significant effort has been invested in the implementation of CDS, the uptake in the clinic has been limited. The barriers to adoption have been extensively discussed in the literature. In oncology, current CDS solutions are not able to support the complex decisions required for stratification and personalized treatment of patients and to keep up with the high rate of change in therapeutic options and knowledge. To address these challenges, we propose a framework enabling efficient implementation of meaningful CDS that incorporates a large variety of clinical knowledge models to bring to the clinic comprehensive solutions leveraging the latest domain knowledge. We use both literature-based models and models built within the p-medicine project using the rich datasets from clinical trials and care provided by the clinical partners. The framework is open to the biomedical community, enabling reuse of deployed models by third-party CDS implementations and supporting collaboration among modelers, CDS implementers, biomedical researchers and clinicians. To increase adoption and cope with the complexity of patient management in oncology, we also support and leverage the clinical processes adhered to by healthcare organizations. We design an architecture that extends the CDS framework with workflow functionality. The clinical models are embedded in the workflow models and executed at the right time, when and where the recommendations are needed in the clinical process. In this paper we present our CDS framework developed in p-medicine and the CDS implementation leveraging the framework. To support complex decisions, the framework relies on clinical models that encapsulate relevant clinical knowledge. Next to

  13. 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…

  14. 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…

  15. Decision aids for people facing health treatment or screening decisions.

    PubMed

    Stacey, Dawn; Légaré, France; Col, Nananda F; Bennett, Carol L; Barry, Michael J; Eden, Karen B; Holmes-Rovner, Margaret; Llewellyn-Thomas, Hilary; Lyddiatt, Anne; Thomson, Richard; Trevena, Lyndal; Wu, Julie H C

    2014-01-28

    Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. To assess the effects of decision aids for people facing treatment or screening decisions. For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:A) 'choice made' attributes;B) 'decision-making process' attributes.Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29

  16. Decision aids for people facing health treatment or screening decisions.

    PubMed

    Stacey, Dawn; Bennett, Carol L; Barry, Michael J; Col, Nananda F; Eden, Karen B; Holmes-Rovner, Margaret; Llewellyn-Thomas, Hilary; Lyddiatt, Anne; Légaré, France; Thomson, Richard

    2011-10-05

    Decision aids prepare people to participate in decisions that involve weighing benefits, harms, and scientific uncertainty. To evaluate the effectiveness of decision aids for people facing treatment or screening decisions. For this update, we searched from January 2006 to December 2009 in MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 4 2009); CINAHL (Ovid) (to September 2008 only); EMBASE (Ovid); PsycINFO (Ovid); and grey literature. Cumulatively, we have searched each database since its start date. We included published randomised controlled trials (RCTs) of decision aids, which are interventions designed to support patients' decision making by providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies in which participants were not making an active treatment or screening decision. Two review authors independently screened abstracts for inclusion, extracted data, and assessed potential risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards, were:A) decision attributes;B) decision making process attributes.Secondary outcomes were behavioral, health, and health system effects. We pooled results of RCTs using mean differences (MD) and relative risks (RR), applying a random effects model. Of 34,316 unique citations, 86 studies involving 20,209 participants met the eligibility criteria and were included. Thirty-one of these studies are new in this update. Twenty-nine trials are ongoing. There was variability in potential risk of bias across studies. The two criteria that were most problematic were lack of blinding and the potential for selective outcome reporting, given that most of the earlier trials were not registered.Of 86 included studies, 63 (73%) used at least one measure that mapped onto an IPDAS effectiveness criterion: A) criteria involving decision attributes

  17. Decision aids for people facing health treatment or screening decisions.

    PubMed

    O'Connor, A M; Stacey, D; Entwistle, V; Llewellyn-Thomas, H; Rovner, D; Holmes-Rovner, M; Tait, V; Tetroe, J; Fiset, V; Barry, M; Jones, J

    2003-01-01

    Decision aids prepare people to participate in preference-sensitive decisions. 1. Create a comprehensive inventory of patient decision aids focused on healthcare options. 2. Review randomized controlled trials (RCT) of decision aids, for people facing healthcare decisions. Studies were identified through databases and contact with researchers active in the field. Two independent reviewers screened abstracts for interventions designed to aid patients' decision making by providing information about treatment or screening options and their associated outcomes. Information about the decision aids was compiled in an inventory; those that had been evaluated in a RCT were reviewed in detail. Two reviewers independently extracted data using standardized forms. Results of RCTs were pooled using weighted mean differences (WMD) and relative risks (RR) using a random effects model. Over 200 decision aids were identified. Of the 131 available decision aids, most are intended for use before counselling. Using the CREDIBLE criteria to evaluate the quality of the decision aids: a) most included potential harms and benefits, credentials of the developers, description of their development process, update policy, and were free of perceived conflict of interest; b) many included reference to relevant literature; c) few included a description of the level of uncertainty regarding the evidence; and d) few were evaluated. Thirty of these decision aids were evaluated in 34 RCTs and another trial evaluated a suite of eight decision aids. An additional 30 trials are yet to be published. Among the trials comparing decision aids to usual care, decision aids performed better in terms of: a) greater knowledge (WMD 19 out of 100, 95% CI: 13 to 24; b) more realistic expectations (RR 1.4, 95%CI: 1.1 to 1.9); c) lower decisional conflict related to feeling informed (WMD -9.1 of 100, 95%CI: -12 to -6); d) increased proportion of people active in decision making (RR 1.4, 95% CI: 1.0 to 2.3); and e

  18. Decision aids for people facing health treatment or screening decisions.

    PubMed

    Stacey, Dawn; Légaré, France; Lewis, Krystina; Barry, Michael J; Bennett, Carol L; Eden, Karen B; Holmes-Rovner, Margaret; Llewellyn-Thomas, Hilary; Lyddiatt, Anne; Thomson, Richard; Trevena, Lyndal

    2017-04-12

    Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. To assess the effects of decision aids in people facing treatment or screening decisions. Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate

  19. Ability Grouping and Differentiated Instruction in an Era of Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Park, Vicki; Datnow, Amanda

    2017-01-01

    Despite data-driven decision making being a ubiquitous part of policy and school reform efforts, little is known about how teachers use data for instructional decision making. Drawing on data from a qualitative case study of four elementary schools, we examine the logic and patterns of teacher decision making about differentiation and ability…

  20. Ability Grouping and Differentiated Instruction in an Era of Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Park, Vicki; Datnow, Amanda

    2017-01-01

    Despite data-driven decision making being a ubiquitous part of policy and school reform efforts, little is known about how teachers use data for instructional decision making. Drawing on data from a qualitative case study of four elementary schools, we examine the logic and patterns of teacher decision making about differentiation and ability…

  1. 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…

  2. An Investigation of How Elementary School Teachers Make Data-Driven Instructional Decisions in Literacy

    ERIC Educational Resources Information Center

    Pham, Cheryl Carangian

    2011-01-01

    The purpose of this mixed methods phenomenological study was to explore the data-driven instructional decisions that elementary teachers make in literacy. Educators have moved towards a culture of being data-driven, and have declared data use in schools to be significant to school improvement and accountability (Marsh, Pane, & Hamilton, 2006).…

  3. An Investigation of How Elementary School Teachers Make Data-Driven Instructional Decisions in Literacy

    ERIC Educational Resources Information Center

    Pham, Cheryl Carangian

    2011-01-01

    The purpose of this mixed methods phenomenological study was to explore the data-driven instructional decisions that elementary teachers make in literacy. Educators have moved towards a culture of being data-driven, and have declared data use in schools to be significant to school improvement and accountability (Marsh, Pane, & Hamilton, 2006).…

  4. Data-driven decision-making tools to improve public resource allocation for care and prevention of HIV/AIDS.

    PubMed

    Ryan, Gery W; Bloom, Evan W; Lowsky, David J; Linthicum, Mark T; Juday, Timothy; Rosenblatt, Lisa; Kulkarni, Sonali; Goldman, Dana P; Sayles, Jennifer N

    2014-03-01

    Public health agencies face difficult decisions when allocating scarce resources to control the spread of HIV/AIDS. Decisions are often made with few local empirical data. We demonstrated the use of the robust decision making approach in Los Angeles County, an approach that is data driven and allows decision makers to compare the performance of various intervention strategies across thousands of simulated future scenarios. We found that the prevailing strategy of emphasizing behavioral risk reduction interventions was unlikely to achieve the policy goals of the national HIV/AIDS strategy. Of the alternative strategies we examined, those that invested most heavily in interventions to initiate antiretroviral treatment and support treatment adherence were the most likely to achieve policy objectives. By employing similar methods, other public health agencies can identify robust strategies and invest in interventions more likely to achieve HIV/AIDS policy goals.

  5. 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…

  6. Parental involvement in paediatric cancer treatment decisions.

    PubMed

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

    2010-09-01

    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.

  7. 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…

  8. 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…

  9. 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…

  10. 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…

  11. 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…

  12. Patient resistance as agency in treatment decisions.

    PubMed

    Koenig, Christopher J

    2011-04-01

    Medication is critical to the management of medical problems, however relatively little attention has been paid to the treatment recommendation process where a new medication is first prescribed. This article argues that how and when a patient agrees to a physician's treatment demonstrates a patient's active involvement in decisions about treatment. Using 100 video recorded primary care visits across 10 internal medicine clinics in the Western United States, this paper uses conversation analysis to document the delivery and reception of treatment recommendations in acute medical visits with adult patients. Specifically, this article analyzes patients demonstrating active participation regarding treatment decisions as a limited form of agency. Starting from the premise that participants orient to physicians' treatment recommendations as normatively requiring patient acceptance before moving to a next activity, this article argues that when patients resist a recommendation, they actively participate in how the treatment recommendation emerges as acceptable. This article argues that through resistance to a treatment recommendation, patients work to negotiate and collaboratively co-construct what counts as an acceptable recommendation. Overall, this article argues that patient resistance is an interactional resource for patients to assert their agency by ensuring the ensuing recommendation is acceptable and in accord with their treatment preferences and concerns. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Multi-Objective Markov Decision Processes for Data-Driven Decision Support

    PubMed Central

    Lizotte, Daniel J.; Laber, Eric B.

    2016-01-01

    We present new methodology based on Multi-Objective Markov Decision Processes for developing sequential decision support systems from data. Our approach uses sequential decision-making data to provide support that is useful to many different decision-makers, each with different, potentially time-varying preference. To accomplish this, we develop an extension of fitted-Q iteration for multiple objectives that computes policies for all scalarization functions, i.e. preference functions, simultaneously from continuous-state, finite-horizon data. We identify and address several conceptual and computational challenges along the way, and we introduce a new solution concept that is appropriate when different actions have similar expected outcomes. Finally, we demonstrate an application of our method using data from the Clinical Antipsychotic Trials of Intervention Effectiveness and show that our approach offers decision-makers increased choice by a larger class of optimal policies. PMID:28018133

  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.

  15. 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…

  16. Grades and Data Driven Decision Making: Issues of Variance and Student Patterns

    ERIC Educational Resources Information Center

    Bowers, Alex Jon

    2007-01-01

    This study addresses the question: "To what extent are teacher assigned subject specific grades useful for data driven decision making in schools?" Recently, schools have been urged to bring teachers and school leaders together around student-level data in an effort to increase dialogue, collaboration and professional communities to…

  17. 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…

  18. 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…

  19. 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…

  20. 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…

  1. 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),…

  2. Comparing two treatments by decision theory.

    PubMed

    Longford, Nicholas T

    2016-09-01

    Decision theory is applied to the general problem of comparing two treatments in an experiment with subjects assigned to the treatments at random. The inferential agenda covers collection of evidence about superiority, non-inferiority and average bioequivalence of the treatments. The proposed approach requires defining the terms 'small' and 'large' to qualify the magnitude of the treatment effect and specifying the losses (or loss functions) that quantify the consequences of the incorrect conclusions. We argue that any analysis that ignores these two inputs is deficient, and so is any ad hoc way of taking them into account. Sample size calculation for studies intended to be analysed by this approach is also discussed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. What is known about parents' treatment decisions? A narrative review of pediatric decision making.

    PubMed

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

    2012-01-01

    With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. 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. 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. 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.

  4. Treatment for Anhedonia: A Neuroscience Driven Approach.

    PubMed

    Craske, Michelle G; Meuret, Alicia E; Ritz, Thomas; Treanor, Michael; Dour, Halina J

    2016-10-01

    Anhedonia, or loss of interest or pleasure in usual activities, is characteristic of depression, some types of anxiety, as well as substance abuse and schizophrenia. Anhedonia is a predictor of poor long-term outcomes, including suicide, and poor treatment response. Because extant psychological and pharmacological treatments are relatively ineffective for anhedonia, there is an unmet therapeutic need for this high-risk symptom. Current psychological and drug treatments for anxiety and depression focus largely on reducing excesses in negative affect rather than improving deficits in positive affect. Recent advances in affective neuroscience posit that anhedonia is associated with deficits in the appetitive reward system, specifically the anticipation, consumption, and learning of reward. In this paper, we review the evidence for positive affect as a symptom cluster, and its neural underpinnings, and introduce a novel psychological treatment for anxiety and depression that targets appetitive responding. First, we review anhedonia in relation to positive and negative valence systems and current treatment approaches. Second, we discuss the evidence linking anhedonia to biological, experiential, and behavioral deficits in the reward subsystems. Third, we describe the therapeutic approach for Positive Affect Treatment (PAT), an intervention designed to specifically target deficits in reward sensitivity. © 2016 Wiley Periodicals, Inc.

  5. 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

  6. Context-Driven Decision Making in Network-Centric Operations: Agent-Based Intelligent Support

    DTIC Science & Technology

    2006-01-01

    SPIIRAS CKM Workshop (MIT, Cambridge, MA; January 24, 2006 Context-Driven Decision Making in Network-Centric Operations: Agent- Based Intelligent...Operations: Agent- Based Intelligent Support 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK...Enterprise and Multi-Agent Systems (Engineering and Physical Sciences Research Council, UK, 2003-2005) Ontology- Based New Order Code Generation for

  7. From data to optimal decision making: a data-driven, probabilistic machine learning approach to decision support for patients with sepsis.

    PubMed

    Tsoukalas, Athanasios; Albertson, Timothy; Tagkopoulos, Ilias

    2015-02-24

    -policy cases, these numbers are 192 (12.9%) and 764 (51.2%) patients (P=4.6e-117), respectively. Furthermore, the percentage of transitions within a trajectory that lead to a better or better/same state are significantly higher by following the policy than for non-policy cases (605 vs 344 patients, P=8.6e-25). Mortality was predicted with an AUC of 0.7 and 0.82 accuracy in the general case and similar performance was obtained for the inference of the length-of-stay (AUC of 0.69 to 0.73 with accuracies from 0.69 to 0.82). A data-driven model was able to suggest favorable actions, predict mortality and length of stay with high accuracy. This work provides a solid basis for a scalable probabilistic clinical decision support framework for sepsis treatment that can be expanded to other clinically relevant states and actions, as well as a data-driven model that can be adopted in other clinical areas with sufficient training data.

  8. From Data to Optimal Decision Making: A Data-Driven, Probabilistic Machine Learning Approach to Decision Support for Patients With Sepsis

    PubMed Central

    Tsoukalas, Athanasios; Albertson, Timothy

    2015-01-01

    (P=4.0e-06), while in the non-policy cases, these numbers are 192 (12.9%) and 764 (51.2%) patients (P=4.6e-117), respectively. Furthermore, the percentage of transitions within a trajectory that lead to a better or better/same state are significantly higher by following the policy than for non-policy cases (605 vs 344 patients, P=8.6e-25). Mortality was predicted with an AUC of 0.7 and 0.82 accuracy in the general case and similar performance was obtained for the inference of the length-of-stay (AUC of 0.69 to 0.73 with accuracies from 0.69 to 0.82). Conclusions A data-driven model was able to suggest favorable actions, predict mortality and length of stay with high accuracy. This work provides a solid basis for a scalable probabilistic clinical decision support framework for sepsis treatment that can be expanded to other clinically relevant states and actions, as well as a data-driven model that can be adopted in other clinical areas with sufficient training data. PMID:25710907

  9. Data to Decisions: Creating a Culture of Model-Driven Drug Discovery.

    PubMed

    Brown, Frank K; Kopti, Farida; Chang, Charlie Zhenyu; Johnson, Scott A; Glick, Meir; Waller, Chris L

    2017-08-02

    Merck & Co., Inc., Kenilworth, NJ, USA, is undergoing a transformation in the way that it prosecutes R&D programs. Through the adoption of a "model-driven" culture, enhanced R&D productivity is anticipated, both in the form of decreased attrition at each stage of the process and by providing a rational framework for understanding and learning from the data generated along the way. This new approach focuses on the concept of a "Design Cycle" that makes use of all the data possible, internally and externally, to drive decision-making. These data can take the form of bioactivity, 3D structures, genomics, pathway, PK/PD, safety data, etc. Synthesis of high-quality data into models utilizing both well-established and cutting-edge methods has been shown to yield high confidence predictions to prioritize decision-making and efficiently reposition resources within R&D. The goal is to design an adaptive research operating plan that uses both modeled data and experiments, rather than just testing, to drive project decision-making. To support this emerging culture, an ambitious information management (IT) program has been initiated to implement a harmonized platform to facilitate the construction of cross-domain workflows to enable data-driven decision-making and the construction and validation of predictive models. These goals are achieved through depositing model-ready data, agile persona-driven access to data, a unified cross-domain predictive model lifecycle management platform, and support for flexible scientist-developed workflows that simplify data manipulation and consume model services. The end-to-end nature of the platform, in turn, not only supports but also drives the culture change by enabling scientists to apply predictive sciences throughout their work and over the lifetime of a project. This shift in mindset for both scientists and IT was driven by an early impactful demonstration of the potential benefits of the platform, in which expert-level early discovery

  10. 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.

  11. Are mobile health applications useful for supporting shared decision making in diagnostic and treatment decisions?

    PubMed

    Abbasgholizadeh Rahimi, Samira; Menear, Matthew; Robitaille, Hubert; Légaré, France

    2017-06-01

    Mobile health (mHealth) applications intended to support shared decision making in diagnostic and treatment decisions are increasingly available. In this paper, we discuss some recent studies on mHealth applications with relevance to shared decision making. We discuss the potential advantages and disadvantages of using mHealth in shared decision making in various contexts, and suggest some directions for future research in this quickly expanding field.

  12. A Genetically Mediated Bias in Decision Making Driven by Failure of Amygdala Control

    PubMed Central

    Roiser, Jonathan P.; de Martino, Benedetto; Tan, Geoffrey C. Y.; Kumaran, Dharshan; Seymour, Ben; Wood, Nicholas W.; Dolan, Raymond J.

    2009-01-01

    Genetic variation at the serotonin transporter-linked polymorphic region (5-HTTLPR) is associated with altered amygdala reactivity and lack of prefrontal regulatory control. Similar regions mediate decision-making biases driven by contextual cues and ambiguity, for example the “framing effect.” We hypothesized that individuals hemozygous for the short (s) allele at the 5-HTTLPR would be more susceptible to framing. Participants, selected as homozygous for either the long (la) or s allele, performed a decision-making task where they made choices between receiving an amount of money for certain and taking a gamble. A strong bias was evident toward choosing the certain option when the option was phrased in terms of gains and toward gambling when the decision was phrased in terms of losses (the frame effect). Critically, this bias was significantly greater in the ss group compared with the lala group. In simultaneously acquired functional magnetic resonance imaging data, the ss group showed greater amygdala during choices made in accord, compared with those made counter to the frame, an effect not seen in the lala group. These differences were also mirrored by differences in anterior cingulate–amygdala coupling between the genotype groups during decision making. Specifically, lala participants showed increased coupling during choices made counter to, relative to those made in accord with, the frame, with no such effect evident in ss participants. These data suggest that genetically mediated differences in prefrontal-amygdala interactions underpin interindividual differences in economic decision making. PMID:19420264

  13. 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

  14. Knowledge-based goal-driven approach for information extraction and decision making for target recognition

    NASA Astrophysics Data System (ADS)

    Wilson, Roderick D.; Wilson, Anitra C.

    1996-06-01

    This paper presents a novel goal-driven approach for designing a knowledge-based system for information extraction and decision-making for target recognition. The underlying goal-driven model uses a goal frame tree schema for target organization, a hybrid rule-based pattern- directed formalism for target structural encoding, and a goal-driven inferential control strategy. The knowledge-base consists of three basic structures for the organization and control of target information: goals, target parameters, and an object-rulebase. Goal frames represent target recognition tasks as goals and subgoals in the knowledge base. Target parameters represent characteristic attributes of targets that are encoded as information atoms. Information atoms may have one or more assigned values and are used for information extraction. The object-rulebase consists of pattern/action assertional implications that describe the logical relationships existing between target parameter values. A goal realization process formulates symbolic patten expressions whose atomic values map to target parameters contained a priori in a hierarchical database of target state information. Symbolic pattern expression creation is accomplished via the application of a novel goal-driven inference strategy that logically prunes an AND/OR tree constructed object-rulebase. Similarity analysis is performed via pattern matching of query symbolic patterns and a priori instantiated target parameters.

  15. 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.

  16. Model-Driven Development of Decision Support Systems: Tackling the Variability Problem

    NASA Astrophysics Data System (ADS)

    Cabello, María Eugenia; Ramos, Isidro

    In this chapter, we present software variability management using conceptual models for diagnostic decision support information systems (DSS) development. We use a software product line (SPL) approach. In the construction of the SPL, two orthogonal variabilities are used to capture domain (i.e., diagnosis) and application domain (i.e., medical diagnosis) particularities. In this context, we describe how variability is managed by using our BOM (baseline-oriented modeling) approach. BOM is a framework that automatically generates applications as PRISMA software architectural models using model transformations and SPL techniques. We use model-driven architecture (MDA) to build domain models (i.e., computational-independent models, CIMs), which are automatically transformed into platform-independent models, PIMs, and then compiled to a executable application (i.e., platform-specific model, PSM). In order to illustrate BOM, we focus on a type of information system, the decision support system, specifically in the diagnostic domain.

  17. Knowledge management in healthcare: towards 'knowledge-driven' decision-support services.

    PubMed

    Abidi, S S

    2001-09-01

    In this paper, we highlight the involvement of Knowledge Management in a healthcare enterprise. We argue that the 'knowledge quotient' of a healthcare enterprise can be enhanced by procuring diverse facets of knowledge from the seemingly placid healthcare data repositories, and subsequently operationalising the procured knowledge to derive a suite of Strategic Healthcare Decision-Support Services that can impact strategic decision-making, planning and management of the healthcare enterprise. In this paper, we firstly present a reference Knowledge Management environment-a Healthcare Enterprise Memory-with the functionality to acquire, share and operationalise the various modalities of healthcare knowledge. Next, we present the functional and architectural specification of a Strategic Healthcare Decision-Support Services Info-structure, which effectuates a synergy between knowledge procurement (vis-à-vis Data Mining) and knowledge operationalisation (vis-à-vis Knowledge Management) techniques to generate a suite of strategic knowledge-driven decision-support services. In conclusion, we argue that the proposed Healthcare Enterprise Memory is an attempt to rethink the possible sources of leverage to improve healthcare delivery, hereby providing a valuable strategic planning and management resource to healthcare policy makers.

  18. Sound-driven enhancement of vision: disentangling detection-level from decision-level contributions

    PubMed Central

    Pérez-Bellido, Alexis; Soto-Faraco, Salvador

    2013-01-01

    Cross-modal enhancement can be mediated both by higher-order effects due to attention and decision making and by detection-level stimulus-driven interactions. However, the contribution of each of these sources to behavioral improvements has not been conclusively determined and quantified separately. Here, we apply psychophysical analysis based on Piéron functions in order to separate stimulus-dependent changes from those accounted by decision-level contributions. Participants performed a simple visual speeded detection task on Gabor patches of different spatial frequencies and contrast values, presented with and without accompanying sounds. On one hand, we identified an additive cross-modal improvement in mean reaction times across all types of visual stimuli that would be well explained by interactions not strictly based on stimulus-driven modulations (e.g., due to reduction of temporal uncertainty and motor times). On the other hand, we singled out an audio-visual benefit that strongly depended on stimulus features such as frequency and contrast. This particular enhancement was selective to low-visual spatial frequency stimuli, optimized for magnocellular sensitivity. We therefore conclude that interactions at detection stages and at decisional processes in response selection that contribute to audio-visual enhancement can be separated online and express on partly different aspects of visual processing. PMID:23221404

  19. Sound-driven enhancement of vision: disentangling detection-level from decision-level contributions.

    PubMed

    Pérez-Bellido, Alexis; Soto-Faraco, Salvador; López-Moliner, Joan

    2013-02-01

    Cross-modal enhancement can be mediated both by higher-order effects due to attention and decision making and by detection-level stimulus-driven interactions. However, the contribution of each of these sources to behavioral improvements has not been conclusively determined and quantified separately. Here, we apply psychophysical analysis based on Piéron functions in order to separate stimulus-dependent changes from those accounted by decision-level contributions. Participants performed a simple visual speeded detection task on Gabor patches of different spatial frequencies and contrast values, presented with and without accompanying sounds. On one hand, we identified an additive cross-modal improvement in mean reaction times across all types of visual stimuli that would be well explained by interactions not strictly based on stimulus-driven modulations (e.g., due to reduction of temporal uncertainty and motor times). On the other hand, we singled out an audio-visual benefit that strongly depended on stimulus features such as frequency and contrast. This particular enhancement was selective to low-visual spatial frequency stimuli, optimized for magnocellular sensitivity. We therefore conclude that interactions at detection stages and at decisional processes in response selection that contribute to audio-visual enhancement can be separated online and express on partly different aspects of visual processing.

  20. The Evolution of Patient Decision-Making Regarding Medical Treatment of Rheumatoid Arthritis

    PubMed Central

    Mathews, Alexandra L.; Coleska, Adriana; Burns, Patricia B.; Chung, Kevin C.

    2016-01-01

    Background The migration of health care toward a consumer driven system favors increased patient participation during the treatment decision-making process. Patient involvement in treatment decision discussions has been linked to increased treatment adherence and patient satisfaction. Previous studies have quantified decision-making styles of patients with Rheumatoid Arthritis (RA); however, none have considered the evolution in patient involvement after living with RA for decades. Objective We conducted a qualitative study to determine the decision-making model used by long-term RA patients, and to describe the changes in their involvement over time. Methods Twenty participants were recruited from the ongoing Silicone Arthroplasty in Rheumatoid Arthritis (SARA) study. Semi-structured interviews were conducted and data were analyzed using Grounded Theory methodology. Results Nineteen out of 20 participants recalled using the paternalistic decision-making model immediately following their diagnosis. Fourteen of the 19 interviewees evolved to shared decision-making (SDM). Participants attributed the change in involvement to the development of a trusting relationship with their physician as well as becoming educated about the disease. Conclusion When initially diagnosed with RA, patients may let their physician decide on the best treatment course. However, over time patients may evolve to exercise a more collaborative role. Physicians should understand that even within SDM, each patient can demonstrate a varied amount of autonomy. It is up to the physician to have a discussion with each patient to determine his or her desired level of involvement. PMID:26315611

  1. Evolution of Patient Decision-Making Regarding Medical Treatment of Rheumatoid Arthritis.

    PubMed

    Mathews, Alexandra L; Coleska, Adriana; Burns, Patricia B; Chung, Kevin C

    2016-03-01

    The migration of health care toward a consumer-driven system favors increased patient participation during the treatment decision-making process. Patient involvement in treatment decision discussions has been linked to increased treatment adherence and patient satisfaction. Previous studies have quantified decision-making styles of patients with rheumatoid arthritis (RA); however, none of them have considered the evolution of patient involvement after living with RA for many years. We conducted a qualitative study to determine the decision-making model used by long-term RA patients, and to describe the changes in their involvement over time. Twenty participants were recruited from the ongoing Silicone Arthroplasty in Rheumatoid Arthritis study. Semistructured interviews were conducted and data were analyzed using grounded theory methodology. Nineteen out of 20 participants recalled using the paternalistic decision-making (PDM) model immediately following their diagnosis. Fourteen of the 19 participants who initially used PDM evolved to shared decision-making (SDM). Participants attributed the change in involvement to the development of a trusting relationship with their physician, as well as to becoming educated about the disease. When initially diagnosed with RA, patients may let their physician decide on the best treatment course. However, over time patients may evolve to exercise a more collaborative role. Physicians should understand that even within SDM, each patient can demonstrate a varied amount of autonomy. It is up to the physician to have a discussion with each patient to determine his or her desired level of involvement. © 2016, American College of Rheumatology.

  2. Informed Decision Making: Assessment of the Quality of Physician Communication about Prostate Cancer Diagnosis and Treatment.

    PubMed

    Holmes-Rovner, Margaret; Montgomery, Jeffrey S; Rovner, David R; Scherer, Laura D; Whitfield, Jesse; Kahn, Valerie C; Merkle, Edgar C; Ubel, Peter A; Fagerlin, Angela

    2015-11-01

    Little is known about how physicians present diagnosis and treatment planning in routine practice in preference-sensitive treatment decisions. We evaluated completeness and quality of informed decision making in localized prostate cancer post biopsy encounters. We analyzed audio-recorded office visits of 252 men with presumed localized prostate cancer (Gleason 6 and Gleason 7 scores) who were seeing 45 physicians at 4 Veterans Affairs Medical Centers. Data were collected between September 2008 and May 2012 in a trial of 2 decision aids (DAs). Braddock's previously validated Informed Decision Making (IDM) system was used to measure quality. Latent variable models for ordinal data examined the relationship of IDM score to treatment received. Mean IDM score showed modest quality (7.61±2.45 out of 18) and high variability. Treatment choice and risks and benefits were discussed in approximately 95% of encounters. However, in more than one-third of encounters, physicians provided a partial set of treatment options and omitted surveillance as a choice. Informing quality was greater in patients treated with surveillance (β = 1.1, p = .04). Gleason score (7 vs 6) and lower age were often cited as reasons to exclude surveillance. Patient preferences were elicited in the majority of cases, but not used to guide treatment planning. Encounter time was modestly correlated with IDM score (r = 0.237, p = .01). DA type was not associated with IDM score. Physicians informed patients of options and risks and benefits, but infrequently engaged patients in core shared decision-making processes. Despite patients having received DAs, physicians rarely provided an opportunity for preference-driven decision making. More attention to the underused patient decision-making and engagement elements could result in improved shared decision making. © The Author(s) 2015.

  3. The reliability of an epilepsy treatment clinical decision support system.

    PubMed

    Standridge, Shannon; Faist, Robert; Pestian, John; Glauser, Tracy; Ittenbach, Richard

    2014-10-01

    We developed a content validated computerized epilepsy treatment clinical decision support system to assist clinicians with selecting the best antiepilepsy treatments. Before disseminating our computerized epilepsy treatment clinical decision support system, further rigorous validation testing was necessary. As reliability is a precondition of validity, we verified proof of reliability first. We evaluated the consistency of the epilepsy treatment clinical decision support system in three areas including the preferred antiepilepsy drug choice, the top three recommended choices, and the rank order of the three choices. We demonstrated 100% reliability on 15,000 executions involving a three-step process on five different common pediatric epilepsy syndromes. Evidence for the reliability of the epilepsy treatment clinical decision support system was essential for the long-term viability of the system, and served as a crucial component for the next phase of system validation.

  4. End-of-life treatment decision making: American Indians' perspective.

    PubMed

    Colclough, Yoshiko Yamashita; Brown, Gary M

    2014-08-01

    This study explored American Indians' end-of-life experiences in treatment decision making. Scarce knowledge about this population's perspective regarding end-of-life treatments has resulted in health care providers (HCPs) functioning at less than optimum levels. Using a community-based participatory research approach, open-ended interview data were collected and analyzed using a grounded theory method. Patient and family participants generally stated that the physicians made the treatment decisions for them, while HCPs believed that patients participated in informed autonomous treatment decision making. Both parties (HCPs and patients and families) were not aware of American Indian's psychological aspect that interfered with the exercise of the right of informed consent. This additional understanding would benefit them in order to result in ethically and legally sound practice of patient's autonomous treatment decision making. © The Author(s) 2013.

  5. [Treatment Decision-Making Process of Cancer Patients].

    PubMed

    Lee, Shiu-Yu C Katie

    2016-10-01

    The decision-making process that is used by cancer patients to determine their treatment has become more multi-foci, difficult and complicated in recent years. This has in part been attributed to the increasing incidence rate of cancer in Taiwan and the rapid development of medical technologies and treatment modalities. Oncology nurses must assist patients and family to make informed and value-based treatment decisions. Decision-making is an information process that involves appraising one's own expectation and values based on his/her knowledge on cancer and treatment options. Because cancer treatment involves risks and uncertainties, and impacts quality of life, the treatment decision-making for cancer is often stressful, or even conflicting. This paper discusses the decision-making behaviors of cancer patients and the decisional conflict, participation, and informational needs that are involved in cancer treatment. The trend toward shared decision-making and decisional support will be also explored in order to facilitate the future development of appropriate clinical interventions and research.

  6. Physician, patient, and contextual factors affecting treatment decisions in older adults with cancer and models of decision making: a literature review.

    PubMed

    Tariman, Joseph D; Berry, Donna L; Cochrane, Barbara; Doorenbos, Ardith; Schepp, Karen G

    2012-01-01

    To review physician, patient, and contextual factors that affect treatment decision making in older adults diagnosed with cancer, and to relate those factors to theoretical models of decision making. PubMed (1966 to April 2010), PsycINFO (1967 to April 2010) and CINAHL® (1982 to April 2010) databases were searched to access relevant medical, psychological, and nursing literature. Physician factors in treatment decisions included physician's personal beliefs and values, medical expertise, practice type, perception of lowered life expectancy, medical factors, power, and communication style. Patient factors included personal beliefs and values, ethnicity, decisional control preferences, previous health-related experience, perception of the decision-making process, and personal factors. Contextual factors included availability of caregiver, insurance, financial status, and geographical barrier. A diverse group of factors were identified, which are likely to form a unique framework to understand clinical decision making and plan future investigations in older adult patient populations. Using longitudinal and prospective designs to examine the real-time interplay of patient, physician, and contextual factors will enable a better understanding of how those divergent factors influence actual treatment decisions. Oncology nurses can advocate autonomous (patient-driven), shared, or family-controlled treatment decisions, depending on an older patient's decisional role preference. Nurses can support patient autonomy during treatment decision making by coaching patients to engage in discussion of various evidence-based treatment options and a comprehensive discussion of the probability of success for each option with specialist providers. Oncology nurses may be able to promote treatment decisions that are consistent with a patient's personal preferences and values, with strong consideration of the patient's personal contexts.

  7. Modern data-driven decision support systems: the role of computing with words and computational linguistics

    NASA Astrophysics Data System (ADS)

    Kacprzyk, Janusz; Zadrożny, Sławomir

    2010-05-01

    We present how the conceptually and numerically simple concept of a fuzzy linguistic database summary can be a very powerful tool for gaining much insight into the very essence of data. The use of linguistic summaries provides tools for the verbalisation of data analysis (mining) results which, in addition to the more commonly used visualisation, e.g. via a graphical user interface, can contribute to an increased human consistency and ease of use, notably for supporting decision makers via the data-driven decision support system paradigm. Two new relevant aspects of the analysis are also outlined which were first initiated by the authors. First, following Kacprzyk and Zadrożny, it is further considered how linguistic data summarisation is closely related to some types of solutions used in natural language generation (NLG). This can make it possible to use more and more effective and efficient tools and techniques developed in NLG. Second, similar remarks are given on relations to systemic functional linguistics. Moreover, following Kacprzyk and Zadrożny, comments are given on an extremely relevant aspect of scalability of linguistic summarisation of data, using a new concept of a conceptual scalability.

  8. Treatment decisions in 330 cases referred for apical surgery.

    PubMed

    von Arx, Thomas; Roux, Eliane; Bürgin, Walter

    2014-02-01

    Apical surgery is an important treatment option for teeth with postendodontic apical periodontitis. However, little information is available regarding treatment planning in cases referred for apical surgery. This study evaluated the decisions made in such cases and analyzed the variables influencing the decision-making process. The study retrospectively assessed clinical and radiographic data of 330 teeth that had been referred to a specialist in apical surgery with regard to the treatment decisions made in those teeth. The clinical and radiographic variables were divided into subcategories to analyze which factors influenced the decision-making process. The treatment decisions included apical surgery (59.1%), tooth extraction (25.8%), no treatment (9.1%), and nonsurgical endodontic retreatment (6.1%). Variables that showed statistically significant differences comparing treatment decisions among subcategories included probing depth (P = .001), clinical attachment level (P = .0001), tooth mobility (P = .012), pain (P = .014), clinical signs (P = .0001), length (P = .041) and quality (P = .026) of the root canal filling, and size (P = .0001) and location (P = .0001) of the periapical lesion. This study shows that apical surgery was the most frequently made treatment decision in teeth referred to a specialist in apical surgery, but every fourth tooth was considered nonretainable and was scheduled for extraction. The data showed that the most common variables that influenced the decision to extract teeth were teeth with an increased probing depth and tooth mobility and teeth presenting with lesions not located at the apex. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  9. Development and initial evaluation of a treatment decision dashboard.

    PubMed

    Dolan, James G; Veazie, Peter J; Russ, Ann J

    2013-04-21

    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. 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. 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 2.7, decision-aiding effectiveness 5

  10. [Treatment evaluation and clinical decision making using HKT-30-ROM].

    PubMed

    Ter Horst, P; van Ham, M; Spreen, M; Bogaerts, S

    2014-01-01

    By means of repeated, well-supported measurements of clinical dynamic indicators from the Historical, Clinical and Future - 30 (HKT-30) it is possible to monitor behavioural changes on the basis of risks and needs. The addition of extra score parameters allows us to distinguish client-specific risks and needs. In treatment evaluation it is important to visualise changes in these indicators of treatment evaluation because they are the key to the clinical decision-making process that determines further treatment and rehabilitation. To investigate whether HKT-30 indicators can be used to measure and visualise behavioral changes for the purpose of treatment evaluation. A case study is used to illustrate how clinicians at the Forensic Psychiatric Clinic (FPK), De Woenselse Poort, ascertain risks, needs and changes and clarify these factors for the purpose of treatment evaluation and clinical decision-making. Routine treatment evaluation aided by visualised clinical HKT-30 indicators give the treatment team and the client a clearer picture of the behavioral changes for which the forensic treatment was prescribed. This evaluation provides significant starting-points for clinical decision making. Routine treatment evaluation along with a suitably adjusted HKT-30 make behavioural changes visible, render clinical decisions more transparent and provide valuable starting-points for a dialogue with the client about his treatment.

  11. Structural Equation Modeling for High School Principals' Data-Driven Decision Making: An Analysis of Information Use Environments

    ERIC Educational Resources Information Center

    Luo, Mingchu

    2008-01-01

    Background: Accountability demands are increasingly pushing school leaders to explore more data and do more sophisticated analyses. Data-driven decision making (DDDM) has become an emerging field of practice for school leadership and a central focus of education policy and practice. Purpose: This study examined principals' DDDM practices and…

  12. How Instructional Coaches Support Data-Driven Decision Making: Policy Implementation and Effects in Florida Middle Schools

    ERIC Educational Resources Information Center

    Marsh, Julie A.; McCombs, Jennifer Sloan; Martorell, Francisco

    2010-01-01

    This article examines the convergence of two popular school improvement policies: instructional coaching and data-driven decision making (DDDM). Drawing on a mixed methods study of a statewide reading coach program in Florida middle schools, the article examines how coaches support DDDM and how this support relates to student and teacher outcomes.…

  13. 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…

  14. Collaborative Data-Driven Decision Making: A Qualitative Study of the Lived Experiences of Primary Grade Classroom Teachers

    ERIC Educational Resources Information Center

    Ralston, Christine R.

    2012-01-01

    The purpose of this qualitative study was to describe the lived experiences of primary classroom teachers participating in collaborative data-driven decision making. Hermeneutic phenomenology served as the theoretical framework. Data were collected by conducting interviews with thirteen classroom teachers who taught in grades kindergarten through…

  15. 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, &…

  16. 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, &…

  17. 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…

  18. 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…

  19. Improving Instructional Practices, Policies, and Student Outcomes for Early Childhood Language and Literacy through Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Gullo, Dominic F.

    2013-01-01

    Since the passage of No Child Left Behind, data-driven decision making has become one of the central foci in schools in their attempt to attain and maintain adequate levels of student academic performance. The importance of early childhood education is well established with language and literacy proficiency in the early years being viewed as a…

  20. 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…

  1. 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…

  2. Toward a theory-driven classification of rehabilitation treatments.

    PubMed

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

    2014-01-01

    Rehabilitation is in need of an organized system or taxonomy for classifying treatments to aid in research, practice, training, and interdisciplinary communication. In this article, we describe a work-in-progress effort to create a rehabilitation treatment taxonomy (RTT) for classifying rehabilitation interventions by the underlying treatment theories that explain their effects. In the RTT, treatments are grouped together according to their targets, or measurable aspects of functioning they are intended to change; ingredients, or measurable clinician decisions and behaviors responsible for effecting changes; and the hypothesized mechanisms of action by which ingredients are transformed into changes in the target. Four treatment groupings are proposed: structural tissue properties, organ functions, skilled performances, and cognitive/affective representations, which are similar in the types of targets addressed, ingredients used, and mechanisms of action that account for change. The typical ingredients and examples of clinical treatments associated with each of these groupings are explored, and the challenges of further subdivision are discussed. Although a Linnaean hierarchical tree structure was envisioned at the outset of work on the RTT, further development may necessitate a model with less rigid boundaries between classification groups, and/or a matrix-like structure for organizing active ingredients along selected continua, to allow for both qualitative and quantitative variations of importance to treatment effects.

  3. Balance Sheets versus Decision Dashboards to support patient treatment choices: A comparative analysis

    PubMed Central

    Dolan, James G.; Veazie, Peter J.

    2015-01-01

    Background Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision making. The use of tabular balance sheets to support clinical decision making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive a deeper understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. Method The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision making. Two separate surveys were conducted: one for the control group and one for the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and asked to choose between three hypothetical drug treatments that varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief washout period, members of the control group made a second treatment choice after reviewing the balance sheet again while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices participants rated their degree of confidence in their choice on a 1–10 scale. Results Members of the dashboard intervention group were more likely to change their choice of preferred drug, (10.2% vs. 7.5%, p=0.054) and had a larger increase in decision confidence than the control group: 0.67 vs. 0.075, p<0.03. There were no statistically significant between group differences in decisional conflict or decision aid acceptability. Conclusion These findings suggest that clinical

  4. School Leaders' Use of Data-Driven Decision-Making for School Improvement: A Study of Promising Practices in Two California Charter Schools

    ERIC Educational Resources Information Center

    Simpson, Guadalupe H.

    2011-01-01

    The current interest in using data-driven decision-making in schools has focused on how best to use student achievement data to meet the demands of current accountability requirements. The purpose of this study was to investigate promising practices specific to school leaders' use of data-driven decision-making for school improvement at two…

  5. 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.

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

    PubMed

    Kazancı, Fatih; Aydoğan, Cihan; Alkan, Özer

    2016-01-01

    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. 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. 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. 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.

  7. 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

  8. Patient Reflections on Decision Making for Laryngeal Cancer Treatment.

    PubMed

    Shuman, Andrew G; Larkin, Knoll; Thomas, Dorothy; Palmer, Frank L; Fins, Joseph J; Baxi, Shrujal S; Lee, Nancy; Shah, Jatin P; Fagerlin, Angela; Patel, Snehal G

    2017-02-01

    Objective To describe the reflections of patients treated for laryngeal cancer with regard to treatment-related decision making. Study Design Cross-sectional survey-based pilot study. Setting Single-institution tertiary care cancer center. Subjects/Methods Adults with laryngeal carcinoma were eligible to participate (N = 57; 46% treated surgically, 54% nonsurgically). Validated surveys measuring decisional conflict and regret explored patients' reflections on their preferences and priorities regarding treatment-related decision making for laryngeal cancer and how patient-reported functional outcomes, professional referral patterns, and desired provider input influenced these reflections. Results When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients were more likely to believe that the specialist whom they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ(2) = 16.2, df = 6, P = .02). Patients who were treated for laryngeal cancer who reported worse voice-related quality of life recalled more decisional conflict ( P = .01) and experienced more decisional regret ( P < .001). Of the patients for whom speech was a top priority prior to treatment, better voice-related quality of life overall scores were correlated with less decision regret about treatment decisions ( P < .02). Of the patients for whom eating and drinking were top priorities prior to treatment, better MD Anderson Dysphagia Inventory global scores were correlated with less decision regret about treatment decisions ( P < .002). Conclusion Patient priorities and attitudes, coupled with functional outcomes and professional referral patterns, influence how patients reflect on their choices regarding management of laryngeal cancer. Better understanding of these variables may assist in ensuring that patients' voices are integrated into individualized laryngeal cancer treatment planning.

  9. A Satellite Data-Driven, Client-Server Decision Support Application for Agricultural Water Resources Management

    NASA Technical Reports Server (NTRS)

    Johnson, Lee F.; Maneta, Marco P.; Kimball, John S.

    2016-01-01

    Water cycle extremes such as droughts and floods present a challenge for water managers and for policy makers responsible for the administration of water supplies in agricultural regions. In addition to the inherent uncertainties associated with forecasting extreme weather events, water planners need to anticipate water demands and water user behavior in a typical circumstances. This requires the use decision support systems capable of simulating agricultural water demand with the latest available data. Unfortunately, managers from local and regional agencies often use different datasets of variable quality, which complicates coordinated action. In previous work we have demonstrated novel methodologies to use satellite-based observational technologies, in conjunction with hydro-economic models and state of the art data assimilation methods, to enable robust regional assessment and prediction of drought impacts on agricultural production, water resources, and land allocation. These methods create an opportunity for new, cost-effective analysis tools to support policy and decision-making over large spatial extents. The methods can be driven with information from existing satellite-derived operational products, such as the Satellite Irrigation Management Support system (SIMS) operational over California, the Cropland Data Layer (CDL), and using a modified light-use efficiency algorithm to retrieve crop yield from the synergistic use of MODIS and Landsat imagery. Here we present an integration of this modeling framework in a client-server architecture based on the Hydra platform. Assimilation and processing of resource intensive remote sensing data, as well as hydrologic and other ancillary information occur on the server side. This information is processed and summarized as attributes in water demand nodes that are part of a vector description of the water distribution network. With this architecture, our decision support system becomes a light weight 'app' that

  10. A satellite data-driven, client-server decision support application for agricultural water resources management

    NASA Astrophysics Data System (ADS)

    Maneta, M. P.; Johnson, L.; Kimball, J. S.

    2016-12-01

    Water cycle extremes such as droughts and floods present a challenge for water managers and for policy makers responsible for the administration of water supplies in agricultural regions. In addition to the inherent uncertainties associated with forecasting extreme weather events, water planners need to anticipate water demands and water user behavior in atypical circumstances. This requires the use decision support systems capable of simulating agricultural water demand with the latest available data. Unfortunately, managers from local and regional agencies often use different datasets of variable quality, which complicates coordinated action. In previous work we have demonstrated novel methodologies to use satellite-based observational technologies, in conjunction with hydro-economic models and state of the art data assimilation methods, to enable robust regional assessment and prediction of drought impacts on agricultural production, water resources, and land allocation. These methods create an opportunity for new, cost-effective analysis tools to support policy and decision-making over large spatial extents. The methods can be driven with information from existing satellite-derived operational products, such as the Satellite Irrigation Management Support system (SIMS) operational over California, the Cropland Data Layer (CDL), and using a modified light-use efficiency algorithm to retrieve crop yield from the synergistic use of MODIS and Landsat imagery. Here we present an integration of this modeling framework in a client-server architecture based on the Hydra platform. Assimilation and processing of resource intensive remote sensing data, as well as hydrologic and other ancillary information occur on the server side. This information is processed and summarized as attributes in water demand nodes that are part of a vector description of the water distribution network. With this architecture, our decision support system becomes a light weight `app` that

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

    PubMed

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

    2014-10-01

    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.

  12. 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

  13. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Race, ethnicity, and shared decision making for hyperlipidemia and hypertension treatment: the DECISIONS survey.

    PubMed

    Ratanawongsa, Neda; Zikmund-Fisher, Brian J; Couper, Mick P; Van Hoewyk, John; Powe, Neil R

    2010-01-01

    Racial/ethnic differences in shared decision making about cardiovascular risk-reduction therapy could affect health disparities. To investigate whether patient race/ethnicity is associated with experiences discussing cardiovascular risk-reduction therapy with health care providers. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted in November 2006 to May 2007. Among participants in the National Survey of Medical Decisions (DECISIONS), a nationally representative sample of English-speaking US adults aged 40 and older, the authors analyzed respondents who reported discussing hyperlipidemia or hypertension medications with a health care provider in the previous 2 years. In multivariate linear and logistic regressions adjusting for age, gender, income, insurance status, perceived health, and current therapy, they assessed the relation between race/ethnicity (black/Hispanic v. white) and decision making: knowledge, discussion of pros and cons of therapy, discussion of patient preference, who made the final decision, preferred involvement, and confidence in the decision. Of respondents who discussed high cholesterol (N = 738) or hypertension (N = 745) medications, 88% were white, 9% black, and 4% Hispanic. Minorities had lower knowledge scores than whites for hyperlipidemia (42% v. 52%, difference -10% [95% confidence interval (CI): 15, -5], P < 0.001), but not for hypertension. For hyperlipidemia, minorities were more likely than whites to report that the health care provider made the final decision for treatment (31.7% v. 12.3% whites, difference 19.4% [95% CI: 6.9, 33.1%], P < 0.01); this was not true for hypertension. Possible limitations include the small percentage of minorities in the sample and potential recall bias. Minorities considering hyperlipidemia therapy may be less informed about and less involved in the final decision-making process.

  15. 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.

  16. Decision aid influences on factors associated with patient empowerment prior to cancer treatment decision making.

    PubMed

    Alden, Dana L

    2014-10-01

    Despite progress, models that incorporate antecedent and mediating factors associated with shared decision making (SDM)-related outcomes remain limited. An experimental study tests patient decision aid (DA) effects on a network of antecedents and mediators associated with patient empowerment prior to a medical decision-making consultation regarding cancer treatment. A pilot study initially evaluated measurement scales, model fit, and the overall effect of the DA experience. The pilot compared matched treatment and control group samples of US adult online panel members exposed to a vignette about meeting their dermatologist to decide on skin cancer treatment. The treatment group also experienced a skin cancer DA with treatment options and value clarification activity, while the control group did not. The main study employed a randomized experimental design to formally test hypothesized path coefficients across the groups. The pilot study suggested an overall enhanced DA effect on self-empowerment. In the experimental study, the DA experience strengthened the direct path from desire for medical information to self-empowerment and the indirect path from comprehension/participation confidence to self-empowerment through cancer attitude. The DA had no strengthening effect on the direct path from life satisfaction to self-empowerment, but in the DA condition, the factor appeared to play a role by contributing to the enhanced association between confidence and cancer attitude. Evidence from this research indicates that experiencing a DA prior to treatment decision making affects patient empowerment through a network that includes desire for information, life satisfaction, and multiple mediators. The studies also demonstrate the role that theory-based, multigroup structural equation modeling (SEM) can play in increasing understanding of DA effects. Such understanding is critical to improving SDM between patients and their physicians. © The Author(s) 2014.

  17. Patients' preferences for involvement in treatment decision making in Japan

    PubMed Central

    Sekimoto, Miho; Asai, Atsushi; Ohnishi, Motoki; Nishigaki, Etsuyo; Fukui, Tsuguya; Shimbo, Takuro; Imanaka, Yuichi

    2004-01-01

    Background A number of previous studies have suggested that the Japanese have few opportunities to participate in medical decision-making, as a result both of entrenched physician paternalism and national characteristics of dependency and passivity. The hypothesis that Japanese patients would wish to participate in treatment decision-making if adequate information were provided, and the decision to be made was clearly identified, was tested by interview survey. Methods The subjects were diabetic patients at a single outpatient clinic in Kyoto. One of three case study vignettes (pneumonia, gangrene or cancer) was randomly assigned to each subject and, employing face-to-face interviews, the subjects were asked what their wishes would be as patients, for treatment information, participation in decision-making and family involvement. Results 134 patients participated in the study, representing a response rate of 90%. The overall proportions of respondents who preferred active, collaborative, and passive roles were 12%, 71%, and 17%, respectively. Respondents to the cancer vignette were less likely to prefer an active role and were more likely to prefer family involvement in decision-making compared to non-cancer vignette respondents. If a physician's recommendation conflicted with their own wishes, 60% of the respondents for each vignette answered that they would choose to respect the physician's opinion, while few respondents would give the family's preference primary importance. Conclusions Our study suggested that a majority of Japanese patients have positive attitudes towards participation in medical decision making if they are fully informed. Physicians will give greater patient satisfaction if they respond to the desire of patients for participation in decision-making. PMID:15053839

  18. Australian women's prediagnostic decision-making styles, relating to treatment choices for early breast cancer treatment.

    PubMed

    Budden, Lea M; Pierce, Penny F; Hayes, Barbara A; Buettner, Petra G

    2003-01-01

    Women diagnosed with early breast cancer are now asked by their doctors to choose from a range of options for their preferred medical treatment plan. Little information is known about women's treatment decision-making and therefore nurses do not have evidence to guide this decision support. The aim of this descriptive survey was to investigate the prediagnostic decision-making behavior of a sample (N = 377) of Australian women, regarding their treatment choices for early breast cancer. The data were collected using the Pre-Decision Portfolio Questionnaire (PDPQ) by Pierce (1996), which includes the Michigan Assessment of Decision Styles (MADS). Of 366 participating women, 19.9% strongly agreed to all three items of the MADS factor Deferring Responsibility; 0.3% strongly agreed to all four factors of Avoidance; 32.7% strongly agreed on all four items of Information Seeking; and 63.4% strongly agreed to all five items of Deliberation. Women showed a variety of preferred decision styles, depending on age, education, occupation and employment status. Only 36% of women indicated it was critically important to "get the treatment over as soon as possible;" 55% to "participate in selecting treatment;" and 53% to "read a lot of information:" The understanding of factors that are important to women when they are making decisions for medical treatment is a mandatory step in designing customized evidence-based decision support, which can be delivered by nurses to help women during this distressing experience.

  19. 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

  20. U-BASE: General Bayesian Network-Driven Context Prediction for Decision Support

    NASA Astrophysics Data System (ADS)

    Lee, Kun Chang; Cho, Heeryon; Lee, Sunyoung

    We propose a new type of ubiquitous decision support system that is powered by a General Bayesian Network (GBN). Because complicated decision support problems are plagued by complexities when interpreting causal relationships among decision variables, GBNs have shown excellent decision support competence because of their flexible structure, which allows them to extract appropriate and robust causal relationships among target variables and related explanatory variables. The potential of GBNs, however, has not been sufficiently investigated in the field of ubiquitous decision support. Hence, we propose a new type of ubiquitous decision support mechanism called U-BASE, which uses a GBN for context prediction in order to improve decision support. To illustrate the validity of the proposed decision support mechanism, we collected a set of contextual data from college students and applied U-BASE to induce useful and robust results. The practical implications are fully discussed, and issues for future studies are suggested.

  1. Understanding Pediatric Dentists’ Dental Caries Management Treatment Decisions

    PubMed Central

    Kateeb, E.T.; Warren, J.J.; Gaeth, G.J.; Momany, E.T.; Damiano, P.C.

    2016-01-01

    When traditional ranking and rating surveys are used to assess dentists’ treatment decisions, the patient’s source of payment appears to be of little importance. Therefore, this study used the marketing research tool conjoint analysis to investigate the relative impact of source of payment along with the child’s age and cooperativeness on pediatric dentists’ willingness to use Atraumatic Restorative Treatment (ART) to restore posterior primary teeth. A conjoint survey was completed by 707 pediatric dentists. Three factors (age of the child, cooperativeness, type of insurance) were varied across 3 levels to create 9 patient scenarios. The relative weights that dentists placed on these factors in the restorative treatment decision process were determined by conjoint analysis. “Cooperativeness” (52%) was the most important factor, “age of the child” (26%) the second-most important factor, followed by “insurance status of the child” (22%). For the third factor, insurance, pediatric dentists were least willing to use ART with publicly insured children (−0.082), and this was significantly different from their willingness to use ART with uninsured children (0.010) but not significantly different than their willingness to use ART for children with private insurance (0.073). Unlike traditional ranking and rating tools, conjoint analysis found that the insurance status of the patient appeared to be an important factor in dentists’ decisions about different restorative treatment options. When pediatric dentists were forced to make tradeoffs among different patients’ factors, they were most willing to use ART technique with young, uncooperative patients when they had no insurance. Knowledge Transfer Statement: The present study suggests the feasibility of using techniques borrowed from marketing research, such as conjoint analysis, to understand dentists’ restorative treatment decisions. Results of this study demonstrate pediatric dentists

  2. Decision theoretic steering and genetic algorithm optimization: application to stereotactic radiosurgery treatment planning.

    PubMed

    Yu, Y; Schell, M C; Zhang, J B

    1997-11-01

    Treatment planning for stereotactic radiosurgery and fractionated radiotherapy is currently a labor intensive, operator-dependent process. Many degrees of freedom exist to make rigorous optimization intractable except by computationally intelligent techniques. The quality of a given plan is determined by an aggregate of clinical objectives, most of which are subject to competing tradeoffs. In this work, we present an autonomous scheme that couples decision theoretic guidance with a genetic algorithm for optimization. Ordinal ranking among a population of viable treatment plans is based on a generalized distance metric, which promotes a decreasing hyperfrontier of the efficient solution set. The solution set is driven toward efficiency by the genetic algorithm, which uses the tournament selection mechanism based on the ordinal ranking. Goals and satisficing conditions can be defined to signal the ultimate and the minimum achievement levels in a given objective. A conventionally challenging case in radiosurgery was used to demonstrate the practical utility and the problem-solving power of the decision theoretic genetic algorithm. Treatment plans with one isocenter and four isocenters were derived under the autonomous scheme and compared to the actual treatment plan manually optimized by the expert planner. Quality assessment based on dose-volume histograms and normal tissue complication probabilities suggested that computational optimization could be driven to offer varying degrees of dosimetric improvement over a human-guided optimization effort. Furthermore, it was possible to achieve a high degree of isodose conformity to the target volume in computational optimization by increasing the degree of freedom in the treatment parameters. The time taken to derive an efficient planning solution was comparable and usually shorter than in the manual planning process, and can be scaled down almost linearly with the number of processors. Overall, the autonomous genetic

  3. Treatment decisions on antidepressants in nursing homes: a qualitative study.

    PubMed

    Iden, Kristina Riis; Hjørleifsson, Stefan; Ruths, Sabine

    2011-12-01

    To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses' observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.

  4. 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.

  5. Oncology Nursing and Shared Decision Making for Cancer Treatment.

    PubMed

    Tariman, Joseph D; Mehmeti, Enisa; Spawn, Nadia; McCarter, Sarah P; Bishop-Royse, Jessica; Garcia, Ima; Hartle, Lisa; Szubski, Katharine

    2016-10-01

    This study aimed to describe the contemporary role of the oncology nurse throughout the entire cancer shared decision-making (SDM) process. Study participants consisted of 30 nurses and nurse practitioners who are actively involved in direct care of patients with cancer in the inpatient or outpatient setting. The major themes that emerged from the content analysis are: oncology nurses have various roles at different time points and settings of cancer SDM processes; patient education, advocacy, and treatment side effects management are among the top nursing roles; oncology nurses value their participation in the cancer SDM process; oncology nurses believe they have a voice, but with various degrees of influence in actual treatment decisions; nurses' level of disease knowledge influences the degree of participation in cancer SDM; and the nursing role during cancer SDM can be complicated and requires flexibility.
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  6. Individualised and personalised QALYs in exceptional treatment decisions.

    PubMed

    Heale, Warwick

    2016-10-01

    Quality-adjusted life years (QALYs) are used to determine how to allocate resources to health programmes or to treatments within those programmes in order to gain maximum utility from those limited, shared healthcare resources. However, if we use those same population- based QALYs when faced with individual treatment decisions we may act unjustly in relation to that individual or in relation to the wider population. A treatment with a population-based incremental cost-effectiveness ratio beyond our willingness to pay threshold may be denied to a patient even if, for that particular patient, the QALYs gained for the cost would fall within that threshold. When considering individual cases, it is proposed that we should take an individualised approach to the cost of treatment and response to treatment ('individualised QALYs') and a personalised approach to the valuation of health states ('personalised QALYs'). Only if we do this, can we maximise utility and give the patient a fair opportunity to benefit. Individualised and personalised QALYs also allow us to express patient choice and religious treatment preferences in terms of utility. Individualised and personalised QALYs are explored in the context of individual funding requests in the National Health Service. In preference to the concept of 'clinical exceptionality', individualised and personalised QALYs provide the potential for better and more consistent decisions and improved utility. Rather than treating unequal patients as if they were equal, individualised and personalised QALYs promote fair and unequal access to resources for some of our most unequal patients. Potential challenges are also considered.

  7. What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer.

    PubMed

    Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J; Homish, D Lynn

    2016-08-01

    We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. © The Author(s) 2016.

  8. What is a “good” treatment decision?: Decisional control, knowledge, treatment decision-making, and quality of life in men with clinically localized prostate cancer

    PubMed Central

    Orom, Heather; Biddle, Caitlin; Underwood, Willie; Nelson, Christian J.; Homish, D. Lynn

    2016-01-01

    Objective We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision-making is an advantageous model for studying patient treatment decision-making dynamics as there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. Methods Men with newly diagnosed clinically localized prostate cancer (N=1529) completed measures of decisional control, prostate cancer knowledge, and their decision-making experience (decisional conflict, and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed 6-months after treatment. Results More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction, but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control predicted better QOL 6-months post-treatment. Conclusion Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects. PMID:26957566

  9. 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

  10. Evolution of Pediatric Chronic Disease Treatment Decisions: A Qualitative, Longitudinal View of Parents' Decision-Making Process.

    PubMed

    Lipstein, Ellen A; Britto, Maria T

    2015-08-01

    In the context of pediatric chronic conditions, patients and families are called upon repeatedly to make treatment decisions. However, little is known about how their decision making evolves over time. The objective was to understand parents' processes for treatment decision making in pediatric chronic conditions. We conducted a qualitative, prospective longitudinal study using recorded clinic visits and individual interviews. After consent was obtained from health care providers, parents, and patients, clinic visits during which treatment decisions were expected to be discussed were video-recorded. Parents then participated in sequential telephone interviews about their decision-making experience. Data were coded by 2 people and analyzed using framework analysis with sequential, time-ordered matrices. 21 families, including 29 parents, participated in video-recording and interviews. We found 3 dominant patterns of decision evolution. Each consisted of a series of decision events, including conversations, disease flares, and researching of treatment options. Within all 3 patterns there were both constant and evolving elements of decision making, such as role perceptions and treatment expectations, respectively. After parents made a treatment decision, they immediately turned to the next decision related to the chronic condition, creating an iterative cycle. In this study, decision making was an iterative process occurring in 3 distinct patterns. Understanding these patterns and the varying elements of parents' decision processes is an essential step toward developing interventions that are appropriate to the setting and that capitalize on the skills families may develop as they gain experience with a chronic condition. Future research should also consider the role of children and adolescents in this decision process. © The Author(s) 2015.

  11. From clinical requirement to personalized wellness decision support: a data-driven framework for computer-supported guideline refinement.

    PubMed

    Hsueh, Pei-Yun; Lan, Ci-Wei; Deng, Vincent; Zhu, Xinxin

    2012-01-01

    Personalized wellness decision support has gained significant attention, owing to the shift to a patient-centric paradigm in healthcare domains, and the consequent availability of a wealth of patient-related data. Despite the success of data-driven analytics in improving practice outcome, there is a gap towards their deployment in guideline-based practice. In this paper we report on findings related to computer-supported guideline refinement, which maps a patient's guideline requirements to personalized recommendations that suit the patient's current context. In particular, we present a novel data-driven personalization framework, casting the mapping task as a statistical decision problem in search of a solution to maximize expected utility. The proposed framework is well suited to produce personalized recommendations based on not only clinical factors but contextual factors that reflect individual differences in non-clinical settings. We then describe its implementation within the guideline-based clinical decision support system and discuss opportunities and challenges looking forward.

  12. Principles for ethical treatment decision-making in veterinary oncology.

    PubMed

    Rohrer Bley, C

    2017-08-31

    Many owners of companion animals with cancer are overwhelmed by having to choose the "right course of action." With the aim of reducing the burden on owners who are forced to act as surrogates for their animals, this work discusses principles that apply to ethical treatment decision-making for animal patients with cancer. Four principles frequently used for ethical decision-making in human medicine will be considered for their potential applicability in veterinary medicine. As a result of these considerations, preliminary guidelines are presented, along which a decision-making discussion can be held. The deliberate integration of the non-maleficence and beneficence principles into the purely empirical facts of what is medically possible helps to maintain a moral perspective in specialized veterinary medicine. At the same time, such guidelines may contribute to individual decision-making in a way that animal patients neither have to endure unnecessarily severe side effects, nor that they are euthanized prematurely. © 2017 John Wiley & Sons Ltd.

  13. Shared decision-making - Rhetoric and reality: Women's experiences and perceptions of adjuvant treatment decision-making for breast cancer.

    PubMed

    Mahmoodi, Neda; Sargeant, Sally

    2017-01-01

    This interview-based study uses phenomenology as a theoretical framework and thematic analysis to challenge existing explanatory frameworks of shared decision-making, in an exploration of women's experiences and perceptions of shared decision-making for adjuvant treatment in breast cancer. Three themes emerged are as follows: (1) women's desire to participate in shared decision-making, (2) the degree to which shared decision-making is perceived to be shared and (3) to what extent are women empowered within shared decision-making. Studying breast cancer patients' subjective experiences of adjuvant treatment decision-making provides a broader perspective on patient participatory role preferences and doctor-patient power dynamics within shared decision-making for breast cancer.

  14. Improving Cybersecurity Governance Through Data-Driven Decision-Making and Execution (Briefing Charts)

    DTIC Science & Technology

    2014-10-01

    Allison, G. T., & Zelikow, P. (1999). Essence of Decision: Explaining the Cuban Missile Crisis (2nd ed.) (Kindle Edition). New York: Longman. 17 Key...G. T., & Zelikow, P. (1999). Essence of Decision: Explaining the Cuban Missile Crisis (2nd ed.) (Kindle Edition). New York: Longman.

  15. An evaluation of treatment decisions at a colorectal cancer multi-disciplinary team.

    PubMed

    Wood, J J; Metcalfe, C; Paes, A; Sylvester, P; Durdey, P; Thomas, M G; Blazeby, J M

    2008-10-01

    It is mandatory for treatment decisions for patients with colorectal cancer to be made within the context of a multi-disciplinary team (MDT) meeting. It is currently uncertain, however, how to best evaluate the quality of MDT decision-making. This study examined MDT decision-making by studying whether MDT treatment decisions were implemented and investigated the reasons why some decisions changed after the meeting. Consecutive MDT treatment decisions were prospectively recorded. Implementation of decisions was studied by examining hospital records. Reasons for changes in MDT decisions were identified. In all, 201 consecutive treatment decisions were analysed, concerning 157 patients. Twenty decisions (10.0%, 95% confidence interval 6.3-15.2%) were not implemented. Looking at the reasons for nonimplementation, nine (40%) related to co-morbidity, seven (35%) to patient choice, two changed in light of new clinical information, one doctor changed a decision and for one changed decision, no reason was apparent. When decisions changed, the final treatment was always more conservative than was originally planned and decisions were more likely to change for colon rather than rectal cancer (P = 0.024). The vast majority of colorectal MDT decisions were implemented and when decisions changed, it mostly related to patient factors that had not been taken into account. Analysis of the implementation of team decisions is an informative process to monitor the quality of MDT decision-making.

  16. Pupil-linked arousal is driven by decision uncertainty and alters serial choice bias

    NASA Astrophysics Data System (ADS)

    Urai, Anne E.; Braun, Anke; Donner, Tobias H.

    2017-03-01

    While judging their sensory environments, decision-makers seem to use the uncertainty about their choices to guide adjustments of their subsequent behaviour. One possible source of these behavioural adjustments is arousal: decision uncertainty might drive the brain's arousal systems, which control global brain state and might thereby shape subsequent decision-making. Here, we measure pupil diameter, a proxy for central arousal state, in human observers performing a perceptual choice task of varying difficulty. Pupil dilation, after choice but before external feedback, reflects three hallmark signatures of decision uncertainty derived from a computational model. This increase in pupil-linked arousal boosts observers' tendency to alternate their choice on the subsequent trial. We conclude that decision uncertainty drives rapid changes in pupil-linked arousal state, which shape the serial correlation structure of ongoing choice behaviour.

  17. Pupil-linked arousal is driven by decision uncertainty and alters serial choice bias

    PubMed Central

    Urai, Anne E.; Braun, Anke; Donner, Tobias H.

    2017-01-01

    While judging their sensory environments, decision-makers seem to use the uncertainty about their choices to guide adjustments of their subsequent behaviour. One possible source of these behavioural adjustments is arousal: decision uncertainty might drive the brain's arousal systems, which control global brain state and might thereby shape subsequent decision-making. Here, we measure pupil diameter, a proxy for central arousal state, in human observers performing a perceptual choice task of varying difficulty. Pupil dilation, after choice but before external feedback, reflects three hallmark signatures of decision uncertainty derived from a computational model. This increase in pupil-linked arousal boosts observers' tendency to alternate their choice on the subsequent trial. We conclude that decision uncertainty drives rapid changes in pupil-linked arousal state, which shape the serial correlation structure of ongoing choice behaviour. PMID:28256514

  18. Pupil-linked arousal is driven by decision uncertainty and alters serial choice bias.

    PubMed

    Urai, Anne E; Braun, Anke; Donner, Tobias H

    2017-03-03

    While judging their sensory environments, decision-makers seem to use the uncertainty about their choices to guide adjustments of their subsequent behaviour. One possible source of these behavioural adjustments is arousal: decision uncertainty might drive the brain's arousal systems, which control global brain state and might thereby shape subsequent decision-making. Here, we measure pupil diameter, a proxy for central arousal state, in human observers performing a perceptual choice task of varying difficulty. Pupil dilation, after choice but before external feedback, reflects three hallmark signatures of decision uncertainty derived from a computational model. This increase in pupil-linked arousal boosts observers' tendency to alternate their choice on the subsequent trial. We conclude that decision uncertainty drives rapid changes in pupil-linked arousal state, which shape the serial correlation structure of ongoing choice behaviour.

  19. Application of Data-Driven Decision Making Using Ayres Sensory Integration(®) With a Child With Autism.

    PubMed

    Faller, Patricia; Hunt, Joanne; van Hooydonk, Elke; Mailloux, Zoe; Schaaf, Roseann

    2016-01-01

    Health care and educational legislation and policy require that clinicians demonstrate, using measurement and report of outcomes, accountability for services rendered. Clinical algorithms have been developed and are used by various health care professionals to assist with hypothesis generation and systematic clinical reasoning; however, they do not explicitly guide measurement of outcomes as part of the reasoning process. Schaaf and colleagues developed the Data-Driven Decision Making (DDDM) process to address the greater need for outcome measurement, systematically support decision making, target intervention more precisely, and measure and document outcomes. This article describes the application of the DDDM process with a child with ASD who received occupational therapy using Ayres Sensory Integration(®). Copyright © 2016 by the American Occupational Therapy Association, Inc.

  20. Considering patient values and treatment preferences enhances patient involvement in rectal cancer treatment decision making.

    PubMed

    Kunneman, Marleen; Marijnen, Corrie A M; Baas-Thijssen, Monique C M; van der Linden, Yvette M; Rozema, Tom; Muller, Karin; Geijsen, Elisabeth D; Stiggelbout, Anne M; Pieterse, Arwen H

    2015-11-01

    The shared decision making (SDM) model states that patients' values and preferences should be clarified to choose a strategy that best fits the patient. This study aimed to assess whether values and preferences of rectal cancer patients are voiced and considered in deciding about preoperative radiotherapy (PRT), and whether this makes patients feel more involved in treatment decision making. Pre-treatment consultations of radiation oncologists and patients eligible for PRT were audiotaped (N=90). Tapes were transcribed and coded to identify patients' values and treatment preferences. Patients filled in a post-consultation questionnaire on their perceived involvement in decision making (N=60). Patients' values were voiced for 62/611 of benefits/harms addressed (10%), in 38/90 consultations (42%; maximum 4 values per consultation), and most often related to major long-term treatment outcomes. Patients' treatment preferences were discussed in 20/90 consultations (22%). In 16/90 consultations (18%), the oncologists explicitly indicated to consider patients' values or preferences. Patients perceived a significantly more active role in decision making if their values or preferences had been voiced or considered. Patients' values and treatment preferences are voiced or considered in a minority of consultations. If they are, this increases patients' perceived involvement in the decision making process. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. 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…

  2. Data-driven decisions for reducing readmissions for heart failure: general methodology and case study.

    PubMed

    Bayati, Mohsen; Braverman, Mark; Gillam, Michael; Mack, Karen M; Ruiz, George; Smith, Mark S; Horvitz, Eric

    2014-01-01

    Several studies have focused on stratifying patients according to their level of readmission risk, fueled in part by incentive programs in the U.S. that link readmission rates to the annual payment update by Medicare. Patient-specific predictions about readmission have not seen widespread use because of their limited accuracy and questions about the efficacy of using measures of risk to guide clinical decisions. We construct a predictive model for readmissions for congestive heart failure (CHF) and study how its predictions can be used to perform patient-specific interventions. We assess the cost-effectiveness of a methodology that combines prediction and decision making to allocate interventions. The results highlight the importance of combining predictions with decision analysis. We construct a statistical classifier from a retrospective database of 793 hospital visits for heart failure that predicts the likelihood that patients will be rehospitalized within 30 days of discharge. We introduce a decision analysis that uses the predictions to guide decisions about post-discharge interventions. We perform a cost-effectiveness analysis of 379 additional hospital visits that were not included in either the formulation of the classifiers or the decision analysis. We report the performance of the methodology and show the overall expected value of employing a real-time decision system. For the cohort studied, readmissions are associated with a mean cost of $13,679 with a standard error of $1,214. Given a post-discharge plan that costs $1,300 and that reduces 30-day rehospitalizations by 35%, use of the proposed methods would provide an 18.2% reduction in rehospitalizations and save 3.8% of costs. Classifiers learned automatically from patient data can be joined with decision analysis to guide the allocation of post-discharge support to CHF patients. Such analyses are especially valuable in the common situation where it is not economically feasible to provide programs to

  3. Influence of analytical bias and imprecision on the number of false positive results using Guideline-Driven Medical Decision Limits.

    PubMed

    Hyltoft Petersen, Per; Klee, George G

    2014-03-20

    Diagnostic decisions based on decision limits according to medical guidelines are different from the majority of clinical decisions due to the strict dichotomization of patients into diseased and non-diseased. Consequently, the influence of analytical performance is more critical than for other diagnostic decisions where much other information is included. The aim of this opinion paper is to investigate consequences of analytical quality and other circumstances for the outcome of "Guideline-Driven Medical Decision Limits". Effects of analytical bias and imprecision should be investigated separately and analytical quality specifications should be estimated accordingly. Use of sharp decision limits doesn't consider biological variation and effects of this variation are closely connected with the effects of analytical performance. Such relationships are investigated for the guidelines for HbA1c in diagnosis of diabetes and in risk of coronary heart disease based on serum cholesterol. The effects of a second sampling in diagnosis give dramatic reduction in the effects of analytical quality showing minimal influence of imprecision up to 3 to 5% for two independent samplings, whereas the reduction in bias is more moderate and a 2% increase in concentration doubles the percentage of false positive diagnoses, both for HbA1c and cholesterol. An alternative approach comes from the current application of guidelines for follow-up laboratory tests according to clinical procedure orders, e.g. frequency of parathyroid hormone requests as a function of serum calcium concentrations. Here, the specifications for bias can be evaluated from the functional increase in requests for increasing serum calcium concentrations. In consequence of the difficulties with biological variation and the practical utilization of concentration dependence of frequency of follow-up laboratory tests already in use, a kind of probability function for diagnosis as function of the key-analyte is proposed

  4. CAPACITY OF PATIENTS WITH BRAIN METASTASES TO MAKE TREATMENT DECISIONS

    PubMed Central

    Triebel, Kristen L.; Gerstenecker, Adam; Meneses, Karen; Fiveash, John B.; Meyers, Christina A.; Cutter, Gary; Marson, Daniel C.; Martin, Roy C.; Eakin, Amanda; Watts, Olivia; Nabors, Louis B.

    2015-01-01

    OBJECTIVE To investigate medical decision-making capacity (MDC) in patients with brain metastasis. METHODS Participants were 41 adults with brain metastases with Karnofsky Performance Status scores ≥70 were recruited from an academic medical center and 41 demographically-matched controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant with brain metastasis using cutoff scores derived statistically from the performance of the control group. RESULTS The brain metastases patient group performed significantly below controls on consent standards of understanding and reasoning. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 60% of the participants with brain metastases demonstrated capacity compromise on at least one MDC standard. CONCLUSION When defining capacity compromise as performance ≤1.5 SD below the control group mean, over half of patients with brain metastases have reduced capacity to make treatment decisions. This impairment is demonstrated shortly after initial diagnosis of brain metastases and highlights the importance of routine clinical assessment of MDC following diagnosis of brain metastasis. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population. PMID:25613039

  5. Clinical equipoise and treatment decisions in cervical spondylotic myelopathy.

    PubMed

    Benatar, Michael

    2007-02-01

    The primary objective of this study is to evaluate clinician attitudes towards the treatment of cervical spondylotic myelopathy (CSM) in order to determine whether clinical equipoise exists for a segment of this patient population. The secondary objective is to examine the factors that influence treatment decisions. Cross-sectional internet-based survey of neurologists, neurosurgeons and orthopedic surgeons. Between 40-60% of respondents recommended surgery for (1) patients with minimal or no symptoms, but incidentally discovered increased T2 signal within the cervical cord on MRI, (2) patients with mild symptoms and indentation of the cervical cord but without increased T2 signal and (3) those with at least moderately severe clinical findings accompanied by MRI showing effacement of the thecal sac but without indentation of the cord or increased T2 signal. The severity of the radiological abnormalities most strongly influence treatment decisions. We conclude that clinical equipoise does exist for certain groups of patients with CSM, suggesting that a randomized controlled trial could be performed in this population.

  6. Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery?

    PubMed

    Lam, Wendy W T; Kwok, Marie; Chan, Miranda; Hung, Wai Ka; Ying, Marcus; Or, Amy; Kwong, Ava; Suen, Dacita; Yoon, Sungwon; Fielding, Richard

    2014-02-01

    To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction. Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret. Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p<0.001), more than one treatment being offered (p<0.001), and fewer questions raised by patients/companions (p<0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients' feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret. These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction. The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. 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…

  8. 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…

  9. Racial and ethnic variation in partner perspectives about the breast cancer treatment decision-making experience.

    PubMed

    Lillie, Sarah E; Janz, Nancy K; Friese, Christopher R; Graff, John J; Schwartz, Kendra; Hamilton, Ann S; Gay, Brittany Bartol; Katz, Steven J; Hawley, Sarah T

    2014-01-01

    To characterize the perspectives of partners (husbands or significant others) of patients with breast cancer in the treatment decision-making process and to evaluate racial and ethnic differences in decision outcomes. A cross-sectional survey. Los Angeles, CA, and Detroit, MI. 517 partners of a population-based sample of patients with breast cancer four years post-treatment. A self-administered mailed questionnaire. Chi-square tests and logistic regression were used to assess associations between race and ethnicity and decision outcomes. Decision regret and three elements of the decision process: information received, actual involvement, and desired involvement. Most partners reported receiving sufficient information (77%), being involved in treatment decisions (74%), and having sufficient involvement (73%). Less-acculturated Hispanic partners were more likely than their Caucasian counterparts to report high decision regret (45% versus 14%, p<0.001). Factors significantly associated (p<0.05) with high decision regret were insufficient receipt of treatment information, low involvement in decision making, and a desire for more involvement. Partners were generally positive regarding their perspectives about participating in the breast cancer treatment decision-making process. However, less acculturated Hispanic partners were most vulnerable to decision regret. In addition, high decision regret was associated with modifiable elements of the decision-making process. Attention should be paid to ensuring racial and ethnic minority partners are sufficiently involved in breast cancer treatment decisions and receive decision support.

  10. 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

  11. "It's not like I can change my mind later": reversibility and decision timing in prostate cancer treatment decision-making.

    PubMed

    Henrikson, Nora B; Ellis, William J; Berry, Donna L

    2009-11-01

    To explore whether reversibility, decision timing, and uncertainty are relevant to men deciding on treatment for localized prostate cancer (LPC). Secondary qualitative data analysis of unstructured interviews. Content analysis of previously collected qualitative data (31 individual interviews, 5 focus groups). We identified the frequency of references to reversibility, decision timing, and uncertainty and related sub-themes. We identified eight themes: reversibility, timing of decision, number of options, "getting it over with," "the way I make decisions," uncertainty among experts, desire for certainty, and probability. Fifteen men mentioned reversibility in individual interviews; 13 mentioned the importance of the timing of their decision. Eleven mentioned the importance of the number of options; twelve "the way I make decisions." Eleven men mentioned the uncertainty of experts, fourteen the desire to "get it over with," and six a desire for certainty. This study provides compelling preliminary data suggesting that men consider the reversibility, decision timing, and uncertainty in the prostate cancer treatment decision. These findings may be helpful in enhancing support for men facing the treatment decision.

  12. Hillsborough part 2: advance decisions and futile treatment.

    PubMed

    Griffith, Richard

    In the second article on the impact of the Hillsborough football stadium disaster on healthcare law, Richard Griffith discusses the case of Tony Bland, who suffered prolonged hypoxia due to the crushing crowd surge, leaving him in a persistent vegetative state. Some 3 years after the incident, the judicial committee of the House of Lords was asked to rule on whether it would be lawful to withdraw his artificial nutrition and hydration, resulting in death. The opinions of the law lords in Airedale NHS Trust v Bland [1993] continue to inform health law 25 years after the disaster, shaping and developing the use of advance decisions to refuse treatment and setting out when it would be lawful to withdraw futile life-sustaining treatment.

  13. 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…

  14. 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…

  15. Interpreting Standardized Test Scores: Strategies for Data-Driven Instructional Decision Making

    ERIC Educational Resources Information Center

    Mertler, Craig A.

    2007-01-01

    This book is designed to help K-12 teachers and administrators understand the nature of standardized tests and, in particular, the scores that result from them. This useful manual helps teachers develop the skills necessary to incorporate these test scores into various types of instructional decision making--a process known as "data-driven…

  16. 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…

  17. 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…

  18. 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,…

  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. Developing instruments to measure the quality of decisions: early results for a set of symptom-driven decisions.

    PubMed

    Sepucha, Karen R; Levin, Carrie A; Uzogara, Ekeoma E; Barry, Michael J; O'Connor, Annette M; Mulley, Albert G

    2008-12-01

    To identify a set of critical facts and key goals and concerns for five common medical conditions, benign prostate disease, hip and knee osteoarthritis, herniated disc and spinal stenosis and examine the validity of the method for identifying these items. Investigators identified facts and goals through literature reviews and qualitative work with patients and providers. A cross-sectional survey of patients and providers was conducted to examine the accuracy, importance and completeness of the identified items. 42 facts (6-16 per condition) and 31 goals and concerns (4-13 per condition) were identified. 182 responses were obtained from patients (76.5% response rate) and 113 responses from providers (78% response rate). Overall, the facts were accurate, important and complete across all conditions. For one condition (hip osteoarthritis), the goals did not meet the criteria for completeness. There was more disagreement between patients and providers around the ranking of goals than of facts. Overall, respondents found the identified facts and goals accurate, important and complete. Significant differences between patients' and providers' rankings highlight the importance of including both perspectives. Instruments to measure whether or not patients are informed and the extent to which treatments reflect patients' goals must balance patients' and providers' perspectives when selecting items to include.

  1. Biomarker classifiers for identifying susceptible subpopulations for treatment decisions.

    PubMed

    Lin, Wei-Jiun; Chen, James J

    2012-01-01

    A main goal of pharmacogenomics is to develop genomic signatures to predict patients' responses to a drug or therapy for treatment decisions. Identification of patients who would have no beneficial effect or have the risk of developing adverse effects from an unnecessary treatment could save enormous cost in the healthcare system and clinical trials. This article presents an approach for developing a biomarker classifier for identifying a fraction of susceptible patients, who should be spared unnecessary treatment prior to treatment. The identification of susceptible patients involves two steps. The first step is to identify biomarkers of susceptibility from a mixture of biomarkers of susceptibility and biomarkers of response; the second step is to develop a classifier using an ensemble classification algorithm, as the number of susceptible patients is generally much smaller than the number of nonsusceptible patients. Selection of the biomarkers of susceptibility is essential to achieve good prediction accuracy. The ensemble algorithm significantly improves the prediction accuracy compared with the standard classifiers. The study shows that classifiers developed based on the biomarkers obtained by comparing the genomic profiles of responders to those of nonresponders may lead to a high misclassification error rate. Classifiers to identify a small fraction of the subpopulation should take imbalanced class sizes into consideration. A large sample size may be needed in order to ensure detection of a sufficient number of biomarkers and a sufficient number of susceptible subjects for classifier development and validation.

  2. Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology.

    PubMed

    Krieger, Janice L; Krok-Schoen, Jessica L; Dailey, Phokeng M; Palmer-Wackerly, Angela L; Schoenberg, Nancy; Paskett, Electra D; Dignan, Mark

    2016-05-12

    Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients (N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.

  3. 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. © The Author(s) 2014.

  4. User Driven Data Mining, Visualization and Decision Making for NOAA Observing System and Data Investments

    NASA Astrophysics Data System (ADS)

    Austin, M.

    2016-12-01

    The National Oceanic and Atmospheric Administration (NOAA) observing system enterprise represents a $2.4B annual investment. Earth observations from these systems are foundational to NOAA's mission to describe, understand, and predict the Earth's environment. NOAA's decision makers are charged with managing this complex portfolio of observing systems to serve the national interest effectively and efficiently. The Technology Planning & Integration for Observation (TPIO) Office currently maintains an observing system portfolio for NOAA's validated user observation requirements, observing capabilities, and resulting data products and services. TPIO performs data analytics to provide NOAA leadership business case recommendations for making sound budgetary decisions. Over the last year, TPIO has moved from massive spreadsheets to intuitive dashboards that enable Federal agencies as well as the general public the ability to explore user observation requirements and environmental observing systems that monitor and predict changes in the environment. This change has led to an organizational data management shift to analytics and visualizations by allowing analysts more time to focus on understanding the data, discovering insights, and effectively communicating the information to decision makers. Moving forward, the next step is to facilitate a cultural change toward self-serve data sharing across NOAA, other Federal agencies, and the public using intuitive data visualizations that answer relevant business questions for users of NOAA's Observing System Enterprise. Users and producers of environmental data will become aware of the need for enhancing communication to simplify information exchange to achieve multipurpose goals across a variety of disciplines. NOAA cannot achieve its goal of producing environmental intelligence without data that can be shared by multiple user communities. This presentation will describe where we are on this journey and will provide examples of

  5. A community-driven hypertension treatment group in rural Honduras.

    PubMed

    Reiger, Sheridan; Harris, Jeffrey R; Chan, Kwun Chuen Gary; Oqueli, Hector Lopez; Kohn, Marlana

    2015-01-01

    Background We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control. Design This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings. Results Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols. Conclusions Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension

  6. Decision making for depression treatment during pregnancy and the postpartum period.

    PubMed

    Patel, Sapana R; Wisner, Katherine L

    2011-07-01

    To explore women's perspectives about the treatment decision-making process for depression during pregnancy and after birth. One hundred pregnant and postpartum women completed an anonymous web-based surveys regarding treatment decision making for depression. Survey data reveal that most women in this sample prefer an active collaborative role in treatment decision making for depression. Sixty-five percent of the sample made a decision for treatment of their major depressive disorder, including a decision for no treatment, and 34% reported not having made a decision or feeling unsure about their decision. More than half of the sample preferred combination treatment with medications and counseling (55%) followed by counseling (22%), no treatment (8%), and medications (8%). Overall, respondents in this sample had low levels of decisional conflict (uncertainty) with younger women in the sample reporting higher levels of decisional conflict. Treatment decision making for depression during the perinatal period is complex. Asking women about their preferences for participation in decision making, their treatment preferences and their decision making needs during the clinical encounter may lead to improved communication, decision making and quality of care. © 2011 Wiley-Liss, Inc.

  7. Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

    PubMed

    LeBlanc, Annie; Wang, Amy T; Wyatt, Kirk; Branda, Megan E; Shah, Nilay D; Van Houten, Holly; Pencille, Laurie; Wermers, Robert; Montori, Victor M

    2015-01-01

    Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown. Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates. We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01), improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively), had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001). Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer). There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07); medication adherence at 6 months was no different across arms. Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results. clinical trials.gov NCT00949611.

  8. 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.

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

    PubMed Central

    Castle, Jessica R.; Jacobs, Peter G.

    2016-01-01

    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

  10. Robust learning for optimal treatment decision with NP-dimensionality

    PubMed Central

    Shi, Chengchun; Song, Rui; Lu, Wenbin

    2016-01-01

    In order to identify important variables that are involved in making optimal treatment decision, Lu, Zhang and Zeng (2013) proposed a penalized least squared regression framework for a fixed number of predictors, which is robust against the misspecification of the conditional mean model. Two problems arise: (i) in a world of explosively big data, effective methods are needed to handle ultra-high dimensional data set, for example, with the dimension of predictors is of the non-polynomial (NP) order of the sample size; (ii) both the propensity score and conditional mean models need to be estimated from data under NP dimensionality. In this paper, we propose a robust procedure for estimating the optimal treatment regime under NP dimensionality. In both steps, penalized regressions are employed with the non-concave penalty function, where the conditional mean model of the response given predictors may be misspecified. The asymptotic properties, such as weak oracle properties, selection consistency and oracle distributions, of the proposed estimators are investigated. In addition, we study the limiting distribution of the estimated value function for the obtained optimal treatment regime. The empirical performance of the proposed estimation method is evaluated by simulations and an application to a depression dataset from the STAR*D study. PMID:28781717

  11. 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

  12. 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

  13. 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.

  14. Pharmacogenetically driven treatments for alcoholism: are we there yet?

    PubMed

    Arias, Albert J; Sewell, R Andrew

    2012-06-01

    Pharmacogenetic analyses of treatments for alcohol dependence attempt to predict treatment response and side-effect risk for specific medications. We review the literature on pharmacogenetics relevant to alcohol dependence treatment, and describe state-of-the-art methods of pharmacogenetic research in this area. Two main pharmacogenetic study designs predominate: challenge studies and treatment-trial analyses. Medications studied include US FDA-approved naltrexone and acamprosate, both indicated for treating alcohol dependence, as well as several investigational (and off-label) treatments such as sertraline, olanzapine and ondansetron. The best-studied functional genetic variant relevant to alcoholism treatment is rs1799971, a single-nucleotide polymorphism in exon 1 of the OPRM1 gene that encodes the μ-opioid receptor. Evidence from clinical trials suggests that the presence of the variant G allele of rs1799971 may predict better treatment response to opioid receptor antagonists such as naltrexone. Evidence from clinical trials also suggests that several medications interact pharmacogenetically with variation in genes that encode proteins involved in dopaminergic and serotonergic neurotransmission. Variation in the DRD4 gene, which encodes the dopamine D(4) receptor, may predict better response to naltrexone and olanzapine. A polymorphism in the serotonin transporter gene SLC6A4 promoter region appears related to differential treatment response to sertraline depending on the subject's age of onset of alcoholism. Genetic variation in SLC6A4 may also be associated with better treatment response to ondansetron. Initial pharmacogenetic efforts in alcohol research have identified functional variants with potential clinical utility, but more research is needed to further elucidate the mechanism of these pharmacogenetic interactions and their moderators in order to translate them into clinical practice.

  15. A community-driven hypertension treatment group in rural Honduras

    PubMed Central

    Reiger, Sheridan; Harris, Jeffrey R.; Chan, Kwun Chuen Gary; Oqueli, Hector Lopez; Kohn, Marlana

    2015-01-01

    Background We formed a self-funded hypertension treatment group in a resource-poor community in rural Honduras. After training community health workers and creating protocols for standardized treatment, we used group membership fees to maintain the group, purchase generic medications in bulk on the local market, and hire a physician to manage treatment. We then assessed whether participation in the group improved treatment, medication adherence, and hypertension control. Design This is a program evaluation using quasi-experimental design and no control group. Using data from the 86 members of the hypertension treatment group, we analyzed baseline and follow-up surveys of members, along with 30 months of clinical records of treatment, medication adherence, and blood pressure readings. Results Our initial hypertension needs assessment revealed that at baseline, community hypertensives relied on the local Ministry of Health clinic as their source of anti-hypertensive medications and reported that irregular supply interfered with medication adherence. At baseline, hypertension group members were mainly female, overweight or obese, physically active, non-smoking, and non-drinking. After 30 months of managing the treatment group, we found a significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the end of the 30-month observation period, the local Ministry of Health system had increased provision of low-cost anti-hypertensive medications and adopted the hypertension treatment group's treatment protocols. Conclusions Formation of a self-funded, community-based hypertension treatment group in a rural, resource-poor community is feasible, and group participation may improve treatment, medication adherence, and hypertension control and can serve as a political driver for improving hypertension

  16. Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

    PubMed Central

    Exley, Catherine E; Rousseau, Nikki S; Steele, Jimmy; Finch, Tracy; Field, James; Donaldson, Cam; Thomason, J Mark; May, Carl R; Ellis, Janice S

    2009-01-01

    Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in

  17. Deciding about (neo-)adjuvant rectal and breast cancer treatment: Missed opportunities for shared decision making.

    PubMed

    Kunneman, Marleen; Engelhardt, Ellen G; Ten Hove, F L Laura; Marijnen, Corrie A M; Portielje, Johanneke E A; Smets, Ellen M A; de Haes, Hanneke J C J M Hanneke; Stiggelbout, Anne M; Pieterse, Arwen H

    2016-01-01

    The first step in shared decision making (SDM) is creating choice awareness. This is particularly relevant in consultations concerning preference-sensitive treatment decisions, e.g. those addressing (neo-)adjuvant therapy. Awareness can be achieved by explicitly stating, as the 'reason for encounter', that a treatment decision needs to be made. It is unknown whether oncologists express such reason for encounter. This study aims to establish: 1) if 'making a treatment decision' is stated as a reason for the encounter and if not, what other reason for encounter is provided; and 2) whether mentioning that a treatment decision needs to be made is associated with enhanced patient involvement in decision making. Consecutive first consultations with: 1) radiation oncologists and rectal cancer patients; or 2) medical oncologists and breast cancer patients, facing a preference-sensitive treatment decision, were audiotaped. The tapes were transcribed and coded using an instrument developed for the study. Oncologists' involvement of patients in decision making was coded using the OPTION-scale. Oncologists (N = 33) gave a reason for encounter in 70/100 consultations, usually (N = 52/70, 74%) at the start of the consultation. The reason for encounter stated was 'making a treatment decision' in 3/100 consultations, and 'explaining treatment details' in 44/100 consultations. The option of foregoing adjuvant treatment was not explicitly presented in any consultation. Oncologist' involvement of patients in decision making was below baseline (Md OPTION-score = 10). Given the small number of consultations in which the need to make a treatment decision was stated, we could not investigate the impact thereof on patient involvement. This study suggests that oncologists rarely express that a treatment decision needs to be made in consultations concerning preference-sensitive treatment decisions. Therefore, patients might not realize that foregoing (neo-)adjuvant treatment is a viable

  18. Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making

    PubMed Central

    Evers-Casey, Sarah; Graden, Sarah; Schnoll, Robert

    2015-01-01

    Rationale: Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in “next steps” consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions. Objective: Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory. Methods: Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of “success” probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions. Measurements and Main Results: Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes. Conclusions: Important presuppositions regarding the potential “success” of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors. PMID:25664676

  19. Treatment decisions in advanced disease: a conceptual framework.

    PubMed

    Broeckaert, Bert

    2009-01-01

    This English translation, made by a professional translator in close cooperation with the author and kindly proofread by Dr. Phil Larkin, follows the original text as closely as possible. However, though we thought it was wise to maintain the official (but not unproblematic) Dutch/Belgian definition of euthanasia in the original text (written for Belgian readers), the English texts offers a new and clearer definition of euthanasia. From the very beginning of the Belgian euthanasia debate in 1999, the Flemish Palliative Care Federation has chosen not to stay on the sideline, but to take an active part in the discussion and formulate recommendations based on our expertise and experience. Time and again we have pointed out that the ethical issues at the end of life are not just restricted to those of euthanasia. We have found that there is still much confusion about, for example, the difference or the boundary between pain control and euthanasia or between euthanasia and withholding life-sustaining treatment. Therefore, we thought it appropriate to put the following conceptual framework with regard to treatment decisions in advanced illness forward.

  20. Age Differences in Cancer Treatment Decision Making and Social Support.

    PubMed

    Krok-Schoen, Jessica L; Palmer-Wackerly, Angela L; Dailey, Phokeng M; Wojno, Julianne C; Krieger, Janice L

    2017-03-01

    The aim of this study was to examine the decision-making (DM) styles of younger (18-39 years), middle-aged (40-59 years), and older (≥60 years) cancer survivors, the type and role of social support, and patient satisfaction with cancer treatment DM. Adult cancer survivors ( N = 604) were surveyed using Qualtrics online software. Older adults reported significantly lower influence of support on DM than younger adults. The most common DM style for the age groups was collaborative DM with their doctors. Younger age was a significant predictor of independent ( p < .05), collaborative with family ( p < .001), delegated to doctor ( p < .01), delegated to family ( p < .001), and demanding ( p < .001) DM styles. Despite having lower received social support in cancer treatment DM, older adults were more satisfied with their DM than younger and middle-aged adults. Health care workers should be aware of different DM styles and influence of social networks to help facilitate optimal patient DM and satisfaction.

  1. 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.

  2. 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

  3. Decaying relevance of clinical data towards future decisions in data-driven inpatient clinical order sets.

    PubMed

    Chen, Jonathan H; Alagappan, Muthuraman; Goldstein, Mary K; Asch, Steven M; Altman, Russ B

    2017-06-01

    Determine how varying longitudinal historical training data can impact prediction of future clinical decisions. Estimate the "decay rate" of clinical data source relevance. We trained a clinical order recommender system, analogous to Netflix or Amazon's "Customers who bought A also bought B..." product recommenders, based on a tertiary academic hospital's structured electronic health record data. We used this system to predict future (2013) admission orders based on different subsets of historical training data (2009 through 2012), relative to existing human-authored order sets. Predicting future (2013) inpatient orders is more accurate with models trained on just one month of recent (2012) data than with 12 months of older (2009) data (ROC AUC 0.91 vs. 0.88, precision 27% vs. 22%, recall 52% vs. 43%, all P<10(-10)). Algorithmically learned models from even the older (2009) data was still more effective than existing human-authored order sets (ROC AUC 0.81, precision 16% recall 35%). Training with more longitudinal data (2009-2012) was no better than using only the most recent (2012) data, unless applying a decaying weighting scheme with a "half-life" of data relevance about 4 months. Clinical practice patterns (automatically) learned from electronic health record data can vary substantially across years. Gold standards for clinical decision support are elusive moving targets, reinforcing the need for automated methods that can adapt to evolving information. Prioritizing small amounts of recent data is more effective than using larger amounts of older data towards future clinical predictions. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  4. 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.

  5. 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

  6. Facilitating Treatment Decision Making, Adjustment, and Coping in Men Newly Diagnosed with Prostate Cancer. Addendum

    DTIC Science & Technology

    2005-05-01

    expectations), to facilitate treatment decision-making for localized prostate cancer ( PrCa ). Methods: CARE identified treatment-related values and goals...information. Couples (N=300) were enrolled after diagnosis with PrCa , but before a definite treatment decision was made. Data were assessed

  7. 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

    ... in Myers et al. (2009) were evaluated with wet bulb depression, the experiment with heat treatment at... 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...

  8. Reuse, treatment, and discharge of the concentrate of pressure-driven membrane processes.

    PubMed

    Van der Bruggen, Bart; Lejon, Liesbeth; Vandecasteele, Carlo

    2003-09-01

    Application of pressure-driven membrane processes (microfiltration, ultrafiltration, nanofiltration, and reverse osmosis) results in the generation of a large concentrated waste stream, the concentrate fraction, as a byproduct of the purification process. Treatment of the concentrate is a major hurdle for the implementation of pressure-driven membrane processes since the concentrate is usually unusable and has to be discharged or further treated. This paper reviews possibilities to treat or discharge the concentrate: (i) reuse, (ii) removal of contaminants, (iii) incineration, (iv) direct or indirect discharge in surface water, (v) direct or indirect discharge in groundwater, and (vi) discharge on a landfill. General guidelines are given for the choice of a proper method as a function of the origin and composition of the water treated. Next, the further treatment of the concentrates in four application areas of pressure-driven membrane processes (drinking water industry, leather industry, and membrane treatment of landfill leachates and of textile process waters) is discussed.

  9. 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.

  10. When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice.

    PubMed

    Robertson, Maggie; Moir, Jim; Skelton, John; Dowell, Jon; Cowan, Sue

    2011-01-01

    Although shared decision making (SDM) in general practice continues to be promoted as a highly desirable means of conducting consultations it is rarely observed in practice. The aim of this study is to identify the discursive features and conversational strategies particular to the negotiation and sharing of treatment decisions in order to understand why SDM is not yet embedded into routine practice. Consultations from Scottish general practices were examined using discourse analysis. Two themes were identified as key components for when the doctor and the patient were intent on sharing decisions: the generation of patient involvement using first-person pronouns, and successful and unsuccessful patient requesting practices. This article identifies a number of conversational activities found to be successful in supporting doctors' agendas and reducing their responsibility for decisions made. Doctor's use of 'partnership talk' was found to minimize resistance and worked to invite consensus rather than involvement. The information from this study provides new insight into the consultation process by identifying how treatment decisions are arrived at through highlighting the complexities involved. Notably, shared decision making does not happen with the ease implied by current models and appears to work to maintain a biomedical 'GP as expert' approach rather than one in which the patient is truly involved in partnership. We suggest that further research on the impact of conversational activities is likely to benefit our understanding of shared decision making and hence training in and the practice of SDM.

  11. 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

  12. UK: AIDS treatment main factor in decision to grant permission to appeal immigration decision.

    PubMed

    Gold, Jennifer

    2003-12-01

    On 26 June 2003, the England and Wales Court of Appeal (Civil Division) granted an application for leave to appeal a decision of the Immigration Appeal Tribunal, which had overturned an adjudicator's decision to allow an HIV-positive citizen of Uganda to immigrate to the United Kingdom (UK).

  13. 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…

  14. An Examination of Staff Perceptions of a Data Driven Decision Making Process Used in a High Performing Title One Urban Elementary School

    ERIC Educational Resources Information Center

    Ziskind, Cassandra

    2013-01-01

    The national focus in education continues to center on school accountability and student results. Districts and states are continually searching for ways to improve student performance and learning outcomes. There are several Data Driven Decision Making models currently being used in school districts across the country. Research continues to…

  15. 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,…

  16. 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,…

  17. Digital technology and clinical decision making in depression treatment: Current findings and future opportunities.

    PubMed

    Hallgren, Kevin A; Bauer, Amy M; Atkins, David C

    2017-06-01

    Clinical decision making encompasses a broad set of processes that contribute to the effectiveness of depression treatments. There is emerging interest in using digital technologies to support effective and efficient clinical decision making. In this paper, we provide "snapshots" of research and current directions on ways that digital technologies can support clinical decision making in depression treatment. Practical facets of clinical decision making are reviewed, then research, design, and implementation opportunities where technology can potentially enhance clinical decision making are outlined. Discussions of these opportunities are organized around three established movements designed to enhance clinical decision making for depression treatment, including measurement-based care, integrated care, and personalized medicine. Research, design, and implementation efforts may support clinical decision making for depression by (1) improving tools to incorporate depression symptom data into existing electronic health record systems, (2) enhancing measurement of treatment fidelity and treatment processes, (3) harnessing smartphone and biosensor data to inform clinical decision making, (4) enhancing tools that support communication and care coordination between patients and providers and within provider teams, and (5) leveraging treatment and outcome data from electronic health record systems to support personalized depression treatment. The current climate of rapid changes in both healthcare and digital technologies facilitates an urgent need for research, design, and implementation of digital technologies that explicitly support clinical decision making. Ensuring that such tools are efficient, effective, and usable in frontline treatment settings will be essential for their success and will require engagement of stakeholders from multiple domains. © 2017 Wiley Periodicals, Inc.

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

    NASA Astrophysics Data System (ADS)

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

    2016-06-01

    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.

  19. Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS.

    PubMed

    López, Mónica E; Kaplan, Celia P; Nápoles, Anna M; Hwang, E Shelley; Livaudais, Jennifer C; Karliner, Leah S

    2014-01-01

    To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS. Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group. Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p<0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2-0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0-12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3-1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7-1.0), independent of ethnicity-language. Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret. Use of professional interpreters may address communication-related disparities for these women. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Development and psychometric properties of a brief measure of subjective decision quality for breast cancer treatment.

    PubMed

    Resnicow, Ken; Abrahamse, Paul; Tocco, Rachel S; Hawley, Sarah; Griggs, Jennifer; Janz, Nancy; Fagerlin, Angela; Wilson, Adrienne; Ward, Kevin C; Gabram, Sheryl G A; Katz, Steven

    2014-12-05

    Breast cancer patients face several preference-sensitive treatment decisions. Feelings such as regret or having had inadequate information about these decisions can significantly alter patient perceptions of recovery and recurrence. Numerous objective measures of decision quality (e.g., knowledge assessments, values concordance measures) have been developed; there are far fewer measures of subjective decision quality and little consensus regarding how the construct should be assessed. The current study explores the psychometric properties of a new subjective quality decision measure for breast cancer treatment that could be used for other preference sensitive decisions. 320 women aged 20-79 diagnosed with AJCC stage 0 - III breast cancer were surveyed at two cancer specialty centers. Decision quality was assessed with single items representing six dimensions: regret, satisfaction, and fit as well as perceived adequacy of information, time, and involvement. Women rated decision quality for their overall treatment experience and surgery, chemotherapy, and radiation decisions separately. Principle components was used to explore factor structure. After scales were formed, internal consistency was computed using Cronbach's alpha. The association of each of the four final scales with patient characteristics scores was examined by Pearson correlation. For overall breast cancer treatment as well as surgery, chemotherapy, and radiation decisions, the six items yielded a single factor solution. Factor loadings of the six decision items were all above .45 across the overall and treatment-specific scales, with the exception of "Right for You" for chemotherapy and radiation. Internal consistency was 0.77, 0.85, 0.82, and 0.78 for the overall, surgery, chemotherapy, and radiation decision quality scales, respectively. Our measure of subjective appraisal of breast cancer treatment decisions includes 5 related elements; regret and satisfaction as well as perceived adequacy of

  1. Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment.

    PubMed

    Liu, Shan; Brandeau, Margaret L; Goldhaber-Fiebert, Jeremy D

    2017-03-01

    How long should a patient with a treatable chronic disease wait for more effective treatments before accepting the best available treatment? We develop a framework to guide optimal treatment decisions for a deteriorating chronic disease when treatment technologies are improving over time. We formulate an optimal stopping problem using a discrete-time, finite-horizon Markov decision process. The goal is to maximize a patient's quality-adjusted life expectancy. We derive structural properties of the model and analytically solve a three-period treatment decision problem. We illustrate the model with the example of treatment for chronic hepatitis C virus (HCV). Chronic HCV affects 3-4 million Americans and has been historically difficult to treat, but increasingly effective treatments have been commercialized in the past few years. We show that the optimal treatment decision is more likely to be to accept currently available treatment-despite expectations for future treatment improvement-for patients who have high-risk history, who are older, or who have more comorbidities. Insights from this study can guide HCV treatment decisions for individual patients. More broadly, our model can guide treatment decisions for curable chronic diseases by finding the optimal treatment policy for individual patients in a heterogeneous population.

  2. 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.

  3. 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.

  4. Shared decision making after severe stroke-How can we improve patient and family involvement in treatment decisions?

    PubMed

    Visvanathan, Akila; Dennis, Martin; Mead, Gillian; Whiteley, William N; Lawton, Julia; Doubal, Fergus Neil

    2017-01-01

    People who are well may regard survival with disability as being worse than death. However, this is often not the case when those surviving with disability (e.g. stroke survivors) are asked the same question. Many routine treatments provided after an acute stroke (e.g. feeding via a tube) increase survival, but with disability. Therefore, clinicians need to support patients and families in making informed decisions about the use of these treatments, in a process termed shared decision making. This is challenging after acute stroke: there is prognostic uncertainty, patients are often too unwell to participate in decision making, and proxies may not know the patients' expressed wishes (i.e. values). Patients' values also change over time and in different situations. There is limited evidence on successful methods to facilitate this process. Changes targeted at components of shared decision making (e.g. decision aids to provide information and discussing patient values) increase patient satisfaction. How this influences decision making is unclear. Presumably, a "shared decision-making tool" that introduces effective changes at various stages in this process might be helpful after acute stroke. For example, by complementing professional judgement with predictions from prognostic models, clinicians could provide information that is more accurate. Decision aids that are personalized may be helpful. Further qualitative research can provide clinicians with a better understanding of patient values and factors influencing this at different time points after a stroke. The evaluation of this tool in its success to achieve outcomes consistent with patients' values may require more than one clinical trial.

  5. 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

  6. CorRECTreatment: A Web-based Decision Support Tool for Rectal Cancer Treatment that Uses the Analytic Hierarchy Process and Decision Tree

    PubMed Central

    Karakülah, G.; Dicle, O.; Sökmen, S.; Çelikoğlu, C.C.

    2015-01-01

    Summary Background The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians’ decision making. Objective The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. Methods The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. Results In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. Conclusions The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options

  7. 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.

  8. Decision support systems in water and wastewater treatment process selection and design: a review.

    PubMed

    Hamouda, M A; Anderson, W B; Huck, P M

    2009-01-01

    The continuously changing drivers of the water treatment industry, embodied by rigorous environmental and health regulations and the challenge of emerging contaminants, necessitates the development of decision support systems for the selection of appropriate treatment trains. This paper explores a systematic approach to developing decision support systems, which includes the analysis of the treatment problem(s), knowledge acquisition and representation, and the identification and evaluation of criteria controlling the selection of optimal treatment systems. The objective of this article is to review approaches and methods used in decision support systems developed to aid in the selection, sequencing of unit processes and design of drinking water, domestic wastewater, and industrial wastewater treatment systems. Not surprisingly, technical considerations were found to dominate the logic of the developed systems. Most of the existing decision-support tools employ heuristic knowledge. It has been determined that there is a need to develop integrated decision support systems that are generic, usable and consider a system analysis approach.

  9. Treatment decision making for incapacitated patients: is development and use of a patient preference predictor feasible?

    PubMed

    Rid, Annette; Wendler, David

    2014-04-01

    It has recently been proposed to incorporate the use of a "Patient Preference Predictor" (PPP) into the process of making treatment decisions for incapacitated patients. A PPP would predict which treatment option a given incapacitated patient would most likely prefer, based on the individual's characteristics and information on what treatment preferences are correlated with these characteristics. Including a PPP in the shared decision-making process between clinicians and surrogates has the potential to better realize important ethical goals for making treatment decisions for incapacitated patients. However, developing and implementing a PPP poses significant practical challenges. The present paper discusses these practical challenges and considers ways to address them.

  10. Integrating data-driven ecological models in an expert-based decision support system for water management in the Du river basin (Vietnam).

    PubMed

    Hoang, Thu Huong; Mouton, Ans; Lock, Koen; De Pauw, Niels; Goethals, Peter L M

    2013-01-01

    In this study, classification trees were combined with the Water Framework Directive (WFD)-Explorer, a modular toolbox that supports integrated water management in a river basin to evaluate the impact of different restoration measures on river ecology. First, the WFD-Explorer toolbox analysed the effect of different restoration options on the abiotic river characteristics based on the water and substance balance embedded in the simulation environment. Based on these abiotic characteristics, the biological index Biological Monitoring Working Party for Vietnam was then predicted by classification trees that were trained on biological and abiotic data collected in the Du river basin in northern Vietnam. The ecological status of streams in the basin ranged from nearly pristine headwaters to severely impacted river stretches. Elimination of point sources from ore extraction and decentralised domestic wastewater treatment proved to be the most effective measures to improve the ecological condition of the Du river basin. The combination of the WFD-Explorer results with data-driven models enabled model application in a situation where expert knowledge was lacking. Consequently, this approach appeared promising for decision support in the context of river restoration and conservation management.

  11. Inhibition of Galectin-1 Sensitizes HRAS-driven Tumor Growth to Rapamycin Treatment.

    PubMed

    Michael, James V; Wurtzel, Jeremy G T; Goldfinger, Lawrence E

    2016-10-01

    The goal of this study was to develop combinatorial application of two drugs currently either in active use as anticancer agents (rapamycin) or in clinical trials (OTX008) as a novel strategy to inhibit Harvey RAS (HRAS)-driven tumor progression. HRAS anchored to the plasma membrane shuttles from the lipid ordered (Lo) domain to the lipid ordered/lipid disordered border upon activation, and retention of HRAS at these sites requires galectin-1. We recently showed that genetically enforced Lo sequestration of HRAS inhibited mitogen-activated protein kinase (MAPK) signaling, but not phoshatidylinositol 3-kinase (PI3K) activation. Here we show that inhibition of galectin-1 with OTX008 sequestered HRAS in the Lo domain, blocked HRAS-mediated MAPK signaling, and attenuated HRAS-driven tumor progression in mice. HRAS-driven tumor growth was also attenuated by treatment with mammalian target of rapamycin (mTOR) inhibitor rapamycin, and this effect was further enhanced in tumors driven by Lo-sequestered HRAS. These drugs also revealed bidirectional cross-talk in HRAS pathways. Moreover, dual pathway inhibition with OTX008 and rapamycin resulted in nearly complete ablation of HRAS-driven tumor growth. These findings indicate that membrane microdomain sequestration of HRAS with galectin-1 inhibition, coupled with mTOR inhibition, may support a novel therapeutic approach to treat HRAS-mutant cancer.

  12. How Can I Change My Patients' Treatment Decision Making by Becoming a Nurse Scientist?
.

    PubMed

    Gray, Tamryn F

    2017-04-01

    "What would you do?" I have heard this question numerous times throughout my nursing career by patients and families affected by cancer. As a pediatric blood and marrow transplantation nurse, I have often seen patients and their families wrestle with difficult treatment decisions. I have witnessed parents struggle between beginning end-of-life care for their child, or pursuing a risky but potentially life-saving clinical trial. With science driving advances in cancer treatments and patients playing more active roles in their care, uncertainty around cancer treatment decisions will only become more complicated. For me, being a good nurse meant helping these patients navigate this uncertainty. I was compelled to pursue research to understand the process patients experience as they make treatment decisions, who they choose to involve in decision making, and what role the unique nurse-
patient relationship could play in facilitating patient-centered decisions.
.

  13. Reported maladaptive decision-making in unipolar and bipolar depression and its change with treatment.

    PubMed

    Alexander, Lara F; Oliver, Alison; Burdine, Lauren K; Tang, Yilang; Dunlop, Boadie W

    2017-11-01

    Mood disorder patients frequently experience difficulty making decisions and may make sub-optimal decisions with adverse life consequences. However, patients' styles for decision-making when ill and after treatment have received little study to date. We assessed healthy controls (HC, n = 69) and patients with major depressive disorder (MDD, n = 61) or bipolar disorder (BP, n = 26) in a current major depressive episode using the Melbourne Decision-making Questionnaire. A subset of participants was re-evaluated after completing six weeks of pharmacotherapy. HC demonstrated significantly greater use of the healthy vigilance style, and significantly lower use of maladaptive decision-making styles, than the MDD and depressed BP patients. After six weeks of treatment, neither the MDD nor BP patients reported meaningful improvements in the vigilance style of decision-making, but scores on most maladaptive decision-making styles declined. BP patients who remitted reported significantly lower buckpassing and procrastination scores than healthy controls. Among MDD patients, however, the maladaptive passive buckpassing style of decision-making did not significantly diminish. For MDD patients, reported decision-making styles may remain impaired even after achieving remission. Among BP patients, low levels of adaptive vigilance decision-making may be a trait component of the illness, whereas for MDD patients, reported maladaptive passive decision-making styles are persistent. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Examining influential factors in providers' chronic pain treatment decisions: a comparison of physicians and medical students.

    PubMed

    Hollingshead, Nicole A; Meints, Samantha; Middleton, Stephanie K; Free, Charnelle A; Hirsh, Adam T

    2015-10-01

    Chronic pain treatment guidelines are unclear and conflicting, which contributes to inconsistent pain care. In order to improve pain care, it is important to understand the various factors that providers rely on to make treatment decisions. The purpose of this study was to examine factors that reportedly influence providers' chronic pain treatment decisions. A secondary aim was to examine differences across participant training level. Eighty-five participants (35 medical students, 50 physicians) made treatment decisions for 16 computer-simulated patients with chronic pain. Participants then selected from provided lists the information they used and the information they would have used (had it been available) to make their chronic pain treatment decisions for the patient vignettes. Frequency analyses indicated that most participants reported using patients' pain histories (97.6 %) and pain description (95.3 %) when making treatment decisions, and they would have used information about patients' previous treatments (97.6 %) and average and current pain ratings (96.5 %) had this information been available. Compared to physicians, medical students endorsed more frequently that they would have used patients' employment and/or disability status (p < 0.05). A greater proportion of medical students wanted information on patients' use of illicit drugs and alcohol to make treatment decisions; while a greater proportion of physicians reported using personal experience to inform their decisions. This study found providers use patients' information and their own experiences and intuition to make chronic pain treatment decisions. Also, participants of different training levels report using different patient and personal factors to guide their treatment decisions. These results highlight the complexity of chronic pain care and suggest a need for more chronic pain education aimed at medical students and practicing providers.

  15. Making decisions about chronic disease treatment: a comparison of parents and their adolescent children.

    PubMed

    Lipstein, Ellen A; Dodds, Cassandra M; Lovell, Daniel J; Denson, Lee A; Britto, Maria T

    2016-06-01

    To compare factors considered by parents to those considered by adolescents making decisions about chronic disease treatments. We conducted individual interviews with 15 parent-adolescent dyads in which the adolescent had either juvenile idiopathic arthritis or Crohn's disease. Questions focused on treatment decisions, with an emphasis on the factors that influenced each individual's preferences related to biologic therapies. A multidisciplinary team developed a coding structure. All interviews were coded by two people with disagreements resolved through discussion. We used content analysis and coding matrices to examine decision factors within and between parent-adolescent dyads. Parents and adolescents both participated in decisions about treatment with biologic therapies but considered decision factors differently. In only half of cases did parents and adolescents agree on the factor that most influenced their decision. Although their decision factors often fell into similar categories (e.g. treatment risks, quality of life), in many cases the specifics varied between adolescents and their parents. Adolescents were more likely to focus on immediate treatment effects and quality of life while parents took a longer term view of the decision. Agreement within dyads was most consistent when a special circumstance influenced the treatment decision. Differences regarding influential decision factors exist within parent-adolescent dyads. Continued research is needed to determine the extent to which such differences are due to individual preferences or to variations in the information available to each person. Future decision support interventions will need to address parents' and adolescents' potentially disparate views and information needs. © 2014 John Wiley & Sons Ltd.

  16. Relationships between life attitude profile and symptoms experienced with treatment decision evaluation in patients with cancer.

    PubMed

    Erci, Behice; Özdemir, Süreyya

    2013-01-01

    Despite many researches that have examined life attitude profile, treatment decision evaluation, and symptoms experienced in cancer populations, the relationships between life attitude profile and symptoms experienced with treatment decision evaluation are still not well understood. A thorough understanding of these relationships is critical for health care professionals to provide appropriate management to patients. The aim of this study was to determine relationships among life attitude profile, the treatment decision evaluation, and symptoms experienced in Turkish patients with cancer. A convenience sample of 199 patients with cancer at a Turkish university hospital completed a structured questionnaire including demographic characteristics and the Life Attitude Profile-Revised Scale for patients with cancer in 2007. The researchers visited the oncology clinic 5 work days every week and conducted interviews with the patients. The life attitude profile was not correlated with the treatment decision evaluation and symptoms experienced (r = 0.082, r = -026). The treatment decision evaluation showed that the patients were uncertain about their satisfaction with the treatment decision. Significant correlations were found between the treatment decision evaluation and symptoms experienced (r = 0.206; P <.01). Holistic nursing interventions can be implemented as they promote healing of the whole person processes as facilitating self-awareness, living meaningfully, and promotion connection with others and with nature and a higher power.

  17. Influence of Men's Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer.

    PubMed

    Reamer, Elyse; Yang, Felix; Holmes-Rovner, Margaret; Liu, Joe; Xu, Jinping

    2017-01-01

    Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p < 0.01; 8.7, p < 0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p = 0.04). Men who consulted family or friends (OR = 2.6, p < 0.01; 3.7, p < 0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. In addition to specialist seen, consulting friends increased men's likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

  18. Influence of Men's Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer

    PubMed Central

    Yang, Felix; Holmes-Rovner, Margaret; Liu, Joe

    2017-01-01

    Background Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. Methods We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Results Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p < 0.01; 8.7, p < 0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p = 0.04). Men who consulted family or friends (OR = 2.6, p < 0.01; 3.7, p < 0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. Conclusions In addition to specialist seen, consulting friends increased men's likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty. PMID:28785574

  19. Use of implicit persuasion in decision making about adjuvant cancer treatment: A potential barrier to shared decision making.

    PubMed

    Engelhardt, Ellen G; Pieterse, Arwen H; van der Hout, Anja; de Haes, Hanneke J C J M; Kroep, Judith R; Quarles van Ufford-Mannesse, Patricia; Portielje, Johanneke E A; Smets, Ellen M A; Stiggelbout, Anne M

    2016-10-01

    Shared decision making (SDM) is widely advocated, especially for preference-sensitive decisions like those on adjuvant treatment for early-stage cancer. Here, decision making involves a subjective trade-off between benefits and side-effects, and therefore, patients' informed preferences should be taken into account. If clinicians consciously or unconsciously steer patients towards the option they think is in their patients' best interest (i.e. implicit persuasion), they may be unwittingly subverting their own efforts to implement SDM. We assessed the frequency of use of implicit persuasion during consultations and whether the use of implicit persuasion was associated with expected treatment benefit and/or decision making. Observational study design in which consecutive consultations about adjuvant systemic therapy with stage I-II breast cancer patients treated at oncology outpatient clinics of general teaching hospitals and university medical centres were audiotaped, transcribed and coded by two researchers independently. In total, 105 patients (median age = 59; range: 35-87 years) were included. A median of five (range: 2-10) implicitly persuasive behaviours were employed per consultation. The number of behaviours used did not differ by disease stage (P = 0.07), but did differ by treatment option presented (P = 0.002) and nodal status (P = 0.01). About 50% of patients with stage I or node-negative disease were steered towards undergoing chemotherapy, whereas 96% of patients were steered towards undergoing endocrine therapy, irrespective of expected treatment benefit. Decisions were less often postponed if more implicit persuasion was used (P = 0.03). Oncologists frequently use implicit persuasion, steering patients towards the treatment option that they think is in their patients' best interest. Expected treatment benefit does not always seem to be the driving force behind implicit persuasion. Awareness of one's use of these steering behaviours

  20. Older adults newly diagnosed with symptomatic myeloma and treatment decision making.

    PubMed

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

    2014-07-01

    To describe the preferences for participation in decision making of older adult patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Descriptive, cross-sectional design. Participants' homes and two large academic cancer centers in Seattle, WA, and Chicago, IL. A convenience sample of 20 older adults (60 years of age and older) with symptomatic myeloma diagnosed within the past six months. The Control Preferences Scale was administered followed by an in-person, one-time, semistructured interview. Role preferences for participation in treatment decision making, age, gender, race, work status, personal relationship status, education, and income. Fifty-five percent of the participants preferred a shared role with the physician and 40% preferred to make the decisions after seriously considering the opinion of their physicians. Only one participant preferred to leave the decision to the doctor, as long as the doctor considered the patient's treatment preferences. The study findings indicate that older adults newly diagnosed with myeloma want to participate in treatment decision making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow him or her to be autonomous in making treatment decisions. Nurses and other oncology clinicians can elicit a patient's preferred level of participation in treatment decision making. Oncology nurses can make sure patients receive disease- and treatment-related information, encourage them to express their decisional role preference to the physician, develop a culture of mutual respect and value their desire for autonomy for treatment decision making, acknowledge that the right to make a treatment choice belongs to the patient, and provide support during treatment decision making throughout the care continuum.

  1. Understanding older women's decision making and coping in the context of breast cancer treatment.

    PubMed

    Lifford, Kate J; Witt, Jana; Burton, Maria; Collins, Karen; Caldon, Lisa; Edwards, Adrian; Reed, Malcolm; Wyld, Lynda; Brain, Kate

    2015-06-10

    Primary endocrine therapy (PET) is a recognised alternative to surgery followed by endocrine therapy for a subset of older, frailer women with breast cancer. Choice of treatment is preference-sensitive and may require decision support. Older patients are often conceptualised as passive decision-makers. The present study used the Coping in Deliberation (CODE) framework to gain insight into decision making and coping processes in a group of older women who have faced breast cancer treatment decisions, and to inform the development of a decision support intervention (DSI). Semi-structured interviews were carried out with older women who had been offered a choice of PET or surgery from five UK hospital clinics. Women's information and support needs, their breast cancer diagnosis and treatment decisions were explored. A secondary analysis of these interviews was conducted using the CODE framework to examine women's appraisals of health threat and coping throughout the deliberation process. Interviews with 35 women aged 75-98 years were analysed. Appraisals of breast cancer and treatment options were sometimes only partial, with most women forming a preference for treatment relatively quickly. However, a number of considerations which women made throughout the deliberation process were identified, including: past experiences of cancer and its treatment; scope for choice; risks, benefits and consequences of treatment; instincts about treatment choice; and healthcare professionals' recommendations. Women also described various strategies to cope with breast cancer and their treatment decisions. These included seeking information, obtaining practical and emotional support from healthcare professionals, friends and relatives, and relying on personal faith. Based on these findings, key questions were identified that women may ask during deliberation. Many older women with breast cancer may be considered involved rather than passive decision-makers, and may benefit from DSIs

  2. End-of-Life Decisions: A Cross-National Study of Treatment Preference Discussions and Surrogate Decision-Maker Appointments

    PubMed Central

    Evans, Natalie; Pasman, H. Roeline; Vega Alonso, Tomás; Van den Block, Lieve; Miccinesi, Guido; Van Casteren, Viviane; Donker, Gé; Bertolissi, Stefano; Zurriaga, Oscar; Deliens, Luc; Onwuteaka-Philipsen, Bregje; EUROIMPACT, on behalf of

    2013-01-01

    Background Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients’ appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors. Methods A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors. Results GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments. Conclusions The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation. PMID:23472122

  3. "I'm the one taking it": adolescent participation in chronic disease treatment decisions.

    PubMed

    Lipstein, Ellen A; Muething, Kelly A; Dodds, Cassandra M; Britto, Maria T

    2013-08-01

    To understand adolescents' roles and preferences in chronic disease treatment decisions, using biologic therapy decisions as an example. We conducted semistructured interviews with adolescents who have Crohn's disease (n = 7) or juvenile idiopathic arthritis (n = 8). Questions focused on biologic therapy decisions, including who participated, preferred roles, and factors considered in the decision. We used pie charts to help teens describe the division of decisional responsibility. We open-coded the initial interviews to develop a coding structure. Interviews then were coded by two people, with disagreements resolved through discussion. Interviews were analyzed using content analysis. Nearly all adolescents participated in the decision about biologic therapy. Roles varied from telling parents about specific symptoms to having the final say in the decision. In addition to discussing their own roles, adolescents identified specific decision-making roles for both parents and physicians. Most factors that influenced adolescents' decision-making related to their quality of life, such as the desire to feel better, concerns about painful injections, and the time needed for treatment. Some adolescents did consider potential side effects and the expected treatment efficacy. Most adolescents were satisfied with how the decision was made, but given a choice would have preferred a different role in the decision. Adolescents with chronic disease wish to be involved in treatment decision making, but also seek the involvement of parents and physicians. Parents and providers can assist by providing adolescents with relevant information and by helping teens develop the skills necessary for future medical decision-making. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  4. Parents' information needs in tumor necrosis factor-α inhibitor treatment decisions.

    PubMed

    Lipstein, Ellen A; Lovell, Daniel J; Denson, Lee A; Moser, David W; Saeed, Shehzad A; Dodds, Cassandra M; Britto, Maria T

    2013-03-01

    The aim of the study was to describe parents' experiences and the information used when making decisions about tumor necrosis factor-α inhibitor (TNFαi) treatment. We interviewed parents of children with Crohn disease (CD) or juvenile idiopathic arthritis who had experience deciding about TNFαi treatment. Interview questions focused on information used to make decisions and factors that influenced decision making. We used thematic analysis for all coding and analysis. Coding structure was developed by a multidisciplinary team review of the initial interviews. Two coders then coded the remaining interviews, compared coding, and resolved disagreements through discussion. Data were analyzed by thematic grouping and then compared between diseases. We interviewed 35 parents. For nearly all parents the decision about TNFαi treatment was the most challenging medical decision they had made; however, parents of children with CD experienced more stress and anxiety than did other parents. Both groups of parents sought information from multiple sources including health care providers, the Internet, and social contacts. They looked for information related to treatment effectiveness, adverse effects, and other individuals' treatment experiences. In CD, information was used to help make the decision, whereas in juvenile idiopathic arthritis it was used to confirm the decision. The decision-making experience, and associated information seeking, leaves some parents with long-lasting concerns and worry about TNFαi treatment. Providing parents with structured decision-making support may lead to more effective and efficient decision making, decreased psychosocial distress, and, ultimately, improved outcomes for their children.

  5. 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

  6. Patients’ priorities for treatment decision making during periods of incapacity: quantitative survey

    PubMed Central

    RID, ANNETTE; WESLEY, ROBERT; PAVLICK, MARK; MAYNARD, SHARON; ROTH, KATALIN; WENDLER, DAVID

    2017-01-01

    Objective Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. Method We employed a self-administered, quantitative survey of patients in a tertiary care center. Results Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Significance of Results Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients’ treatment preferences. Clinicians should also discuss and document patients’ priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making. PMID:25273677

  7. Patients' priorities for treatment decision making during periods of incapacity: quantitative survey.

    PubMed

    Rid, Annette; Wesley, Robert; Pavlick, Mark; Maynard, Sharon; Roth, Katalin; Wendler, David

    2015-10-01

    Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. We employed a self-administered, quantitative survey of patients in a tertiary care center. Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients' treatment preferences. Clinicians should also discuss and document patients' priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making.

  8. Using decision aids in community-based primary care: A theory-driven evaluation with ethnically diverse patients

    PubMed Central

    Frosch, Dominick L.; Légaré, France; Mangione, Carol M.

    2010-01-01

    Objective To assess the effects of informational brochures and video decision aids about cancer screening on patient intention to engage in shared decision making and its predictors in a racially diverse sample. Methods Participants were recruited from 13 community-based primary care practices serving racially and ethnically diverse patients in predominately economically disadvantaged neighborhoods. Participants completed theory-based measures assessing attitudes, perceived social norms, self-efficacy and intentions for working with their physician to make a cancer screening decision after reviewing a brochure or video decision aid, but before seeing the physician. A post-questionnaire assessed screening decisions and participant knowledge. Results Participants who reviewed a video decision aid had higher knowledge and were more likely to want to be the primary decision-maker. They reported lower perceived social norms, self-efficacy and intentions to work with their physicians than participants who reviewed a brochure. Participants who decided against cancer screening reported lower intentions to work with their physician in making a decision and were less likely to report having spoken with their physician about screening. Conclusion Participants who opted against cancer screening after reviewing a brochure or decision aid were less likely to discuss their decision with their physician. The tendency toward autonomous decision-making was stronger among participants who reviewed a video decision aid. PMID:18771875

  9. Shared Decision Making for Hydroxyurea Treatment Initiation in Children with Sickle Cell Anemia

    PubMed Central

    Crosby, Lori E.; Shook, Lisa M.; Ware, Russell E.; Brinkman, William B.

    2017-01-01

    Clinical trials have demonstrated hydroxyurea’s efficacy in improving health outcomes for children with sickle cell anemia (SCA) who have medical complications. New NHLBI clinical guidelines will recommend offering hydroxyurea to young patients regardless of clinical severity. Shared decision making may be an effective approach for implementing this practice change. Decision aids that help patients/parents feel empowered to make this decision and help providers feel comfortable discussing hydroxyurea as a preventive treatment may facilitate shared discussions between families and providers. We recommend six strategies providers can use to facilitate these discussions while decision aids and tools are being developed. PMID:25308571

  10. Spirituality is associated with better prostate cancer treatment decision making experiences.

    PubMed

    Mollica, Michelle A; Underwood, Willie; Homish, Gregory G; Homish, D Lynn; Orom, Heather

    2016-02-01

    This study examined whether spiritual beliefs are associated with greater decision-making satisfaction, lower decisional conflict and decision-making difficulty with the decision-making process in newly diagnosed men with prostate cancer. Participants were 1114 men diagnosed with localized prostate cancer who had recently made their treatment decision, but had not yet been treated. We used multivariable linear regression to analyze relationships between spirituality and decision-making satisfaction, decisional conflict, and decision-making difficulty, controlling for optimism and resilience, and clinical and sociodemographic factors. Results indicated that greater spirituality was associated with greater decision-making satisfaction (B = 0.02; p < 0.001), less decisional conflict (B = -0.42; p < 0.001), and less decision-making difficulty (B = -0.08; p < 0.001). These results confirm that spiritual beliefs may be a coping resource during the treatment decision-making process. Providing opportunities for patients to integrate their spiritual beliefs and their perceptions of their cancer diagnosis and trajectory could help reduce patient uncertainty and stress during this important phase of cancer care continuum.

  11. Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

    PubMed

    Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

    To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Determinants of parental decisions on 'drop out' from cancer treatment for childhood cancer patients.

    PubMed

    Yeh, C H; Lin, C F; Tsai, J L; Lai, Y M; Ku, H C

    1999-07-01

    Little is known about the psychosocial process of parental decisions on 'drop out' from cancer treatment for paediatric patients in Taiwan. This study, based on structured in-depth interviews, attempted to document the determinants of parental decisions on drop out. A total of 19 parents of paediatric cancer patients who dropped out from a cancer treatment for at least a month within 3 years since first treatment were interviewed. Content analysis of qualitative data revealed six categories of determinants associated with parental decisions: suffering severe pain from medical treatments and adverse side-effects; desire for better and less painful treatments; adverse effect of other patients' experiences; searching for possible explanations for disease after prolonged denial of diagnosis; lack of empathy from health care professionals; and misinterpretation of improved prognostics. These findings reflected the deficiency of psychological and emotional support for parents from health care professionals prior to and during cancer treatment.

  13. Using Decision Lists to Construct Interpretable and Parsimonious Treatment Regimes

    PubMed Central

    Zhang, Yichi; Laber, Eric B.; Tsiatis, Anastasios; Davidian, Marie

    2015-01-01

    Summary A treatment regime formalizes personalized medicine as a function from individual patient characteristics to a recommended treatment. A high-quality treatment regime can improve patient outcomes while reducing cost, resource consumption, and treatment burden. Thus, there is tremendous interest in estimating treatment regimes from observational and randomized studies. However, the development of treatment regimes for application in clinical practice requires the long-term, joint effort of statisticians and clinical scientists. In this collaborative process, the statistician must integrate clinical science into the statistical models underlying a treatment regime and the clinician must scrutinize the estimated treatment regime for scientific validity. To facilitate meaningful information exchange, it is important that estimated treatment regimes be interpretable in a subject-matter context. We propose a simple, yet flexible class of treatment regimes whose members are representable as a short list of if-then statements. Regimes in this class are immediately interpretable and are therefore an appealing choice for broad application in practice. We derive a robust estimator of the optimal regime within this class and demonstrate its finite sample performance using simulation experiments. The proposed method is illustrated with data from two clinical trials. PMID:26193819

  14. Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid.

    PubMed

    Jibaja-Weiss, Maria L; Volk, Robert J; Granch, Thomas S; Nefe, Nancy E; Spann, Stephen J; Aoki, Noriaki; Robinson, Emily K; Freidman, Lois C; Beck, J Robert

    2006-01-01

    We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users.

  15. 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.

  16. Impact of centralized intake on drug and alcohol treatment placement decisions.

    PubMed

    Scott, Christy K; Foss, Mark A

    2002-01-01

    The American Society of Addiction Medicine (ASAM) and others have asserted that matching persons to an appropriate level of care will result in more positive and cost-effective treatment outcomes. The Center for Substance Abuse Treatment, through its Target Cities demonstration project, proposed the implementation of centralized intake and the use of comprehensive standardized assessment procedures as mechanisms for improving the treatment process. As part of Chicago Target Cities, it was decided to implement ASAM criteria at the central intake units (CIU). A comprehensive assessment instrument was developed, assessors were trained, and decision protocols were designed to facilitate the implementation. This article examines the impact of these interventions on the placement decision process. The placement decisions of the assessors employed by individual treatment agencies before implementation of the CIU were compared to the placement decision process of the CIU assessors. The role of patient preferences, the information assessors used to make placement decisions, and the willingness of assessors to make the clinical judgments indicated by ASAM PPC-2 were examined. Results indicate that the CIU assessors' final treatment recommendations were more similar to what they thought was best for the patient, and less related to patient preference than those made by assessors at the individual treatment agencies. The CIU assessors also used a wider range of information when making their placement decisions than did the Pre-CIU assessors. Finally, the CIU assessors were more willing to rate patients on ASAM criteria than were the Pre-CIU assessors. Implementation of the ASAM PPC-2 at the CIUs produced the expected differences in the placement decision processes at the CIU from those observed at the treatment agencies. The results indicate that the implementation of ASAM PPC-2 is both feasible and produces expected changes in the placement decision process.

  17. 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.

  18. Jordanian Physicians’ Attitudes toward Disclosure of Cancer Information and Patient Participation in Treatment Decision-making

    PubMed Central

    Obeidat, Rana; Khrais, Huthaifah I.

    2016-01-01

    Objective: This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making. Methods: A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians’ views of shared decision making. Results: Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians’ usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians’ comfort level with the shared approach. Conclusions: Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system. PMID:27981172

  19. [Decisions on limiting treatment in critically-ill neonates: a multicenter study].

    PubMed

    2002-12-01

    Backgrounds Some patients with a poor prognosis cause serious doubts about the real benefit of life-sustaining treatment. In some cases the possibility of limiting those treatments is raised. Such end-of-life decisions provoke ethical dilemmas and questions about procedure.ObjectivesTwo determine the frequency of end-of-life decisions in neonates, patient characteristics, and the criteria used by those taking decisions.Patients and methodsWe performed a multicenter, descriptive, prospective study. Neonates from 15 neonatal intensive care units who died during their stay in the hospital between 1999 and 2000, as well as those in whom end-of-life decisions were taken, were included. End-of-life decisions were defined as clinical decisions to withhold or withdraw life-sustaining treatment.ResultsA total of 330 patients were included. End-of-life decisions were taken in 171 (52 %); of these, 169 (98.8 %) died. The remaining 159 patients (48.2 %) died without treatment limitation. The main disorders involving end-of-life decisions were congenital malformation (47 %), neurologic disorders secondary to perinatal asphyxia and intracranial hemorrhage-periventricular leukomalacia (37 %). Of the 171 neonates, treatment was withheld in 80 and vital support was withdrawn in 91. The most frequently withdrawn life-sustaining treatment was mechanical ventilation (68 %). The criteria most commonly used in end-of-life decisions were poor vital prognosis (79.5 %), and current and future quality of life (37 % and 48 % respectively). The patient's external factors such as unfavorable family environment or possible negative consequences for familial equilibrium were a factor in 5 % of decisions.ConclusionsThe present study, the first of this type performed in Spain, reveals little-known aspects about the clinical practice of withholding and/or withdrawing life-sustaining treatment in critically ill neonates. End-of-life decisions were frequent (52 %) and were followed by death in most

  20. Efficacy of a manualized and workbook-driven individual treatment for social anxiety disorder.

    PubMed

    Ledley, Deborah Roth; Heimberg, Richard G; Hope, Debra A; Hayes, Sarah A; Zaider, Talia I; Dyke, Melanie Van; Turk, Cynthia L; Kraus, Cynthia; Fresco, David M

    2009-12-01

    Social anxiety disorder is a prevalent and impairing disorder for which viable cognitive-behavioral therapies exist. However, these treatments have not been easily packaged for dissemination and may be underutilized as a result. The current study reports on the findings of a randomized controlled trial of a manualized and workbook-driven individual cognitive-behavioral treatment for social anxiety disorder (Hope, Heimberg, Juster, & Turk, 2000; Hope, Heimberg, & Turk, 2006). This treatment package was derived from an empirically supported group treatment for social anxiety disorder and intended for broad dissemination, but it has not previously been subjected to empirical examination on its own. As a first step in that examination, 38 clients seeking treatment for social anxiety disorder at either the Adult Anxiety Clinic of Temple University or the Anxiety Disorders Clinic of the University of Nebraska-Lincoln were randomly assigned to receive either immediate treatment with this cognitive-behavioral treatment package or treatment delayed for 20 weeks. Evaluation at the posttreatment/postdelay period revealed substantially greater improvements among immediate treatment clients on interviewer-rated and self-report measures of social anxiety and impairment. Three-month follow-up assessment revealed maintenance of gains. Clinical implications and directions for future research are discussed.

  1. Physician Perspectives on Decision Making for Treatment of Pediatric Sleep-Disordered Breathing.

    PubMed

    Boss, Emily F; Links, Anne R; Saxton, Ron; Cheng, Tina L; Beach, Mary Catherine

    2017-10-01

    Sleep-disordered breathing (SDB) is prevalent in children and most commonly treated by surgery with adenotonsillectomy. We aimed to learn physician perspectives of social and communication factors that influence decision making for treatment of pediatric SDB. Purposive sampling identified 10 physician key informants across disciplines and practice settings, who participated in semistructured interviews regarding SDB care experiences and communication with parents. Interviews were analyzed using directed qualitative content analysis. Physicians provided a variety of perspectives on decision making for treatment that fell into 3 overarching themes: approach to surgery and alternatives, communication and decision making with families, and sociocultural factors/barriers to care. Perspectives were moderately heterogeneous, suggesting that individual social and relational elements may significantly influence how physicians refer patients and recommend treatment, and how parents choose surgery for this prevalent condition. These findings will inform development of culturally competent communication strategies and support tools to enhance shared decision making for physicians treating children with SDB.

  2. An informed decision? Breast cancer patients and their knowledge about treatment.

    PubMed

    Fagerlin, Angela; Lakhani, Indu; Lantz, Paula M; Janz, Nancy K; Morrow, Monica; Schwartz, Kendra; Deapen, Dennis; Salem, Barbara; Liu, Lihua; Katz, Steven J

    2006-12-01

    Although involving women in breast cancer treatment decisions is advocated, there is little understanding of whether women have the information they need to make informed decisions. The objective of the current study was to evaluate women's knowledge of survival and recurrence rates for mastectomy and breast conserving surgery (BCS) and the factors associated with this knowledge. We used a population-based sample of women diagnosed with breast cancer in metropolitan Los Angeles and Detroit between December 2001 and January 2003. All women with ductal carcinoma in situ and a random sample of women with invasive disease were selected (N=2382), of which 1844 participated (77.4%). All participants were mailed surveys. The main outcome measures were knowledge of survival and recurrence rates by surgical treatment type. Only 16% of women knew that recurrence rates were different for mastectomy and BCS, and 48% knew that the survival rates were equivalent across treatment. Knowledge about survival and recurrence was improved by exposure to the Internet and health pamphlets (p<0.01). Women who had a female (versus male) surgeon, and/or a surgeon who explained both treatments (rather than just one treatment) demonstrated higher survival knowledge (p<0.01). The majority of women had inadequate knowledge with which to make informed decisions about breast cancer surgical treatment. Previous explanations for poor knowledge, such as irrelevance of knowledge to decision making and lack of access to information, were not shown to be plausible explanations for the low levels of knowledge observed in this sample. These results suggest a need for fundamental changes in patient education to ensure that women are able to make informed decisions about their breast cancer treatment. These changes may include an increase in the use of decision aids and in decreasing the speed at which treatment decisions are made.

  3. Preferences and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis.

    PubMed

    Zhang, Yuhai; Su, Haixia; Shang, Lei; Li, Duan; Wang, Rui; Zhang, Ruiqiao; Xu, Yongyong

    2011-01-01

    The objectives of this study were to measure the preferences for and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis and to explore the factors that may influence patients' preferences. The study also aimed to analyze patients' satisfaction with decision and information provision and their relationships with the decisional role. Semistructured interviews were performed with 178 chronic hepatitis patients. The Control Preferences Scale was translated into Chinese from English and adopted to measure patients' preferred and perceived decisional role. Patients' satisfaction with decision and information provision was also investigated by a 5-point Likert-type scale. Patients with chronic hepatitis in the study generally preferred a collaborative role (45%) or passive role (44%); only 11% of patients preferred an active role in treatment decision making. The agreement between patients' perceived and preferred role was not perfect (Bowker's S = 33.8, P < 0.001). Age and education level were significantly associated with patients' preferences: Younger, better educated patients tended to prefer more active roles. A total of 54% of patients felt satisfied with treatment decisions, whereas 39% of patients felt satisfied with information provision. Patients' levels of satisfaction with their treatment decisions were correlated not only with the perceived role itself but also with its agreement with the preferred role. Patients' satisfaction with information provision was significantly correlated with patients' preferred role. Moreover, there was a significant correlation between patients' satisfaction with the treatment decision and information provision. Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and

  4. 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 Jr, Albert G.; Sepucha, Karen R.

    2010-01-01

    Abstract 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 is 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 the 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  Thirty‐eight 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. Conclusions  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

  5. 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

  6. Influential factors on treatment decision making among patients with colorectal cancer: A scoping review.

    PubMed

    Cranley, Nicole M; Curbow, Barbara; George, Thomas J; Christie, Juliette

    2017-09-01

    In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.

  7. Treatment decision-making by men with localized prostate cancer: the influence of personal factors.

    PubMed

    Berry, Donna L; Ellis, William J; Woods, Nancy Fugate; Schwien, Christina; Mullen, Kristin H; Yang, Claire

    2003-01-01

    For many men with localized prostate cancer, there is no definite answer or unequivocal choice regarding treatment modality. This high-stakes treatment decision is made in the context of great uncertainty. The purpose of this study is to systematically document meaningful and relevant aspects of treatment decision-making reported by men with localized prostate cancer. Focus groups and individual interviews were conducted with 44 men who were within 6 months of a diagnosis of localized prostate cancer. Using content analysis and grounded theory analytic techniques, major aspects and processes of men's treatment decision making are identified and described. The participants reported their experiences beginning with influential personal history factors, followed by detailed descriptions of information gathering and the important influence of expected treatment outcomes and other individuals' cancer histories and/or shared opinions. Twenty of the 44 (45%) participants relied heavily on the influence of another's opinion or history to finalize a decision, yet only 10 of the 44 (22.7%) reported this individual to be their physician. A common process, "making the best choice for me" was explicated. Clinicians assume that men are making rational treatment decisions based on reliable information, yet this study documents a different reality. Patient education about medical therapies and the patients' own medical factors is not enough. A clinic visit dialogue that brings personal factors to the conversation along with medical factors can guide a man to making his "best choice" for localized prostate cancer.

  8. Treatment decision making experiences of migrant cancer patients and their families in Australia.

    PubMed

    Shaw, Joanne; Zou, Xian; Butow, Phyllis

    2015-06-01

    To explore treatment decision-making experiences of Australian migrants with cancer from Arabic, Chinese, or Greek backgrounds and their relatives. 73 patients and 18 caregivers from cancer support groups and oncology clinics participated in either a focus group (n=14) or semi-structured interview (n=21) conducted in the participant's own language. Participant treatment decision-making preferences were discussed as part of patients' overall treatment experience and a thematic analysis conducted. Four main themes emerged from the data: (1) perceived role of the patient in decision-making; (2) access to information and the impact of language; (3) cultural influences (4) family involvement. The majority of participants experienced passive involvement during treatment consultations, but expressed a desire for greater involvement. Language rather than culture was a greater obstacle to active participation. Difficulty communicating effectively in English was the most significant barrier to participation in treatment decisions. To overcome language challenges, participants actively sought information from alternative sources. This study provides new insights into the influence of language and culture on the treatment decision-making experiences of migrants with cancer and their families within the Australian cancer care system. To reduce health disparities doctors need to address language difficulties and be aware of cultural differences. Copyright © 2015. Published by Elsevier Ireland Ltd.

  9. Psychometric evaluation of a decision quality instrument for treatment of lumbar herniated disc.

    PubMed

    Sepucha, Karen R; Feibelmann, Sandra; Abdu, William A; Clay, Catharine F; Cosenza, Carol; Kearing, Stephen; Levin, Carrie A; Atlas, Steven J

    2012-08-15

    Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file. To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc. There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality. The herniated disc-decision quality instrument (HD-DQI) was developed with input from clinical experts, survey research experts, and patients. The HD-DQI produces 2 scores each scaled to 0% to 100%, with higher scores indicating better quality: (1) a total knowledge score and (2) a concordance score (indicating the percentage of patients who received treatments that matched their goals). We examined hypotheses relating to the acceptability, feasibility, validity, and reliability of the instrument, using data from 3 samples. The HD-DQI survey was feasible to implement and acceptable to patients, with good response rates and low missing data. The knowledge score discriminated between patients who had seen a decision aid or no decision aid (55% vs. 38%, P < 0.001) and between providers and patients (73% vs. 46%, P < 0.001). The knowledge score also had good retest reliability (intraclass correlation coefficient = 0.85). Most patients (78%) received treatments that matched their goals. Patients who received treatments that matched their goals were less likely to regret the decision than those who did not (13% vs. 39%, P = 0.004). The HD-DQI met several criteria for high-quality patient-reported survey instruments. It can be used to determine the quality of decisions for treatment of herniated disc. More work is needed to examine acceptability for use as part of routine patient care.

  10. 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.

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

    PubMed

    Alistar, Sabina S; Brandeau, Margaret L

    2012-01-01

    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. 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. 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. 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.

  12. Treatment decision making for adolescents with familial hypercholesterolemia: Role of family history and past experiences.

    PubMed

    Mackie, Thomas I; Tse, Lisa L; de Ferranti, Sarah D; Ryan, Heather R; Leslie, Laurel K

    2015-01-01

    Adolescents and young adults (AYAs) with familial hypercholesterolemia (FH) are at high risk for underdiagnosis and inadequate treatment. Yet, little is known about the factors that influence the medical decision making of AYAs with FH and their families. This study explores how family medical history, family narratives of medical experiences, and AYA medical experiences together function as "experiential evidence" and influence screening and treatment decisions. Twenty-four parents and AYAs affected by FH from a pediatric preventive cardiology practice responded to a survey and a semistructured qualitative interview. Transcribed interviews were analyzed using a modified grounded theory approach. Study design, instruments, and interpretation of results were informed by a 20-member stakeholder panel. AYAs and parents reported extensive personal and family experiences with cholesterol and cardiovascular conditions and treatments, sometimes distinct from FH, which were used as evidence to inform their own perceptions of FH risk and treatment. This experiential evidence impacted perceptions of: (1) hereditary risk for FH diagnoses, (2) risk for future cardiovascular disease, (3) risks associated with treatments, and (4) capacity to comply with recommended treatments. Although experiences of family members initially informed screening and treatment decisions, the subsequent personal experiences of AYAs led to new experiential evidence that informed future decisions. Family cardiovascular history related to and distinct from FH influenced screening and treatment decisions of AYAs and parents affected by FH. Additional clinical assessment of personal and family medical experiences may enhance understanding of the decision-making processes among AYAs and ultimately improve adherence to screening and treatment recommendations. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  13. 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.

  14. Watson will see you now: a supercomputer to help clinicians make informed treatment decisions.

    PubMed

    Doyle-Lindrud, Susan

    2015-02-01

    IBM has collaborated with several cancer care providers to develop and train the IBM supercomputer Watson to help clinicians make informed treatment decisions. When a patient is seen in clinic, the oncologist can input all of the clinical information into the computer system. Watson will then review all of the data and recommend treatment options based on the latest evidence and guidelines. Once the oncologist makes the treatment decision, this information can be sent directly to the insurance company for approval. Watson has the ability to standardize care and accelerate the approval process, a benefit to the healthcare provider and the patient.

  15. Impact of Advanced Health Care Directives on Treatment Decisions by Physicians in Patients with Acute Stroke

    PubMed Central

    Qureshi, Adnan I; Chaudhry, Saqib A.; Connelly, Bo; Abott, Emily; Janjua, Tariq; Kim, Stanley H.; Miley, Jefferson T.; Rodriguez, Gustavo J.; Uzun, Guven; Watanabe, Masaki

    2012-01-01

    Background The implementation of advance health care directives, prepared by almost half of the adult population in United States remains relatively under studied. We determined the impact of advance health care directives on treatment decisions by multiple physicians in stroke patients. Methods A de-identified summary of clinical and radiological records of 28 patients with stroke was given to six stroke physicians who were not involved in the care of the patients. Each physician independently rated 28 treatment decisions per patient in the presence or absence of advance health care directives 1 month apart to allow memory washout. The percentage agreement to treat/intervene per patient and proportion of treatment withheld as a group were estimated for each of the 28 treatment decision items. We also determined the interobserver reliability between the two raters (attorneys) in interpretation of 6 items characterizing the adequacy of documentation within the 28 advance health care directives. Results The percentage agreement among physician raters for treatment decisions in 28 stroke patients was highest for treatment of hyperpyrexia (100%, 100%) and lowest for intensive care unit monitoring duration based on family-physician considerations outside of accepted criteria within institution (68%, 69%) in presence and absence of advance care health directives. The physician rater agreement in choosing “yes” was highest for “routine complexity” treatment decisions and lowest for “moderate complexity” treatment decisions. The choice of withholding treatment in routine complexity,” “moderate complexity,” or “high complexity” treatment decisions was remarkably similar among raters in presence or absence of advance care health directives. The only treatment decision that showed an impact of advance care health directives was intensive care unit monitoring withheld in 32% of treatment decisions in presence of directives (compared with 8% in the absence

  16. 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,…

  17. Tools to aid post-wildfire assessment and erosion-mitigation treatment decisions

    Treesearch

    Peter R. Robichaud; Louise E. Ashmun

    2013-01-01

    A considerable investment in post-fire research over the past decade has improved our understanding of wildfire effects on soil, hydrology, erosion and erosion-mitigation treatment effectiveness. Using this new knowledge, we have developed several tools to assist land managers with post-wildfire assessment and treatment decisions, such as prediction models, research...

  18. 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…

  19. 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,…

  20. 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

  1. 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…

  2. Examining cultural factors that influence treatment decisions: a pilot study of Latino men with cancer.

    PubMed

    Carrion, Iraida V; Nedjat-Haiem, Frances R; Marquez, David X

    2013-12-01

    The objective of this study was to explore beliefs and treatment decisions of foreign-born Latino men from Cuba, Mexico, Colombia, and Venezuela, who have been diagnosed with cancer and who live in Central Florida, USA. Experiences related to knowledge of diagnosis, treatment decisions, communication with health providers, family involvement, and advance care planning (ACP) discussions following the diagnosis of cancer are central to this study. This study used qualitative in-depth semi-structured interviews and thematic analysis. The interviews were conducted with 15 Latino men who have been diagnosed with cancer within the past 5 years and who reside in the community. The interviews were conducted and transcribed in Spanish and then translated into English. The median age was 55.4 years. Nine Latino men had prostate cancer, two had brain cancer, two had colorectal cancer, and two had lung cancer. Emerging themes involved the suddenness of the diagnosis, fear of dying, expectations of diagnosis-related communication, reliance on physicians for treatment decisions, limited information pertaining to ACP, family support, and role changes. Latino men's limited knowledge of cancer diagnosis and treatment options coupled with their fear led them to immediately believe that they were going to die. Knowledge gaps regarding diagnosis-related communication, treatment decisions, and ACP varied among the men. The forthright diagnosis communication and the expectation to engage in decision making are contrary to Latinos men's beliefs of reliance on health providers decisions. The findings contribute to understanding Latino men's beliefs about a cancer diagnosis and treatment decisions.

  3. Treatment decision making in breast cancer: a longitudinal exploration of women's experiences.

    PubMed

    Swainston, Katherine; Campbell, Carol; van Wersch, Anna; Durning, Patricia

    2012-02-01

    To explore the lived experience of breast cancer in relation to the treatment decision-making process over time. Adopting a hermeneutic phenomenological approach, semi-structured interviews were undertaken at three points in time during the year following diagnosis. After ethical approval had been obtained, 20 women who were recently diagnosed with breast cancer were recruited from a Symptomatic Breast Cancer Unit in the North East of England. Four themes emerged: role in the treatment decision-making process; acceptance of medical opinions; getting rid of it; and cancer schemas. The majority of women reported a passive role in the surgical treatment decision-making process and all women did so in relation to subsequent treatment decisions. However, women adopted this role consciously and consequently were not disengaged from the process but maintained a sense of ownership and control over their health. The women did not describe experiencing decisional regret at any point in the year following diagnosis and rarely revisited the decisions made, only doing so in a positive manner. Trust in the abilities and experience of healthcare professionals and maximizing chances of survival were cited as reasons for not having had greater involvement. Despite being given information about treatment options, many women made the decision not to attend to this information perceiving this to be anxiety provoking. The findings from this study suggest a need for eliciting more specific psycho-social interactions in the treatment decision-making process in order to identify ways in which women can be supported throughout their experience. ©2011 The British Psychological Society.

  4. Can Decision Support Help Patients with Spinal Stenosis Make a Treatment Choice? A Prospective Study Assessing the Impact of a Patient Decision Aid and Health Coaching

    PubMed Central

    Kearing, Stephen; Berg, Susan Z.; Lurie, Jon D.

    2015-01-01

    Study Design A prospective, randomized study on patients with lumbar spinal stenosis who received a decision support intervention to facilitate their treatment choice. Objective To assess the impact of telephone health coaching in addition to a video decision aid compared to a decision aid alone for patients with spinal stenosis. Summary of Background Data Treatment options for lumbar spinal stenosis include surgical and non-surgical approaches. Patient decision aids (DAs) and health coaching (HC) have been shown to help patients make an informed treatment choice consistent with personal preferences. Methods Eligible patients with spinal stenosis were identified by an orthopaedic surgeon or non-surgical spine specialist. Consenting participants were randomly assigned to either: a video decision aid (DA) or a video decision aid plus health coaching (DA+HC). Patients completed baseline and follow up questionnaires at 2 weeks, and 6 months after the decision support intervention(s). Results Ninety eight patients were randomized to the DA+HC group and 101 to the DA only group; 168/199 (84%) patients completed responses at all time points. Both groups showed improved understanding of spinal stenosis treatments and progress in decision making after watching the DA (p < 0.001). At two weeks, more patients in the coaching group had made a treatment decision (DA+HC 74% vs. DA only 52%, p<0.01). At 6 month follow up, the uptake of surgery was similar for both groups (DA+HC - 21%) had surgery vs. (DA only - 17%); satisfaction with the treatments received was similar for both groups (DA+HC, 84% satisfied vs. DA only, 85%). Conclusions These results suggest watching the video decision aid improved patient knowledge and reduced decisional uncertainty about their spinal stenosis treatment choice. The addition of telephone coaching helped some patients choose a treatment more quickly; 6-month decisional outcomes were similar for both groups. PMID:27018897

  5. Are patients' decisions to refuse treatment binding on health care professionals?

    PubMed

    Murphy, Peter

    2005-06-01

    When patients refuse to receive medical treatment, the consequences of honouring their decisions can be tragic. This is no less true of patients who autonomously decide to refuse treatment. I distinguish three possible implications of these autonomous decisions. According to the Permissibility Claim, such a decision implies that it is permissible for the patient who has made the autonomous decision to forego medical treatment. According to the Anti-Paternalism Claim, it follows that health-care professionals are not morally permitted to treat that patient. According to the Binding Claim it follows that these decisions are binding on health-care professionals. My focus is the last claim. After arguing that it is importantly different from each of the first two claims, I give two arguments to show that it is false. One argument against the Binding Claim draws a comparison with cases in which patients autonomously choose perilous positive treatments. The other argument appeals to considered judgments about cases in which disincentives are used to deter patients from refusing sound treatments.

  6. Impact of ultrasonography on treatment decision in rheumatoid arthritis: the IMPULSAR study.

    PubMed

    Díaz-Torné, Cèsar; Moragues, Carme; Toniolo, Elide; Geli, Carme; Castellví, Iván; Moya, Patricia; Gich, Ignasi; Llobet, Josep M

    2017-06-01

    Ultrasonography (US) has shown to be more sensitive than physical examination for diagnosis and assessment of rheumatoid arthritis (RA). It is also a useful approach for accurate monitoring and intensive treatment adjustment. However, there is limited information concerning the impact of US on therapeutic decision-making in routine daily practice. A single-center cross-sectional study in routine daily practice was conducted to determine the percentage of patients with rheumatoid arthritis (RA) in which treatment decision was modified on the basis of results of musculoskeletal ultrasonography. All consecutive patients with RA visited for the control of their disease between September and November 2014 were included. Patients were visited by their attending rheumatologist, who made a therapeutic decision according to the results of physical examination and laboratory tests. Thereafter, a musculoskeletal ultrasound (US) was performed by an independent expert sonographer. According to US findings, a change in therapeutic decision was considered, and categorized as 'negative' (maintenance of the therapeutic attitude) or 'positive' (intensification or reduction of treatment). A total of 78 patients (83% women, mean age 63.3 years) were included. In 29 patients [32%, 95% confidence interval (CI) 26.5-48.9], a change in the therapeutic decision was made, which included intensification of treatment in 18 (62.1%) and reduction of treatment in 11 (37.9%). Change of treatment was more frequent in patients with intermediate disease activity (low and moderate) than in those in clinical remission or with high activity (41.4 vs. 25%), in men than in women (53.8 vs. 33.8%), and in the presence than in the absence of bone erosions (43.6 vs. 21.7%), although differences were not statistically significant. We conclude that in patients with RA, joint US is a relevant complementary tool for treatment decisions in daily practice, particularly in patients with intermediate disease

  7. Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions.

    PubMed

    Bowie, Janice V; Bell, Caryn N; Ewing, Altovise; Kinlock, Ballington; Ezema, Ashley; Thorpe, Roland J; LaVeist, Thomas A

    2017-02-01

    Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main dependent variables sought respondents' use of resources or advisors when making treatment decisions. Questions also assessed men perceptions of prostate cancer from the perspective of religious coping. After adjusting for age, marital status, education, and insurance status, race differences in the number of sources utilized were partially mediated by cancer was a punishment from God (β = -0.46, SE = 0.012, p < .001), cancer was a test of faith (β = -0.49, SE = 0.013, p < .001), and cancer can be cured with enough prayer (β = -0.47, SE = 0.013, p < .001). Similarly, race differences in the number of advisors utilized in making the treatment decision were partially mediated by cancer was a punishment from God (β = -0.39, SE = 0.014, p = .006), and cancer was a test of faith (β = -0.39, SE = 0.014, p = .006). Religious views on prostate cancer may play an important role in explaining race differences in information used and the number of advisors utilized for treatment decision making for prostate cancer.

  8. Treatment decision-making for localized prostate cancer: what younger men choose and why.

    PubMed

    Sidana, Abhinav; Hernandez, David J; Feng, Zhaoyong; Partin, Alan W; Trock, Bruce J; Saha, Surajit; Epstein, Jonathan I

    2012-01-01

    The literature lacks knowledge about information preferences and decision-making in young prostate cancer patients. This study provides insight into information sources consulted and factors dictating treatment decision-making in young prostate cancer patients. Subjects were identified from pathology consult service of a National Center of Excellence. Questionnaires were mailed to 986 men, under 50 years of age, diagnosed with Gleason score 6 prostate cancer between 2001 and 2005. Four hundred ninety-three men responded. The most common primary therapies were surgery 397 (81.4%), radiation 52 (10.7%), and active surveillance (AS) 26 (5.3%). Participants with at least some college education (P = 0.003) or annual income >$100,000 (P = 0.003) were more likely to consult three or more doctors. Amongst all treatments, "doctor's recommendation" was the most influential information source, although relatively less important in the AS group. Internet was the second most frequent information source. Participants with higher education (P = 0.0003) and higher income (P = 0.002) considered sexual function more important while making a treatment choice. Only 2% of the men preferred a passive role in the decision-making. Informed decision-making was preferred more by patients who chose radiation and AS while shared decision-making was preferred more by surgery patients (P < 0.05). The majority (89%) of the respondents did not regret their decision. No difference in satisfaction levels was found between different treatment modalities. This study provides insight into information sources consulted, such as the greater internet use, and various factors dictating treatment decision-making in young prostate cancer patients. There was an overall very high satisfaction rate regardless of the therapy chosen. Copyright © 2011 Wiley Periodicals, Inc.

  9. 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

  10. Treatment Decision-Making for Localized Prostate Cancer: What Younger Men Choose and Why

    PubMed Central

    Sidana, Abhinav; Hernandez, David J.; Feng, Zhaoyong; Partin, Alan W.; Trock, Bruce J.; Saha, Surajit; Epstein, Jonathan I.

    2015-01-01

    Background and Objective The literature lacks knowledge about information preferences and decision-making in young prostate cancer patients. This study provides insight into information sources consulted and factors dictating treatment decision-making in young prostate cancer patients. Methods Subjects were identified from pathology consult service of a National Center of Excellence. Questionnaires were mailed to 986 men, under 50 years of age, diagnosed with Gleason score 6 prostate cancer between 2001 and 2005. Results Four hundred ninety-three men responded. The most common primary therapies were surgery 397 (81.4%), radiation 52 (10.7%), and active surveillance (AS) 26 (5.3%). Participants with at least some college education (P = 0.003) or annual income >$100,000 (P = 0.003) were more likely to consult three or more doctors. Amongst all treatments, “doctor's recommendation” was the most influential information source, although relatively less important in the AS group. Internet was the second most frequent information source. Participants with higher education (P = 0.0003) and higher income (P = 0.002) considered sexual function more important while making a treatment choice. Only 2% of the men preferred a passive role in the decision-making. Informed decision-making was preferred more by patients who chose radiation and AS while shared decision-making was preferred more by surgery patients (P < 0.05). The majority (89%) of the respondents did not regret their decision. No difference in satisfaction levels was found between different treatment modalities. Conclusions This study provides insight into information sources consulted, such as the greater internet use, and various factors dictating treatment decision-making in young prostate cancer patients. There was an overall very high satisfaction rate regardless of the therapy chosen. PMID:21520163

  11. Drug regimens identified and optimized by output-driven platform markedly reduce tuberculosis treatment time.

    PubMed

    Lee, Bai-Yu; Clemens, Daniel L; Silva, Aleidy; Dillon, Barbara Jane; Masleša-Galić, Saša; Nava, Susana; Ding, Xianting; Ho, Chih-Ming; Horwitz, Marcus A

    2017-01-24

    The current drug regimens for treating tuberculosis are lengthy and onerous, and hence complicated by poor adherence leading to drug resistance and disease relapse. Previously, using an output-driven optimization platform and an in vitro macrophage model of Mycobacterium tuberculosis infection, we identified several experimental drug regimens among billions of possible drug-dose combinations that outperform the current standard regimen. Here we use this platform to optimize the in vivo drug doses of two of these regimens in a mouse model of pulmonary tuberculosis. The experimental regimens kill M. tuberculosis much more rapidly than the standard regimen and reduce treatment time to relapse-free cure by 75%. Thus, these regimens have the potential to provide a markedly shorter course of treatment for tuberculosis in humans. As these regimens omit isoniazid, rifampicin, fluoroquinolones and injectable aminoglycosides, they would be suitable for treating many cases of multidrug and extensively drug-resistant tuberculosis.

  12. Drug regimens identified and optimized by output-driven platform markedly reduce tuberculosis treatment time

    PubMed Central

    Lee, Bai-Yu; Clemens, Daniel L.; Silva, Aleidy; Dillon, Barbara Jane; Masleša-Galić, Saša; Nava, Susana; Ding, Xianting; Ho, Chih-Ming; Horwitz, Marcus A.

    2017-01-01

    The current drug regimens for treating tuberculosis are lengthy and onerous, and hence complicated by poor adherence leading to drug resistance and disease relapse. Previously, using an output-driven optimization platform and an in vitro macrophage model of Mycobacterium tuberculosis infection, we identified several experimental drug regimens among billions of possible drug-dose combinations that outperform the current standard regimen. Here we use this platform to optimize the in vivo drug doses of two of these regimens in a mouse model of pulmonary tuberculosis. The experimental regimens kill M. tuberculosis much more rapidly than the standard regimen and reduce treatment time to relapse-free cure by 75%. Thus, these regimens have the potential to provide a markedly shorter course of treatment for tuberculosis in humans. As these regimens omit isoniazid, rifampicin, fluoroquinolones and injectable aminoglycosides, they would be suitable for treating many cases of multidrug and extensively drug-resistant tuberculosis. PMID:28117835

  13. Reprint of "Influence of analytical bias and imprecision on the number of false positive results using Guideline-Driven Medical Decision Limits".

    PubMed

    Hyltoft Petersen, Per; Klee, George G

    2014-05-15

    Diagnostic decisions based on decision limits according to medical guidelines are different from the majority of clinical decisions due to the strict dichotomization of patients into diseased and non-diseased. Consequently, the influence of analytical performance is more critical than for other diagnostic decisions where much other information is included. The aim of this opinion paper is to investigate consequences of analytical quality and other circumstances for the outcome of "Guideline-Driven Medical Decision Limits". Effects of analytical bias and imprecision should be investigated separately and analytical quality specifications should be estimated accordingly. Use of sharp decision limits doesn't consider biological variation and effects of this variation are closely connected with the effects of analytical performance. Such relationships are investigated for the guidelines for HbA1c in diagnosis of diabetes and in risk of coronary heart disease based on serum cholesterol. The effects of a second sampling in diagnosis give dramatic reduction in the effects of analytical quality showing minimal influence of imprecision up to 3 to 5% for two independent samplings, whereas the reduction in bias is more moderate and a 2% increase in concentration doubles the percentage of false positive diagnoses, both for HbA1c and cholesterol. An alternative approach comes from the current application of guidelines for follow-up laboratory tests according to clinical procedure orders, e.g. frequency of parathyroid hormone requests as a function of serum calcium concentrations. Here, the specifications for bias can be evaluated from the functional increase in requests for increasing serum calcium concentrations. In consequence of the difficulties with biological variation and the practical utilization of concentration dependence of frequency of follow-up laboratory tests already in use, a kind of probability function for diagnosis as function of the key-analyte is proposed

  14. Planning treatment of ischemic heart disease with partially observable Markov decision processes.

    PubMed

    Hauskrecht, M; Fraser, H

    2000-03-01

    Diagnosis of a disease and its treatment are not separate, one-shot activities. Instead, they are very often dependent and interleaved over time. This is mostly due to uncertainty about the underlying disease, uncertainty associated with the response of a patient to the treatment and varying cost of different diagnostic (investigative) and treatment procedures. The framework of partially observable Markov decision processes (POMDPs) developed and used in the operations research, control theory and artificial intelligence communities is particularly suitable for modeling such a complex decision process. In this paper, we show how the POMDP framework can be used to model and solve the problem of the management of patients with ischemic heart disease (IHD), and demonstrate the modeling advantages of the framework over standard decision formalisms.

  15. Modeling treatment of ischemic heart disease with partially observable Markov decision processes.

    PubMed

    Hauskrecht, M; Fraser, H

    1998-01-01

    Diagnosis of a disease and its treatment are not separate, one-shot activities. Instead they are very often dependent and interleaved over time, mostly due to uncertainty about the underlying disease, uncertainty associated with the response of a patient to the treatment and varying cost of different diagnostic (investigative) and treatment procedures. The framework of Partially observable Markov decision processes (POMDPs) developed and used in operations research, control theory and artificial intelligence communities is particularly suitable for modeling such a complex decision process. In the paper, we show how the POMDP framework could be used to model and solve the problem of the management of patients with ischemic heart disease, and point out modeling advantages of the framework over standard decision formalisms.

  16. Factors associated with clinical decision-making in relation to treatment need for temporomandibular disorders.

    PubMed

    Yekkalam, Negin; Wänman, Anders

    2016-01-01

    The aim of this study was to analyze dentist's clinical decision-making related to treatment need for temporomandibular disorders (TMD) in an adult population. The study population comprised 779 randomly selected 35, 50, 65 and 75 year old individuals living in the county of Västerbotten, Sweden. The participants filled out a questionnaire and were examined clinically according to a structured protocol. The four examiners (two men, two women) were experienced dentists and were calibrated before the start of the study. After examination they individually assessed the need of treatment owing to TMD. In total, 15% of the study population was considered to have a treatment need owing to TMD. The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men. Overall, 21% of the women and 8% of the men were considered to have a treatment need owing to TMD, with statistically significant differences between men and women for the 35 and 50 years old groups. Inter-individual variations in dentists' decisions were observed. In a multivariate analysis, female gender, signs and symptoms of TMD pain, signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need. The prevalence of estimated treatment need owing to TMD was fairly high, but the dentists' clinical decision-making process showed large inter-individual variability. The observation calls for further research on the factors affecting the decision-making process in care providers.

  17. Wind-driven surficial oxygen transfer and dinitrogen gas emission from treatment lagoons.

    PubMed

    Ro, K S; Hunt, P G; Poach, M E

    2006-01-01

    Surficial oxygen transfer plays an important role, when analyzing the complex biochemical and physical processes responsible for ammonia and dinitrogen gas emission in animal waste treatment lagoons. This paper analyzes if currently known nitrogen biochemical pathways can explain the enigmatic dinitrogen gas emissions recently observed from the treatment lagoons, based on the amount of wind-driven oxygen that can be transferred through the air-water interface. The stoichiometric amounts of the maximum dinitrogen gas production potential per unit mass of O(2) transferred were calculated according to three most likely biochemical pathways for ammonia removal in the treatment lagoons-classical nitrification-denitrification, partial nitrification-denitrification, and partial nitrification-Anammox. Partial nitrification-Anammox pathway would produce the largest N(2) emission, followed by partial nitrification-denitrification pathway, then by classical nitrification-denitrification pathway. In order to estimate stoichiometric amount (i.e., maximum) of N(2) emission from these pathways, we assumed that heterotrophic respiration was substantially inhibited due to high levels of free ammonia prevalent in treatment lagoons. Most observed N(2) emission data were below the maximum N(2) emission potentials by the classical nitrification-denitrification pathway. However, one value of observed N(2) emission was much higher than that could be produced by even the partial nitrification-Anammox pathway. This finding suggests yet unknown biological processes and/or non-biological nitrogen processes such as chemodenitrification may also be important in these treatment lagoons.

  18. Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries.

    PubMed

    Bradley, James P; Elkousy, Hussein

    2003-04-01

    The classification system devised by Allman and Tossy, and revised by Rockwood, defines the extent of injury to the AC joint and helps to guide management of AC joint injuries [1,4,6]. In general, type I and II injuries may be treated nonoperatively with a sling, mainly for comfort, for a short period of time. Once this is removed, strength and motion are regained with rehabilitation. Patients typically have manageable long-term symptoms without any intervention, but some may require a steroid injection or distal clavicle excision for chronic pain from degenerative changes at the AC joint due to the injury. On the other end of the spectrum, type IV, V, and VI injuries nearly always require operative intervention. The surgical procedures for these injuries are performed in the acute phase if possible to minimize symptoms and maximize long-term function. Type III injuries are the center of the controversy for management of AC joint injuries. No perfect study exists which demonstrates clear superiority of surgical or nonsurgical treatment. Most of the studies in the literature support nonoperative treatment for most patients, however. Yet, other factors must be considered, including the patient's occupation and physical demands as well as the age of the injury. Overhead athletes and manual laborers place high demands on their shoulders, prompting some authors to consider acute surgical management for these patients. We, on the other hand, agree with the current consensus opinion that all type III injuries should initially be treated conservatively, regardless of occupation. The only advantage to operative intervention consistently borne out in the literature is an increased probability of anatomic reduction. There is no correlation between reduction and improvement in pain, strength, or motion, however. These patients usually are able to return to full sport with no deficits if rehabilitation is emphasized. For those patients who fail conservative management, a

  19. Decision Regret following Treatment for Localized Breast Cancer: Is Regret Stable Over Time?

    PubMed

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

    2015-05-01

    While studies suggest most women have little regret regarding their breast cancer treatment decisions immediately following treatment, no studies to date have evaluated how regret may change over time. To measure the stability of posttreatment decision regret over time among women with breast cancer. 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 and 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 2 decision regret scores at both time 1 and time 2 (range, 0-20). 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. The analytic sample included 1536 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 a 2.6-point increase in regret over time compared with women without an additional diagnosis (P = 0.003). Receipt of reconstruction was not associated with change in decision regret over time. 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. © The Author(s) 2014.

  20. Cognitive Predictors of Understanding Treatment Decisions in Patients with Newly Diagnosed Brain Metastases

    PubMed Central

    Gerstenecker, Adam; Meneses, Karen; Duff, Kevin; Fiveash, John B.; Marson, Daniel C.; Triebel, Kristen L.

    2015-01-01

    Background Medical decision-making capacity is a higher-order functional skill that refers to a patient’s ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient’s ability to comprehend information to the extent that informed decisions can be made. Methods The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically-matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. Conclusions Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as “red flags” for reduced consent capacity in this patient population, and, thus, signal that a more comprehensive medical decision-making capacity evaluation is warranted. PMID:25735262

  1. Rational decision-making about treatment and care in dementia: a contradiction in terms?

    PubMed

    Wolfs, Claire A G; de Vugt, Marjolein E; Verkaaik, Mike; Haufe, Marc; Verkade, Paul-Jeroen; Verhey, Frans R J; Stevens, Fred

    2012-04-01

    To gain caregivers' insights into the decision-making process in dementia patients with regard to treatment and care. Four focus group interviews (n=29). The decision-making process consists of three elementary components: (1) identifying an individual's needs; (2) exploring options; and (3) making a choice. The most important phase is the exploration phase as it is crucial for the acceptance of the disease. Furthermore, the decision is experienced more as an emotional choice than a rational one. It is influenced by personal preferences whereas practical aspects do not seem to play a substantial role. Several aspects make decision-making in dementia different from decision-making in the context of other chronic diseases: (1) the difficulty accepting dementia; (2) the progressive nature of dementia; (3) patient's reliance on surrogate decision-making; and (4) strong emotions. Due to these aspects, the decision-making process is very time-consuming, especially the crucial exploration phase. A more active role is required of both the caregiver and the health care professional especially in the exploration phase, enabling easier acceptance and adjustment to the disease. Acceptance is an important condition for reducing anxiety and resistance to care that may offer significant benefits in the future. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  2. Factors influencing cancer treatment decision-making by indigenous peoples: a systematic review.

    PubMed

    Tranberg, Rona; Alexander, Susan; Hatcher, Deborah; Mackey, Sandra; Shahid, Shaouli; Holden, Lynda; Kwok, Cannas

    2016-02-01

    We aim to systematically review studies that identify factors influencing cancer treatment decision-making among indigenous peoples. Following the outline suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis, a rigorous systematic review and meta-synthesis were conducted of factors that influence cancer treatment decision-making by indigenous peoples. A total of 733 articles were retrieved from eight databases and a manual search. After screening the titles and abstracts, the full text of 26 articles were critically appraised, resulting in five articles that met inclusion criteria for the review. Because the five articles to be reviewed were qualitative studies, the Critical Appraisal Skills Program toolkit was used to evaluate the methodological quality. A thematic synthesis was employed to identify common themes across the studies. Multiple socio-economic and cultural factors were identified that all had the potential to influence cancer treatment decision-making by indigenous people. These factors were distilled into four themes: spiritual beliefs, cultural influences, communication and existing healthcare systems and structures. Although existing research identified multiple factors influencing decision-making, this review identified that quality studies in this domain are scarce. There is scope for further investigation, both into decision-making factors and into the subsequent design of culturally appropriate programmes and services that meet the needs of indigenous peoples. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Reducing variability in treatment decision-making: effectiveness of educating clinicians about uncertainty.

    PubMed

    Choi, B C; Jokovic, A; Kay, E J; Main, P A; Leake, J L

    1998-01-01

    The objective of this study was to investigate whether or not education about the concept of uncertainty reduced variability in treatment decision-making. Three small groups of dentists in North York, Canada were asked to make restorative treatment decisions about simulated bitewing radiographs. They subsequently took part in a seminar about variations in perception and judgement and were given explanations of sensitivity, specificity and receiver operating characteristic (ROC) curve analysis. A repeat reading of the radiographs was then performed by both test and control groups. Results indicated that the intervention increased the accuracy, and decreased the variability of dentists' restorative treatment decisions. Kappa statistics were 0.33, 0.34 and 0.31 before the seminar, and 0.40, 0.43 and 0.41 after the seminar. Standard errors for kappas were 0.06, 0.05 and 0.05 before the seminar, and 0.02, 0.02 and 0.05 after the seminar. The area under the ROC curve was 0.7136 before the seminar and 0.7835 after the seminar. The data demonstrate that the dentists' decisions were less variable and more accurate following the educative intervention. This study suggests that there is potential for improving consistency and accuracy in clinical decision-making through education in probabilistic reasoning.

  4. The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa.

    PubMed

    Stiles-Shields, Colleen; DclinPsy, Bryony Bamford; Lock, James; Le Grange, Daniel

    2015-05-01

    This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05). The results of this secondary exploratory data suggest that DE is prevalent for adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs. © 2014 Wiley Periodicals, Inc.

  5. A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

    PubMed

    Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

    2017-01-13

    Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

  6. Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

    PubMed Central

    2011-01-01

    Background A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis. Methods The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined. Results In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not. Conclusions The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals. PMID:21729315

  7. Evaluation of Nurses' Self-Insight into their Pain Assessment and Treatment Decisions

    PubMed Central

    Hirsh, Adam T.; Jensen, Mark P.; Robinson, Michael E.

    2009-01-01

    Research generally indicates that providers demonstrate modest insight into their clinical decision processes. In a previous study utilizing virtual human (VH) technology, we found that patient demographic characteristics and facial expressions of pain were statistically significant predictors of many nurses' pain-related decisions. The current study examined the correspondence between the statistically-identified and self-reported influences of contextual information on pain-related decisions. Fifty-four nurses viewed vignettes containing a video of a VH patient and text describing a post-surgical context. VH sex, race, age, and facial expression varied across vignettes. Participants made pain assessment and treatment decisions on visual analogue scales. Participants subsequently indicated the information they relied on when making decisions. None of the participants reported using VH sex, race, or age in their decision process. Statistical modeling indicated that 28–54% of participants (depending on the decision) used VH demographic cues. 76% of participants demonstrated concordance between their reported and actual use of the VH facial expression cue. Vital signs, text-based clinical summary, and VH movement were also reported as influential factors. These data suggest that biases may be prominent in practitioner decision-making about pain, but that providers have minimal awareness of and/or a lack of willingness to acknowledge this bias. Perspective: The current study highlights the complexity of provider decision-making about pain management. The VH technology could be used in future research and education applications aimed at improving the care of all persons in pain. PMID:20015702

  8. Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians

    PubMed Central

    Leo, Raphael J.

    1999-01-01

    Common law dictates that individuals possess autonomy and self-determination, which encompass the right to accept or refuse medical treatment. Management of medical treatment can be complicated in situations when the ability of the patient to make reasonable decisions is called into question. Our legal system endorses the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise. This review will discuss the standards upon which capacity and competency assessments are made. Practical suggestions are offered for clinicians to employ in patient interviews conducted to assess capacity. Issues related to advance directives, surrogate decision making, guardianship, and implied consent are also discussed. The role psychiatric consultants take in capacity assessment can assist the primary care physician confronting the complexities encountered when attempting to treat the incapacitated or incompetent patient. PMID:15014674

  9. The role of culture in families' treatment decisions for children with autism spectrum disorders.

    PubMed

    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, interpretation of the symptoms of ASD, its etiology and course, and their experiences with the health system influence treatment decisions. This article addresses these issues within the context of cultural influences. We review the small body of existing literature regarding cultural influences on decisions regarding ASD and draw implications for the study and treatment of ASD from the larger body of literature on culture and other health conditions of childhood. In addition to examining the potential for differences in clinical presentation by culture and different experiences with the healthcare system, we use Kleinman's framework of questions for understanding the role of culture in the interpretation and treatment of ASD. These questions address interpretation of symptoms and beliefs about their cause, course, and treatment. Finally, we present specific language for clinicians to use in discussion with families with different cultural beliefs about the use of less traditional treatment strategies.

  10. Direct Water-treatment by DC Driven Micro-hollow Cathode Discharge

    NASA Astrophysics Data System (ADS)

    Yamatake, Atsushi; Yasuoka, Koichi; Ishii, Shozo

    Direct water-treatment method by O and OH radicals has been developed using DC driven atmospheric micro-plasmas operated in fast gas flow conditions. Over atmospheric pressure gas of pure oxygen, moist oxygen or water vapor passed through a small cavity of 200 μm in diameter where micro-plasmas were generated. The resident time of the feed gas within the cavity was around microsecond. The emission spectra of OH radical were observed. The oxidizing effects depend on the gas flow rate from the decolorizing rate for a food color. In comparison with the ozone decolorization, the fast gas-flow conditions are inevitable for utilizing short-lived radicals such as O and OH, to react with the water directly.

  11. The competency of children and adolescents to make informed treatment decisions.

    PubMed

    Weithorn, L A; Campbell, S B

    1982-12-01

    This study was a test for developmental differences in competency to make informed treatment decisions. 96 subjects, 24 (12 males and 12 females) at each of 4 age levels (9, 14, 18, and 21), were administered a measure developed to assess competency according to 4 legal standards. The measure included 4 hypothetical treatment dilemmas and a structured interview protocol. Overall, 14-year-olds did not differ from adults. 9-year-olds appeared less competent than adults with respect to their ability to reason about and understand the treatment information provided in the dilemmas. However, they did not differ from older subjects in their expression of reasonable preferences regarding treatment. It is concluded that the findings do not support the denial of the right of self-determination to adolescents in health-care situations on the basis of a presumption of incapacity. Further, children as young as 9 appear able to participate meaningfully in personal health-care decision making.

  12. Racial/ethnic group differences in treatment decision-making and treatment received among older breast carcinoma patients.

    PubMed

    Maly, Rose C; Umezawa, Yoshiko; Ratliff, Carl T; Leake, Barbara

    2006-02-15

    Health care disparities have been identified in the treatment of older and racial/ethnic minority breast carcinoma patients. The purpose of the current study was to examine racial/ethnic group differences in the treatment decision-making process of older breast carcinoma patients and the differential impact on treatment received. A cross-sectional survey was conducted of a population-based, consecutive sample identified by the Los Angeles Cancer Surveillance Program comprised of Latina (n = 99), African-American (n = 66), and white (n = 92) women age > or = 55 years (total n = 257) and who were between 3-9 months after their primary breast carcinoma diagnosis. Approximately 49% of less acculturated Latinas and 18% of more acculturated Latinas indicated that their family members determined the final treatment decision, compared with less than 4% of African-Americans and whites (P < 0.001). This disparity remained in multiple logistic regression analysis, controlling for potential confounders, including sociodemographic, physician-patient communication, social support, and health variables. Compared with African-American and white women, Latina women were more likely to identify a family member as the final treatment decision-maker (adjusted odds ratio [AOR] of 7.97; 95% confidence interval [95% CI], 2.43-26.20, for less acculturated Latinas; and AOR of 4.48; 95% CI, 1.09-18.45, for more acculturated Latinas). A multiple logistic regression model, controlling for sociodemographic and health characteristics, indicated that patients were less likely to receive breast-conserving surgery (BCS) when the family made the final treatment decision (AOR of 0.39; 95% CI, 0.18-0.85). Family appears to play a powerful role in treatment decision-making among older Latina breast carcinoma patients, regardless of the level of acculturation. This family influence appears to contribute to racial/ethnic group differences in treatment received. Physicians should acknowledge and educate

  13. 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.…

  14. 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…

  15. 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…

  16. National fuel-treatment budgeting in US federal agencies: capturing opportunities for transparent decision-making

    Treesearch

    Keith M. Reynolds; Paul F. Hessburg; Robert E. Keane; James P. Menakis

    2009-01-01

    The Ecosystem Management Decision Support (EMDS) system has been used by the US Department of Agriculture, Forest Service and Bureaus of the Department of the Interior since 2006 to evaluate wildfire potential across all administrative units in the continental US, and to establish priorities for allocating fuel-treatment budgets. This article discusses an EMDS fuels-...

  17. 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.…

  18. 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…

  19. Five cases, four actors and a moral: lessons from studies of contested treatment decisions

    PubMed Central

    McIver, Shirley; Ham, Chris

    2008-01-01

    The case of Jaymee Bowen (child B) illustrated the conflict that may arise over treatment decisions in the National Health Service (NHS). This article reviews four further cases involving disagreement between patients and families on the one hand, and health authorities on the other, and a fifth case in which a health authority questioned the treatment decision of a medical specialist. The cases illustrate the rise of consumerism in health care and the challenge for health authorities in weighing the claims of individual patients against the needs of communities. They also demonstrate the increasing role of lawyers and the courts in resolving disputes over treatment decisions. Clinicians were closely involved in all cases, both in recommending treatment options and in serving as independent advisers when disputes arose. The findings presented here indicate that there is a need to strengthen the process of decision‐making in cases of this kind and to make greater use of evidence in informing decisions. In future, decision‐making needs to be characterized by openness, reason giving, an appeals procedure and regulation of the process to ensure that these conditions are met. The funders of health care also need to consider each individual in his or her own right while also using their resources for the benefit of the population as a whole. PMID:11281918

  20. Do Alzheimer's disease patients want to participate in a treatment decision, and would their caregivers let them?

    PubMed

    Hirschman, Karen B; Joyce, Colette M; James, Bryan D; Xie, Sharon X; Karlawish, Jason H T

    2005-06-01

    This study was designed to examine the factors associated with the preferences of Alzheimer's disease patients to participate in a decision to use an Alzheimer's disease-slowing medication and how involved their caregivers would let them be in this decision. Interviews were conducted with 48 patients in the mild-to-moderate stage of Alzheimer's disease and their caregivers. Ninety-two percent of patients indicated they would participate in an Alzheimer's disease treatment decision, whereas 71% of caregivers thought the patient would participate. Half of the caregivers who indicated that their relatives would participate had relatives who did not have the capacity to make the decision based on a consensus of three expert psychiatrists. Patients' insight into their diagnosis and prognosis, and having less cognitive impairment, being a female caregiver, and being a spousal caregiver were all associated with the likelihood that the patient would participate in the treatment decision. Patients talked about wanting to be involved in the process of making a treatment decision, whereas caregivers talked about assessing whether their relative could participate in the process of decision making. Mild-to-moderate stage Alzheimer's disease patients want to be involved in making treatment decisions, and caregivers are generally willing to involve them. Caregivers of Alzheimer's disease patients talk about patient participation in relation to elements of the capacity to make a treatment decision. Clinicians can provide guidance and education to assist caregivers in understanding how to assess their relatives' abilities to make decisions and navigate the decision-making process.

  1. Mobile Clinical Decision Support System for Acid-base Balance Diagnosis and Treatment Recommendation.

    PubMed

    Mandzuka, Mensur; Begic, Edin; Boskovic, Dusanka; Begic, Zijo; Masic, Izet

    2017-06-01

    This paper presents mobile application implementing a decision support system for acid-base disorder diagnosis and treatment recommendation. The application was developed using the official integrated development environment for the Android platform (to maximize availability and minimize investments in specialized hardware) called Android Studio. The application identifies disorder, based on the blood gas analysis, evaluates whether the disorder has been compensated, and based on additional input related to electrolyte imbalance, provides recommendations for treatment. The application is a tool in the hands of the user, which provides assistance during acid-base disorders treatment. The application will assist the physician in clinical practice and is focused on the treatment in intensive care.

  2. Decision criteria for the selection of wet oxidation and conventional biological treatment.

    PubMed

    Collado, Sergio; Laca, Adriana; Diaz, Mario

    2012-07-15

    The suitability of wet oxidation or biological treatments for the degradation of industrial wastewaters is here discussed. Advantages of these operations, either singly or in combination, are discussed on the basis of previous experimental results from laboratory and industry. Decision diagrams for the selection of conventional biological treatment, wet oxidation or a combination of both techniques are suggested according to the type of pollutant, its concentration and the wastewater flow rate.

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

    PubMed Central

    Stanley, J M

    1989-01-01

    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

  4. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation.

    PubMed

    Durif-Bruckert, C; Roux, P; Morelle, M; Mignotte, H; Faure, C; Moumjid-Ferdjaoui, N

    2015-07-01

    The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.

  5. Decision making software for effective selection of treatment train alternative for wastewater using analytical hierarchy process.

    PubMed

    Prasad, A D; Tembhurkar, A R

    2013-10-01

    Proper selection of treatment process and synthesis of treatment train is complex engineering activity requires crucial decision making during planning and designing of any Wastewater Treatment Plant (WWTP). Earlier studies on process selection mainly considered cost as the most important selection criteria and number of studies focused on cost optimization models using dynamic programming, geometric programming and nonlinear programming. However, it has been noticed that traditional cost analysis alone cannot be applied to evaluate Treatment Train (TT) alternatives, as number of important non-tangible factors cannot be easily expressed in monetary units. Recently researches focus on use of multi-criteria technique for selection of treatment process. AHP provides a powerful tool for multi-hierarchy and multi-variable system overcoming limitation of traditional techniques. The AHP model designed to facilitate proper decision making and reduce the margin of errors during optimization due to number of parameters in the hierarchy levels has been used in this study. About 14 important factors and 13 sub factors were identified for the selection of treatment alternatives for wastewater and sludge stream although cost is one of the most important selection criteria. The present paper provides details of developing a soft-tool called "ProSelArt" using an AHP model aiding for proper decision making.

  6. Decision making concerning life-sustaining treatment in paediatric nephrology: professionals' experiences and values

    PubMed Central

    Fauriel, Isabelle; Moutel, Grégoire; Duchange, Nathalie; Montuclard, Luc; Moutard, Marie-Laure; Cochat, Pierre; Hervé, Christian

    2005-01-01

    Background In a previous paper, we studied decisions to withhold or withdraw life-sustaining treatment (LST) taken between 1995 and 2001 in 31 French-speaking paediatric nephrology centres. Files were available for 18 of the 31 centres. A grid was used to analyse the criteria on which decisions were based, and the results were enriched by an analysis of interviews with the doctors in at these centres (31 interviews with doctors from the 18 centres). The goal was to describe in detail and to specify the criteria on which decisions to withhold or withdraw LST were based, extracted from the files. The second paper deals exclusively with the interviews with doctors and analyses their lifetime’s experience and perception Methods We carried out semi-directed interviews with nephrologists from all the paediatric nephrology centres in France and the French-speaking regions of Switzerland and Belgium. Results We interviewed 46 paediatric nephrologists. Most were aware that decisions relating to LST are necessary and based on the assessment of the child’s quality of life. According to them, decisions are not based on scientific criteria, but on the capacity to accept handicap, the family’s past experiences and the doctor’s own projections. They report that their task is particularly difficult when their action may contribute to death (withdrawal of treatment, acceleration of the process). They feel that their duty is to help the families in the acceptation of the doctors’ decision rather than to encourage their participation in the decision-making process. Conclusions This paper shows that paediatric nephrologists differ in their opinions, mostly due to their own ethical convictions. This observation highlights the need to establish common rules taking into account the views held by doctors. This is the only way to establish an ethical code shared by professionals. PMID:16204280

  7. Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study.

    PubMed

    Soukup, Tayana; Lamb, Benjamin W; Sarkar, Somita; Arora, Sonal; Shah, Sujay; Darzi, Ara; Green, James S A; Sevdalis, Nick

    2016-12-01

    In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review. This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and specialist cancer nurses). The teams' ability to reach a decision was a dichotomous outcome variable (yes/no). Using multiple logistic regression analysis, the significant positive predictors of the teams' ability to reach a decision were patient psychosocial information (odds ratio [OR] 1.35) and the inputs of surgeons (OR 1.62), radiologists (OR 1.48), pathologists (OR 1.23), and oncologists (OR 1.13). The significant negative predictors were patient comorbidity information (OR 0.83) and nursing inputs (OR 0.87). Multidisciplinary inputs into case reviews and patient psychosocial information stimulate decision making, thereby reinforcing the role of MTBs in cancer care in processing such information. Information on patients' comorbidities, as well as nursing inputs, make decision making harder, possibly indicating that a case is complex and requires more detailed review. Research should further define case complexity and determine ways to better integrate patient psychosocial

  8. Primary Care Clinicians’ Experiences with Treatment Decision-Making for Older Persons with Multiple Conditions

    PubMed Central

    Fried, Terri R.; Tinetti, Mary E.; Iannone, Lynne

    2010-01-01

    Background Clinicians are caring for an increasing number of older patients with multiple diseases, in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision-making for these patients is critical to the design of improving the decision-making process. Methods Focus groups were conducted with study with forty primary care clinicians (physicians, nurse-practitioners, physician assistants) in academic, community, and VA-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision-making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. Results Participants were concerned about their patients’ ability to adhere to complex regimens deriving from guideline-directed care. There was variability in beliefs regarding and approaches to balancing the benefits and harms of guideline-directed care. There was also variability in how they involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients’ goals. Participants listed a number of barriers to making good treatment decisions, including lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. Conclusions The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients’ priorities, the support of their subspecialist colleagues, and an altered reimbursement system. PMID:20837819

  9. Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.

    PubMed

    Fried, Terri R; Tinetti, Mary E; Iannone, Lynne

    2011-01-10

    Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process. Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.

  10. Intuition: A Needed Component of Leadership for Decision-making in Today’s Technology Driven Air Force

    DTIC Science & Technology

    2009-12-15

    in the decision -making process. 29 During orientation observed data is 26 The Myers Briggs ...assessment tool is the Myers Briggs Type Indicator (MBTI). 26 The MBTI has been a reliable and valid assessment tool over the last 40 years. 27 The...1997. The Myers Briggs Foundation. Http://www.myersbriggs.org. Noddings, Nel and Paul Shore. Awakening The Inner Eye: Intuition In Education. New

  11. Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive-behavioral decision-based treatment for obesity.

    PubMed

    Sbrocco, T; Nedegaard, R C; Stone, J M; Lewis, E L

    1999-04-01

    Twenty-four obese women were randomly assigned to 1 of 2 group treatments: behavioral choice treatment (BCT) or traditional behavioral treatment (TBT). BCT uses decision theory to promote moderate behavior change that can be comfortably, and therefore permanently, maintained. Groups completed a moderate-intensity walking program and obtained feedback from computerized eating dairies. The TBT group evidenced greater weight loss at posttreatment. However, the TBT group also evidenced a trend to regain weight, whereas the BCT group continued a slow weight loss during follow-up. Exercise followed a similar pattern. Both groups decreased in restraint and increased in self-esteem.

  12. 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.

  13. A novel classification method for aid decision of traditional Chinese patent medicines for stroke treatment.

    PubMed

    Zhao, Yufeng; Liu, Bo; He, Liyun; Bai, Wenjing; Yu, Xueyun; Cao, Xinyu; Luo, Lin; Rong, Peijing; Zhao, Yuxue; Li, Guozheng; Liu, Baoyan

    2017-09-01

    Traditional Chinese patent medicines are widely used to treat stroke because it has good efficacy in the clinical environment. However, because of the lack of knowledge on traditional Chinese patent medicines, many Western physicians, who are accountable for the majority of clinical prescriptions for such medicine, are confused with the use of traditional Chinese patent medicines. Therefore, the aid-decision method is critical and necessary to help Western physicians rationally use traditional Chinese patent medicines. In this paper, Manifold Ranking is employed to develop the aid-decision model of traditional Chinese patent medicines for stroke treatment. First, 115 stroke patients from three hospitals are recruited in the cross-sectional survey. Simultaneously, traditional Chinese physicians determine the traditional Chinese patent medicines appropriate for each patient. Second, particular indicators are explored to characterize the population feature of traditional Chinese patent medicines for stroke treatment. Moreover, these particular indicators can be easily obtained byWestern physicians and are feasible for widespread clinical application in the future. Third, the aid-decision model of traditional Chinese patent medicines for stroke treatment is constructed based on Manifold Ranking. Experimental results reveal that traditional Chinese patent medicines can be differentiated. Moreover, the proposed model can obtain high accuracy of aid decision.

  14. An integrated decision making approach for assessing healthcare waste treatment technologies from a multiple stakeholder.

    PubMed

    Shi, Hua; Liu, Hu-Chen; Li, Ping; Xu, Xue-Guo

    2017-01-01

    With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment.

  15. Different views on treatment decisions by first-year interprofessional healthcare students.

    PubMed

    Nagao, N; Tamura, Y; Bontje, P; Takimoto, Y; Hirai, M; Ishikawa, Y

    2017-02-28

    This study explored ethical treatment decisions of healthcare professional students beginning their education. As part of a first-semester modern medicine and bioethics course, 311 students watched and discussed, in interprofessional groups, a video titled Dax's Case: Who Should Decide? regarding the treatment of a life-threatening infectious disease against Dax's wish. The students then discussed and made their decision regarding treating or not. Their decisions, recorded on a worksheet, were classified as "will treat" or "won't treat." Professional groups' decision patterns were compared using the chi-square test. Overall, 151 (71%) opinions from students were classified as "will treat," and 61 (29%) as "won't treat." Nursing students were more likely to decide "won't treat" (in line with Dax's preference); however, the majority of other professions' students favoured treatment (against Dax's wish). Given the students' limited exposure to profession-specific education, our preliminary study supports the notion that healthcare profession students hold different values that align with their chosen profession at the start of their studies.

  16. Making the Right Treatment Decision Requires Consideration of Utility and Reconsideration of Value.

    PubMed

    Rossi, Michael J; Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T

    2017-02-01

    To achieve a good clinical outcome, arthroscopic and related surgeons must choose the proper treatment, and the basis of this choice is accurate diagnosis. Generally, our clinical focus is on outcome, but outcome is achieved after the fact. While this seems obvious, arthroscopic and related surgeons-and our patients who participate in shared decision making-evaluate the utility, or usefulness, of potential treatments based on desired and expected benefits versus potential risks. Today, cost is frequently considered as a determinant of value in medicine and may be applied to the decision analysis, but if an individual patient perceives health to be priceless, cost becomes irrelevant. In the end, an individual patient's satisfaction is determined on a case-by-case basis. Proper choice of treatment cannot be formulaic. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. On the decision rules of cost-effective treatment for patients with diabetic foot syndrome

    PubMed Central

    Goulionis, John E; Vozikis, Athanassios; Benos, VK; Nikolakis, D

    2010-01-01

    Objective: To assess the cost-effectiveness of two treatments (medical treatment and amputation) in patients with diabetic foot syndrome, one of the most disabling diabetic complications. Diabetes mellitus is a massive health care problem worldwide with a current prevalence of 150 millions diabetic cases, estimated to increase to 300 million cases in 2025. Methods: Integrating medical knowledge and advances into the clinical setting is often difficult due to the complexity of the algorithms and protocols. Clinical decision support systems assist the clinician in applying new information to patient care through the analysis of patient-specific clinical variables. We require strategic decision support to analyze the cost-effectiveness of these programs compared to the status quo. We provide a simple partially observable Markov model to investigate that issue, and we propose an heuristic algorithm to find the best policy of intervention. Results: This study assesses the potential cost-effectiveness of two alternative treatment interventions in patients with diabetic foot syndrome. The implementation of the heuristic algorithm solution will assist doctors in clinical decision making, and health care organizations in evaluating medication choices for effective treatment. Finally, our study reveals that treatment programs are highly cost-effective for patients at high risk of diabetic foot ulcers and lower extremity amputations. PMID:21935321

  18. The Role of Cancer Boards in the Treatment Decisions Regarding Chemotherapy

    PubMed Central

    Nakamura, Sho; Fukui, Tadahisa; (Ito) Sasahara, Yuriko; Suzuki, Shuhei; Takeda, Hiroyuki; Miwa, Misako; Ichikawa, Mayumi; Nemoto, Kenji; Yamakawa, Mayumi; Yoshioka, Takashi

    2016-01-01

    Objective The influence of cancer boards with respect to the treatment decisions regarding chemotherapy remains to be elucidated. In the present study, we investigated the cases that presented at our institutional cancer boards, to assess the effect of cancer boards on the treatment decisions regarding chemotherapy. Methods Data from the cancer boards at Yamagata University Hospital, Yamagata, Japan, were collected. Along with data from the clinical records, the details of the discussions and the chosen plan of treatment of the cancer boards were analyzed. Results From February 2010 to February 2014, 1,541 cases were discussed at our cancer boards. Of these, 811 cases (52.6%) involved discussions about chemotherapy. Of those 811 cases, recommendations were made to alter the treatment plans for 189 cases (23.3%). The reasons for discouraging chemotherapy varied; however, 29/45 (64.4%) cases involved discouragement for the following reasons: old age, a comorbid condition, the physical (performance) status, or insufficient evidence to administer chemotherapy. Eighty-six patients were referred to the medical oncology department through the cancer boards. Conclusion Our results showed that cancer boards have a great influence on the treatment decisions regarding chemotherapy and the prompt referral of cases to medical oncologists as necessary. In terms of future research, we will evaluate the effect of cancer boards on the prognosis and outcomes of cases using the institutional cancer registry. PMID:27803404

  19. Clinical Decision-Making in the Treatment of Schizophrenia: Focus on Long-Acting Injectable Antipsychotics

    PubMed Central

    Samalin, Ludovic; Garnier, Marion; Auclair, Candy; Llorca, Pierre-Michel

    2016-01-01

    The purpose of this study was to identify clinician characteristics associated with higher prescription rates of long-acting injectable (LAI) antipsychotics, as well as the sources that influence medical decision-making regarding the treatment of schizophrenia. We surveyed 202 psychiatrists during six regional French conferences (Bordeaux, Lyon, Marseille, Nice, Paris, and Strasbourg). Data on the characteristics of practice, prescription rates of antipsychotic, and information sources about their clinical decisions were collected. Most psychiatrists used second-generation antipsychotics (SGAs), and preferentially an oral formulation, in the treatment of schizophrenia. LAI SGAs were prescribed to 30.4% of schizophrenic patients. The duration and type of practice did not influence the class or formulation of antipsychotics used. The clinicians following the higher percentage of schizophrenic patients were associated with a higher use of LAI antipsychotics and a lower use of oral SGAs. Personal experience, government regulatory approval, and guidelines for the treatment of schizophrenia were the three main contributing factors guiding clinicians’ decision-making regarding the treatment of schizophrenia. The more clinicians follow schizophrenic patients, the more they use LAI antipsychotics. The development of specialized programs with top specialists should lead to better use of LAI antipsychotics in the treatment of schizophrenia. PMID:27869767

  20. Clinical Decision-Making in the Treatment of Schizophrenia: Focus on Long-Acting Injectable Antipsychotics.

    PubMed

    Samalin, Ludovic; Garnier, Marion; Auclair, Candy; Llorca, Pierre-Michel

    2016-11-19

    The purpose of this study was to identify clinician characteristics associated with higher prescription rates of long-acting injectable (LAI) antipsychotics, as well as the sources that influence medical decision-making regarding the treatment of schizophrenia. We surveyed 202 psychiatrists during six regional French conferences (Bordeaux, Lyon, Marseille, Nice, Paris, and Strasbourg). Data on the characteristics of practice, prescription rates of antipsychotic, and information sources about their clinical decisions were collected. Most psychiatrists used second-generation antipsychotics (SGAs), and preferentially an oral formulation, in the treatment of schizophrenia. LAI SGAs were prescribed to 30.4% of schizophrenic patients. The duration and type of practice did not influence the class or formulation of antipsychotics used. The clinicians following the higher percentage of schizophrenic patients were associated with a higher use of LAI antipsychotics and a lower use of oral SGAs. Personal experience, government regulatory approval, and guidelines for the treatment of schizophrenia were the three main contributing factors guiding clinicians' decision-making regarding the treatment of schizophrenia. The more clinicians follow schizophrenic patients, the more they use LAI antipsychotics. The development of specialized programs with top specialists should lead to better use of LAI antipsychotics in the treatment of schizophrenia.

  1. When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret.

    PubMed

    Nicolai, Jennifer; Buchholz, Angela; Seefried, Nathalie; Reuter, Katrin; Härter, Martin; Eich, Wolfgang; Bieber, Christiane

    2016-05-01

    To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p<0.01) and lower decision regret (β=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74). PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. 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

  3. 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

  4. Using decision analysis to assess comparative clinical efficacy of surgical treatment of unstable ankle fractures.

    PubMed

    Michelson, James D

    2013-11-01

    The development of a robust treatment algorithm for ankle fractures based on well-established stability criteria has been shown to be prognostic with respect to treatment and outcomes. In parallel with the development of improved understanding of the biomechanical rationale of ankle fracture treatment has been an increased emphasis on assessing the effectiveness of medical and surgical interventions. The purpose of this study was to investigate the use of using decision analysis in the assessment of the cost effectiveness of operative treatment of ankle fractures based on the existing clinical data in the literature. Using the data obtained from a previous structured review of the ankle fracture literature, decision analysis trees were constructed using standard software. The decision nodes for the trees were based on ankle fracture stability criteria previously published. The outcomes were assessed by calculated Quality-Adjusted Life Years (QALYs) assigned to achieving normal ankle function, developing posttraumatic arthritis, or sustaining a postoperative infection. Sensitivity analysis was undertaken by varying the patient's age, incidence of arthritis, and incidence or infection. Decision analysis trees captured the essential aspects of clinical decision making in ankle fracture treatment in a clinically useful manner. In general, stable fractures yielded better outcomes with nonoperative treatment, whereas unstable fractures had better outcomes with surgery. These were consistent results over a wide range of postoperative infection rates. Varying the age of the patient did not qualitatively change the results. Between the ages of 30 and 80 years, surgery yielded higher expected QALYs than nonoperative care for unstable fractures, and generated lower QALYs than nonoperative care for stable fractures. Using local cost estimates for operative and nonoperative treatment, the incremental cost of surgery for unstable fractures was less than $40,000 per QALY (the

  5. Understanding Pediatric Dentists' Dental Caries Management Treatment Decisions: A Conjoint Experiment.

    PubMed

    Kateeb, E T; Warren, J J; Gaeth, G J; Momany, E T; Damiano, P C

    2016-04-01

    When traditional ranking and rating surveys are used to assess dentists' treatment decisions, the patient's source of payment appears to be of little importance. Therefore, this study used the marketing research tool conjoint analysis to investigate the relative impact of source of payment along with the child's age and cooperativeness on pediatric dentists' willingness to use Atraumatic Restorative Treatment (ART) to restore posterior primary teeth. A conjoint survey was completed by 707 pediatric dentists. Three factors (age of the child, cooperativeness, type of insurance) were varied across 3 levels to create 9 patient scenarios. The relative weights that dentists placed on these factors in the restorative treatment decision process were determined by conjoint analysis. "Cooperativeness" (52%) was the most important factor, "age of the child" (26%) the second-most important factor, followed by "insurance status of the child" (22%). For the third factor, insurance, pediatric dentists were least willing to use ART with publicly insured children (-0.082), and this was significantly different from their willingness to use ART with uninsured children (0.010) but not significantly different than their willingness to use ART for children with private insurance (0.073). Unlike traditional ranking and rating tools, conjoint analysis found that the insurance status of the patient appeared to be an important factor in dentists' decisions about different restorative treatment options. When pediatric dentists were forced to make tradeoffs among different patients' factors, they were most willing to use ART technique with young, uncooperative patients when they had no insurance. Knowledge Transfer Statement: The present study suggests the feasibility of using techniques borrowed from marketing research, such as conjoint analysis, to understand dentists' restorative treatment decisions. Results of this study demonstrate pediatric dentists' willingness to use a particular

  6. Patients' Preferences for Participation in Treatment Decision-Making at the End of Life: Qualitative Interviews with Advanced Cancer Patients

    PubMed Central

    Brom, Linda; Pasman, H. Roeline W.; Widdershoven, Guy A. M.; van der Vorst, Maurice J. D. L.; Reijneveld, Jaap C.; Postma, Tjeerd J.; Onwuteaka-Philipsen, Bregje D.

    2014-01-01

    Purpose Patients are often encouraged to participate in treatment decision-making. Most studies on this subject focus on choosing between different curative treatment types. In the last phase of life treatment decisions differ as they often put more emphasis on weighing quantity against quality of life, such as whether or not to start treatment aimed at life prolongation but with the possibility of side effects. This study aimed to obtain insight into cancer patients' preferences and the reasons for patients' preferred role in treatment decision-making at the end of life. Methods 28 advanced cancer patients were included at the start of their first line treatment. In-depth interviews were held prior to upcoming treatment decisions whether or not to start a life prolonging treatment. The Control Preference Scale was used to start discussing the extent and type of influence patients wanted to have concerning upcoming treatment decision-making. Interviews were audio taped and transcribed. Results All patients wanted their physician to participate in the treatment decision-making process. The extent to which patients themselves preferred to participate seemed to depend on how patients saw their own role or assessed their own capabilities for participating in treatment decision-making. Patients foresaw a shift in the preferred level of participation to a more active role depending in the later phase of illness when life prolongation would become more limited and quality of life would become more important. Conclusion Patients vary in how much involvement they would like to have in upcoming treatment decision-making. Individual patients' preferences may change in the course of the illness, with a shift to more active participation in the later phases. Communication about patients' expectations, wishes and preferences for participation in upcoming treatment decisions is of great importance. An approach in which these topics are openly discussed would be beneficial. PMID

  7. 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.

  8. How do patients choose between active surveillance, radical prostatectomy, and radiotherapy? The effect of a preference-sensitive decision aid on treatment decision making for localized prostate cancer.

    PubMed

    Lamers, Romy E D; Cuypers, Maarten; de Vries, Marieke; van de Poll-Franse, Lonneke V; Ruud Bosch, J L H; Kil, Paul J M

    2017-02-01

    To determine the effect of a decision aid (DA) on treatment preferences and to investigate which patient preferences are important for final treatment preferences. We also determined if the patient׳s treatment decision was influenced by the urologist׳s treatment preference. Between August 2014 and July 2015, newly diagnosed patients with low-/intermediate-risk prostate cancer were offered to use a web-based DA after diagnosis. Treatment preferences and patient׳s values were extracted from the DA. Urologists׳ treatment preferences were indicated at the time of inclusion. We included 181 patients, of whom 21% preferred active surveillance, 33% radical prostatectomy, 10% brachytherapy, 3% external beam radiotherapy, and 34% did not indicate a specific preferred treatment option after DA use (missing N = 6). Among 67%, treatment preference before DA use did not change after DA use. In men who chose active surveillance after DA use, 97% (37/38) preferred to postpone unnecessary treatment. For radical prostatectomy, 91% (52/57) of the patients valued tumor removal, and for brachytherapy, 88% (15/17) valued incontinence worse than bowel complaints. For 64% (missing N = 21) of the patients, urologists indicated one specific preferred treatment option as most suitable for the patient concerned. Agreement between final treatment decision and urologist׳s preference was lower (κ = 0.68) than between final treatment decision and preferred treatment after DA use (κ = 0.82). Most patients with prostate cancer chose the treatment in accordance with the post-DA preference and to a lesser extent the urologists preference; implications of this are prospectively investigated in an ongoing study. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. 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)

  10. Falls in the elderly were predicted opportunistically using a decision tree and systematically using a database-driven screening tool.

    PubMed

    Rafiq, Meena; McGovern, Andrew; Jones, Simon; Harris, Kevin; Tomson, Charles; Gallagher, Hugh; de Lusignan, Simon

    2014-08-01

    To identify risk factors for falls and generate two screening tools: an opportunistic tool for use in consultation to flag at risk patients and a systematic database screening tool for comprehensive falls assessment of the practice population. This multicenter cohort study was part of the quality improvement in chronic kidney disease trial. Routine data for participants aged 65 years and above were collected from 127 general practice (GP) databases across the UK, including sociodemographic, physical, diagnostic, pharmaceutical, lifestyle factors, and records of falls or fractures over 5 years. Multilevel logistic regression analyses were performed to identify predictors. The strongest predictors were used to generate a decision tree and risk score. Of the 135,433 individuals included, 10,766 (8%) experienced a fall or fracture during follow-up. Age, female sex, previous fall, nocturia, anti-depressant use, and urinary incontinence were the strongest predictors from our risk profile (area under the receiver operating characteristics curve = 0.72). Medication for hypertension did not increase the falls risk. Females aged over 75 years and subjects with a previous fall were the highest risk groups from the decision tree. The risk profile was converted into a risk score (range -7 to 56). Using a cut-off of ≥9, sensitivity was 68%, and specificity was 60%. Our study developed opportunistic and systematic tools to predict falls without additional mobility assessments. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study

    PubMed Central

    2008-01-01

    Objective To estimate the prevalence of mental capacity to make decisions on treatment in people from different diagnostic and legal groups admitted to psychiatric hospital. Design Cross sectional study. Setting General adult acute psychiatric inpatient units. Participants 350 consecutive people admitted to psychiatric wards from the community over 16 months. Main outcome measure Mental capacity assessed by clinical interview and the MacArthur competence assessment tool for treatment. Results Estimates of mental capacity were obtained on 97% (n=338) of the 350 people admitted. Of those an estimated 60% (95% confidence interval 55% to 65%) lacked mental capacity to make decisions on treatment. This proportion varied according to diagnosis, ranging from 97% (n=36) in people with mania to 4% (n=24) in people with personality disorder. Mental incapacity was common in patients admitted informally to the psychiatric wards (n=188; 39%, 32% to 46%). Incapacity and detention are closely associated under non-capacity based mental health law. Conclusions Mental incapacity to make decisions on treatment is common in people admitted to psychiatric wards from the community but cannot be presumed. It is usual in those detained under the Mental Health Act and common in those admitted voluntarily. PMID:18595931

  12. Development and maintenance of guideline-based decision support for pharmacological treatment of hypertension.

    PubMed

    Persson, M; Bohlin, J; Eklund, P

    2000-03-01

    The objective was to build a computer-based decision support system (DSS), which could apply the formal rules embedded in guidelines regarding pharmacological treatment of hypertension. The aim was also to test VISUAL BASIC as a development tool for DSS's in health care. From the Swedish guidelines for treatment of hypertension, the most widely accepted and scientifically best proved treatment strategies were chosen and implemented as rules. A DSS that is capable of applying the evidence-based rules extracted from guidelines regarding drug treatment of hypertension, to any patient's medical profile, was constructed. The output consists of a recommendation regarding preferred generic drug class and also a written report, reflecting decision steps provided by the rule-base and inference engine. We also provide methods for formalising an implementable language of guidelines. A mainstream programming language like VISUAL BASIC can be an alternative when building complicated decision support systems. A logic formal notation can facilitate communication between the expert and the programmer. The program is a stand-alone product independent of computerized medical records and thereby easy to install and maintain.

  13. 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.

  14. Preferences of lung cancer patients for treatment and decision-making: a systematic literature review.

    PubMed

    Schmidt, K; Damm, K; Prenzler, A; Golpon, H; Welte, T

    2016-07-01

    The consideration of patient preferences in decision-making has become more important, especially for life-threatening diseases such as lung cancer. This paper aims to identify the preferences of lung cancer patients with regard to their treatment and involvement in the decision-making process. We conducted a systematic literature review from 12 electronic databases and included studies published between 2000 and 2012. A total of 20 studies were included in this review. These revealed that lung cancer patients do have preferences that should be considered in treatment decisions; however, these preferences are not homogenous. We found that patients often consider life extension to be more important than the health-related quality of life or undesirable side effects. This preference seems to depend on patient age. Nausea and vomiting are the most important side effects to be avoided; the relevance of other side effects differs highly between subgroups. The majority of lung cancer patients, nevertheless, seem to prefer a passive rather than an active role in decision-making, although the self-reported preferences differed partly from the physicians' perceptions. Overall, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques. © 2015 John Wiley & Sons Ltd.

  15. Racial bias in mock juror decision-making: a meta-analytic review of defendant treatment.

    PubMed

    Mitchell, Tara L; Haw, Ryann M; Pfeifer, Jeffrey E; Meissner, Christian A

    2005-12-01

    Common wisdom seems to suggest that racial bias, defined as disparate treatment of minority defendants, exists in jury decision-making, with Black defendants being treated more harshly by jurors than White defendants. The empirical research, however, is inconsistent--some studies show racial bias while others do not. Two previous meta-analyses have found conflicting results regarding the existence of racial bias in juror decision-making (Mazzella & Feingold, 1994, Journal of Applied Social Psychology, 24, 1315-1344; Sweeney & Haney, 1992, Behavioral Sciences and the Law, 10, 179-195). This research takes a meta-analytic approach to further investigate the inconsistencies within the empirical literature on racial bias in juror decision-making by defining racial bias as disparate treatment of racial out-groups (rather than focusing upon the minority group alone). Our results suggest that a small, yet significant, effect of racial bias in decision-making is present across studies, but that the effect becomes more pronounced when certain moderators are considered. The state of the research will be discussed in light of these findings.

  16. Children should be seen and heard. Chronically ill children should have a voice in treatment decisions.

    PubMed

    Deatrick, J A; Woodring, B C; Tollefson, T L

    1990-04-01

    Traditionally, sick children have obeyed orders--the doctor's orders, their parents' orders. Father (mother, doctor, nurse) knows best. But indications are that in the future, chronically ill children will have some say in their own treatment decisions. And although few healthcare facilities today have any policies in place to ensure such participation, they may face increasing pressure to implement such policies. Both the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and the American Academy of Pediatrics recommend that children actively participate in the consent-assent-dissent process for healthcare decisions. Children's participation need not be total or complete; it may involve only selected aspects. Participation will (1) increase their ownership of the decision and encourage them to obtain the necessary follow-up care, (2) increase their ability to make such decisions in the future, and (3) perhaps make healthcare less threatening and more attractive to them as future healthcare consumers. Providers could encourage a cautious, gradual increase in participation by chronically ill children and adolescents. It should start by involving them in concrete tasks (like setting dates and times) and lead to active negotiation with parents and healthcare workers regarding treatment.

  17. 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...

  18. 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 ...

  19. Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis.

    PubMed

    Stovell, Diana; Morrison, Anthony P; Panayiotou, Margarita; Hutton, Paul

    2016-07-01

    In the UK almost 60% of people with a diagnosis of schizophrenia who use mental health services say they are not involved in decisions about their treatment. Guidelines and policy documents recommend that shared decision-making should be implemented, yet whether it leads to greater treatment-related empowerment for this group has not been systematically assessed. To examine the effects of shared decision-making on indices of treatment-related empowerment of people with psychosis. We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) of shared decision-making concerning current or future treatment for psychosis (PROSPERO registration CRD42013006161). Primary outcomes were indices of treatment-related empowerment and objective coercion (compulsory treatment). Secondary outcomes were treatment decision-making ability and the quality of the therapeutic relationship. We identified 11 RCTs. Small beneficial effects of increased shared decision-making were found on indices of treatment-related empowerment (6 RCTs; g = 0.30, 95% CI 0.09-0.51), although the effect was smaller if trials with >25% missing data were excluded. There was a trend towards shared decision-making for future care leading to reduced use of compulsory treatment over 15-18 months (3 RCTs; RR = 0.59, 95% CI 0.35-1.02), with a number needed to treat of approximately 10 (95% CI 5-∞). No clear effect on treatment decision-making ability (3 RCTs) or the quality of the therapeutic relationship (8 RCTs) was found, but data were heterogeneous. For people with psychosis the implementation of shared treatment decision-making appears to have small beneficial effects on indices of treatment-related empowerment, but more direct evidence is required. © The Royal College of Psychiatrists 2016.

  20. Treatment decision-making among Canadian youth with severe haemophilia: a qualitative approach.

    PubMed

    Lane, S J; Walker, I; Chan, A K; Heddle, N M; Poon, M-C; Minuk, L; Jardine, L; Arnold, E; Sholapur, N; Webert, K E

    2015-03-01

    The first generation of young men using primary prophylaxis is coming of age. Important questions regarding the management of severe haemophilia with prophylaxis persist: Can prophylaxis be stopped? At what age? To what effect? Can the regimen be individualized? The reasons why some individuals discontinue or poorly comply with prophylaxis are not well understood. These issues have been explored using predominantly quantitative research approaches, yielding little insight into treatment decision-making from the perspectives of persons with haemophilia (PWH). Positioning the PWH as a source of expertise about their condition and its management, we undertook a qualitative study: (i) to explore and understand the lived experience of young men with severe haemophilia A or B and (ii) to identify the factors and inter-relationships between factors that affect young men's treatment decision-making. This manuscript reports primarily on the second objective. A modified Straussian, grounded theory methodology was used for data collection (interviews) and preliminary analysis. The study sample, youth aged 15-29, with severe haemophilia A or B, was chosen selectively and recruited through three Canadian Haemophilia Treatment Centres. We found treatment decision-making to be multi-factorial and used the Framework method to analyze the inter-relationships between factors. A typology of four distinct approaches to treatment was identified: lifestyle routine prophylaxis, situational prophylaxis, strict routine prophylaxis and no prophylaxis. Standardized treatment definitions (i.e.: 'primary' and 'secondary', 'prophylaxis') do not adequately describe the ways participants treat. Naming the variation of approaches documented in this study can improve PWH/provider communication, treatment planning and education.

  1. [An aid to decision making in the treatment of furcation diseases. Part 1: Results of surgical treatment of furcation diseases].

    PubMed

    De Beule, F; Defleur, P; Bercy, P

    1998-01-01

    Periodontal diseases combined with furcation defects are more difficult to treat; it's evidence. Furcation defects occur still very frequently. GTR treatments have shown some efficacy in those lesions, but, the success of those treatments is still uncertain and, therefore, indications are limited. Root amputations are, at this time, frequently chosen to treat furcation defects. The goal of this work was to evaluate the success rate of root amputations, to discuss the origin of the failures and to propose a new design for a better decision making.

  2. Difficult decisions: are intellectually disabled patients given enough information to consent to medical treatment?

    PubMed

    Huneke, Nathan T M; Gupta, Rupa; Halder, Neel; Chaudhry, Nasim

    2012-12-01

    Patients with learning disabilities are not always involved in decision-making about their medications. This may mean that some patients are unfairly denied of their autonomy. We carried out an audit of current practice concerning consent to treatment in patients with learning disabilities against best practice guidelines. Data were collected via a questionnaire given to a sample of 70 patients with learning disabilities within the Salford catchment area. This questionnaire assessed whether patients were involved in decision-making regarding their medications and whether they were being given enough information to give informed consent. A total of 45 patients completed questionnaires. Overall, the patients' knowledge of their medications was poor, particularly of the proposed duration, possible disadvantages and name of the treatment. It appears that doctors are engaging these patients during consultations and discussing their medications. However, the delivery of this information needs to be improved, and patients' understanding and recall need to be checked more thoroughly.

  3. Moving to place: childhood cancer treatment decision making in single-parent and repartnered family structures.

    PubMed

    Kelly, Katherine Patterson; Ganong, Lawrence

    2011-03-01

    Few researchers have studied how parents from diverse family structures cope with childhood chronic illness. We designed this study to discern the childhood cancer treatment decision-making (TDM) process in these families. Using grounded theory, we interviewed 15 custodial parents, nonresidential parents, and stepparents who had previously made a major treatment decision for their children with cancer. "Moving to place" was the central psychosocial process by which parents negotiated involvement in TDM. Parents moved toward or were moved away from involvement based on parent position in the family (custodial, nonresidential, and stepparent), prediagnosis family dynamics, and time since diagnosis. Parents used the actions of stepping up, stepping back, being pushed, and stepping away to respond to the need for TDM. Parents faced additional stressors because of their family situations, which affected the TDM process. Findings from this study provide important insight into diverse families and their unique parental TDM experiences.

  4. Variation of orthodontic treatment decision-making based on dental model type: A systematic review.

    PubMed

    Pachêco-Pereira, Camila; De Luca Canto, Graziela; Major, Paul W; Flores-Mir, Carlos

    2015-05-01

    To determine in which clinical scenarios digital models are valid as replacements for plaster models during orthodontic treatment decision-making process and treatment planning. An attempt to identify all pertinent published information was made. Retained articles were those where a decision-making process leading to differential orthodontic treatment plans based on either method were compared. The search was tailored for PubMed and adapted for EMBASE, MEDLINE, the Cochrane Library, LILACS, and Web of Science. A partial grey literature search was conducted through Google Scholar. References lists of the included articles were screened for potential relevant studies. The methodology of selected studies was evaluated using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS). Only two studies were finally selected for the qualitative and quantitative synthesis. QUADAS results scores from selected studies ranged from 61% to 83% of 11 items evaluated. In one, the overall treatment plan regarding orthognathic surgery for Class II malocclusion changed in 13% to 22% of the cases. In the other one, 6% of the orthodontic treatment plans changed. Digital models could be used to replace plaster models in Class II malocclusion treatment planning.

  5. 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

  6. Factors influencing treatment decision-making for maintaining or extracting compromised teeth.

    PubMed

    Lang-Hua, Bich Hue; McGrath, Colman P J; Lo, Edward C M; Lang, Niklaus P

    2014-01-01

    To evaluate treatment decision-making with respect to maintaining periodontally compromised teeth among dentists with or without postgraduate qualifications in implant dentistry. A series of patient scenarios with varying degrees of periodontal disease levels was presented to dental practitioners. Practitioners' decision-making outcome was determined, and intention to retain the compromised teeth was analyzed in bivariate and regression analyses (accounting for postgraduate implant training, gender, years in dental practice, and implant placement experience). This study involved 30 dental practitioners with postgraduate implant qualifications (GDPP), 33 dental practitioners without postgraduate implant qualifications (GDP), and 27 practitioners undergoing training for postgraduate implant qualifications (GDPT). Variations in treatment decision-making were evident between the three groups. Differences in treatment approaches to retaining compromised teeth were apparent. Furthermore, variations in rehabilitation of extracted scenarios existed in terms of use of implant and number of implants need for rehabilitation. Accounting for dentist and practice factors in regression analyses, GDPP/GDPT were three times as likely to retain periodontally compromised upper molar, with or without pain, compared to GDP (without pain OR 3.10, 95%CI 1.04, 10.62 P = 0.04; with pain OR 3.08, 95%CI 1.09, 8.14 P = 0.03). Variations in treatment decision-making with respect to retaining periodontally compromised teeth exist between dental practitioners with and those without postgraduate training in implant dentistry. Furthermore differences in management approaches in how they would retain the teeth or rehabilitate the dental arch were apparent. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  7. Preference and Utilities for Prostate Cancer Screening and Treatment: Assessment of the Underlying Decision Making Process

    DTIC Science & Technology

    2005-01-01

    Watkins-Bruner, Deborah radio advertisements was overwhelming! In between radio ads we continued to recruit through outreach activities and advertising ... AD Award Number: DAMD17-02-1-0055 TITLE: Preference and Utilities for Prostate Cancer Screening & Treatment: Assessment of the Underlying Decision...most recently, radio and newspaper ads . The community sample will include men age 40 to 80 years of age and without prostate cancer. C. Key Research

  8. Solar-driven photocatalytic treatment of diclofenac using immobilized TiO2-based zeolite composites.

    PubMed

    Kovacic, Marin; Salaeh, Subhan; Kusic, Hrvoje; Suligoj, Andraz; Kete, Marko; Fanetti, Mattia; Stangar, Urska Lavrencic; Dionysiou, Dionysios D; Bozic, Ana Loncaric

    2016-09-01

    The study is aimed at evaluating the potential of immobilized TiO2-based zeolite composite for solar-driven photocatalytic water treatment. In that purpose, TiO2-iron-exchanged zeolite (FeZ) composite was prepared using commercial Aeroxide TiO2 P25 and iron-exchanged zeolite of ZSM5 type, FeZ. The activity of TiO2-FeZ, immobilized on glass support, was evaluated under solar irradiation for removal of diclofenac (DCF) in water. TiO2-FeZ immobilized in a form of thin film was characterized for its morphology, structure, and composition using scanning electron microscopy/energy-dispersive x-ray spectroscopy (SEM/EDX). Diffuse reflectance spectroscopy (DRS) was used to determine potential changes in band gaps of prepared TiO2-FeZ in comparison to pure TiO2. The influence of pH, concentration of hydrogen peroxide, FeZ wt% within the composite, and photocatalyst dosage on DCF removal and conversion efficiency by solar/TiO2-FeZ/H2O2 process was investigated. TiO2-FeZ demonstrated higher photocatalytic activity than pure TiO2 under solar irradiation in acidic conditions and presence of H2O2.

  9. Ontology driven decision support systems for medical diagnosis - an interactive form for consultation in patients with plasma cell disease.

    PubMed

    Donfack Guefack, Valéry; Bertaud Gounot, Valérie; Duvauferrier, Régis; Bourde, Annabel; Morelli, John; Lasbleiz, Jérémy

    2012-01-01

    Multiple myeloma (MM) is a malignant disorder characterized by the monoclonal proliferation of B cell derived plasma cells in the bone marrow. The diagnosis depends on the identification of abnormal monoclonal marrow plasma cells, monoclonal protein in the serum or urine, evidence of end-organ damage, and a clinical picture consistent with MM. The distinction between MM stages- monoclonal gammopathy of undetermined significance or indolent myeloma-is critical in guiding therapy. This paper describes how to produce ontology-driven semiological rules base (SRB) and a consultation form to aid in the diagnosis of plasma cells diseases. We have extracted the MM sub-ontology from the NCI Thesaurus. Using Protégé 3.4.2 and owl1, criteria in the literature for the diagnosis and staging of MM have been added to the ontology. All quantitative parameters have been transformed to a qualitative format. A formal description of MM variants and stages has been given. The obtained ontology has been checked by a reasoner and instantiated to obtain a SRB. The form created has been tested and evaluated utilizing 63 clinical medical reports. The likelihood for a disease being the correct diagnosis is determined by computing a ratio. The resulting tool is relevant for MM diagnosis and staging.

  10. 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

  11. Treatment decisions in multiple sclerosis - insights from real-world observational studies.

    PubMed

    Trojano, Maria; Tintore, Mar; Montalban, Xavier; Hillert, Jan; Kalincik, Tomas; Iaffaldano, Pietro; Spelman, Tim; Sormani, Maria Pia; Butzkueven, Helmut

    2017-02-01

    The complexity of multiple sclerosis (MS) treatment means that doctors and decision-makers need the best available evidence to make the best decisions for patient care. Randomized controlled trials (RCTs) are accepted as the gold standard for assessing the efficacy and safety of any new drug, but conclusions of these trials do not always aid in daily decision-making processes. Indeed, RCTs are usually conducted in ideal conditions, so can measure efficacy only in restricted and unrepresentative populations. In the past decade, a growing number of MS databases and registries have started to produce long-term outcome data from large cohorts of patients with MS treated with disease-modifying therapies in real-world settings. Such observational studies are addressing issues that are otherwise difficult or impossible to study. In this Review, we focus on the most recently published observational studies designed to identify predictors of poor outcome and treatment response or failure, and to evaluate the relative and long-term effectiveness of currently used MS treatments. We also outline the statistical approaches that are most commonly used to reduce bias and limitations in these studies, and the challenges associated with the use of 'big MS data' to facilitate the implementation of personalized medicine in MS.

  12. Implementation and evaluation of an Asbru-based decision support system for adjuvant treatment in breast cancer.

    PubMed

    Eccher, Claudio; Seyfang, Andreas; Ferro, Antonella

    2014-11-01

    The domain of cancer treatment is a promising field for the implementation and evaluation of a protocol-based clinical decision support system, because of the algorithmic nature of treatment recommendations. However, many factors can limit such systems' potential to support the decision of clinicians: technical challenges related to the interoperability with existing electronic patient records and clinical challenges related to the inherent complexity of the decisions, often collectively taken by panels of different specialists. In this paper, we evaluate the performances of an Asbru-based decision support system implementing treatment protocols for breast cancer, which accesses data from an oncological electronic patient record. Focusing on the decision on the adjuvant pharmaceutical treatment for patients affected by early invasive breast cancer, we evaluate the matching of the system's recommendations with those issued by the multidisciplinary panel held weekly in a hospital. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec.

    PubMed

    Carnevale, Franco A; Canoui, Pierre; Cremer, Robin; Farrell, Catherine; Doussau, Amélie; Seguin, Marie-Josée; Hubert, Philippe; Leclerc, Francis; Lacroix, Jacques

    2007-07-01

    To examine whether physicians or parents assume responsibility for treatment decisions for critically ill children and how this relates to subsequent parental experience. A significant controversy has emerged regarding the role of parents, relative to physicians, in relation to treatment decisions for critically ill children. Anglo-American settings have adopted decision-making models where parents are regarded as responsible for such life-support decisions, while in France physicians are commonly considered the decision makers. Grounded theory qualitative methodology. Four pediatric intensive care units (two in France and two in Quebec, Canada). Thirty-one parents of critically ill children; nine physicians and 13 nurses who cared for their children. None. Semistructured interviews were conducted. In France, physicians were predominantly the decision makers for treatment decisions. In Quebec, decisional authority practices were more varied; parents were the most common decision maker, but sometimes it was physicians, while for some decisional responsibility depended on the type of decision to be made. French parents appeared more satisfied with their communication and relationship experiences than Quebec parents. French parents referred primarily to the importance of the quality of communication rather than decisional authority. There was no relationship between parents' actual responsibility for decisions and their subsequent guilt experience. It was remarkable that a certain degree of medical paternalism was unavoidable, regardless of the legal and ethical norms that were in place. This may not necessarily harm parents' moral experiences. Further research is required to examine parental decisional experience in other pediatric settings.

  14. Doctors' authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany

    PubMed Central

    Richter, J.; Eisemann, M.; Zgonnikova, E.

    2001-01-01

    Objectives—The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and to explore the compliance of doctors with patient wishes Participants and measurement—Five hundred and thirty-five physicians were surveyed in Sweden (Umeå), Germany (Rostock and Neubrandenburg), and in Russia (Arkhangelsk) by a questionnaire. The participants were recruited according to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains three case vignettes about an 82-year-old Alzheimer patient with an acute life-threatening condition; the questionnaire includes different levels of information about his treatment wishes. We have added various questions about attitudes determining doctors' decision making process (legal and ethical concerns, patient's and family wishes, hospital costs, patient's age and level of dementia and physician's religion). Results—Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. Swedish physicians would perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest less frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countries. Conclusions—The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter. Key Words: End-of-life decision • DNR order • advance directive • physicians • cross-cultural comparison • survey PMID:11417027

  15. Decision-making process for treatment of mandibular fractures among minority groups.

    PubMed

    Der-Martirosian, Claudia; Gironda, Melanie W; Black, Edward; Leathers, Richard; Atchison, Kathryn A

    2006-01-01

    While patients' preferences for medical care are widely studied, only a small number of studies have looked at the decision-making process for dental treatment of mandibular fracture. This study examines the decision-making process for treatment of mandibular fractures among minority groups. Study participants were asked to consider Maxillomandibular Fixation (MMF--a non-surgical approach of wiring the teeth for 4-8 weeks) or Rigid Internal Fixation (RIF--surgical placement of bone plate). A qualitative study of patients receiving care at an inner-city hospital for either 3rd molar extraction under general anesthesia or a mandibular fracture were recruited to participate in an hour-long focus group to discuss their preferences. The 3rd molar group was selected as a comparison group exemplifying experience with oral surgery and recovery from general anesthesia. Seven decision-making factors affecting choice of treatment were discussed by both jaw fracture and 3rd molar groups, including: side effects, effectiveness of each treatment, trusting doctor's recommendation, what to expect from each procedure, use of pictures from previous case studies, surgery location of scar/incision, and size of scar. Rigid Internal Fixation (RIF) participants discussed a different set of concerns compared to Maxillomandibular Fixation (MMF) participants. Regardless of gender, the treatment of choice for both 3rd molar and jaw fracture participants was the non-surgical method of wiring of the teeth for 4-8 weeks. The Phase II part of this study will systematically examine patient preferences among a larger sample of 3rd molar and jaw fracture patients by incorporating the patient-reported concerns about treatment of jaw fracture found in this inductive, phenomenological study.

  16. Can Decision Support Help Patients With Spinal Stenosis Make a Treatment Choice?: A Prospective Study Assessing the Impact of a Patient Decision Aid and Health Coaching.

    PubMed

    Kearing, Stephen; Berg, Susan Z; Lurie, Jon D

    2016-04-01

    A prospective, randomized study on patients with lumbar spinal stenosis who received a decision support intervention to facilitate their treatment choice. The aim of this study was to assess the impact of telephone health coaching (HC) in addition to a video decision aid (DA) compared with a DA alone for patients with spinal stenosis. Treatment options for lumbar spinal stenosis include surgical and nonsurgical approaches. Patient DAs and HC have been shown to help patients make an informed treatment choice consistent with personal preferences. Eligible patients with spinal stenosis were identified by an orthopedic surgeon or a nonsurgical spine specialist. Consenting participants were randomly assigned to either a video DA or a video DA along with HC (DA + HC). Patients completed baseline and follow-up questionnaires at 2 weeks, and 6 months after the decision support intervention(s). Ninety-eight patients were randomized to the DA + HC group and 101 to the DA-only group; 168 of 199 (84%) patients completed responses at all time points. Both groups showed improved understanding of spinal stenosis treatments and progress in decision making after watching the DA (P < 0.001). At 2 weeks, more patients in the coaching group had made a treatment decision (DA + HC 74% vs. DA only 52%, P < 0.01). At 6-month follow-up, the uptake of surgery was similar for both groups (DA + HC 21% had surgery vs. DA only 17%); satisfaction with the treatments received was similar for both groups (DA + HC, 84% satisfied vs. DA only, 85%). These results suggest that watching the video DA improved patient knowledge and reduced decisional uncertainty about their spinal stenosis treatment choice. The addition of telephone coaching helped some patients choose a treatment more quickly; 6-month decisional outcomes were similar for both groups. 3.

  17. [Adaptive remodeling of temporomandibular joint following anterior disc displacement and treatment decision making].

    PubMed

    Gu, Z Y

    2017-03-09

    Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is one of the common oral diseases. The TMJ can be remodeled after disc displacement. The author's recent studies show that remodeled bilaminar zone is similar to the disc in composition and functions. The remodeled condyle can match the disc-like bilaminar zone. The new disc-condylar relationship can, to a certain extent, restore the function of the TMJ. Based on these studies, the author believes that the adaptive remodeling in TMJ has important guiding significance for clinical treatment and discusses the views of the treatment decision for various stages of temporomandibular disorders.

  18. The clinician's perspective on sarcoma pathology reporting: impact on treatment decisions?

    PubMed

    Blay, Jean-Yves; Derbel, Olfa; Ray-Coquard, Isabelle

    2014-02-01

    The current refinement of nosological classification of sarcoma which integrates molecular typing with a growing number of subtypes contrasts with the one-size-fits-all approach proposed in clinical practice guidelines for both local treatment and systemic treatment in the past. However, there is a growing proportion of sarcomas in which specific treatment strategies are proposed as standard. As a consequence, central review by expert sarcoma pathologists should be organised to ensure the optimal management of all patients. The key parameters in the pathology report influencing treatment decisions are therefore rapidly evolving. First a diagnostic biopsy, ideally an imaged guided microbiopsy performed by an experienced team, is a recommended practice. On the resection specimen, the size, histological grade, location, depth, surgical margins and tumour fragmentation are essential parameters to guide the treating physician. Molecular characterisation of the driving genomic event is becoming increasingly important for treatment decision making, in routine practice and in clinical trials. Molecular grade is a research tool with potentially high utility, and requires further evaluation and validation in prospective clinical trials.

  19. Patient preference and the impact of decision-making aids on prostate cancer treatment choices and post-intervention regret

    PubMed Central

    Aning, J.J.; Wassersug, R.J.; Goldenberg, S.L.

    2012-01-01

    The number of prostate cancer survivors is rapidly growing in the Western world. As a result of better oncologic outcomes, more patients are living longer with the adverse effects of treatment, which can be both functional and psychological. Clinicians, in an era of shared decision-making, must not only cure the cancer, but also ensure that, after treatment, their patients experience the best quality of life and minimal post-treatment decisional regret. To participate in the decision-making process, men and their involved partners and family need to fully understand the relative benefits and harms of prostate cancer treatments. Patient preference studies indicate that men with prostate cancer are not well informed. Decision-making aids are a positive treatment adjunct both to convey information and to allow patients to explore their own beliefs and values during the decision-making process. The evidence suggests that decision-making aids better prepare patients for involvement in treatment decisions, but further studies are required to investigate the relationship between the use of decision-making aids and post-treatment decisional regret in prostate cancer. PMID:23355792

  20. [Patient choice for cancer treatment: towards a shared-decision model?].

    PubMed

    Vennin, P; Taïeb, S; Carpentier, P

    2001-04-01

    The process of medical decision implies the elaboration of a choice between alternatives. Who has the choice? The doctor? The patient? Both? That depends on the particular characteristics of the patient and of the tumour, but also of the characteristics of the doctor and of his approach of medical discipline. For that reason, we planned first to remind some principles. In our analysis, the patient-doctor's relationship ties with environment, culture and habits. Philosophical principles, moral, and models of the relation between patient and doctor concern first part. In the second part, these ideas are compared with our routine practice: surveys about patients' needs, the obstacles for complete information and participation, studies on patients' preferences. The authors' analysis is that we are going inescapably towards shared decision-making taking into account the patients preferences. This evolution is not only tied with ethical principles, but with medical reason, i.e. the variability of patients' preferences led to tailor the treatment to the individual patient especially when benefit is limited. Of course, the applicability of a shared model depends on the particular situation of the patient and of his demand. It is all the easier as the consequences of the treatment are well known the riks tiny and distant. In the classical paternalistic model, there is no choice for the patient because the doctor(s) give the treatment. In the ideal model of the shared decision, doctor and patient progress together towards medical decision, in this case, the patient is not alone facing a choice, and in all cases, he is never alone.

  1. 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.

  2. [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.

  3. 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…

  4. Understanding how patients (vs physicians) approach the decision to escalate treatment: a proposed conceptual model.

    PubMed

    Fraenkel, Liana; Seng, Elizabeth K; Cunningham, Meaghan; Mattocks, Kristin

    2015-02-01

    We performed a qualitative study to better understand how patients with RA approach risk-benefit trade-offs inherent in the choice of remaining with their current treatment vs escalating care. We used a think-aloud protocol to examine how patients with RA approach risk-benefit trade-offs inherent in the choice of remaining with their current treatment vs adding a biologic. The data emerging from the protocols were used to develop a conceptual model describing how patients approach the decision to escalate care. Participants who were strongly impacted by their disease were not open to considering alternative options. For some patients, being highly impacted by their disease results in a strong preference to escalate care. For others, the same level of distress is reason to unconditionally refuse additional medications. In contrast, those who were moderately impacted were more open to consider treatment options. Among these participants, however, subjects' risk-benefit trade-offs were consistently modified by factors unrelated to medication, including sociodemographic characteristics, role responsibilities and the quality of the patient-physician relationship. The conceptual model indicates that patients approach the decision to escalate care differently from physicians. In order to improve care in RA, it is important to recognize that many patients with moderate to high disease activity are not open to alternative treatments, which is a prerequisite to engaging in decision making. Routine clinical encounters should enable health care providers to identify these patients in order to tailor education prior to recommending treatment escalation. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. 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

  6. Mobile Clinical Decision Support System for Acid-base Balance Diagnosis and Treatment Recommendation

    PubMed Central

    Mandzuka, Mensur; Begic, Edin; Boskovic, Dusanka; Begic, Zijo; Masic, Izet

    2017-01-01

    Introduction: This paper presents mobile application implementing a decision support system for acid-base disorder diagnosis and treatment recommendation. Material and methods: The application was developed using the official integrated development environment for the Android platform (to maximize availability and minimize investments in specialized hardware) called Android Studio. Results: The application identifies disorder, based on the blood gas analysis, evaluates whether the disorder has been compensated, and based on additional input related to electrolyte imbalance, provides recommendations for treatment. Conclusion: The application is a tool in the hands of the user, which provides assistance during acid-base disorders treatment. The application will assist the physician in clinical practice and is focused on the treatment in intensive care. PMID:28883678

  7. Do general practitioners follow treatment recommendations from guidelines in their decisions on heart failure management? A cross-sectional study

    PubMed Central

    Swennen, Maartje H J; Rutten, Frans H; Kalkman, Cor J; van der Graaf, Yolanda; Sachs, Alfred P E; van der Heijden, Geert J M G

    2013-01-01

    Objective To investigate whether general practitioners (GPs) follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients, and assess whether doctors’ characteristics are related to their decisions. Design Cross-sectional vignette study. Setting Continuing Medical Education meeting. Participants 451 Dutch GPs. Main outcome measures Answers to four multiple-choice treatment decisions in clinical vignettes of a patient with heart failure and a reduced ejection fraction. With univariable and multivariable regression analyses, respondent characteristics were related to optimal treatment decisions. Results Of the 451 GPs, none took four optimal decisions: 7% considered stopping statin treatment, 36% initiated β-blocker treatment at a low-dose and 4% doubled the β-blocker in the up-titration phase. Finally, for our vignette patient now also suffering from chronic obstructive pulmonary disease, 45% of the GPs continued β-blocker therapy even when they considered prescribing a long-acting β2-agonist. While the relation between respondent characteristics and each decision was very different, none was independently associated with all four decisions. Giving priority to evidence-based medicine was independently related to stopping statin treatment and doubling the β-blocker in the up-titration phase. Conclusions GPs seem not to follow treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. The recommendations from guidelines may appear counterintuitive when statin treatment needs to be stopped when a patient feels comfortable, or when a β-blocker should be up-titrated in patients who experience more symptoms. Giving priority to evidence-based medicine is possibly positively related to difficult treatment decisions. PMID:24041845

  8. Development of a patient decision aid for the treatment of localised prostate cancer: a participatory design approach.

    PubMed

    Al-Itejawi, Hoda H M; van Uden-Kraan, Cornelia F; Vis, André N; Nieuwenhuijzen, Jakko A; Hofstee, Myrna J A; van Moorselaar, Reindert Jeroen A; Verdonck-de Leeuw, Irma M

    2016-04-01

    To develop a patient decision aid and to prepare an overview of requirements for implementation. We developed a decision aid that fits the preferences of patients and health care professionals to ensure adequate uptake in clinical practice. A participatory design approach was used to acquire insight into preferences regarding the content and design of a decision aid and into barriers and aspects of the decision aid that facilitate implementation in clinical practice. Three focus group interviews with patients, their partners and health care professionals were conducted. A prototype of the decision aid was developed and presented to patients (n = 14) and health care professionals (n = 13) in semi-structured interviews. Patients (n = 5) participated in a usability study. Data were analysed by two independent coders. Health care professionals considered medical information on treatments and side effects as the most important aspect to be included in the decision aid. Patients also focused on nonmedical considerations, such as location. Both expected the decision aid to support patients in making a treatment choice. According to health care professionals, the oncology nurse was the most suitable to discuss the decision aid with patients, while some patients preferred to discuss the patient decision aid with the urologist. The main barrier to implementation of the decision aid was said to be the expectation that it is time and money consuming, while the incorporation of the decision aid into clinical guidelines and basing the content on these guidelines, would promote implementation. By using a participatory design approach a patient decision aid was designed to meet patients' and health care professionals' needs. Insight was also gained on requirements for implementation. Wide-scale implementation of decision aids is desirable. An overview is provided of requirements for implementation to successfully incorporate a decision aid into clinical practice. © 2016 John

  9. Cognitive Predictors of Reasoning through Treatment Decisions in Patients with Newly Diagnosed Brain Metastases.

    PubMed

    Gerstenecker, Adam; Duff, Kevin; Meneses, Karen; Fiveash, John B; Nabors, Louis B; Triebel, Kristen L

    2015-07-01

    To examine the association between reasoning through medical treatment decisions and cognition in a sample of patients with brain metastasis. The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results indicate that measures of episodic memory and processing speed were associated with reasoning. Using these two predictors, actuarial equations were constructed that can be used to help screen for impaired reasoning ability in patients' with brain metastasis. The equations presented in this study have clinical significance as they can be used to help identify patients at risk for possessing a diminished ability to reason through medical treatment decisions and, thus, are in need of a more comprehensive evaluation of their medical decision-making capacity.

  10. Cognitive Predictors of Reasoning Through Treatment Decisions in Patients with Newly Diagnosed Brain Metastases

    PubMed Central

    Gerstenecker, Adam; Duff, Kevin; Meneses, Karen; Fiveash, John B.; Nabors, Louis B.; Triebel, Kristen L.

    2015-01-01

    Objective To examine the association between reasoning through medical treatment decisions and cognition in a sample of patients with brain metastasis. Methods The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically-matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results Results indicate that measures of episodic memory and processing speed were associated with reasoning. Using these two predictors, actuarial equations were constructed that can be used to help screen for impaired reasoning ability in patients’ with brain metastasis. Conclusions The equations presented in this study have clinical significance as they can be used to help identify patients at risk for possessing a diminished ability to reason through medical treatment decisions and, thus, are in need of a more comprehensive evaluation of their medical decision-making capacity. PMID:26149751

  11. A Qualitative Exploration of Clinician Views and Experiences of Treatment Decision-Making in Bipolar II Disorder.

    PubMed

    Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

    2017-01-19

    This study qualitatively explored clinicians' views and experiences of treatment decision-making in BPII. Semi-structured interviews were conducted with 20 practising clinicians (n = 10 clinical psychologists, n = 6 GPs, n = 4 psychiatrists) with experience in treating adult outpatients with BPII. Interviews were audiotaped, transcribed verbatim and thematically analysed using framework methods. Professional experience, and preferences for patient involvement in decision-making were also assessed. Qualitative analyses yielded four inter-related themes: (1) (non-)acceptance of diagnosis and treatment; (2) types of decisions; (3) treatment uncertainty and balancing act; and (4) decision-making in consultations. Clinician preferences for treatment, professional experience, and self-reported preferences for patient/family involvement seemed to influence decision-making. This study is the first to explore clinician views and experiences of treatment decision-making in BPII. Findings demonstrate how clinician-related factors may shape treatment decision-making, and suggest potential problems such as patient perceptions of lower-than-preferred involvement.

  12. 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.

  13. Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"?

    PubMed

    Harris, Alex H S; Chen, Cheng; Rubinsky, Anna D; Hoggatt, Katherine J; Neuman, Matthew; Vanneman, Megan E

    2016-04-01

    Process measures of healthcare quality are usually formulated as the number of patients who receive evidence-based treatment (numerator) divided by the number of patients in the target population (denominator). When the systems being evaluated can influence which patients are included in the denominator, it is reasonable to wonder if improvements in measured quality are driven by expanding numerators or contracting denominators. In 2003, the US Department of Veteran Affairs (VA) based executive compensation in part on performance on a substance use disorder (SUD) continuity-of-care quality measure. The first goal of this study was to evaluate if implementing the measure in this way resulted in expected improvements in measured performance. The second goal was to examine if the proportion of patients with SUD who qualified for the denominator contracted after the quality measure was implemented, and to describe the facility-level variation in and correlates of denominator contraction or expansion. Using 40 quarters of data straddling the implementation of the performance measure, an interrupted time series design was used to evaluate changes in two outcomes. All veterans with an SUD diagnosis in all VA facilities from fiscal year 2000 to 2009. The two outcomes were 1) measured performance-patients retained/patients qualified and 2) denominator prevalence-patients qualified/patients with SUD program contact. Measured performance improved over time (P < 0.001). Notably, the proportion of patients with SUD program contact who qualified for the denominator decreased more rapidly after the measure was implemented (p = 0.02). Facilities with higher pre-implementation denominator prevalence had steeper declines in denominator prevalence after implementation (p < 0.001). These results should motivate the development of measures that are less vulnerable to denominator management, and also the exploration of "shadow measures" to monitor and reduce undesirable

  14. 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.

  15. A Preliminary Study in Applying the Function-Based Intervention Decision Model in Consultation to Increase Treatment Integrity

    ERIC Educational Resources Information Center

    Gann, Candace J.; Kunnavatana, S. Shanun

    2016-01-01

    This preliminary study investigated the use of the Function-Based Intervention Decision Model (Decision Model; Umbreit, Ferro, Liaupsin, & Lane, 2007) to improve teacher treatment integrity for a function-based classroom management plan. The participants were a special education teacher and three elementary-age students receiving special…

  16. 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

  17. 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…

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

    PubMed

    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

    To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders' decision making roles in localized prostate cancer (PCa) treatment. 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. 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. 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.

  19. 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…

  20. A Preliminary Study in Applying the Function-Based Intervention Decision Model in Consultation to Increase Treatment Integrity

    ERIC Educational Resources Information Center

    Gann, Candace J.; Kunnavatana, S. Shanun

    2016-01-01

    This preliminary study investigated the use of the Function-Based Intervention Decision Model (Decision Model; Umbreit, Ferro, Liaupsin, & Lane, 2007) to improve teacher treatment integrity for a function-based classroom management plan. The participants were a special education teacher and three elementary-age students receiving special…

  1. Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission?

    PubMed

    Nikoubashman, Omid; Probst, Thomas; Schürmann, Kolja; Othman, Ahmed E; Matz, Oliver; Brockmann, Marc-Alexander; Müller, Marguerite; Wiesmann, Martin; Reich, Arno

    2017-04-01

    Epidemiologic studies identified a 'weekend effect' or 'out-of-hours effect', which implies that procedural and clinical outcomes of patients with stroke, who are admitted out-of-hours, are less favorable than for patients admitted during working-hours. To determine (1) whether our procedural times and clinical outcome were affected by an out-of-hours effect and (2) whether the decision in favor of, or against, endovascular stroke treatment (EST) depends on the time of admission. Between February 2010 and January 2015, 6412 consecutive patients presenting with symptoms of acute ischemic stroke were evaluated for EST eligibility according to established local protocols and generally accepted consensus criteria, and dichotomized into working-hours and out-of-hours cohorts according to admission times. Within both groups, patients given EST were identified and the rate of treatment decision, procedural times, and clinical outcome were compared and analyzed. Clinical and radiological features of patients admitted in working-hours and out-of-hours did not differ significantly. Procedural times and clinical outcome were not affected by an out-of-hours effect (p≥0.054). 221/240 (92.1%) out-of-hours patients and 154/166 (92.8%) working-hours patients who were eligible for EST were transferred to the angiography suite for EST (p=0.798). The rationale not to treat patients who were eligible for EST did not differ between working-hours and out-of-hours admission (p=0.756). It is possible to produce competitive procedural times regardless of the time of admission and to prevent a treatment decision bias when standard operating procedures are applied consistently. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective.

    PubMed

    Pieterse, A H; Kunneman, M; Engelhardt, E G; Brouwer, N J; Kroep, J R; Marijnen, C A M; Stiggelbout, A M; Smets, E M A

    2017-07-01

    To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively.

    PubMed

    Langer, David A; Jensen-Doss, Amanda

    2016-12-02

    The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.

  4. 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.

  5. Involvement in Decision Making and Satisfaction With Treatment Among Partners of Patients With Newly Diagnosed Localized Prostate Cancer.

    PubMed

    Symes, Yael; Song, Lixin; Heineman, Rachael G; Barbosa, Brittney D; Tatum, Kimberly; Greene, Giselle; Weaver, Mark; Chen, Ronald C

    2015-11-01

    To examine partner involvement in treatment decision making for localized prostate cancer, congruence between partner involvement and patient preference, reasons for partner noninvolvement, and partner satisfaction with patient treatment
. Cross-sectional exploratory study.
 100 counties in North Carolina. 281 partners of men with newly diagnosed localized prostate cancer. Participants completed a phone survey. Logistic regression analyses were used. Partners' involvement in treatment decision making, partner satisfaction with treatment, activities of partner involvement, and reasons for noninvolvement. Of the 228 partners (81%) related to decision making, 205 (73%) were very satisfied with the treatment the patients received, and partner involvement was congruent with patient preference in 242 partners (86%). Partners reported several reasons for noninvolvement. Most partners engaged in multiple activities during treatment decision making for localized prostate cancer and were satisfied with the patient's treatment. Partner involvement was mostly congruent with patient preference. Partners' active involvement in treatment decision making for localized prostate cancer (e.g., being involved in patients' conversations with doctors) should be encouraged and facilitated for those who prefer this type of decision making. 
.

  6. Autonomy and dependence: a discussion paper on decision-making in teenagers and young adults undergoing cancer treatment.

    PubMed

    Davies, Jane; Kelly, Daniel; Hannigan, Ben

    2015-09-01

    A discussion which aims to explore the diversity of decision-making during teenage and young adult cancer treatment. The discussion will be related to the concepts of autonomy, dependence and decision-making in this age group. The experience of cancer involves a significant series of treatment decisions. However, other non-treatment decisions also have to be made which can relate to any aspect of everyday life. These decisions occur against the backdrop of young people's disease experience. Discussion paper. A literature search for the period 1990-2013 was undertaken. This included searching the following databases: Cumulative Index for Nursing and Allied Health Literature (CINAHL), SCOPUS, Medline, DARE, Applied Social Sciences Index and Abstracts (ASSIA), (Psych Info) and The Cochrane Library. There is a lack of evidence into the experience of everyday decisions made by young people during cancer treatment. This may affect them in the form of unmet needs that nurses, or other professionals, fail to appreciate. Further exploration of how teenagers and young adults experience the range and process of decision-making during cancer treatment could be useful in helping to provide effective supportive care for this age group. © 2015 John Wiley & Sons Ltd.

  7. Innovation attributes and adoption decisions: perspectives from leaders of a national sample of addiction treatment organizations.

    PubMed

    Knudsen, Hannah K; Roman, Paul M

    2015-02-01

    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 enhance efforts to increase

  8. Clinical decision-making in multiple sclerosis: Challenges reported internationally with emerging treatment complexity.

    PubMed

    Ng, Pamela; Murray, Suzanne; Hayes, Sean M

    2015-07-01

    The introduction of several new disease-modifying therapies (DMTs) to the field of Multiple Sclerosis (MS) treatment requires that MS healthcare providers have a comprehensive understanding of the implications of each new treatment option in order to select the treatment that best suits their patient. An international study was conducted in 6 countries to obtain a better understanding of the issues and challenges experienced by Neurologists and Nurses in the treatment and management of their patients with MS. The goal of this research was to obtain evidence to inform future Continuing Medical Education (CME) initiatives and health policies that promote knowledge translation to clinical practice. This article focuses on challenges reported in relation to the use of newly approved therapies, in light of the risks of these new treatments, as well as screening and monitoring precautions that must be taken. An exploratory study and literature review informed the design of an IRB-approved online survey deployed to MS Neurologists and Nurses practicing in 6 countries (Germany, France, Italy, Spain, UK, USA). The sample consisted of actively practicing Neurologists (n=156) and Nurses (n=153). Substantive challenges were reported in participant's knowledge of and confidence in three categories: i) safety profile of newly approved therapies, ii) screening patients for treatment with newly approved therapies, and iii) monitoring for serious adverse events. Findings indicate that, internationally, healthcare providers report substantive challenges integrating newly approved therapies into their clinical decision-making. This study highlights potential factors underlying the challenges, and identifies important targets for CME interventions and policymakers to enhance clinical decision-making amongst MS providers. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. 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

  10. Clinical factors associated with decision to recommend methylphenidate treatment for children with ADHD in France.

    PubMed

    Courtabessis, Elodie; Pupier, Florence; Surig, Laurie; Picot, Marie-Christine; Nogué, Erika; Macioce, Valérie; Stein, Elizabeth; Purper-Ouakil, Diane

    2017-10-05

    European guidelines advise on best practices for the diagnosis and non-pharmacological and pharmacological treatment of attention-deficit hyperactivity disorder (ADHD). This study aimed to (1) assess whether clinician's decisions to initiate methylphenidate treatment in children diagnosed with ADHD are in accordance with European guidelines and (2) identify clinical factors associated with the decision to recommend methylphenidate prescription. 5 to 13-year-old patients with an ADHD diagnosis were consecutively evaluated in an outpatient child and adolescent psychiatry clinic in France. Patients underwent a multidisciplinary evaluation including a diagnostic interview, symptom severity assessments with parent questionnaires, and IQ testing. We compared children with (n = 105) and without (n = 55) recommended methylphenidate treatment using Student's t test or Wilcoxon Mann-Whitney test and Chi-square or Fisher's test. Multivariate logistic regression was implemented to determine the respective influence of each variable on treatment recommendation. Recommendation to initiate methylphenidate treatment was associated with (1) ADHD combined presentation, (2) co-occurring Oppositional Defiant Disorder/Conduct Disorder (ODD/CD), Developmental Coordination Disorder (DCD) and Learning Disorder (LD), (3) clinical severity and impairment indicated on parent questionnaires, and (4) reduced perceptual reasoning. Using a multivariate regression model, ADHD combined presentation [combined versus predominantly hyperactive/impulsive and unspecified OR 4.52 (1.23-16.55), p = 0.023], age [OR 1.46 (1.14-1.88), p = 0.003], ODD/CD [OR 5.53 (2.19-14.01), p < 0.001], DCD [OR 4.22 (1.70-10.48), p = 0.002], PRI [OR 0.97 (0.94-0.99), p = 0.01] were significantly associated with recommendation of methylphenidate treatment. Our results indicate that clinicians' treatment decision-making complies with European guidelines and is furthermore associated with the type and severity

  11. What information is used in treatment decision aids? A systematic review of the types of evidence populating health decision aids.

    PubMed

    Clifford, Amanda M; Ryan, Jean; Walsh, Cathal; McCurtin, Arlene

    2017-02-23

    Patient decision aids (DAs) are support tools designed to provide patients with relevant information to help them make informed decisions about their healthcare. While DAs can be effective in improving patient knowledge and decision quality, it is unknown what types of information and evidence are used to populate such decision tools. Systematic methods were used to identify and appraise the relevant literature and patient DAs published between 2006 and 2015. Six databases (Academic Search Complete, AMED, CINAHL, Biomedical Reference Collection, General Sciences and MEDLINE) and reference list searching were used. Articles evaluating the effectiveness of the DAs were appraised using the Cochrane Risk of Bias tool. The content, quality and sources of evidence in the decision aids were evaluated using the IPDASi-SF and a novel classification system. Findings were synthesised and a narrative analysis was performed on the results. Thirteen studies representing ten DAs met the inclusion criteria. The IPDASI-SF score ranged from 9 to 16 indicating many of the studies met the majority of quality criteria. Sources of evidence were described but reports were sometimes generic or missing important information. The majority of DAs incorporated high quality research evidence including systematic reviews and meta-analyses. Patient and practice evidence was less commonly employed, with only a third of included DAs using these to populate decision aid content. The quality of practice and patient evidence ranged from high to low. Contextual factors were addressed across all DAs to varying degrees and covered a range of factors. This is an initial study examining the information and evidence used to populate DAs. While research evidence and contextual factors are well represented in included DAs, consideration should be given to incorporating high quality information representing all four pillars of evidence based practice when developing DAs. Further, patient and expert practice

  12. Empirical relationships between health literacy and treatment decision making: a scoping review of the literature.

    PubMed

    Malloy-Weir, Leslie J; Charles, Cathy; Gafni, Amiram; Entwistle, Vikki A

    2015-03-01

    This study asked: What is known from the existing literature about the empirical relationships between health literacy (HL) and the three stages of the treatment decision making (TDM) process: information exchange, deliberation, and deciding on the treatment to implement? A scoping review of the literature was conducted. Four databases were searched and a total of 2772 records were returned. After de-duplication and three levels of relevance screening, 41 primary studies were included. Relationships between HL and information exchange were studied more often than relationships between HL and deliberation and deciding on the treatment to implement. Across the 41 studies, there was little overlap in terms the measure(s) of HL adopted, the aspect of TDM considered, and the characteristics of the study populations--making comparisons of the findings difficult. Multiple knowledge gaps and measurement-related problems were identified; including, the possibility that the process of TDM influences HL. The importance of HL to the three stages of TDM is unclear because of the knowledge gaps and measurement-related problems that exist. There are many uncertainties about how TDM, or the design and use of patient decision aids, should respond to patients with different levels of HL. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. 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

  14. Extraction decision and identification of treatment predictors in Class I malocclusions.

    PubMed

    Konstantonis, Dimitrios; Anthopoulou, Chrysi; Makou, Margarita

    2013-11-19

    The extraction rate in orthodontics varies throughout the years. While the extraction decision is easily made or excluded in clear-cut cases, it still remains controversial what makes an orthodontist decide to extract in borderline cases. The aim of this retrospective study was to identify the percentage of extraction cases in a large group of Class I malocclusions and to clarify which variables contributed most to the extraction decision. The sample consisted of 542 randomly selected records of Class I patients treated in a university graduate program and in five private orthodontic offices. Of these patients, 331 were female and 211 male. The mean age was 14.55 (standard deviation (SD) 5.36) for the non-extraction group and 14.52 (SD 4.86) for the extraction group. The extensive series of 32 linear and angular measurements derived from the cephalometric analysis and the dental casts, along with the variables of age and gender, fueled a stepwise discriminant analysis. The percentage of the patients treated with four first premolar extractions was 26.8%. The results showed that the variables of lower crowding, lower lip to E-plane, upper crowding, and overjet accounted most for the decision to extract at a very significant level (Sig. 0.000). The discriminant analysis assigned a classification power of 83.9% to the predictive model (p<0.0001). Fisher's linear discriminant functions provided a mathematical model, according to which any case can be classified into the adequate treatment group. In a large contemporary sample of 542 Class I patients, the extraction rate was 26.8%. The most important measurements when the orthodontist decides extractions in Class I cases are lower crowding, lower lip to E-plane, upper crowding, and overjet. In clinical orthodontic practice, the findings facilitate treatment by providing evidence-based treatment predictors for Class I malocclusions.

  15. Increased trends in the use of treatment-limiting decisions in a regional neurosurgical unit.

    PubMed

    Wilson, William T; McMillan, Tristan; Young, Adam M H; White, Mark A J

    2017-04-01

    Treatment-limiting decisions (TLDs) are employed to actively withhold treatment from patients whom clinicians feel would derive no benefit or suffer detrimental effects from further intervention. The use of such decisions has been heavily discussed in the media and clinicians in the past have been reluctant to institute them, even though it is in the best interests of the patients. Their use is influenced by several ethical, religious and social factors all of which have changed significantly over time. This study reports the trends in use of TLDs in a regional neurosurgical unit over 23 years. Patient archives were reviewed to identify the number of admissions and procedures performed at the Institute of Neurological Sciences, Glasgow, in the years 1988, 1997 and 2011. Death certificate records were used to identify mortality in the unit in the year 2011. Patient records were used to obtain details of diagnosis, time from admission to death, and the presence and timing of a TLD. The results show an increase in the use of TLDs, with decisions made for 89% of those who died in 2011, compared to 68% in 1997 and 51% in 1988. The number of admissions has increased substantially since 1988 as has the percentage of patients undergoing surgery (46, 67 and 72% in 1988, 1997 and 2011, respectively). There is a trending increase in the number of patients who have a TLD in our regional neurosurgical unit. This demonstrates an increased willingness of clinicians to recognise poor prognosis and to withdraw or withhold treatment in these cases. Continued appropriate use of the TLD is recommended but it is to only ever reflect the best interests of the patient.

  16. Ketamine use among regular tobacco and alcohol users as revealed by respondent driven sampling in Taipei: prevalence, expectancy, and users’ risky decision making

    PubMed Central

    Chen, Wei J.; Ting, Te-Tien; Chang, Chao-Ming; Liu, Ying-Chun; Chen, Chuan-Yu

    2014-01-01

    The popularity of ketamine for recreational use among young people began to increase, particularly in Asia, in 2000. To gain more knowledge about the use of ketamine among high risk individuals, a respondent-driven sampling (RDS) was implemented among regular alcohol and tobacco users in the Taipei metropolitan area from 2007 to 2010. The sampling was initiated in three different settings (i.e., two in the community and one in a clinic) to recruit seed individuals. Each participant was asked to refer one to five friends known to be regular tobacco smokers and alcohol drinkers to participate in the present study. Incentives were offered differentially upon the completion of an interview and successful referral. Information pertaining to drug use experience was collected by an audio computer-assisted self-interview instrument. Software built for RDS analyses was used for data analyses. Of the 1,115 subjects recruited, about 11.7% of the RDS respondents reported ever having used ketamine. Positive expectancy of ketamine use was positively associated with ketamine use; in contrast, negative expectancy inversely associated with ketamine use. Decision-making characteristics as measured on the Iowa Gambling Task using reinforcement learning models revealed that ketamine users learned less from the most recent event than both tobacco- and drug-naïve controls and regular tobacco and alcohol users. These findings about ketamine use among young people have implications for its prevention and intervention. PMID:25264412

  17. Decision peptide-driven: a free software tool for accurate protein quantification using gel electrophoresis and matrix assisted laser desorption ionization time of flight mass spectrometry.

    PubMed

    Santos, Hugo M; Reboiro-Jato, Miguel; Glez-Peña, Daniel; Nunes-Miranda, J D; Fdez-Riverola, Florentino; Carvallo, R; Capelo, J L

    2010-09-15

    The decision peptide-driven tool implements a software application for assisting the user in a protocol for accurate protein quantification based on the following steps: (1) protein separation through gel electrophoresis; (2) in-gel protein digestion; (3) direct and inverse (18)O-labeling and (4) matrix assisted laser desorption ionization time of flight mass spectrometry, MALDI analysis. The DPD software compares the MALDI results of the direct and inverse (18)O-labeling experiments and quickly identifies those peptides with paralleled loses in different sets of a typical proteomic workflow. Those peptides are used for subsequent accurate protein quantification. The interpretation of the MALDI data from direct and inverse labeling experiments is time-consuming requiring a significant amount of time to do all comparisons manually. The DPD software shortens and simplifies the searching of the peptides that must be used for quantification from a week to just some minutes. To do so, it takes as input several MALDI spectra and aids the researcher in an automatic mode (i) to compare data from direct and inverse (18)O-labeling experiments, calculating the corresponding ratios to determine those peptides with paralleled losses throughout different sets of experiments; and (ii) allow to use those peptides as internal standards for subsequent accurate protein quantification using (18)O-labeling. In this work the DPD software is presented and explained with the quantification of protein carbonic anhydrase.

  18. 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.

  19. 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

  20. 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.

  1. Ethical perspectives on decision-making capacity and consent for treatment and research.

    PubMed

    Berghmans, Ron L; Widdershoven, Guy A

    2003-01-01

    Decision-making capacity for treatment and research raises complex conceptual issues. Given the fact that both considerations of respect for patient autonomy and beneficence/harm prevention have moral relevance in many cases, in the practice of health care the need exists to balance both in a moral responsible way. The moral concept of (mental) capacity or decisional capacity has a role to play in this balancing process. The current dominant approach towards the conceptualization and assessment of decision-making capacity, which focuses on cognition and rationality, has some serious shortcomings. In order to compensate for these shortcomings of the dominant approach, a number of alternative approaches may be promising. A first alternative focuses on issues of emotion and narrative; a second on identity and identification, and a third on dialogue and deliberation. By paying attention to the way in which people interprete their world (not only by cognition, but also by emotion), and how they shape their lives by processes of identification and communication, a broader perspective on capacity assessment in health care can be developed. Above that, these alternative approaches are less focused on the assessment of (in)capacity and more on enabling a person to become more competent through a process of empowerment, participation, and shared decision-making.

  2. Depression and decision-making capacity for treatment or research: a systematic review

    PubMed Central

    2013-01-01

    Background Psychiatric disorders can pose problems in the assessment of decision-making capacity (DMC). This is so particularly where psychopathology is seen as the extreme end of a dimension that includes normality. Depression is an example of such a psychiatric disorder. Four abilities (understanding, appreciating, reasoning and ability to express a choice) are commonly assessed when determining DMC in psychiatry and uncertainty exists about the extent to which depression impacts capacity to make treatment or research participation decisions. Methods A systematic review of the medical ethical and empirical literature concerning depression and DMC was conducted. Medline, EMBASE and PsycInfo databases were searched for studies of depression and consent and DMC. Empirical studies and papers containing ethical analysis were extracted and analysed. Results 17 publications were identified. The clinical ethics studies highlighted appreciation of information as the ability that can be impaired in depression, indicating that emotional factors can impact on DMC. The empirical studies reporting decision-making ability scores also highlighted impairment of appreciation but without evidence of strong impact. Measurement problems, however, looked likely. The frequency of clinical judgements of lack of DMC in people with depression varied greatly according to acuity of illness and whether judgements are structured or unstructured. Conclusions Depression can impair DMC especially if severe. Most evidence indicates appreciation as the ability primarily impaired by depressive illness. Understanding and measuring the appreciation ability in depression remains a problem in need of further research. PMID:24330745

  3. Family involvement in cancer treatment decision-making: A qualitative study of patient, family, and clinician attitudes and experiences.

    PubMed

    Laidsaar-Powell, Rebekah; Butow, Phyllis; Bu, Stella; Charles, Cathy; Gafni, Amiram; Fisher, Alana; Juraskova, Ilona

    2016-07-01

    Little is known about how family are involved in cancer treatment decision-making. This study aimed to qualitatively explore Australian oncology clinicians', patients', and family members' attitudes towards, and experiences of, family involvement in decision-making. Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Three main themes were uncovered: (i) how family are involved in the decision-making process: specific behaviours of family across 5 (extended) decision-making stages; (ii) attitudes towards family involvement in the decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and decision. This study highlighted many specific behaviours of family throughout the decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in decision-making. Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in decision-making. Given the important role of family in the decision-making process, family inclusive consultation strategies are needed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Assigning Treatment to HCC Patients for Transplantation: Utility of a New Decision-Making Tool.

    PubMed

    Shah, Najmul Hassan; Dar, Faisal Saud; Bhatti, Abu Bakar Hafeez; Rana, Atif; Salih, Mohammad

    2016-10-28

    BACKGROUND The Barcelona clinic liver cancer (BCLC) staging system is considered the standard of care for hepatocellular carcinoma (HCC) management. It has various limitations, including lack of second-line treatment options and combination therapy. We prospectively collected data on our HCC patients based on a new decision-making tool (NDT). The objective of this study was to determine the applicability of this tool and compare it with BCLC for treatment allocation, in particular with respect to liver transplantation. MATERIAL AND METHODS We retrospectively reviewed HCC patients who were managed based on an NDT that was developed in 2012. All patients whose treatment decision was based on this tool between 2012 and 2015 were included. Comparison was made with BCLC. Survival was compared for patients who underwent liver transplantation. RESULTS Based on the NDT, 406 (40.6%) patients were eligible for curative treatment versus only 22 (2.2%) patients based on BCLC. A total of 58 (5.8%) patients underwent liver transplant based on the NDT, while only 2 (0.2%) were transplantable based on BCLC. Estimated 3-year survival for transplanted patients based on the NDT was 73%. There were 41 (4.1%) stage C and 15 (1.5%) stage D BCLC patients who received transplant based on the NDT. Estimated 3-year survival for stage A, C, and D BCLC patients who received transplantation was 100%,72%, and 67%, respectively (P=0.6). CONCLUSIONS The NDT correctly identified a group of HCC patients for liver transplantation who would otherwise have received palliative treatment based on the BCLC algorithm.

  5. 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.

  6. Patients' decisions for treatment of end-stage renal disease and their implications for access to transplantation.

    PubMed

    Gordon, E J

    2001-10-01

    Gaining access to kidney transplantation is a complex process that involves treatment decisions made by patients. Despite several advantages of kidney transplantation, some patients choose to remain on hemodialysis for treatment of end-stage renal disease. The present study was undertaken to describe the sociocultural factors influencing patients' decisions to remain on dialysis compared to those who sought a transplant. The study also examined whether African Americans made decisions different from European Americans which would offer insights into one of many factors resulting in them receiving disproportionately fewer kidney transplants. Using a qualitative approach supplemented by a quantitative approach, interviews employing open-ended questions and a card sort technique were conducted with 79 hemodialysis patients. Patients who preferred to remain on dialysis were significantly older and more likely to be unmarried and Protestant. The relationship between treatment decisions and ethnicity was inconclusive due to multiple, interrelated covariates. The three most common reasons patients reported for remaining on dialysis included: doing well on dialysis, fear of being "cut on" from a transplant, and knowing other patients whose kidney transplant failed. This study identified sociocultural and ethnomedical beliefs and values about the body and transplantation that inform patients' treatment decisions. This study also generated data that illuminate the complexity of patients' decisions and how these affect patients' preferences regarding transplantation. The results emphasize the need for policy makers to recognize patients' decisions when accounting for alleged difficulties in gaining access to transplantation.

  7. The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

    PubMed

    Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

    2017-01-01

    Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

  8. Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

    PubMed Central

    Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

    2017-01-01

    Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. PMID:28545197

  9. Congruence between Preferred and Actual Participation Roles Increases Satisfaction with Treatment Decision Making among Japanese Women with Breast Cancer

    PubMed

    Yamauchi, Keiko; Nakao, Motoyuki; Nakashima, Mitsuyo; Ishihara, Yoko

    2017-04-01

    Objective: This study investigated the correlation between participation in the treatment decision-making process and satisfaction with the process among Japanese women with breast cancer. The influence of sociodemographic and clinical characteristics on satisfaction with the treatment decision-making process was also examined. Methods: We conducted a cross-sectional, self-administered internet survey of 650 Japanese women with breast cancer in March 2016. Decisional role (active, collaborative, passive) in the treatment decision-making was elicited using the Japanese version of the Control Preference Scale. Satisfaction with the decision-making process was assessed. Result: About half of the participants preferred to play a collaborative role, while half of the participants perceived that they played an active role. Satisfaction among the participants who made their treatment choice collaboratively with their physicians was significantly higher than that of participants who made the choice by themselves or entrusted their physicians to make the decision. However, two-way ANOVA demonstrated that satisfaction level was associated with the congruence between the participants’ preferred and actual decisional roles, but not with the actual decisional roles that they played. This association had no interaction with sociodemographic and clinical status, except for education level. A majority of the participants who participated in the roles they preferred in choosing their treatment option indicated that they would participate in the same role if they were to face a similar decision-making situation in the future. Conclusion: Regardless of their role played in the cancer treatment decision-making process, and irrespective of their sociodemographic and clinical status, Japanese women with breast cancer are more satisfied with the treatment decision-making process when their participation in the process matches their preferred role in the process. Creative Commons

  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. A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic.

    PubMed

    Hurwitz, Lauren M; Cullen, Jennifer; Elsamanoudi, Sally; Kim, Daniel J; Hudak, Jane; Colston, Maryellen; Travis, Judith; Kuo, Huai-Ching; Porter, Christopher R; Rosner, Inger L

    2016-05-01

    Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make their treatment decisions, as well as the effect of treatment choice on long-term outcomes, is critical to ensuring effective, patient-centered care. This study examined treatment decision-making in a racially diverse, equal-access, contemporary cohort of patients with PCa counseled on treatment options at a multidisciplinary clinic. A prospective cohort study was initiated at the Walter Reed National Military Medical Center (formerly Walter Reed Army Medical Center) in 2006. Newly diagnosed patients with PCa were enrolled before attending a multidisciplinary clinic. Patients completed surveys preclinic and postclinic to assess treatment preferences, reasons for treatment choice, and decisional regret. As of January 2014, 925 patients with PCa enrolled in this study. Surgery (54%), external radiation (20%), and active surveillance (12%) were the most common primary treatments for patients with low- and intermediate-risk PCa, whereas patients with high-risk PCa chose surgery (34%) or external radiation with neoadjuvant hormones (57%). Treatment choice differed by age at diagnosis, race, comorbidity status, and calendar year in both univariable and multivariable analyses. Patients preferred to play an active role in the decision-making process and cited doctors at the clinic as the most helpful source of treatment-related information. Almost all patients reported satisfaction with their decision. This is one of the first prospective cohort studies to examine treatment decision-making in an equal-access, multidisciplinary clinic setting. Studies of this cohort would aid in understanding and improving the PCa decision-making process. Published by Elsevier Inc.

  12. Circulating tumor DNA for triple-negative breast cancer diagnosis and treatment decisions.

    PubMed

    Saliou, Adrien; Bidard, François-Clément; Lantz, Olivier; Stern, Marc-Henri; Vincent-Salomon, Anne; Proudhon, Charlotte; Pierga, Jean-Yves

    2016-01-01

    Triple-negative breast cancer (TNBC) is a highly aggressive disease characterized by a high number of relapses and poor overall survival. The heterogeneity of the disease and the limited treatment options compared to other breast cancer subtypes mainly explain these clinical outcomes. New biomarkers are urgently needed to improve the management of TNBC. Circulating tumor DNA, identified by tumor-related molecular alterations, could be used in the context of non-invasive "liquid biopsy" and help in TNBC diagnosis and treatment decisions. In this review, we discuss the key issues related to the potential of circulating tumor DNA to improve the management of this disease and the future steps to overcome before its implementation into clinical routine within the next 5 years.

  13. Procalcitonin for Diagnostics and Treatment Decisions in Pediatric Lower Respiratory Tract Infections

    PubMed Central

    Baumann, Philipp; Baer, Gurli; Bonhoeffer, Jessica; Fuchs, Aline; Gotta, Verena; Heininger, Ulrich; Ritz, Nicole; Szinnai, Gabor; Bonhoeffer, Jan

    2017-01-01

    Mortality and morbidity remain high in pediatric lower respiratory tract infections (LRTIs) despite progress in research and implementation of global diagnostic and treatment strategies in the last decade. Still, 120 million annual episodes of pneumonia affect children younger than 5 years each year leading to 1.3 million fatalities with the major burden of disease carried by low- and middle-income countries (95%). The definition of pneumonia is still challenging. Traditional diagnostic measures (i.e., chest radiographs, C-reactive protein) are unable to distinguish viral and from bacterial etiology. As a result, common antibiotic overuse contributes to growing antibiotic resistance. We present an overview of current evidence from observational and randomized controlled trials on a procalcitonin (PCT)-based diagnosis of pediatric LRTIs and discuss the need for an adequate PCT threshold for antibiotic treatment decision-making. PMID:28894729

  14. Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis.

    PubMed

    Furlan, J C; Urbach, D R; Fehlings, M G

    2007-09-01

    When conservative management fails in patients with chronic spinal cord injury (SCI) and neurogenic bowel dysfunction, clinicians have to choose from a variety of treatment options which include colostomy, ileostomy, Malone anterograde continence enema (MACE) and sacral anterior root stimulator (SARS) implantation. This study employed a decision analysis to examine the optimal treatment for bowel management of young individuals with chronic refractory constipation in the setting of chronic SCI. A decision analysis was created to compare the four surgical strategies using baseline analysis, one-way and two-way sensitivity analyses, 'worst scenario' and 'best scenario' sensitivity analyses, and probabilistic sensitivity analyses. Quality-adjusted life expectancy (QALE) was the primary outcome. The baseline analysis indicated that patients who underwent the MACE procedure had the highest QALE value compared with the other interventions. Sensitivity analyses showed that these results were robust. The MACE procedure may provide the best long-term outcome in terms of the probability of improving bowel function, reducing complication rates and the incidence of autonomic dysreflexia, and being congruent with patients' preferences. The analysis was sensitive to changes in assumptions about quality of life/utility, and thus the results could change if more specific estimates of utility became available. Copyright (c) 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  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.

  16. Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis.

    PubMed

    Kalkan, A; Hallert, E; Carlsson, P; Roback, K; Sjöwall, C

    2015-01-01

    In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objectives were to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices. Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (Yes/No) and to explain their decisions. The response rate was 26/105 (25%). Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the 10 hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decisions to prescribe biologics and also not to prescribe biologics were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or the social function of the patient. The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practicing at the same clinic. Treatment choices were motivated primarily by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

  17. Why do men choose one treatment over another?: a review of patient decision making for localized prostate cancer.

    PubMed

    Zeliadt, Steven B; Ramsey, Scott D; Penson, David F; Hall, Ingrid J; Ekwueme, Donatus U; Stroud, Leonard; Lee, Judith W

    2006-05-01

    Treatment choices for localized prostate cancer appear to vary widely, although it is unclear whether this variation is a result of patient values or other factors. The authors conducted a systematic review of the literature, identifying 70 articles that focused on prostate cancer decision making. Studies suggest that men consider several issues when making treatment decisions. The authors found conflicting evidence regarding the importance that men place on cancer eradication, with considerable variation in how patients interpret evidence regarding treatment efficacy. The number of physicians that men see and the importance of the physician recommendation were found to vary considerably. Although men stated that side effects are important, few patients reported that side effect factors ultimately influenced their treatment choice. To the authors' knowledge, there is little research regarding how patients' personal values shape and influence their decision, or the role of race/ethnicity or socioeconomic status in preferences for treatment. The authors conclude that variations in treatment decisions may be more indicative of differences in the information patients receive rather than truly reflective of underlying patient preferences. Considerable progress is needed in helping patients fully understand how to balance the complex issues surrounding prostate cancer treatment decision making.

  18. 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

  19. 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.

  20. New perspectives in treatment decision for integrated management of rectal cancer: multimodal research for multimodal treatments

    PubMed Central

    VALENTINI, V.; CELLINI, F.

    2014-01-01

    Rectal cancer management improved results in the last thirty-five applying new integrated treatment options. Preoperative radiochemotherapy or radiotherapy alone joined to the modern surgery gaining significant improvement of outcomes. Nevertheless, a definitive conclusion about superiority of one on the other in term of survival and toxicity is still lacking, and further improvement is in general required and seems obtainable. The need for a wide sharing of the accumulated knowledge is represented by the consensus conferences that over the years summarizes the state of the art for the management of rectal cancer. One of the most promising opportunities comes from the attempt of characterization of the tumor heterogeneity. An always-increasing number of new parameters come from different sources including genomic, imaging, pathological features and many others. The need of new informatics technologies able to handle and continuously incorporate new inputs derived from the evidences is also imperative. The combined use of large shared databases and “learning models” could allow generating and rapidly testing new hypotheses, providing further survival improvement in the next years. PMID:24979100

  1. Bottlenecks in Geospatial Data-Driven Decision-Making for Natural Disaster Management: A Case Study of Forest Fire Prevention and Control in Guatemala's Maya Biosphere Reserve

    NASA Astrophysics Data System (ADS)

    Berenter, J. S.; Mueller, J. M.; Morrison, I.

    2016-12-01

    of support systems for use of Earth observation data is thus required to maximize the value of data-driven forest fire management in the MBR. Findings further validate a need for continued cooperation between scientific and governance institutions to disseminate and integrate geospatial data into environmental decision-making.

  2. Patient, Physician and Contextual Factors Are Influential in the Treatment Decision Making of Older Adults Newly Diagnosed with Symptomatic Myeloma.

    PubMed

    Tariman, Joseph D; Doorenbos, Ardith; Schepp, Karen G; Becker, Pamela S; Berry, Donna L

    2014-01-01

    To examine patient perspectives on their personal and contextual factors relevant to TDM. The second aim was to describe physician perspectives on the TDM in older adults (≥60 y.o.) diagnosed with symptomatic MM. Descriptive, cross-sectional. A semi-structured interview schedule was administered. Directed content analysis procedures were used to develop major themes from the patient and physician participant interviews. Themes related to treatment decision making among patient participants include various decisional role preferences; several sources of information related to myeloma; contextual and patient-specific factors influence treatment decisions; negative perceptions related to the treatment decision-making process exist; strong desire to be in remission and to live a longer life; For physician participants, top themes related to decision making were: QOL or survival considerations or simultaneously considerations of treatment effectiveness, QOL and survival; screening patients for eligibility for autologous HSCT; time is a barrier to effective TDM; Various methods were used to assess patient decisional role preferences. Treatment decision making in older adults newly diagnosed with symptomatic myeloma is influenced by personal, social and contextual factors. Patients must be given the opportunity to choose the best possible treatment within the limits of the patient's personal, social and medical contexts.

  3. Patients' experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians.

    PubMed

    Siouta, Eleni; Hellström Muhli, Ulla; Hedberg, Berith; Broström, Anders; Fossum, Bjöörn; Karlgren, Klas

    2016-09-01

    Insights in consultations across patient interactions with physicians and nurses are of vital importance for strengthening the patients' involvement in the treatment decision-making process. The experience of involvement and communication in decision-making from the patients' perspective has been sparsely explored. To examine how patients describe involvement in and communication about decision-making regarding treatment in consultations with nurses and physicians. Twenty-two patients with atrial fibrillation (AF), aged 37-90 years, were interviewed directly after their consultations with nurses and physicians in outpatient AF clinics in six Swedish hospitals. In consultations with nurses, the patients felt involved when obtaining clarifications about AF as a disease and its treatment and when preparing for and building up confidence in decision-making. In consultations with physicians, the patients felt involved when they could cooperate in decision-making, when acquiring knowledge, and when they felt that they were being understood. One shared category was found in consultations with both nurses and physicians, and the patients felt involved when they had a sense of trust and felt secure during and between consultations. Patients with AF stated that they would need to acquire knowledge and build up confidence and ability in order to be effectively involved in the decision-making about treatment. Despite not being actively involved in decision-making, patients felt involved through experiencing supportive and confirming communication. Attention must be given to the relationship with the patient to create the conditions for patient involvement in the consultation. This can be achieved through supportive communication attempting to create a feeling of clarity and building confidence. This will support involvement in decision-making concerning AF treatment and feelings of being understood and of trust in physicians and/or nurses. © 2015 Nordic College of Caring

  4. 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.

  5. 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

  6. Treatment plan for integrating evidence-based decision making into dental education.

    PubMed

    Forrest, Jane L

    2006-03-01

    The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.

  7. Selection of hydrothermal pre-treatment conditions of waste sludge destruction using multicriteria decision-making.

    PubMed

    Al-Shiekh Khalil, Wael; Shanableh, Abdullah; Rigby, Portia; Kokot, Serge

    2005-04-01

    The effectiveness of hydrothermal treatment for the destruction of the organic content of sludge waste was investigated. The sludge sampled in this study contained approximately 2% solids. The experimental program consisted of hydrothermal treatment experiments conducted in a batch reactor at temperatures between 100 and 250 degrees C, with the addition of an oxidant (hydrogen peroxide) in the range of 0-150% with reference to TCOD, and reaction times of up to 60 min. The results suggested that the availability of oxidant, reaction temperature and reaction time were the determining factors for COD removal. A significant fraction of the COD remaining after treatment consisted of the dissolved COD. The results confirmed that hydrothermal treatment proceeds through hydrolysis resulting in the production of dissolved organic products followed by COD removal through oxidation. Two MCDM chemometrics methods, PROMETHEE and GAIA, were applied to process the large data matrix so as to facilitate the selection of the most suitable hydrothermal conditions for sludge destruction. Two possible scenarios were produced from this analysis-one depended on the use of high temperatures and no oxidant, while the second offered a choice of compromise solutions at lower temperatures but with the use of at least some oxidant. Thus, for the final choice of operating conditions, the decision maker needs local knowledge of the costs and available infrastructure. In principle, such information could be added as further criteria to the data matrix and new rankings obtained.

  8. Second opinion strategies in breast pathology: a decision analysis addressing over-treatment, under-treatment, and care costs.

    PubMed

    Tosteson, Anna N A; Yang, Qian; Nelson, Heidi D; Longton, Gary; Soneji, Samir S; Pepe, Margaret; Geller, Berta; Carney, Patricia A; Onega, Tracy; Allison, Kimberly H; Elmore, Joann G; Weaver, Donald L

    2017-09-06

    To estimate the potential near-term population impact of alternative second opinion breast biopsy pathology interpretation strategies. Decision analysis examining 12-month outcomes of breast biopsy for nine breast pathology interpretation strategies in the U.S. health system. Diagnoses of 115 practicing pathologists in the Breast Pathology Study were compared to reference-standard-consensus diagnoses with and without second opinions. Interpretation strategies were defined by whether a second opinion was sought universally or selectively (e.g., 2nd opinion if invasive). Main outcomes were the expected proportion of concordant breast biopsy diagnoses, the proportion involving over- or under-interpretation, and cost of care in U.S. dollars within one-year of biopsy. Without a second opinion, 92.2% of biopsies received a concordant diagnosis. Concordance rates increased under all second opinion strategies, and the rate was highest (95.1%) and under-treatment lowest (2.6%) when all biopsies had second opinions. However, over-treatment was lowest when second opinions were sought selectively for initial diagnoses of invasive cancer, DCIS, or atypia (1.8 vs. 4.7% with no 2nd opinions). This strategy also had the lowest projected 12-month care costs ($5.907 billion vs. $6.049 billion with no 2nd opinions). Second opinion strategies could lower overall care costs while reducing both over- and under-treatment. The most accurate cost-saving strategy required second opinions for initial diagnoses of invasive cancer, DCIS, or atypia.

  9. [Visual presentation of psychiatric clinical decision-making by "graphic assessment sheet for diagnoses and treatments"].

    PubMed

    Ota, Toshio; Yoshida, Sumiko; Tsunashima, Sousuke; Totsuka, Takao; Watanabe, Takafumi; Toyoshima, Ryoichi

    2011-01-01

    Psychiatrists often have to treat patients even when the clinical information is insufficient to make a definite diagnosis. This is the case especially when we are treating first-visit outpatients or inpatients who have just been admitted. One of the causes of information insufficiency is a delay in obtaining clinical information on the patient, and another is a lack of characteristic manifestations of the disease because of an immature developmental stage. Even in such situations, however, clinicians have to make reasonable judgements using the information that is available at that time. The framework for making judgements on such occasions, or "the framework of decision-making under imperfect-information conditions", is becoming more and more important in psychiatric clinical practice in Japan for the following reasons. First, team members in charge of a patient became very heterogeneous in terms of their career and motivation after the start of the new post-graduate clinical training system in Japan several years ago, resulting in a higher risk of miscommunication. Secondly, the need for precise explanation to patients and their families has become crucial in recent years as the result of various social changes. Ota T, one of the authors, once put forward the framework of decision-making under imperfect-information conditions on the basis of Bayesian statistics. In the present paper, in consideration of the above background, we devised a sheet for visualizing the above framework so that relevant staff could share the clinical decision-making process. Specifically, we visually arranged on a sheet of paper the components and variables of the framework, so that the staff could communicate with each other explicitly and precisely about the estimated probability of each possible disease, merits and demerits of each treatment option, etc. We employed the sheet on treating patients in our acute psychiatric ward, 2 of whom are presented in the paper. Discussions were

  10. Cost-effectiveness of integrating methadone maintenance and antiretroviral treatment for HIV-positive drug users in Vietnam's injection-driven HIV epidemics.

    PubMed

    Tran, Bach Xuan; Ohinmaa, Arto; Duong, Anh Thuy; Nguyen, Long Thanh; Vu, Phu Xuan; Mills, Steve; Houston, Stan; Jacobs, Philip

    2012-10-01

    Drug use negatively affects adherence to and outcomes of antiretroviral treatment (ART). This study evaluated the cost-effectiveness of integrating methadone maintenance treatment (MMT) with ART for HIV-positive drug users (DUs) in Vietnam. A decision analytical model was developed to compare the costs and consequences of 3 HIV/AIDS treatment strategies for DUs: (1) only ART, (2) providing ART and MMT in separated sites (ART-MMT), and (3) integrating ART and MMT with direct administration (DAART-MMT). The model was parameterized using empirical data of costs and outcomes extracted from the MMT and ART cohort studies in Vietnam, and international published sources. Probabilistic sensitivity analysis was conducted to examine the model's robustness. The base-case analysis showed that the cost-effectiveness ratio of ART, DAART-MMT, and ART-MMT strategies was USD 1358.9, 1118.0 and 1327.1 per 1 Quality-Adjusted Life Year (QALY), equivalent to 1.22, 1.00, and 1.19 times Gross Domestic Product per capita (GDPpc). The incremental cost-effectiveness ratio for DAART-MMT and ART-MMT versus ART strategy was 569.4 and 1227.8, approximately 0.51 and 1.10 times GDPpc/QALY. At the willingness to pay threshold of 3 times GDPpc, the probability of being cost-effective of DAART-MMT versus ART was 86.1%. These findings indicated that providing MMT along with ART for HIV-positive DUs is a cost-effective intervention in Vietnam. Integrating MMT and ART services could facilitate the use of directly observed therapy that supports treatment adherence and brings about clinically important improvements in health outcomes. This approach is also incrementally cost-effective in this large injection-driven HIV epidemic. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. 75 FR 60807 - Notice of Availability of the Record of Decision for Vegetation Treatments Using Herbicides on...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... Using Herbicides on Bureau of Land Management Lands in Oregon Final Environmental Impact Statement...) has prepared a Record of Decision (ROD) for Vegetation Treatments Using Herbicides on Bureau of Land... Vegetation Treatments Using Herbicides on Bureau of Land Management Lands in Oregon, notice of which...

  12. 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…

  13. 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.

  14. Optimal treatment for duodenal ulcer disease: a cost-decision analysis in Malaysian patients.

    PubMed

    Goh, K L; Cutler, A; Chua, A B; Ding, R P; Kandasami, P; Mazlam, M Z; Raj, S M

    1999-01-01

    The aim of the present study was to determine the cost-efficiency of different duodenal ulcer disease treatment practices in Malaysia. Six Malaysian gastroenterologists met to discuss the direct costs related to Helicobacter pylori (HP) eradication treatment. Five treatment strategies were compared: (i) histamine H2 receptor antagonists (H2RA), acid suppression therapy for 6 weeks followed by maintenance therapy as needed; (ii) bismuth triple + proton pump inhibitor (PPI), bismuth (120 mg, q.i.d.), metronidazole (400 mg; t.i.d.), tetracycline (500 mg, q.i.d.) for 7 days and PPI, b.i.d., for 7 days; (iii) OAC, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; (iv) OMC, omeprazole (20mg, b.i.d.), metronidazole (400mg, b.i.d.) and clarithromycin (500 mg, b.i.d.) for 7 days; and (v) OAM, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d.) and metronidazole (400 mg, b.i.d.) for 7 days. A decision tree model was created to determine which therapy would be the most cost-effective. The model considered eradication rates, resistance to anti-microbial agents, compliance and cost implications of treatment regimens, physician visits and ulcer recurrences during a 1 year time period assumption. The H2RA maintenance therapy was the most expensive treatment at Malaysian Ringgit (MR) 2335, followed by bismuth triple therapy (MR 1839), OMC (MR 1786), OAM (MR 1775) and OAC, being the most cost-effective therapy, at MR 1679. In conclusion, HP eradication therapy is superior to H2RA maintenance therapy in the treatment of duodenal ulcer disease. Of the HP eradication regimens, OAC is the most cost-effective.

  15. 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

  16. Fertility knowledge and beliefs about fertility treatment: findings from the International Fertility Decision-making Study.

    PubMed

    Bunting, Laura; Tsibulsky, Ivan; Boivin, Jacky

    2013-02-01

    How good is fertility knowledge and what are treatment beliefs in an international sample of men and women currently trying to conceive? The study population had a modest level of fertility knowledge and held positive and negative views of treatment. Few studies have examined general fertility treatment attitudes but studies of specific interventions show that attitudes are related to characteristics of the patient, doctor and context. Further, research shows that fertility knowledge is poor. However, the majority of these studies have examined the prevalence of infertility, the optimal fertile period and/or age-related infertility in women, in university students and/or people from high-resource countries making it difficult to generalize findings. A cross-sectional sample completed the International Fertility Decision-making Study (IFDMS) over a 9-month period, online or via social research panels and in fertility clinics. Participants were 10 045 people (8355 women, 1690 men) who were on average 31.8 years old, had been trying to conceive for 2.8 years with 53.9% university educated. From a total of 79 countries, sample size was >100 in 18 countries. All 79 countries were assigned to either a very high Human Development Index (VH HDI) or a not very high HDI (NVH HDI). The IFDMS was a 45-min, 64-item English survey translated into 12 languages. The inclusion criteria were the age between 18 and 50 years and currently trying to conceive for at least 6 months. Fertility knowledge was assessed using a 13-item correct/incorrect scale concerned with risk factors, misconceptions and basic fertility facts (range: 0-100% correct). Treatment beliefs were assessed with positive and negative statements about fertility treatment rated on a five-point agree/disagree response scale. Average correct score for Fertility Knowledge was 56.9%, with greater knowledge significantly related to female gender, university education, paid employment, VH HDI and prior medical consultation

  17. eHealth Literacy and Partner Involvement in Treatment Decision Making for Men With Newly Diagnosed Localized Prostate Cancer.

    PubMed

    Song, Lixin; Tatum, Kimberly; Greene, Giselle; Chen, Ronald C

    2017-03-01

    To examine how the eHealth literacy of partners of patients with newly diagnosed prostate cancer affects their involvement in decision making, and to identify the factors that influence their eHealth literacy.
. Cross-sectional exploratory study.
. North Carolina.
. 142 partners of men with newly diagnosed localized prostate cancer. 
. A telephone survey and descriptive and multiple linear regression analyses were used.
. The partners' eHealth literacy, involvement in treatment decision making, and demographics, and the health statuses of the patients and their partners. 
. Higher levels of eHealth literacy among partners were significantly associated with their involvement in getting a second opinion, their awareness of treatment options, and the size of the social network they relied on for additional information and support for treatment decision making for prostate cancer. The factor influencing eHealth literacy was the partners' access to the Internet for personal use, which explained some of the variance in eHealth literacy.
. This study described how partners' eHealth literacy influenced their involvement in treatment decision making for prostate cancer and highlighted the influencing factors (i.e., partners' access to the Internet for personal use).
. When helping men with prostate cancer and their partners with treatment decision making, nurses need to assess eHealth literacy levels to determine whether nonelectronically based education materials are needed and to provide clear instructions on how to use eHealth resources.

  18. Effects of Alternative Decision Support Technologies on Breast Cancer Patients’ Knowledge of Options and Satisfaction With Treatment Decisions

    DTIC Science & Technology

    1999-07-01

    in a CHESS Topics Menu: Overview - Detection and Prevention of Breast Cancer Treatments Emotional and Social Concerns Menopause Diet and Nutrition...unaffected breast U--i Other Li 78. For each of the following breast cancer treatments , give the approximate starting and ending dates, or mark the box

  19. Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review.

    PubMed

    Munro, Sarah; Stacey, Dawn; Lewis, Krystina B; Bansback, Nick

    2016-04-01

    To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation. A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n=8). Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures. Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Persuasion factors influencing the decision to use sustainable household water treatment.

    PubMed

    Kraemer, Silvie M; Mosler, Hans-Joachim

    2010-02-01

    Solar water disinfection (SODIS) is a sustainable water treatment method. With the help of the sun and plastic bottles, water is treated and illnesses prevented. This paper aims to identify the factors influencing SODIS uptake, that is, why someone may become a SODIS user. This uptake decision can be influenced by persuasion. From behaviour theory, variables are recognised which have been proven to influence intention and behaviour and simultaneously can be influenced by persuasion. A total of (n = 878) structured interviews were conducted in a field study in Zimbabwe. Linear and binary logistic regressions showed that several of the initially proposed persuasion variables have significant influence. Persuasion factors have a stronger influence on the uptake of SODIS use and on intention to use SODIS in the future than on the amount of SODIS water consumed. Ideas are presented for using the effective variables in future SODIS campaigns and campaigns in other fields.

  1. Biliary tract cancers: molecular profiling as a tool for treatment decisions. A literature review.

    PubMed

    Berardi, Rossana; Rossana, Berardi; Scartozzi, Mario; Mario, Scartozzi; Freddari, Federica; Federica, Freddari; Squadroni, Michela; Michela, Squadroni; Santinelli, Alfredo; Alfredo, Santinelli; Bearzi, Italo; Italo, Bearzi; Fabris, Guidalberto; Guidalberto, Fabris; Cascinu, Stefano; Stefano, Cascinu

    2006-08-01

    Biliary tract cancer is a quite rare disease; despite recent significant advances in imaging modalities, most of the patients have advanced disease at presentation thus making radical surgery not feasible. Many different chemotherapeutic regimens have been investigated in small uncontrolled studies, with generally disappointing results. We extensively reviewed the literature on this topic trying to give an explanation to chemoresistance in this setting of patients and considering the molecular profiling as a tool for treatment decision. This review is divided in two parts, in the first one we illustrated chemotherapy results and possible mechanisms of resistance. In the second part we analysed the new molecular targets developing an hypothesis about the future therapeutics perspectives.

  2. Deconstructing Fatalism: Ethnographic Perspectives on Women's Decision Making about Cancer Prevention and Treatment

    PubMed Central

    Drew, Elaine M.; Schoenberg, Nancy E.

    2011-01-01

    Researchers have long held that fatalism (the belief in a lack of personal power or control over destiny or fate) constitutes a major barrier to participation in positive health behaviors and, subsequently, adversely affects health outcomes. In this paper, we present two in-depth, ethnographic studies of rural women's health decisions surrounding cancer treatments to illustrate the complexity and contestability of the long-established fatalism construct. Narrative analyses suggest that for these women, numerous and complex factors—including inadequate access to health services, a legacy of self-reliance, insufficient privacy, combined with a culturally acceptable idiom of fatalism—foster the use of, but not necessarily a rigid conviction in, the notion of fatalism. PMID:21834356

  3. 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.

  4. Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review.

    PubMed

    Lamore, Kristopher; Montalescot, Lucile; Untas, Aurélie

    2017-08-14

    This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    PubMed

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

    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.

  6. 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

  7. Shared decision making in mental health treatment: qualitative findings from stakeholder focus groups.

    PubMed

    Mahone, Irma H; Farrell, Sarah; Hinton, Ivora; Johnson, Robert; Moody, David; Rifkin, Karen; Moore, Kenneth; Becker, Marcia; Barker, Missy Rand

    2011-12-01

    This article reports on findings from seven stakeholder focus groups conducted in exploring shared decision making (SDM) between provider and consumer in mental health (MH) treatment in public MH. Seven focus groups were conducted with stakeholders-consumers, family members, prescribers, MH clinicians, and rural providers. Each of the focus groups was recorded digitally, transcribed into text, and analyzed qualitatively for recurring themes. Provider barriers to SDM include history of the medical model, MH crises, lack of system support, and time. Consumer-related barriers included consumer competency, fears, insight, literacy, and trauma from past experiences. Information-exchange issues include consumer passivity, whether consumers could be viewed as experts, and importance of adequate history information. New skills needed to practice SDM included provider's knowledge about alternative treatments, mastery of person-first language, and listening skills; consumer's ability to articulate their expert information; and computer skills for both providers and consumers. Outcomes expected from practice of SDM include greater sharing of power between provider and consumer, greater follow-through with treatment plans, greater self-management on the part of consumers, and improved therapeutic alliances. Implementing SDM in public MH will impact consumers and their families, providers, prescribers, and administrators. More SDM trials in public MH are needed to answer some of the many questions that remain. 2011 Elsevier Inc. All rights reserved.

  8. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women.

    PubMed

    Obeidat, Rana F

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

  9. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women

    PubMed Central

    Obeidat, Rana F.

    2015-01-01

    To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers’ support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system. PMID:27981122

  10. A model-based decision support system for critiquing mechanical ventilation treatments.

    PubMed

    Tehrani, Fleur T; Abbasi, Soraya

    2012-06-01

    A computerized system for critiquing mechanical ventilation treatments is presented that can be used as an aide to the intensivist. The presented system is based on the physiological model of the subject's respiratory system. It uses modified versions of previously developed models of adult and neonatal respiratory systems to simulate the effects of different ventilator treatments on the patient's blood gases. The physiological models that have been used for research and teaching purposes by many researchers in the field include lungs, body tissue, and the brain tissue. The lung volume is continuously time-varying and the effects of shunt in the lung, changes in cardiac output and cerebral blood flow, and the arterial transport delays are included in the system. Evaluation tests were done on adult and neonate patients with different diagnoses. In both groups combined, the differences between the arterial partial pressures of CO(2) predicted by the system and the experimental values were 1.86 ± 1.6 mmHg (mean ± SD), and the differences between the predicted arterial hemoglobin oxygen saturation values, S(aO2), and the experimental values measured by using pulse oximetry, S(pO2), were 0.032 ± 0.02 (mean ± SD). The proposed system has the potential to be used alone or in combination with other decision support systems to set ventilation parameters and optimize treatment for patients on mechanical ventilation.

  11. 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.

  12. The evolving role of the nurse during the cancer treatment decision-making process: a literature review.

    PubMed

    Tariman, Joseph D; Szubski, Katharine L

    2015-10-01

    Many models of patient-physician relationships have been described since a paternalistic model was postulated in the early 1950s. Among them are the informative model, doctor-as-agent model, shared model of care, family-centered model, and Degner and Beaton's Patterns of Decision Making. This article aims to examine the contemporary role of the nurse during the cancer treatment decision-making process. This article reviews the current and evidence-based role of the nurse during cancer treatment decision making, and implications for practice and research are discussed. Because of external forces, such as rising cost of health care, increasing healthcare consumerism, and increased emphasis on patient-centered care, the shared model of care is taking hold, particularly in the cancer setting. The evolution of these models has caused a shift in the dialogue related to cancer treatment decision making between patients and physicians, as well as oncology nurses. These events contribute to the evolving role of the nurse during the cancer treatment decision-making process.

  13. Effect of a Novel Clinical Decision Support Tool on the Efficiency and Accuracy of Treatment Recommendations for Cholesterol Management.

    PubMed

    Scheitel, Marianne R; Kessler, Maya E; Shellum, Jane L; Peters, Steve G; Milliner, Dawn S; Liu, Hongfang; Komandur Elayavilli, Ravikumar; Poterack, Karl A; Miksch, Timothy A; Boysen, Jennifer; Hankey, Ron A; Chaudhry, Rajeev

    2017-02-08

    The 2013 American College of Cardiology / American Heart Association Guidelines for the Treatment of Blood Cholesterol emphasize treatment based on cardiovascular risk. But finding time in a primary care visit to manually calculate cardiovascular risk and prescribe treatment based on risk is challenging. We developed an informatics-based clinical decision support tool, MayoExpertAdvisor, to deliver automated cardiovascular risk scores and guideline-based treatment recommendations based on patient-specific data in the electronic heath record. To assess the impact of our clinical decision support tool on the efficiency and accuracy of clinician calculation of cardiovascular risk and its effect on the delivery of guideline-consistent treatment recommendations. Clinicians were asked to review the EHR records of selected patients. We evaluated the amount of time and the number of clicks and keystrokes needed to calculate cardiovascular risk and provide a treatment recommendation with and without our clinical decision support tool. We also compared the treatment recommendation arrived at by clinicians with and without the use of our tool to those recommended by the guidelines. Clinicians saved 3 minutes and 38 seconds in completing both tasks with MayoExpertAdvisor, used 94 fewer clicks and 23 fewer key strokes, and improved accuracy from the baseline of 60.61% to 100% for both the risk score calculation and guideline-consistent treatment recommendation. Informatics solution can greatly improve the efficiency and accuracy of individualized treatment recommendations and have the potential to increase guideline compliance.

  14. 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.

  15. 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.

  16. 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

  17. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy.

    PubMed

    de Ruiter, Godard C W; Wurzer, Johannes A L; Kloet, Alfred

    2012-10-01

    Surgical treatment options for meralgia paresthetica include neurolysis and neurectomy procedures. Reported success rates for pain relief are generally higher after neurectomy, but an obvious disadvantage compared with neurolysis is the loss of sensation in the anterolateral part of the thigh. In this study we analyzed our results on pain relief after both procedures, and we determined the impact of loss of sensation with a questionnaire. Between 1999 and 2009, all patients with persistent symptoms of meralgia paresthetica who presented to our clinic after failure of conservative treatment were offered a neurectomy procedure. After this period, the surgical strategy was changed to first neurolysis followed by neurectomy in case of failure. We retrospectively analyzed our results for both strategies with a questionnaire that was focused on pain relief, numbness and the impact of numbness. Ten patients underwent a neurolysis with a 60 % pain relief rate compared to 87.5 % of the eight patients that primarily underwent a neurectomy. Most neurectomy patients (62.5 %) were not hindered by the numbness, 25 % sometimes and only one patient was frequently bothered, but was still satisfied with the outcome. The failures of neurolysis were secondarily treated by neurectomy, which resulted in pain relief in three out of four patients. This series confirms previous reports in the literature that have shown higher success rates for the neurectomy procedure. In addition, it shows that most patients are not bothered by the numbness following this procedure. These observations can be used in the surgical decision making for meralgia paresthetica.

  18. Multi-criteria Decision Support System (DSS) for optimal locations of Soil Aquifer Treatment (SAT) facilities.

    PubMed

    Tsangaratos, P; Kallioras, A; Pizpikis, Th; Vasileiou, E; Ilia, I; Pliakas, F

    2017-12-15

    Managed Aquifer Recharge is a wide-spread well-established groundwater engineering method which is largely seen as sound and sustainable solution to water scarcity hydrologically sensitive areas, such as the Circum Mediterranean. The process of site selection for the installation of a MAR facility is of paramount importance for the feasibility and effectiveness of the project itself, especially when the facility will include the use of waters of impaired quality as a recharge source, as in the case of Soil-Aquifer-Treatment systems. The main objective of this study is to present the developed framework of a multi-criteria Decision Support System (DSS) that integrates within a dynamic platform the main groundwater engineering parameters associated with MAR applications together with the general geographical features which determine the effectiveness of such a project. The proposed system will provide an advanced coupled DSS-GIS tool capable of handling local MAR-related issues -such as hydrogeology, topography, soil, climate etc., and spatially distributed variables -such as societal, economic, administrative, legislative etc., with special reference to Soil-Aquifer-Treatment technologies. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. ESR1 mutations: Moving towards guiding treatment decision-making in metastatic breast cancer patients.

    PubMed

    Angus, Lindsay; Beije, Nick; Jager, Agnes; Martens, John W M; Sleijfer, Stefan

    2017-01-01

    Mutations in the gene coding for the estrogen receptor (ER), ESR1, have been associated with acquired endocrine resistance in patients with ER-positive metastatic breast cancer (MBC). Functional studies revealed that these ESR1 mutations lead to constitutive activity of the ER, meaning that the receptor is active in absence of its ligand estrogen, conferring resistance against several endocrine agents. While recent clinical studies reported that the occurrence of ESR1 mutations is rare in primary breast cancer tumors, these mutations are more frequently observed in metastatic tissue and circulating cell-free DNA of MBC patients pretreated with endocrine therapy. Given the assumed impact that the presence of ESR1 mutations has on outcome to endocrine therapy, assessing ESR1 mutations in MBC patients is likely to be of significant interest to further individualize treatment for MBC patients. Here, ESR1 mutation detection methods and the most relevant pre-clinical and clinical studies on ESR1 mutations regarding endocrine resistance are reviewed, with particular interest in the ultimate goal of guiding treatment decision-making based on ESR1 mutations. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  20. An efficacy driven approach for medication recommendation in type 2 diabetes treatment using data mining techniques.

    PubMed

    Liu, Haifeng; Xie, Guotong; Mei, Jing; Shen, Weijia; Sun, Wen; Li, Xiang

    2013-01-01

    We demonstrate how data mining techniques can help recommend effective medications when physicians need to control the glucose level of patients with type 2 diabetes. We first identify the factors that may affect physicians' medication decisions and then develop a patient-similarity based approach to automatically recommend medications for a patient with the specific condition so that his blood glucose level (measured by HbA1C value) can be well controlled. The approach is validated through experiments on real data sets and compared with the recommendations by following a clinical guideline.

  1. 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

  2. Factors influencing patient decisions to initiate and discontinue subcutaneous testosterone pellets (Testopel) for treatment of hypogonadism.

    PubMed

    Smith, Ryan P; Khanna, Abhinav; Coward, Robert M; Rajanahally, Saneal; Kovac, Jason R; Gonzales, Marshall A; Lipshultz, Larry I

    2013-09-01

    A variety of modalities for testosterone replacement therapy (TRT) are available, including topical gels, injections, and Testopel subcutaneous testosterone pellets (STP). STP are becoming more commonly utilized in the United States; however, patient preferences, expectations, and usage patterns regarding this therapy remain poorly characterized. To identify factors influencing patients' decisions to initiate or discontinue STP. A total of 175 men from an academic urology clinic who were currently using or who had previously used STP for hypogonadism received a 32-item electronic survey. Assessment of the impact of convenience, efficacy, side effects, cost, and symptom relief on initiation and discontinuation of STP. One hundred and thirteen men (64.6% response rate) of mean age 51.4 years who previously underwent a mean of 2.8 STP implant procedures completed the survey. Fifty-nine (52.2%) and 40 (35.4%) men had switched to STP from topical gel and injection therapy, respectively, whereas 14 (12.4%) men initially started TRT with STP. Convenience (68.8%) was the most important factor in patients' decision to start STP, while cost of the previous form of TRT (14.7%) was least important. At the time of the survey, 32 men (28.3%) had discontinued STP therapy. Cost of therapy (50%) was the primary factor in discontinuing STP. There was no difference in serum testosterone levels between men who continued STP and those who discontinued therapy (642.8 vs. 629.0 ng/dL, P = 0.83). Overall, 68.1% of patients continued STP therapy at the time of survey completion. Convenience is the most important factor in a patient's decision to initiate STP; however, physician recommendation also plays a substantial role. Cost was the primary reason for discontinuation. Upon survey completion, greater than two-thirds of respondents elected to continue STP therapy. STP are a viable treatment option for hypogonadal men seeking a convenient and efficacious alternative modality of TRT

  3. Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team.

    PubMed

    Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik; Christensen, Ib Jarle; Lundvall, Lene; Thomsen, Lotte Nedergaard; Høgdall, Claus

    2017-02-01

    Proper planning of intervention and care of ovarian cancer surgery is of outmost importance and involves a wide range of personnel at the departments involved. The aim of this study is to evaluate the introduction of an ovarian surgery classification (COVA) system for facilitating multidisciplinary team (MDT) decisions. Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3 classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA performed. The MDT meeting allocated 213 women (51%) to pre-COVA 1, 136 (33%) to pre-COVA 2, and 52 (12%) to pre-COVA 3. At the end of surgery, 168 (40%) were classified as COVA 1, 158 (38%) were classified as COVA 2, and 28 (7%) were classified as COVA 3. Traced individually, 212 (51%) patients were correctly preclassified at the MDT meeting and distributed into 110 (52%) COVA 1, 71 (52%) COVA 2, and 17 (32%) COVA 3. Analyzing the subgroup of patients with cancer, 164 (47%) were correctly preclassified. Regarding the International Federation of Gynecology and Obstetrics (FIGO) stages, the pre-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV. The COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre-COVA classification facilitates well-organized patient care-relevant procedures to be undertaken. Pre-COVA accurately predicts the final COVA in 51% classified women.

  4. Patient's Cognitive Function and Attitudes Towards Family Involvement in Cancer Treatment Decision Making: A Patient-Family Caregiver Dyadic Analysis.

    PubMed

    Shin, Dong Wook; Cho, Juhee; Roter, Debra L; Kim, So Young; Park, Jong Hyock; Yang, Hyung Kook; Lee, Hyun Woo; Kweon, Sun-Seog; Kang, Yune Sik; Park, Keeho

    2017-07-04

    Older patient populations commonly have cognitive impairment, which might impact decisional capacity. We examined patients and family caregivers preferences for family involvement in treatment decision making assuming different level of cognitive impairment, and sought to explore the factors associated with the preferences and the degree to which patients and family members agree on preferences. A total of 358 elderly cancer patient and caregiver dyads were recruited from the 11 cancer centers in Korea, and were asked to express their preferences for family involvement in treatment decision making using hypothetical scenarios with three different levels of cognitive status (intact, mild impairment, and severe impairment). Both patients and family caregivers preferred greater family dominance in treatment decision making with the increasing the level of cognitive impairment (39.7, 60.9, and 86.6% for patients and 45.0, 66.2, 89.7% for caregivers in each scenarios). Patient and family caregiver concordance in decisional control preference was small for all 3 scenarios (weighted κ=0.32, 0.26, and 0.36, respectively). Higher patient education was associated with preference for patient dominance in treatment decision in conditions of both mild and severe cognitive impairment. The association of higher patient education and patient-caregiver preference concordance was positive with intact cognition, while it was negative with severe cognitive impairment. Decision control preferences were affected by hypothesized cognitive status of the patients. Findings from our study would be helpful to develop effective strategy for optimizing family involvement in cancer treatment decision in the context of deteriorating cognitive function of the patients.

  5. Developing a framework to support shared decision making for youth mental health medication treatment.

    PubMed

    Crickard, Elizabeth L; O'Brien, Megan S; Rapp, Charles A; Holmes, Cheryl L

    2010-10-01

    Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making. The framework includes three functional areas (1) setting the stage for youth shared decision making, (2) facilitating youth shared decision making, and (3) supporting youth shared decision making. While still in the formative stages, the value of a specific framework for a youth model in support of moving from a client-practitioner value system to a systematic, intentional process is evident.

  6. Assessing the Acceptability and Usability of an Interactive Serious Game in Aiding Treatment Decisions for Patients with Localized Prostate Cancer

    PubMed Central

    2011-01-01

    Background Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men’s awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. Objective This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. Methods The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. Results A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient’s health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. Conclusions Serious games are a promising approach to health education

  7. 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

  8. Evaluation with Decision Trees of Efficacy and Safety of Semirigid Ureteroscopy in the Treatment of Proximal Ureteral Calculi.

    PubMed

    Sancak, Eyup Burak; Kılınç, Muhammet Fatih; Yücebaş, Sait Can

    2017-05-05

    The decision on the choice of proximal ureteral stone therapy depends on many factors, and sometimes urologists have difficulty in choosing the treatment option. This study is aimed at evaluating the factors affecting the success of semirigid ureterorenoscopy (URS) using the "decision tree" method. From January 2005 to November 2015, the data of consecutive patients treated for proximal ureteral stone were retrospectively analyzed. A total of 920 patients with proximal ureteral stone treated with semirigid URS were included in the study. All statistically significant attributes were tested using the decision tree method. The model created using decision tree had a sensitivity of 0.993 and an accuracy of 0.857. While URS treatment was successful in 752 patients (81.7%), it was unsuccessful in 168 patients (18.3%). According to the decision tree method, the most important factor affecting the success of URS is whether the stone is impacted to the ureteral wall. The second most important factor affecting treatment was intramural stricture requiring dilatation if the stone is impacted, and the size of the stone if not impacted. Our study suggests that the impacted stone, intramural stricture requiring dilatation and stone size may have a significant effect on the success rate of semirigid URS for proximal ureteral stone. Further studies with population-based and longitudinal design should be conducted to confirm this finding. © 2017 S. Karger AG, Basel.

  9. 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

  10. Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

    PubMed

    Jauhar, Sameer; Guloksuz, Sinan; Andlauer, Olivier; Lydall, Greg; Marques, João Gama; Mendonca, Luis; Dumitrescu, Iolanda; Roventa, Costin; De Vriendt, Nele; Van Zanten, Jeroen; Riese, Florian; Nwachukwu, Izu; Nawka, Alexander; Psaras, Raphael; Masson, Neil; Krishnadas, Rajeev; Volpe, Umberto

    2012-03-30

    Little is known about the factors influencing treatment choice in psychosis, the majority of this work being conducted with specialists (consultant) in psychiatry. We sought to examine trainees' choices of treatment for psychosis if they had to prescribe it for themselves, their patients, and factors influencing decision-making. Cross-sectional, semi-structured questionnaire-based study. Of the 726 respondents (response rate = 66%), the majority chose second-generation antipsychotics (SGAs) if they had to prescribe it for themselves (n = 530, 93%) or for their patients (n = 546, 94%). The main factor influencing choice was perceived efficacy, 84.8% (n = 475) of trainees stating this was the most important factor for the patient, and 77.8% (n = 404) stating this was the most important factor for their own treatment. Trainees with knowledge of trials questioning use of SGAs (CATIE, CUtLASS, TEOSS) were more likely to choose second-generation antipsychotics than those without knowledge of these trials (χ2 = 3.943; p = 0.047; O.R. = 2.11; 95% C.I. = 1.0-4.48). Regarding psychotherapy, cognitive behavioural therapy (CBT) was the most popular choice for self (33.1%; n = 240) and patient (30.9%; n = 224). Trainees were significantly more likely to prefer some form