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Sample records for driven treatment decisions

  1. 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…

  2. 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.

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. 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…

  8. 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…

  9. 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.

  10. 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.

  11. 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…

  12. 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).…

  13. 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…

  14. 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…

  15. 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…

  16. 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.

  17. 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

  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. 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…

  20. 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…

  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. 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

  3. 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

  4. 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

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

    PubMed

    Siminoff, Laura A; Step, Mary M

    2005-07-01

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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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…

  19. 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…

  20. 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, &…

  1. 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…

  2. 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.…

  3. 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…

  4. 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…

  5. 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…

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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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  15. 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.

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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…

  4. 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

  5. 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.

  6. 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…

  7. 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

  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. 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

  10. 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

  11. 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…

  12. 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…

  13. 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…

  14. 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.

  15. 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

  16. 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

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

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

  18. 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.

  19. 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.

  20. 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

  1. 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).

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  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. 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

  10. 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

  11. 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.

  12. 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,…

  13. 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…

  14. 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.

  15. 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.

  16. 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.
.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. [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

  7. 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.

  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. 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.

  10. 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

  11. 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,…

  12. 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…

  13. 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.

  14. 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

  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. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. 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…

  9. 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…

  10. 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.…

  11. 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

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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)

  17. 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.

  18. [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.

  19. 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.

  20. 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

  1. 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.

  2. 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…

  3. 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…

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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

  10. 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…

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. 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

  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. 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.

  20. 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

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

    PubMed

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

    2013-12-01

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

  2. 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

  3. 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.

  4. 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.

  5. 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…

  6. 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...

  7. [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

  8. 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

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. 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

  2. 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.

  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. 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

  5. Choice of antipsychotic treatment by European psychiatry trainees: are decisions based on evidence?

    PubMed Central

    2012-01-01

    Background 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. Methods Cross-sectional, semi-structured questionnaire-based study. Results 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 of psychotherapy for themselves rather than patients (χ2 = 9.98; p < 0,002; O.R. = 1.54; 95% CIs = 1.18-2.0). Conclusions Trainees are more likely to choose second-generation antipsychotic medication for patients and themselves. Despite being aware of evidence that suggests otherwise, they predominantly base these choices on perceived efficacy. PMID:22463055

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

    ERIC Educational Resources Information Center

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

    2013-01-01

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

  7. Significance of the EEG in the decision to initiate antiepileptic treatment in patients with epilepsy: a perspective on recent evidence.

    PubMed

    Jaseja, Harinder

    2009-10-01

    The significance of electroencephalography in the prediction of seizure recurrence after a first unprovoked seizure remains a topic of debate. Opinion on the initiation of antiepileptic treatment after a first seizure also remains divided. However, in view of recent evidence, this article is intended to highlight the significance of a properly performed EEG in the decision to initiate antiepileptic drug treatment as early as possible to prevent further morbidity and other consequences.

  8. 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.

  9. Determining the Best Treatment for Coronal Angular Deformity of the Knee Joint in Growing Children: A Decision Analysis

    PubMed Central

    Sung, Ki Hyuk; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon; Park, Moon Seok

    2014-01-01

    This study aimed to determine the best treatment modality for coronal angular deformity of the knee joint in growing children using decision analysis. A decision tree was created to evaluate 3 treatment modalities for coronal angular deformity in growing children: temporary hemiepiphysiodesis using staples, percutaneous screws, or a tension band plate. A decision analysis model was constructed containing the final outcome score, probability of metal failure, and incomplete correction of deformity. The final outcome was defined as health-related quality of life and was used as a utility in the decision tree. The probabilities associated with each case were obtained by literature review, and health-related quality of life was evaluated by a questionnaire completed by 25 pediatric orthopedic experts. Our decision analysis model favored temporary hemiepiphysiodesis using a tension band plate over temporary hemiepiphysiodesis using percutaneous screws or stapling, with utilities of 0.969, 0.957, and 0.962, respectively. One-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was better than temporary hemiepiphysiodesis using percutaneous screws, when the overall complication rate of hemiepiphysiodesis using a tension band plate was lower than 15.7%. Two-way sensitivity analysis showed that hemiepiphysiodesis using a tension band plate was more beneficial than temporary hemiepiphysiodesis using percutaneous screws. PMID:25276801

  10. BRIDGING FROM CLINICAL ENDPOINTS TO ESTIMATES OF TREATMENT VALUE FOR EXTERNAL DECISION MAKERS

    PubMed Central

    ZHU, C.W.; LEIBMAN, C.; TOWNSEND, R.; MCLAUGHLIN, T.; SCARMEAS, N.; ALBERT, M.; BRANDT, J.; BLACKER, D.; SANO, M.; STERN, Y.

    2009-01-01

    Aim While clinical endpoints provide important information on the efficacy of treatment in controlled conditions, they often are not relevant to decision makers trying to gauge the potential economic impact or value of new treatments. Therefore, it is often necessary to translate changes in cognition, function or behavior into changes in cost or other measures, which can be problematic if not conducted in a transparent manner. The Dependence Scale (DS), which measures the level of assistance a patient requires due to AD-related deficits, may provide a useful measure of the impact of AD progression in a way that is relevant to patients, providers and payers, by linking clinical endpoints to estimates of cost effectiveness or value. The aim of this analysis was to test the association of the DS to clinical endpoints and AD-related costs. Method The relationship between DS score and other endpoints was explored using the Predictors Study, a large, multi-center cohort of patients with probable AD followed annually for four years. Enrollment required a modified Mini-Mental State Examination (mMMS) score ≥30, equivalent to a score of approximately ≥16 on the MMSE. DS summated scores (range: 0–15) were compared to measures of cognition (MMSE), function (Blessed Dementia Rating Scale, BDRS, 0–17), behavior, extrapyramidal symptoms (EPS), and psychotic symptoms (illusions, delusions or hallucinations). Also, estimates for total cost (sum of direct medical cost, direct non-medical cost, and cost of informal caregivers’ time) were compared to DS scores. Results For the 172 patients in the analysis, mean baseline scores were: DS: 5.2 (SD: 2.0), MMSE: 23.0 (SD: 3.5), BDRS: 2.9 (SD: 1.3), EPS: 10.8%, behavior: 28.9% psychotic symptoms: 21.1%. After 4 years, mean scores were: DS: 8.9 (SD: 2.9), MMSE: 17.2 (SD: 4.7), BDRS: 5.2 (SD: 1.4), EPS: 37.5%, behavior: 60.0%, psychotic symptoms: 46.7%. At baseline, DS scores were significantly correlated with MMSE (r=−0.299, p<0

  11. How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

    PubMed Central

    Clarke, Gemma; Harrison, Katy; Holland, Anthony; Kuhn, Isla; Barclay, Stephen

    2013-01-01

    Background Worldwide, the number of individuals lacking the mental capacity to participate in decisions about their own healthcare is increasing. Due to the ageing global population and advancing medical treatments, there are now many more people living longer with neurological disorders, such as dementia, acquired brain injuries, and intellectual disabilities. Many of these individuals have feeding difficulties and may require artificial nutrition. However, little is known about the decision-making process; the evidence base is uncertain and often ethically complex. Using the exemplar of artificial nutrition, the objective of this review is to examine how treatment decisions are made when patients are at risk of lacking capacity. Methods and Findings We undertook a systematic review according to PRISMA guidelines to determine who was involved in decisions, and what factors were considered. We searched PubMed, AMED, CINAHL, EMBASE, PsychINFO, and OpenSigle for quantitative and qualitative studies (1990–2011). Citation, reference, hand searches and expert consultation were also undertaken. Data extraction and quality assessment were undertaken independently and in duplicate. We utilised Thomas and Harden’s ‘Thematic Synthesis’ for analysis. Sixty-six studies met inclusion criteria, comprising data from 40 countries and 34,649 patients, carers and clinicians. Six themes emerged: clinical indications were similar across countries but were insufficient alone for determining outcomes; quality of life was the main decision-making factor but its meaning varied; prolonging life was the second most cited factor; patient’s wishes were influential but not determinative; families had some influence but were infrequently involved in final recommendations; clinicians often felt conflicted about their roles. Conclusions When individuals lack mental capacity, decisions must be made on their behalf. Dynamic interactive factors, such as protecting right to life, not

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

    PubMed

    Pang, M C

    1999-06-01

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

  13. Liquid Biopsy in Metastasized Breast Cancer as Basis for Treatment Decisions.

    PubMed

    Krawczyk, Natalia; Fehm, Tanja; Banys-Paluchowski, Malgorzata; Janni, Wolfgang; Schramm, Amelie

    2016-01-01

    According to current guidelines, the additional biopsy of breast cancer metastases to analyze the receptor status for phenotype assessment is recommended. However, due to clinical difficulties in performing biopsies of metastatic lesions, the phenotype of the primary tumor most often determines the treatment decisions in metastatic breast cancer. Liquid biopsy allows the analysis of several circulating biomarkers like circulating tumor cells (CTCs) or circulating tumor DNA (ctDNA) in peripheral blood samples of cancer patients. Thus, it is an elegant and easily practicable technique that delivers information on the current disease status. Determination of the CTC phenotype regarding the hormone receptor and human epidermal growth factor receptor 2 (HER2) status might replace additional tissue biopsy for planning further therapy strategies. Liquid biopsy is a crucial step towards a more individualized cancer therapy. In contrast to the conventional concept of tissue biopsy, it offers an easy, less invasive acquisition of biomaterial. In addition, it allows multiple repetitions and real-time monitoring of metastasized disease in the clinical routine. However, the clinical utility of liquid biopsy still needs to be evaluated.

  14. 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.

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

    PubMed Central

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

    2015-01-01

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

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

    DTIC Science & Technology

    2006-01-01

    STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Prospect Theory (PT), with risk-attitudes, helps...the groups studied. Background: Expected Utility theory (EU) and its psychologically more accurate extension, Prospect Theory (PT), have...recently moved from the realm of economic decision making into healthcare decision making. These theories underlie several cost-utility analyses (CUA

  17. How can we best respect patient autonomy in breast cancer treatment decisions?

    PubMed Central

    Martinez, Kathryn A; Kurian, Allison W

    2015-01-01

    SUMMARY Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care. Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician. Application of this approach in breast cancer decision-making has not been uniform across cancer-specific interventions (e.g., surgery, chemotherapy), and in some circumstances may present challenges to evidence-based care delivery. Increasingly precise estimates of individual patients’ risk of recurrence and commensurate predicted benefit from certain therapies hold significant promise in helping patients exercise autonomous decision-making for their breast cancer care, yet will also likely complicate decision-making for certain subgroups of patients. PMID:25733982

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

    PubMed Central

    Scheitel, Marianne R.; Kessler, Maya E.; Shellum, Jane L.; Peters, Steve G.; Milliner, Dawn S.; Liu, Hongfang; Elayavilli, Ravikumar Komandur; Poterack, Karl A.; Miksch, Timothy A.; Boysen, Jennifer J.; Hankey, Ron A.

    2017-01-01

    Summary Background 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. Objective 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. Methods 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. Results 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. Conclusion Informatics solution can greatly improve the efficiency and accuracy of individualized treatment recommendations and have the potential to increase guideline compliance. PMID:28174820

  19. [End-of-life decisions and reluctant treatment of newborns on the borderline of viability in the Netherlands].

    PubMed

    Kollée, L A A

    2005-09-10

    End-of-life decisions are taken in the majority of deaths below one year of age, especially in neonatal intensive-care units. In the Netherlands, the frequency of such decisions has not increased in recent years. Intentional termination of life occurred in 1% of the deaths, which would be about 10 cases each year. However, only 3 such cases are reported to the public prosecutor for review by the responsible physician. Proposals from the government to facilitate reporting of such cases are awaited. Dutch neonatologists are reluctant to administer full neonatal intensive care to extremely preterm infants. Currently, the policy regarding antenatal referral and treatment of extremely preterm infants is being re-evaluated by obstetricians and neonatologists. Behind the stable frequency of end-of-life decisions, difficult ethical issues remain to be solved.

  20. Data Driven Approach to Burden of Treatment Measurement: A Study of Patients with Breast Cancer

    PubMed Central

    Cheng, Alex C.; Levy, Mia A.

    2016-01-01

    Chronic disease affects patient quality of life through symptoms of the disease and the work of receiving treatment. While the effects of illness are well investigated, the burden of treatment is not commonly studied or monitored. We developed a method to quantify one dimension of the burden of treatment based on patient encounters with the healthcare system. We applied this method to a population of stage I-III breast cancer patients. As hypothesized and observed, stage IIIpatients had more appointments, spent more time in clinic, and spent more time admitted to the hospital in the first 18 months after diagnosis compared to stage I and II patients. Future work will evaluate the reproducibility and generalizability of this method for quantifying burden of treatment across other clinical settings and chronic diseases. This approach could enable identification of high-risk groups that could benefit from interventions to decrease patient work and improve outcomes. PMID:28269934

  1. Factors affecting decisions to seek treatment for sick children in Kerala, India.

    PubMed

    Pillai, Rajamohanan K; Williams, Sankey V; Glick, Henry A; Polsky, Daniel; Berlin, Jesse A; Lowe, Robert A

    2003-09-01

    The purpose of this study was to measure the effects of social and economic variables, disease-related variables, and child gender on the decisions of parents in Kerala, India, to seek care for their children and on their choice of providers in the allopathic vs. the alternative system. A case-control analysis was done using data from the Kerala section of the 1996 Indian National Family Health Survey, a cross-sectional survey of a probability sample of households conducted by trained interviewers with a close-ended questionnaire. Of the 469 children who were eligible for this study because they had at least one common symptom suggestive of acute respiratory illness or diarrhea during the 2 weeks before the interview, 78 (17%) did not receive medical care, while the remaining 391 (83%) received medical care. Of the 391 children who received medical care, 342 (88%) received allopathic medical care, and 48 (12%) received alternative medical care. In multivariable analyses, parents chose not to seek medical care for their children significantly more often when the illness was mild, the child had a specific diagnosis, the mother had previously made fewer antenatal visits, and the family had a higher economic status. When parents sought medical care for their children, care was sought significantly more often in the alternative provider system when the child was a boy, the family lived in a rural area, and the family had a lower social class. We conclude that, in Kerala, disease severity and economic status predict whether children with acute respiratory infection or diarrhea are taken to medical providers. In contrast, most studies of this issue carried out in other populations have identified economic status as the primary predictor of medical system utilization. Also in Kerala, the gender of the child did not influence whether or not the child was taken for treatment but did influence whether care was sought in the alternative or the allopathic system.

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

    PubMed Central

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

    2001-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  4. Research to practice in addiction treatment: key terms and a field-driven model of technology transfer.

    PubMed

    2011-09-01

    The transfer of new technologies (e.g., evidence-based practices) into substance abuse treatment organizations often occurs long after they have been developed and shown to be effective. Transfer is slowed, in part, due to a lack of clear understanding about all that is needed to achieve full implementation of these technologies. Such misunderstanding is exacerbated by inconsistent terminology and overlapping models of an innovation, including its development and validation, dissemination to the public, and implementation or use in the field. For this reason, a workgroup of the Addiction Technology Transfer Center (ATTC) Network developed a field-driven conceptual model of the innovation process that more precisely defines relevant terms and concepts and integrates them into a comprehensive taxonomy. The proposed definitions and conceptual framework will allow for improved understanding and consensus regarding the distinct meaning and conceptual relationships between dimensions of the technology transfer process and accelerate the use of evidence-based practices.

  5. Hypothesis-Driven Medication Discovery for the Treatment of Psychostimulant Addiction

    PubMed Central

    Xi, Zheng-Xiong; Gardner, Eliot L.

    2008-01-01

    Psychostimulant abuse is a serious social and health problem, for which no effective treatments currently exist. A number of review articles have described predominantly ‘clinic’-based pharmacotherapies for the treatment of psychostimulant addiction, but none have yet been shown to be definitively effective for use in humans. In the present article, we review various ‘hypothesis’- or ‘mechanism’-based pharmacological agents that have been studied at the preclinical level and evaluate their potential use in the treatment of psychostimulant addiction in humans. These compounds target brain neurotransmitter or neuromodulator systems, including dopamine (DA), γ-aminobutyric acid (GABA), endocannabinoid, glutamate, opioid and serotonin, which have been shown to be critically involved in drug reward and addiction. For drugs in each category, we first briefly review the role of each neurotransmitter system in psychostimulant actions, and then discuss the mechanistic rationale for each drug’s potential anti-addiction efficacy, major findings with each drug in animal models of psychostimulant addiction, abuse liability and potential problems, and future research directions. We conclude that hypothesis-based medication development strategies could significantly promote medication discovery for the effective treatment of psychostimulant addiction. PMID:19430578

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

    PubMed

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

    2014-06-17

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

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

    PubMed Central

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

    2016-01-01

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

  8. No Further Action Decision Under CERCLA, Fort Devens Study Area 19, 20 and 21, Waste Water Treatment Plant

    DTIC Science & Technology

    1995-11-01

    Priorities List under the Comprehensive Environmental Response, Compensation and Liability Act ( CERCLA ) as amended by the Superfund Amendments and...i U.S. Army NO FURTHER ACTION DECISION UNDER CERCLA - Environmental Center FORT DEVENS STUDY AREA 19, 20 AND 21 WASTE WATER TREATMENT PLANT II...AEC Farm 45, 1 Feb 93 replaces THAMA Form 45 which is obsolete. I I I NO FURTHER ACTION DECISIONI UNDER CERCLA STUDY AREAS 19, 20 and 213WASTE WATER

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

    PubMed Central

    Bellavance, Emily Catherine; Kesmodel, Susan Beth

    2016-01-01

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

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

    NASA Astrophysics Data System (ADS)

    Chiam, Tze; Mitchell, Cary; Yih, Yuehwern

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

  11. A treatment planning study to assess the feasibility of laser-driven proton therapy using a compact gantry design

    SciTech Connect

    Hofmann, Kerstin M. Wilkens, Jan J.; Masood, Umar; Pawelke, Joerg

    2015-09-15

    Purpose: Laser-driven proton acceleration is suggested as a cost- and space-efficient alternative for future radiation therapy centers, although the properties of these beams are fairly different compared to conventionally accelerated proton beams. The laser-driven proton beam is extremely pulsed containing a very high proton number within ultrashort bunches at low bunch repetition rates of few Hz and the energy spectrum of the protons per bunch is very broad. Moreover, these laser accelerated bunches are subject to shot-to-shot fluctuations. Therefore, the aim of this study was to investigate the feasibility of a compact gantry design for laser-driven proton therapy and to determine limitations to comply with. Methods: Based on a published gantry beam line design which can filter parabolic spectra from an exponentially decaying broad initial spectrum, a treatment planning study was performed on real patient data sets. All potential parabolic spectra were fed into a treatment planning system and numerous spot scanning proton plans were calculated. To investigate limitations in the fluence per bunch, the proton number of the initial spectrum and the beam width at patient entrance were varied. A scenario where only integer shots are delivered as well as an intensity modulation from shot to shot was studied. The resulting plans were evaluated depending on their dosimetric quality and in terms of required treatment time. In addition, the influence of random shot-to-shot fluctuations on the plan quality was analyzed. Results: The study showed that clinically relevant dose distributions can be produced with the system under investigation even with integer shots. For small target volumes receiving high doses per fraction, the initial proton number per bunch must remain between 1.4 × 10{sup 8} and 8.3 × 10{sup 9} to achieve acceptable delivery times as well as plan qualities. For larger target volumes and standard doses per fraction, the initial proton number is even

  12. 'Omics'-driven discoveries in prevention and treatment of type 2 diabetes.

    PubMed

    Gjesing, Anette P; Pedersen, Oluf

    2012-06-01

    Eur J Clin Invest 2012; 42 (6): 579-588 ABSTRACT: Glucose-based methods are currently gold standards for identifying individuals at risk of type 2 diabetes. Obviously, these methods only consider one of many pathologies of impaired glucose metabolism and they all suffer from a poor specificity as type 2 diabetes risk assessment tools. Recently, however, panels of multiple biomarkers reflecting several pre-diabetic pathologies have been developed. Their specificity and potentials for future risk stratification are discussed. As a multifactorial disorder type 2 diabetes calls for a multifactorial treatment approach targeting multiple but modifiable vascular risk factors. The same holds for pre-diabetic states and prevention hereof. In addition, type 2 diabetes and pre-diabetes show major heterogeneity between affected individuals in pathology, risk of organ damages, progression rate and responsiveness to treatment or prevention. Despite the heterogeneity and uniqueness of type 2 diabetes and pre-diabetes most affected individuals are currently offered interventions as if they all have the same disease or risk of disease and will respond similarly. The complex origin and course of type 2 diabetes combined with uniformity and non-specificity of current interventions may explain the high rate of treatment failures and the relative poor prognosis of many diabetes patients. Given this situation, the present review also explores the perspectives of selected examples within applied genomics and metagenomics for improving patient care by facilitating interventions tailored to specific subpopulations.

  13. Purchasing health insurance coverage for smoking cessation treatment: employers describe the most influential information in this decision.

    PubMed

    Woolf, Nicholas H; Burns, Marguerite E; Bosworth, Timothy W; Fiore, Michael C

    2006-12-01

    Employer provision of insurance coverage for smoking cessation treatment (SCT) remains spotty despite a body of treatment efficacy and cost-effectiveness evidence available to inform and support this health care purchasing decision. This qualitative study examined the information on which this coverage decision is made. In this study, state employers describe the content and sources of the most influential information in their decision to provide insurance coverage for SCT as well as a second health benefit for comparative purposes. We provide insight into the extent to which SCT evidence informs the SCT coverage decision and suggest topics and targets for research dissemination. We interviewed 55 employee benefit staff in 35 states. Responses were compared from states with and without SCT coverage to explore the types of information that may be more effective at promoting coverage. The content and sources of the information employers judged most useful varied notably between states with and without SCT coverage. Compelling evidence of the efficacy of SCT and its cost-effectiveness did not appear to play an influential role in the SCT decision among states without SCT coverage relative to states with SCT coverage. States with SCT coverage relied significantly on benefit consultants and actuaries for the information they described as most influential; in comparison, noncovered states reported service providers, staff, and the Internet as major information sources. To foster employers' provision of SCT coverage, research dissemination efforts should emphasize SCT efficacy and cost-effectiveness information and tailor communication to benefit consultants and actuaries in addition to employers themselves.

  14. Caries detection methods: can they aid decision making for invasive sealant treatment?

    PubMed

    Pereira, A C; Verdonschot, E H; Huysmans, M C

    2001-01-01

    The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut-offs for traditional dentine caries detection and at reduced cut-offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut-offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut-offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut-offs may aid the indication of invasive sealant

  15. Tools to Support Policy Decisions Related to Treatment Strategies and Surveillance of Schistosomiasis Japonica towards Elimination

    PubMed Central

    Zhou, Xiao-Nong; Xu, Jing; Chen, Hong-Gen; Wang, Tian-Ping; Huang, Xi-Bao; Lin, Dan-Dan; Wang, Qi-Zhi; Tang, Li; Guo, Jia-Gang; Wu, Xiao-Hua; Feng, Ting; Chen, Jia-Xu; Guo, Jian; Chen, Shao-Hong; Li, Hao; Wu, Zhong-Dao; Peeling, Rosanna W.

    2011-01-01

    Background Appropriate diagnostics to monitor disease trends and assess the effectiveness and impact of interventions are essential for guiding treatment strategies at different thresholds of schistosomiasis transmission and for certifying elimination. Field validation of these assays is urgently needed before they can be adopted to support policy decisions of the national programme for control and elimination of schistosomiasis in P.R. China. We compared the efficacy and utility of different immunoassays in guiding control strategies and monitoring the endemic status of S. japonicum infections towards elimination. Methodology/Principal Findings A cross-sectional survey was conducted in seven villages with different transmission intensities settings to assess the performance and utility of three immunoassays, e.g., an indirect hemagglutination assay (IHA_JX), an enzyme linked immunosorbent assay (ELISA_SZ), and a dot immunogold filtration assay (DIGFA_SH). 6,248 individuals aged 6–65 years old who gave consent and supplied their stool and blood samples were included for data analysis. Results showed that ELISA_SZ performed significantly higher sensitivity (95.45%, 95%CI: 92.94–97.97%) than IHA_JX (87.59%, 95%CI: 83.51–91.49%) and DIGFA_SH (79.55%, 95%CI: 74.68–84.41%), especially in subgroups with very low infection intensity. The specificity of ELISA_SZ, IHA_JX, DIGFA_SH in 6–9 year olds with occasional exposure was nearly 90%. DIGFA_SH performed the highest screening efficacy for patients among three assays with overall positive predicative value of 13.07% (95%CI: 11.42–14.72%). We found a positive correlation of antibody positive rate of IHA_JX with results of stool examination in age strata (r = 0.70, P<0.001). Seropositivity of IHA_JX in children aged 6–9 years old showed an excellent correlation with prevalence of schistosome infection in the seven communities (r = 0.77, P<0.05). Conclusions/Significance Studies suggest that ELISA

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

    PubMed Central

    van der Veeken, Frida C. A.

    2016-01-01

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

  17. Decision Support for Medical Treatment: A TPN Prescription System on a Central Hospital Computer

    PubMed Central

    Moliver, Nina; Coates, Allan L.

    1987-01-01

    An interactive decision-support system for the prescription of total or partial parenteral nutrition (TPN) is described. The system is applicable to all sizes and ages of patients, from premature infants to adults. Both the physician and the pharmacist are users of the system, with the physician using rule-based safety checks and branching algorithms to make decisions in the prescription process, and the pharmacist receiving the prescription totals electronically in order to complete further calculations needed. Since its introduction, the system appears to have increased the safety of the TPN prescription, saved time, and improved the quality and appropriateness of TPN prescriptions.

  18. Decision-making analysis for allergen immunotherapy versus nasal steroids in the treatment of nasal steroid–responsive allergic rhinitis

    PubMed Central

    Robinson, Derek; Christophel, Jared; Borish, Larry; Payne, Spencer

    2014-01-01

    Background: The purpose of the study was to determine the age at which initiation of specific subcutaneous immunotherapy (SCIT) becomes more cost-effective than continued lifetime intranasal steroid (NS) therapy in the treatment of allergic rhinitis, with the use of a decision analysis model. Methods: A Markov decision analysis model was created for this study. Economic analyses were performed to identify “break-even” points in the treatment of allergic rhinitis with the use of SCIT and NS. Efficacy rates for therapy and cost data were collected from the published literature. Models in which there was only incomplete improvement while receiving SCIT were also evaluated for economic break-even points. The primary perspective of the study was societal. Results: Multiple break-even point curves were obtained corresponding to various clinical scenarios. For patients with seasonal allergic rhinitis requiring NS (i.e., fluticasone) 6 months per year, the age at which initiation of SCIT provides long-term direct cost advantage is less than 41 years. For patients with perennial rhinitis symptoms requiring year-round NS, the cut-off age for SCIT cost-effectiveness increases to 60 years. Hypothetical subjects who require continued NS treatment (50% reduction of previous dosage) while receiving SCIT also display break-even points, whereby it is economically advantageous to consider allergy referral and SCIT, dependent on the cost of the NS prescribed. Conclusion: The age at which SCIT provides economic advantages over NS in the treatment of allergic rhinitis depends on multiple clinical factors. Decision analysis models can assist the physician in accounting for these factors and customize patient counseling with regard to treatment options. PMID:24717886

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

    PubMed

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

    2015-05-01

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

  20. Unethical bunglers or humane professionals? Discussions in the media of end-of-life treatment decisions.

    PubMed

    Hildén, Hanna-Mari; Honkasalo, Marja-Liisa

    2006-01-01

    We studied media discussions of end-of-life decision making to find out how the doctor-patient relationship is portrayed and what types of positions the media takes and how it is represented by other discussion participants in this context. The significance of the end-of-life decision making is related to the fact that it forms a contested site for the realization of patient autonomy. Our material consisted of two newspaper discussions and one television program. In all three samples, the consumerist physician-patient relationship model was promoted in the context of end-of-life decision making by the media representatives and the laypeople (patients, relatives, and a patient advocate). In the first, the media representatives make use of the romance narrative, which presents physicians as villains, and constructs patients as knowledgeable and competent 'ordinary heroes'. This justifies public scrutiny of healthcare. In the second sample, the relatives stress their competence but now by appealing to their knowledge and caring for the patient. This promotes their right to make decisions for patients. In the third sample, the journalist again pictures patients as 'ordinary heroes' who acquire their knowledge from the media. Patients are now empowered as consumers of healthcare. In conclusion, the consumerist doctor-patient relationship is promoted and the media's position as the source of information and as patient advocate is stabilized.

  1. Relationship of Youth Involvement in Diabetes-Related Decisions to Treatment Adherence

    PubMed Central

    Miller, Victoria A.; Jawad, Abbas F.

    2014-01-01

    The aim of this study was to examine the relationship of youth’s involvement in diabetes-related decisions to adherence. Children and adolescents (8–19 years) and their parents (N = 89) completed the Decision Making Involvement Scale (DMIS) and the Self Care Inventory, a self-report measure of adherence. After controlling for youth age, the degree to which youth expressed an opinion and information to parents was associated with better parent- and youth- reported adherence. The degree to which parents expressed an opinion and information to youth was associated with worse parent-reported adherence. Joint decision-making behaviors (e.g., negotiation; provision of options) also were associated with better youth-reported adherence. Encouraging youth to express opinions and share illness-related information with parents during illness management discussions may improve adherence. Additional research is needed to identify mechanisms of effect and determine associations between decision making involvement and health behaviors and outcomes over time. PMID:24659299

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

    ERIC Educational Resources Information Center

    Ramsey, Gregory W.

    2010-01-01

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

  3. Anaplastic lymphoma kinase (ALK) inhibitors in the treatment of ALK-driven lung cancers.

    PubMed

    Roskoski, Robert

    2017-03-01

    Anaplastic lymphoma kinase is expressed in two-thirds of the anaplastic large-cell lymphomas as an NPM-ALK fusion protein. Physiological ALK is a receptor protein-tyrosine kinase within the insulin receptor superfamily of proteins that participates in nervous system development. The EML4-ALK fusion protein and four other ALK-fusion proteins play a fundamental role in the development in about 5% of non-small cell lung cancers. The amino-terminal portions of the ALK fusion proteins result in dimerization and subsequent activation of the ALK protein kinase domain that plays a key role in the pathogenesis of various tumors. Downstream signaling from the ALK fusion protein leads to the activation of the Ras/Raf/MEK/ERK1/2 cell proliferation module and the JAK/STAT cell survival pathways. Moreover, nearly two dozen ALK activating mutations are involved in the pathogenesis of childhood neuroblastomas. The occurrence of oncogenic ALK-fusion proteins, particularly in non-small cell lung cancer, has fostered considerable interest in the development of ALK inhibitors. Crizotinib was the first such inhibitor approved by the US Food and Drug Administration for the treatment of ALK-positive non-small cell lung cancer in 2011. The median time for the emergence of crizotinib drug resistance is 10.5 months after the initiation of therapy. Such resistance prompted the development of second-generation drugs including ceritinib and alectinib, which are approved for the treatment of non-small cell lung cancer. Unlike the single gatekeeper mutation that occurs in drug-resistant epidermal growth factor receptor in lung cancer, nearly a dozen different mutations in the catalytic domain of ALK fusion proteins have been discovered that result in crizotinib resistance. Crizotinib, ceritinib, and alectinib form a complex within the front cleft between the small and large lobes of an inactive ALK protein-kinase domain with a compact activation segment. These drugs are classified as type I½ B

  4. Model-driven therapeutic treatment of neurological disorders: reshaping brain rhythms with neuromodulation

    PubMed Central

    Modolo, Julien; Legros, Alexandre; Thomas, Alex W.; Beuter, Anne

    2011-01-01

    Electric stimulation has been investigated for several decades to treat, with various degrees of success, a broad spectrum of neurological disorders. Historically, the development of these methods has been largely empirical but has led to a remarkably efficient, yet invasive treatment: deep brain stimulation (DBS). However, the efficiency of DBS is limited by our lack of understanding of the underlying physiological mechanisms and by the complex relationship existing between brain processing and behaviour. Biophysical modelling of brain activity, describing multi-scale spatio-temporal patterns of neuronal activity using a mathematical model and taking into account the physical properties of brain tissue, represents one way to fill this gap. In this review, we illustrate how biophysical modelling is beginning to emerge as a driving force orienting the development of innovative brain stimulation methods that may move DBS forward. We present examples of modelling works that have provided fruitful insights in regards to DBS underlying mechanisms, and others that also suggest potential improvements for this neurosurgical procedure. The reviewed literature emphasizes that biophysical modelling is a valuable tool to assist a rational development of electrical and/or magnetic brain stimulation methods tailored to both the disease and the patient's characteristics. PMID:22419974

  5. ErbB Receptor-Driven Prolactinomas Respond to Targeted Lapatinib Treatment in Female Transgenic Mice

    PubMed Central

    Liu, Xiaohai; Kano, Maya; Araki, Takako; Cooper, Odelia; Fukuoka, Hidenori; Tone, Yukiko; Tone, Masahide

    2015-01-01

    As ErbB receptors are expressed in prolactinomas and exhibit downstream effects on prolactin (PRL) production and cell proliferation, we generated transgenic mice using a PRL enhancer/promoter expression system to restrict lactotroph-specific expression of human epidermal growth factor receptor (EGFR) or human EGFR2 (HER2). EGFR or HER2 transgenic mice developed prolactinomas between 13 and 15 months, and confocal immunofluorescence and Western blot analysis confirmed lactotroph-restricted PRL and EGFR or HER2 coexpression. Circulating PRL levels in EGFR and HER2 transgenic mice were increased 5- and 3.8-fold, respectively. Inhibiting EGFR or HER2 signaling with oral lapatinib (100 mg/kg), a dual tyrosine kinase inhibitor for both EGFR and HER2, suppressed circulating PRL by 72% and attenuated tumor PRL expression by 80% and also attenuated downstream tumor EGFR/HER2 signaling. This model demonstrates the role of ErbB receptors underlying prolactinoma tumorigenesis and the feasibility of targeting these receptors for translation to treatment of refractory prolactinomas. PMID:25375038

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

    PubMed

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

    2015-06-01

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

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

    PubMed Central

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  9. 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 the Plant Protection and Quarantine Treatment Manual and to retain the current treatment schedule... out in the Plant Protection and Quarantine (PPQ) Treatment Manual.\\1\\ Section 305.3 sets out a process... Protection and Quarantine, Manuals Unit, 92 Thomas Johnson Drive, Suite 200, Frederick, MD 21702....

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

    PubMed

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

    2016-07-05

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

  11. A patient decision aid to support shared decision‐making on anti‐thrombotic treatment of patients with atrial fibrillation: randomised controlled trial

    PubMed Central

    Thomson, Richard G; Eccles, Martin P; Steen, I Nick; Greenaway, Jane; Stobbart, Lynne; Murtagh, Madeleine J; May, Carl R

    2007-01-01

    Objective To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy. Design Two‐armed open exploratory randomised controlled trial. Setting Two research clinics deriving participants from general practices in Northeast England. Participants 109 patients with atrial fibrillation aged over 60. Interventions Computerised decision aid applied in shared decision‐making clinic compared to evidence‐based paper guidelines applied as direct advice. Main outcome measures Primary outcome measure was the decision conflict scale. Secondary outcome measures included anxiety, knowledge, decision‐making preference, treatment decision, use of primary and secondary care services and health outcomes. Results Decision conflict was lower in the computerised decision aid group immediately after the clinic; mean difference −0.18 (95% CI −0.34 to −0.01). Participants in this group not already on warfarin were much less likely to start warfarin than those in the guidelines arm (4/16, 25% compared to the guidelines group 15/16, 93.8%, RR 0.27, 95% CI 0.11 to 0.63). Conclusions Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision‐making consultation than immediately following direct doctor‐led advice based on paper guidelines. Furthermore, participants in the computerised decision aid group were significantly much less likely to start warfarin than those in the guidelines arm. The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids, but also reduces the uptake of a clinically effective treatment that may have important implications for health outcomes. PMID:17545350

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

    PubMed

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

    2015-06-01

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

  13. Decision making for pregnant adolescents: applying reasoned action theory to research and treatment.

    PubMed

    Cervera, N J

    1993-06-01

    Unmarried adolescent mothers face greater risk of less schooling, more emotional problems, higher poverty, and less income than those who relinquish their infants for adoption. Currently, around 5% of unmarried mothers give up their children for adoption (52,000 children annually, of which 24,500 are infants). Reasoned-action theory according to Ajzen and Fishbein (1980) was utilized in order to examine the potent family and personal variables that underlie this decision. In addition, a literature review of research studies applying reasoned-action theory to pregnant teenagers is provided, along with suggestions for clinical application of the theory. Family support has been found an important variable in the teenagers' decision. Family members may encourage or discourage the teenagers to keep the baby. Families may come closer together to cope with an unplanned pregnancy; however, some families experience deterioration of adaptability over time. The theory focuses 1) on the relationship of the individual and the decision or behavioral intention (BI), and 2) on immediate sociopsychological determinants of a BI. In some instances behavior (B) and BI are unrelated. The theory characterizes BIs in terms of the subjective probability concerning behavioral performance. The person's intention to perform a behavior is the result of a choice between behavioral alternatives: 1) adoption, 2) keeping the child as single mother, 3) keeping the child and raising it with the father in a formal relationship, 4) keeping the child and raising it with the help of parents. According to the Fishbein and Ajzen model, differences between minority and White relinquishment rates occur because these groups 1) differ in their beliefs and attitudes toward behavioral alternatives, 2) differ in normative beliefs, and/or 3) differ in relative weights they accord to attitudes versus cultural norms. This model with many variables is useful in measuring behavior, choice, and BI; attitudes and

  14. [Decisions around the end of life on Intensive Care: making the transition from curative to palliative treatment].

    PubMed

    van der Werf, T S; Zijlstra, J G; Ligtenberg, J J M; Tulleken, J E

    2005-04-02

    The decision to move from curative treatment to palliative care in the intensive-care situation is less related to morals and ethics than it is to the assessment of medical issues, professionalism, communication and orchestration. Treatment should be considered medically pointless if, in the view of the treating physicians, it does not offer realistic chance to return to a meaningful life. Continuing futile care can be seen as disrespectful, both to the patient, his partner and the family, as well as to the members of the ICU team. Intensivists are responsible for withholding or withdrawing life support to patients in whom further life support is considered futile and who are unable to express their wishes due to critical illness and sedation. The intensivist typically makes this type of decision after a period in which medical and other information has been collected and after intensive discussions with other medical professionals as well as the partner and family. This is based on the trust that is built up through their skill, attitude and behaviour and that is perpetuated in a continuing process of intensive communication. Conflicts should be prevented, or at least recognised early and discussed. Ifa conflict is ongoing then it should be tackled by planning a number of consecutive consultations.

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

    SciTech Connect

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

    2010-05-15

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

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

    PubMed

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

    2010-05-01

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

  17. Design and implementation of decision support for tobacco dependence treatment in an inpatient electronic medical record: a randomized trial.

    PubMed

    Bernstein, Steven L; Rosner, June; DeWitt, Michelle; Tetrault, Jeanette; Hsiao, Allen L; Dziura, James; Sussman, Scott; O'Connor, Patrick; Toll, Benjamin

    2017-02-13

    Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city. When an adult patient was admitted to a medical service, an electronic alert appeared if the patient was coded in the EHR as a smoker. For physicians randomized to the intervention, the alert linked to an order set to prescribe tobacco treatment medications and refer the patient to the state tobacco quitline. Additionally, "tobacco use disorder" was added to the patient's problem list, and an e-mail was sent to the patient's primary care provider (PCP). In the control arm, an alert fired with no screen visibility. Generalized estimating equations were used to model the data. Since August 2013, the alert has appeared for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication (35 vs. 29%, P < 0.0001), populate the problem list with tobacco use disorder (41 vs. 2%, P < 0.0001), and make a referral to the state smokers' quitline (30 vs. 0%, P < 0.0001). In addition, intervention physicians sent an e-mail to the patient's PCP 4152 (99%) times. Designing and implementing an order set and alert for tobacco treatment in an EHR is feasible and helps physicians place more orders for tobacco treatment medication, referrals to the state smokers' quitline, and e-mails to patients' PCPs

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

    PubMed

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

    2016-04-01

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

  19. Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years

    PubMed Central

    2009-01-01

    Introduction Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level. Programme approach We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008. Discussion and Evaluation Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. Conclusion Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates

  20. Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians with and without Training in Evidence-Based Treatment

    ERIC Educational Resources Information Center

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

    2015-01-01

    Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…

  1. Preliminary testing of a just‐in‐time, user‐defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions

    PubMed Central

    Jibaja‐Weiss, Maria L.; Volk, Robert J.; Friedman, Lois C.; Granchi, Thomas S.; Neff, Nancy E.; Spann, Stephen J.; Robinson, Emily K.; Aoki, Noriaki; Robert Beck, J.

    2006-01-01

    Abstract Objective  To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. Design  Pre‐post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. Sample  Fifty‐one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. Intervention  A computerized decision aid that combines entertainment‐education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. Outcomes  Patients’ use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). Results  Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. Conclusions  A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients. PMID:16911136

  2. Benefits and risks of emerging technologies: integrating life cycle assessment and decision analysis to assess lumber treatment alternatives.

    PubMed

    Tsang, Michael P; Bates, Matthew E; Madison, Marcus; Linkov, Igor

    2014-10-07

    Assessing the best options among emerging technologies (e.g., new chemicals, nanotechnologies) is complicated because of trade-offs across benefits and risks that are difficult to quantify given limited and fragmented availability of information. This study demonstrates the integration of multicriteria decision analysis (MCDA) and life cycle assessment (LCA) to address technology alternative selection decisions. As a case study, prioritization of six lumber treatment alternatives [micronized copper quaternary (MCQ); alkaline copper quaternary (ACQ); water-borne copper naphthenate (CN); oil-borne copper naphthenate (CNo); water-borne copper quinolate (CQ); and water-borne zinc naphthenate (ZN)] for military use are considered. Multiattribute value theory (MAVT) is used to derive risk and benefit scores. Risk scores are calculated using a cradle-to-gate LCA. Benefit scores are calculated by scoring of cost, durability, and corrosiveness criteria. Three weighting schemes are used, representing Environmental, Military and Balanced stakeholder perspectives. Aggregated scores from all three perspectives show CQ to be the least favorable alterative. MCQ is identified as the most favorable alternative from the Environmental stakeholder perspective. From the Military stakeholder perspective, ZN is determined to be the most favorable alternative, followed closely by MCQ. This type of scoring and ranking of multiple heterogeneous criteria in a systematic and transparent way facilitates better justification of technology selection and regulation.

  3. Do objective estimates of chances for survival influence decisions to withhold or withdraw treatment? The French Multicentric Group of ICU Research.

    PubMed

    Knaus, W A; Rauss, A; Alperovitch, A; Le Gall, J R; Loirat, P; Patois, E; Marcus, S E

    1990-01-01

    The authors studied the impact on clinical decision making of providing feedback of objective prognostic information describing the probability of survival for ICU patients with multiple organ system failure (OSF). The prognostic estimates, derived from a control period (1), were to be provided on a daily basis to physicians providing treatment in 25 French ICUs during a subsequent experimental period (2). The types of, frequencies of, and reasons for decisions to limit or stop treatment in the two periods were compared. In the experimental period 2, 17 ICUs participated in the feedback study. Within these 17 units, there was a small but significant (p less than 0.05) increase in decisions to stop active treatment and provide comfort care that was limited to patients with three or more OSFs. There was no change in decision making in the eight units that did not participate in the feedback study. Although these results suggest a direct causal relationship between the provision of objective prognostic data and changes in physician decision making, the small increase in comfort care decisions (n = 14) between period 1 and period 2 and the fact that only 17 of the 25 original units participated in the feedback study make it difficult to eliminate other influences. There was no indication in this study, however, that explicit provision of prognostic data led to a sense of therapeutic futility.

  4. 'Consumers are patients!' shared decision-making and treatment non-compliance as business opportunity.

    PubMed

    Applbaum, Kalman

    2009-03-01

    This article describes an aspect of the progressive insertion of commercial interests into the relationship between patients and their clinicians, with particular reference to psychiatry. Treatment noncompliance, a long-standing problem for healthcare professionals, has lately drawn the attention of the pharmaceutical and allied industries as a site at which to improve return on investment (ROI). Newly founded corporate ;compliance departments' and specialized consultancies that regard noncompliance as a form of marketing failure are seeking to rectify it with reinvigorated models and strategies. This intervention stands to impact patients' experience of illness as well as the participation of those formally (physicians, case managers, etc.) and informally (family, friends, etc.) involved in treatment. My analysis draws upon observation at compliance conferences to demonstrate the contrasting models of patient empowerment underlying the marketing vs. medical approaches. I propose a research agenda for measuring the effects of industry compliance programs.

  5. StrandAdvantage test for early-line and advanced-stage treatment decisions in solid tumors.

    PubMed

    Sen, Manimala; Katragadda, Shanmukh; Ravichandran, Aarthi; Deshpande, Gouri; Parulekar, Minothi; Nayanala, Swetha; Vittal, Vikram; Shen, Weiming; Phooi Nee Yong, Melanie; Jacob, Jemima; Parchuru, Sravanthi; Dhanuskodi, Kalpana; Eyring, Kenneth; Agrawal, Pooja; Agarwal, Smita; Shanmugam, Ashwini; Gupta, Satish; Vishwanath, Divya; Kumari, Kiran; Hariharan, Arun K; Balaji, Sai A; Liang, Qiaoling; Robolledo, Belen; Gauribidanur Raghavendrachar, Vijayashree; Oomer Farooque, Mohammed; Buresh, Cary J; Ramamoorthy, Preveen; Bahadur, Urvashi; Subramanian, Kalyanasundaram; Hariharan, Ramesh; Veeramachaneni, Vamsi; Sankaran, Satish; Gupta, Vaijayanti

    2017-04-03

    Comprehensive genetic profiling of tumors using next-generation sequencing (NGS) is gaining acceptance for guiding treatment decisions in cancer care. We designed a cancer profiling test combining both deep sequencing and immunohistochemistry (IHC) of relevant cancer targets to aid therapy choices in both standard-of-care (SOC) and advanced-stage treatments for solid tumors. The SOC report is provided in a short turnaround time for four tumors, namely lung, breast, colon, and melanoma, followed by an investigational report. For other tumor types, an investigational report is provided. The NGS assay reports single-nucleotide variants (SNVs), copy number variations (CNVs), and translocations in 152 cancer-related genes. The tissue-specific IHC tests include routine and less common markers associated with drugs used in SOC settings. We describe the standardization, validation, and clinical utility of the StrandAdvantage test (SA test) using more than 250 solid tumor formalin-fixed paraffin-embedded (FFPE) samples and control cell line samples. The NGS test showed high reproducibility and accuracy of >99%. The test provided relevant clinical information for SOC treatment as well as more information related to investigational options and clinical trials for >95% of advanced-stage patients. In conclusion, the SA test comprising a robust and accurate NGS assay combined with clinically relevant IHC tests can detect somatic changes of clinical significance for strategic cancer management in all the stages.

  6. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria

    PubMed Central

    Naik, Aanand D.; Skelton, Felicia; Amspoker, Amber B.; Glasgow, Russell A.; Trautner, Barbara W.

    2017-01-01

    Objectives Guidelines for managing catheter-associated urinary tract infection (CAUTI) and asymptomatic bacteria (ASB) are poorly translated into routine care due in part to cognitive diagnostic errors. This study determines if the accuracy for CAUTI and ASB diagnosis and treatment improves after implementation of a fast and frugal algorithm compared with traditional education methods. Materials and methods A pre and post-intervention with contemporaneous comparison site involving inpatient and long term care wards at two regional Veterans Affairs Systems in United States. Participants included 216 internal medicine residents and 16 primary care clinicians. Intervention clinicians received training with a fast and frugal algorithm. Comparison site clinicians received guidelines education. Diagnosis and treatment accuracy compared with a criterion standard was assessed during similar three-month, pre- and post-intervention periods. Sensitivity, specificity, and likelihood ratios were compared for both periods at each site. Results Bacteriuria management was evaluated against criterion standard in 196 cases pre-implementation and 117 cases post-implementation. Accuracy of bacteriuria management among intervention participants was significantly higher, post-implementation, than those at the comparison site (Intervention: positive likelihood ratio (LR+) = 8.5, specificity = 0.89, 95% confidence interval (CI) = 0.78−1.00; comparison: LR+ = 4.62, specificity (95%CI) = 0.79 (0.63−0.95). Further, improvements at the intervention site were statistically significant (pre-implementation: LR+ = 2.1, specificity (95%CI) = 0.60 (0.50−0.71); post-implementation: LR+ = 8.5, specificity (95%CI) = 0.89 (0.78−1.00). At both sites, there were similar improvements in negative LR from pre- to post-implementation: [Intervention site = 0.28 to 0.08; comparison site = 0.13 to 0.04]. Inappropriate management of ASB declined markedly from 32 (40%) to 3 (11%) cases at the intervention

  7. The impact of counselling with a practical statistical model on patients' decision-making about treatment for epilepsy: findings from a pilot study.

    PubMed

    Jacoby, A; Baker, G; Chadwick, D; Johnson, A

    1993-12-01

    To ascertain the impact of a computer-based predictive model on patients' decisions about continuing treatment of their epilepsy, 72 subjects were asked to complete questionnaires prior to and following counselling with the model. The subjects were attending the neurology out-patient clinic in a large UK hospital, and were identified from medical records as eligible for withdrawal of AEDs. The effect of counselling with the model was to make the majority of patients opt to continue AED therapy. Positive or negative framing of risk information appeared to influence the decisions of patients who were initially uncertain about continuing treatment, as did patients' perceptions of the clinician's views. The prognostic model appeared to allow relatively complex statistical information to be conveyed to patients in an accessible form. We suggest its use will aid clinicians in counselling patients and will help patients reach better-informed decisions about treatment.

  8. [Forgoing treatments: a kind of euthanasia? A scientific approach to the debate about end of life decisions].

    PubMed

    Riccioni, Luigi; Busca, Maria Teresa; Busatta, Lucia; Orsi, Luciano; Gristina, Giuseppe R

    2016-03-01

    In the last decade an extensive debate on the topic of end of life decisions has developed in western countries, obtaining a worldwide media relevance. Philosophers, theologians, legal experts and doctors, focus their attention on the three thorny issues of the topic: forgoing treatments, euthanasia and assisted suicide. A thorough and respectful discussion on these issues should include all stakeholders - above all palliative care physicians - and should be encouraged in order to understand the views in favor or against the three practices, checking the different moral positions, and analyzing the cultural, social and legal aspects in the background on one hand, and, on the other, their impact on the health care systems. At present, in the fields of communications and politics, the debate related to the topic of these end of life practices is characterized by a confusion of terms and meanings. As an outcome, the term "euthanasia" is misused as a "container" including forgoing treatments, euthanasia and assisted suicide, while palliative sedation is wrongly considered as a procedure to cause death. This confusing approach does not permit to understand the real issues at the stake, keeping the debate at the tabloid level. Conversely, sharing the precise meaning of the words is the only way to provide tools to make rational, autonomous and responsible decisions, allowing individual informed choices in compliance with the principle of autonomy. This article is not aimed to take a moral stand in favor or against forgoing treatments, euthanasia and assisted suicide. Through an analysis based on scientific criteria, the authors firstly review the definitions of these three practices, examining the concepts enclosed in each term; secondly, they offer a glance on the legal approach to end of life issues in western countries; lastly, they investigate the relationship between these practices and palliative care culture in light of the medical societies official statements

  9. Preferences and flexibility in decision-making among dental clinicians regarding the treatment of multirooted teeth: an interactive communication device-based survey at two academic conferences

    PubMed Central

    2016-01-01

    Purpose Decision-making by dental and medical experts can be influenced by their biases, interests, and experiences, and academic arguments about controversial issues may additionally be considered indirect experiences capable of affecting decision-making. This study reports on the use of interactive communication devices to evaluate preferences and flexibility in decision-making among dental care providers who attended two distinct academic conferences. Methods Two debates were presented by a team of two lecturers at two academic conferences (focusing on periodontology and implant dentistry, respectively) and the audience members of each session were surveyed. Before each lecture, two case modules about the diagnosis and treatment of multirooted molar lesions were provided, and interactive communication devices were used to collect responses about decision-making preferences in treatment planning immediately before and after a debate about treatment strategies. Results In total, 81 and 84 completed answers from both conferences were obtained for the first and second case modules, respectively. The preferred treatment plan differed significantly according to the focus of the conference, and a tendency emerged for the clinicians participating in each conference to express uniform preferences. However, attending the debates resulted in significant changes in decision-making preferences regardless of the conference focus or the characteristics of the participants. Conclusions Our findings suggest that providing continuing education via debates on controversial issues may be effective in widening conceptual knowledge and reducing biases among experts in the dental and medical fields. PMID:27382505

  10. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies

    PubMed Central

    Tong, A; Howard, K; Snelling, P; Webster, A C

    2010-01-01

    Objective To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions. Design Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies. Data sources Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes. Results 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life or death, being a burden, living in limbo), lack of choice (medical decision, lack of information, constraints on resources), gaining knowledge of options (peer influence, timing of information), and weighing alternatives (maintaining lifestyle, family influences, maintaining the status quo). Conclusions The experiences of other patients greatly influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy. PMID:20085970

  11. Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytical model.

    PubMed

    Vinken, A; Li, Z; Balan, D; Rittenhouse, B; Wilike, R; Nathwani, D

    2001-12-01

    Standard antibiotic treatment of infections has become more difficult and costly due to treatment failure associated with the rise in bacterial resistance. New antibiotics that can overcome such resistant pathogens have the potential for great clinical and economic impact. Linezolid is a new antibiotic that is effective in the treatment of both antibiotic-susceptible and antibiotic-resistant Gram-positive bacterial infections, including those resistant to other available antibiotics. This breadth of activity is unique in existing antibiotics for Gram-positive bacteria and serves as the rationale for exploring the hypothesis that linezolid is an appropriate choice when considering empirical treatment of cellulitis in complicated or compromised patients in the nosocomial setting. A decision-modelling approach was used to compare the predicted first-line treatment efficacy and direct medical costs of linezolid with standard treatment of cellulitis among hospitalized patients. For the purposes of this analysis, standard care is defined along two main pathways: (1) initiating care with intravenous (iv) flucloxacillin, switching to vancomycin if the pathogen is found to be resistant to flucloxacillin, or maintaining flucloxacillin if the pathogen is found susceptible, or when culture and sensitivity analysis is inconclusive; or (2) initiating care with vancomycin, switching to iv flucloxacillin if the pathogen is found susceptible to flucloxacillin, maintaining vancomycin if the infection is found resistant, or when culture and sensitivity are inconclusive. For those patients taking iv flucloxacillin, a switch to oral flucloxacillin was allowed when clinically appropriate. We hypothesized that the cost of care of initiating treatment with linezolid would be less than that for both vancomycin and flucloxacillin in resistance risk ranges typically encountered in UK hospitals. In addition, while the registration trials showed equivalence of linezolid with the comparators in

  12. Multidisciplinary approach of organic catatonia in children and adolescents may improve treatment decision making.

    PubMed

    Lahutte, Bertrand; Cornic, Françoise; Bonnot, Olivier; Consoli, Angèle; An-Gourfinkel, Isabelle; Amoura, Zahir; Sedel, Frédéric; Cohen, David

    2008-08-01

    Catatonia is an infrequent but severe condition in young people. Organic diseases may be associated and need to be investigated though no specific recommendations and guidelines are available. We extensively reviewed the literature of all the cases of organic catatonia in children and adolescents from January 1969 to June 2007. We screened socio-demographic characteristics, organic diagnosis, clinical characteristics and treatment. We found 38 cases of children and adolescents with catatonia due to an organic condition. The catatonic syndrome occurred in 21 (57%) females and 16 (43%) males. The mean age of patients was 14.5 years (+/-3.39) [range=7-18 years], and three died from their condition. The organic conditions included infectious diseases (N=10), neurological conditions (N=10), toxic induced states (N=12) and genetic conditions including inborn errors of metabolism (N=6). The onset was dominantly acute, and the clinical presentation most frequently stuporous. Although benzodiazepines were recommended as primary symptomatic treatment, they were rarely prescribed. In several cases, therapeutic approach was related to organic cause (e.g., plasma exchange in lupus erythematosus; copper chelators in Wilson's disease). Based on this review and on our own experience of catatonia in youth, we proposed a consensual and multidisciplinary diagnostic strategy to help practitioners to identify underlying organic diseases.

  13. Incorporating financial protection into decision rules for publicly financed healthcare treatments.

    PubMed

    Smith, Peter C

    2013-02-01

    Almost all health systems seek to offer some form of publicly financed healthcare insurance, and governments must therefore choose the size of the benefit package and the types of treatments to cover. Conventionally, the usual approach of economists has been to recommend choices on the basis of cost effectiveness of treatments, using metrics such as the 'cost per quality adjusted life year'. However, this approach is based on the assumption of health maximization subject to a budget constraint and ignores the potential impact of any additional concern with protecting individuals from the financial consequences of a health shock. Furthermore, it does not take account of the possible availability of complementary privately funded health care. This paper develops a model in which risk-averse individuals care about health but also place a value on protection from the financial consequences of rare but costly events. The paper shows how conventional cost-effectiveness analysis can readily be augmented to take account of financial protection objectives. The results depend on whether or not there exists a market in complementary privately funded health care. They have important implications for the methodology adopted by health technology assessment agencies and for the broader design of publicly funded health systems.

  14. [Liquid Biopsy: Detection of Molecular Markers for Treatment Decisions in Lung Cancer].

    PubMed

    Brückl, W M; Wirtz, R M; Bertsch, T; Ficker, J H; Jung, A

    2017-02-14

    Personalized, individualized, targeted therapy has successfully found entrance in the palliative treatment of lung cancer as they enable a personalized and individualized strategy going ahead with biomarker testing. Due to the crescending amount of predictive molecular and immunhistochemical analyses at different time points during therapy the need for more and actual tumor tissue increases; however these samples cannot always be obtained without major discomfort for the patients. Therefore, analyses from blood, the so called "liquid biopsy", is an alternative or additional method. Activating mutations in the EGFR gene and the inhibitory mutation T790 M can already be detected from blood during clinical routine. This review presents the status of liquid biopsy for diagnosis, prognosis and as predictive parameter during the course of therapy in lung cancer and gives an outlook on future developments.

  15. Optimal Treatment Decision for Brain Metastases of Unknown Primary Origin: The Role and Timing of Radiosurgery

    PubMed Central

    Han, Hyun Jin; Chang, Won Seok; Jung, Hyun Ho; Park, Yong Gou

    2016-01-01

    Background Up to 15% of all patients with brain metastases have no clearly detected primary site despite intensive evaluation, and this incidence has decreased with the use of improved imaging technology. Radiosurgery has been evaluated as one of the treatment modality for patients with limited brain metastases. In this study, we evaluated the effectiveness of radiosurgery for brain metastases from unknown primary tumors. Methods We retrospectively evaluated 540 patients who underwent gamma knife radiosurgery (GKRS) for brain metastases radiologically diagnosed between August 1992 and September 2007 in our institution. First, the brain metastases were grouped into metachronous, synchronous, and precocious presentations according to the timing of diagnosis of the brain metastases. Then, synchronous and precocious brain metastases were further grouped into 1) unknown primary; 2) delayed known primary; and 3) synchronous metastases according to the timing of diagnosis of the primary origin. We analyzed the survival time and time to new brain metastasis in each group. Results Of the 540 patients, 29 (5.4%) presented precocious or synchronous metastases (34 GKRS procedures for 174 lesions). The primary tumor was not found even after intensive and repeated systemic evaluation in 10 patients (unknown primary, 34.5%); found after 8 months in 3 patients (delayed known primary, 1.2%); and diagnosed at the same time as the brain metastases in 16 patients (synchronous metastasis, 55.2%). No statistically significant differences in survival time and time to new brain metastasis were found among the three groups. Conclusion Identification of a primary tumor before GKRS did not affect the patient outcomes. If other possible differential diagnoses were completely excluded, early GKRS can be an effective treatment option for brain metastases from unknown primary tumor. PMID:27867920

  16. Parental refusal of life-saving treatments for adolescents: Chinese familism in medical decision-making re-visited.

    PubMed

    Hui, Edwin

    2008-06-01

    This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession.

  17. Enhancing Medical Decision-Making Evaluations: Introduction of Normative Data for the Capacity to Consent to Treatment Instrument.

    PubMed

    Gerstenecker, Adam; Niccolai, Lindsay; Marson, Daniel; Triebel, Kristen L

    2016-04-01

    A number of measures have been developed to assess medical decision-making capacity (MDC) in adults. However, their clinical utility is limited by a lack of available normative data. In the current study, we introduce age-independent and age-adjusted normative data for a measure of MDC: the Capacity to Consent to Treatment Instrument. The sample consisted of 308 cognitively normal, community-dwelling adults ranging in age from 19 to 86 years. For age-adjusted norms, individual raw scores were first converted to age-corrected scaled scores based on position within a cumulative frequency distribution and then grouped according to empirically supported age ranges. For age-independent norms, the same method was utilized but without age-corrections being applied or participants being grouped into age ranges. This study has the potential to enhance MDC evaluations by allowing clinicians to compare a patient's performance on the Capacity to Consent to Treatment Instrument with that of adults regardless of age as well as to same age peers. Tables containing normative corrections are supplementary material available online at http://asm.sagepub.com/supplemental.

  18. Treatment decision-making for sporadic small vestibular schwannoma in a pediatric patient: A case report and literature review

    PubMed Central

    WANG, JUN; XU, YAJING; LEI, TING; ZENG, LIANG

    2015-01-01

    The current study reports the case of a 15-year-old male who presented with hearing loss due to a small left-sided vestibular schwannoma (VS) not associated with neurofibromatosis type 2 (NF2), which had been apparent for six months. Magnetic resonance imaging with gadolinium diethylenetriamine penta-acetic acid revealed a mass, 10 mm in diameter, located in the left inner auditory canal. The patient had no family history of NF2 and gene mutation analysis showed no signs of the condition. Small sporadic or non-NF2 VS is extremely rare and the treatment decision-making process is complicated in children when considering the implications for the impairment of childhood development and lifelong disability. Following careful consideration, the patient in the present study underwent treatment with stereotactic radiosurgery. The five-year post-operative follow-up examination showed tumor stability without additional neurological deficits and at the time of writing the patient was alive and well. PMID:26137073

  19. Predicting stone composition before treatment – can it really drive clinical decisions?

    PubMed Central

    Bres–Niewada, Ewa; Radziszewski, Piotr

    2014-01-01

    Introduction Determination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL). Material and methods This short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings. Results Stone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques such as Dual–Energy CT or analysis of shape, density and homogeneity of stones on plain X–rays are used as promising methods of predicting stone composition and ESWL outcome. Conclusions New imaging techniques facilitate the identification of uric acid stones and ESWL–resistant stones. Therefore, they may help in selecting the best therapeutic option. PMID:25667761

  20. Design of SGLT2 Inhibitors for the Treatment of Type 2 Diabetes: A History Driven by Biology to Chemistry.

    PubMed

    Cai, Wenqing; Jiang, Linlin; Xie, Yafei; Liu, Yuqiang; Liu, Wei; Zhao, Guilong

    2015-01-01

    A brief history of the design of sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors is reviewed. The design of O-glucoside SGLT2 inhibitors by structural modification of phlorizin, a naturally occurring O-glucoside, in the early stage was a process mainly driven by biology with anticipation of improving SGLT2/SGLT1 selectivity and increasing metabolic stability. Discovery of dapagliflozin, a pioneering C-glucoside SGLT2 inhibitor developed by Bristol-Myers Squibb, represents an important milestone in this history. In the second stage, the design of C-glycoside SGLT2 inhibitors by modifications of the aglycone and glucose moiety of dapagliflozin, an original structural template for almost all C-glycoside SGLT2 inhibitors, was mainly driven by synthetic organic chemistry due to the challenge of designing dapagliflozin derivatives that are patentable, biologically active and synthetically accessible. Structure-activity relationships (SAR) of the SGLT2 inhibitors are also discussed.

  1. Genomic Grade Index (GGI): Feasibility in Routine Practice and Impact on Treatment Decisions in Early Breast Cancer

    PubMed Central

    Metzger-Filho, Otto; Catteau, Aurélie; Michiels, Stefan; Buyse, Marc; Ignatiadis, Michail; Saini, Kamal S.; de Azambuja, Evandro; Fasolo, Virginie; Naji, Sihem; Canon, Jean Luc; Delrée, Paul; Coibion, Michel; Cusumano, Pino; Jossa, Veronique; Kains, Jean Pierre; Larsimont, Denis; Richard, Vincent; Faverly, Daniel; Cornez, Nathalie; Vuylsteke, Peter; Vanderschueren, Brigitte; Peyro-Saint-Paul, Hélène; Piccart, Martine; Sotiriou, Christos

    2013-01-01

    Purpose Genomic Grade Index (GGI) is a 97-gene signature that improves histologic grade (HG) classification in invasive breast carcinoma. In this prospective study we sought to evaluate the feasibility of performing GGI in routine clinical practice and its impact on treatment recommendations. Methods Patients with pT1pT2 or operable pT3, N0-3 invasive breast carcinoma were recruited from 8 centers in Belgium. Fresh surgical samples were sent at room temperature in the MapQuant Dx™ PathKit for centralized genomic analysis. Genomic profiles were determined using Affymetrix U133 Plus 2.0 and GGI calculated using the MapQuant Dx® protocol, which defines tumors as low or high Genomic Grade (GG-1 and GG-3 respectively). Results 180 pts were recruited and 155 were eligible. The MapQuant test was performed in 142 cases and GGI was obtained in 78% of cases (n=111). Reasons for failures were 15 samples with <30% of invasive tumor cells (11%), 15 with insufficient RNA quality (10%), and 1 failed hybridization (<1%). For tumors with an available representative sample (≥ 30% inv. tumor cells) (n=127), the success rate was 87.5%. GGI reclassified 69% of the 54 HG2 tumors as GG-1 (54%) or GG-3 (46%). Changes in treatment recommendations occurred mainly in the subset of HG2 tumors reclassified into GG-3, with increased use of chemotherapy in this subset. Conclusion The use of GGI is feasible in routine clinical practice and impacts treatment decisions in early-stage breast cancer. Trial Registration ClinicalTrials.gov NCT01916837, http://clinicaltrials.gov/ct2/show/NCT01916837 PMID:23990869

  2. A Multi-Attribute Utility Decision Analysis for Treatment Alternatives for the DOE/SR Aluminum-Based Spent Nuclear Fuel

    SciTech Connect

    Davis, F.; Kuzio, K.; Sorenson, K.; Weiner, R.; Wheeler, T.

    1998-11-01

    A multi-attribute utility analysis is applied to the decision to select a treatment method for the management of aluminum-based spent nuclear i%el (A1-SNF) owned by the United States Department of Energy (DOE). DOE will receive, treat, and temporarily store Al- SNF, most of which is composed of highly enriched uranium, at its Savannah River Site in South Carolina. DOE intends ultimately to send the treated Al-SNJ? to a geologic repository for permanent disposal. DOE initially considered ten treatment alternatives for the management of A1-SNF, and has narrowed the choice to two of these the direct disposal and melt and dilute alternatives. The decision analysis presented in this document focuses on a decision between these two remaining alternatives.

  3. In vitro evaluation of ICDAS and radiographic examination of occlusal surfaces and their association with treatment decisions.

    PubMed

    Diniz, Michele B; Lima, Luciana Monti; Eckert, George; Zandona, Andrea G Ferreira; Cordeiro, Rita C L; Pinto, Lourdes Santos

    2011-01-01

    This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10× occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (0–6), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and interexaminer repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was

  4. The Treatment Decision-Making Process: Age Differences in a Sample of Women Recently Diagnosed with Nonrecurrent Early-Stage Breast Cancer.

    ERIC Educational Resources Information Center

    Petrisek, Ann C.; Laliberte, Linda L.; Allen, Susan M.; Mor, Vincent

    1997-01-01

    Using retrospective, self-report data collected from women recently diagnosed with breast cancer (N=179), examines the influence of age differences in the treatment decision-making process. Findings indicate that older women were less likely than their younger counterparts to have desired participation in therapy selection or sought out medical…

  5. The use of control charts by laypeople and hospital decision-makers for guiding decision making.

    PubMed

    Schmidtke, K A; Watson, D G; Vlaev, I

    2017-07-01

    Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.

  6. Chronic atomoxetine treatment during adolescence does not influence decision-making on a rodent gambling task, but does modulate amphetamine's effect on impulsive action in adulthood.

    PubMed

    Silveira, Mason M; Murch, W Spencer; Clark, Luke; Winstanley, Catharine A

    2016-06-01

    In addition to the symptoms of inattention, hyperactivity, and impulsivity, individuals with attention deficit hyperactivity disorder exhibit impaired performance on tests of real-world cost/benefit decision-making. Atomoxetine, a nonstimulant drug approved for the treatment of attention deficit hyperactivity disorder, is a selective norepinephrine reuptake inhibitor administered chronically during adolescence, a time during which the frontal brain regions necessary for executive function undergo extensive maturation. This treatment protocol can affect behavior well into adulthood, but whether it produces long-term changes in complex decision-making has not been investigated. Twenty-four Long-Evans rats were administered saline or 1.0 mg/kg atomoxetine daily from postnatal day 40 to 54. Two weeks after treatment, the adult rats were trained and assessed on the rodent gambling task, in which the animals chose from four options varying in reward, punishment, and uncertainty. Impulsive action was also measured by recording the number of premature responses made. Regardless of the treatment administered during adolescence, rats learned to favor the advantageous options characterized by small, low-penalty rewards in lieu of the larger, higher-penalty reward options. Rodent gambling task performance was then assessed following acute treatment with atomoxetine (0.1-1.0 mg/kg) and amphetamine (0.3-1.5 mg/kg). Across groups, the highest dose of atomoxetine impaired decision-making and decreased premature responding at all doses tested. Amphetamine also impaired choice performance, but selectively increased impulsive action in rats that had previously received atomoxetine treatment during adolescence. These findings contribute to our understanding of the long-term effects associated with chronic adolescent atomoxetine exposure and suggest that this treatment does not alter decision-making under conditions of risk and uncertainty in adulthood.

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

    SciTech Connect

    Kan, E.; Huling, S.G.

    2009-03-01

    The effects of temperature and acidic pretreatment on Fenton-driven chemical oxidation of methyl tert-butyl ether (MTBE)-spent granular activated carbon (GAC, derived from bituminous coal) were investigated. Limiting factors in MTBE removal in GAC include the heterogeneous distribution of amended Fe, and slow intraparticle diffusive transport of MTBE and hydrogen peroxide (H{sub 2}O{sub 2}) into the 'reactive zone'. Acid pretreatment of GAC before Fe amendment altered the surface chemistry of the GAC, lowered the pH point of zero charge, and resulted in greater penetration and more uniform distribution of Fe in GAC. This led to a condition where Fe, MTBE, and H{sub 2}O{sub 2} coexisted over a larger volume of the GAC contributing to greater MTBE oxidation and removal. H{sub 2}O{sub 2} reaction and MTBE removal in GAC increased with temperature. Modeling H{sub 2}O{sub 2} transport and reaction in GAC indicated that H{sub 2}O{sub 2} penetration was inversely proportional with temperature and tortuosity, and occurred over a larger fraction of the total volume of small GAC particles (0.3 mm diameter) relative to large particles (1.2 mm diameter). Acidic pretreatment of GAC, Fe-amendment, elevated reaction temperature, and use of small GAC particles are operational parameters that improve Fenton-driven oxidation of MTBE in GAC. 29 refs., 6 figs., 1 tab.

  8. Making Decisions about Treatment

    MedlinePlus

    ... Until There’s a Cure Game Night. https://t.co/0oxmfOVYM8 17 hours . reply . retweet . favorite ProjectInform Join ... fight against HIV/AIDs. RSVP below https://t.co/XMziboITC7 2 days . reply . retweet . favorite ProjectInform Peter ...

  9. Treatment Decision Making in Early-Stage Prostate Cancer: Evaluation of Computer-Based Patient Education and an Interactive Decision Aid

    DTIC Science & Technology

    2006-02-01

    of times used CD More than once 79.8% Once 20.2% Discussed PrCa Issues with others after using CD 74.5% Rate amount of information in CD Much less/a...prostate cancer and its treatment? Mostly/completely 78.7% Some 21.3% No 0% Did the CD make you feel nervous or fearful about PrCa treatment? Yes/yes

  10. Do Alzheimer's Disease Patients Want to Participate in a Treatment Decision, and Would Their Caregivers Let Them?

    ERIC Educational Resources Information Center

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

    2005-01-01

    Purpose: 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. Design and Methods: Interviews were conducted with 48 patients in the…

  11. The impact of the economic downturn and health care reform on treatment decisions for haemophilia A: patient, caregiver and health care provider perspectives.

    PubMed

    Tarantino, M D; Ye, X; Bergstrom, F; Skorija, K; Luo, M P

    2013-01-01

    Little is known about the impact of the recent US economic downturn and health care reform on patient, caregiver and health care provider (HCP) decision-making for haemophilia A. To explore the impact of the recent economic downturn and perceived impact of health care reform on haemophilia A treatment decisions from patient, caregiver and HCP perspectives. Patients/caregivers and HCPs completed a self-administered survey in 2011. Survey participants were asked about demographics, the impact of the recent economic downturn and health care reform provisions on their treatment decisions. Seventy three of the 134 (54%) patients/caregivers and 39 of 48 (81%) HCPs indicated that the economic downturn negatively impacted haemophilia care. Seventy of the 73 negatively impacted patients made financially related treatment modifications, including delaying/cancelling routine health care visit, skipping doses and/or skipping filling prescription. Treatment modifications made by HCPs included delaying elective surgery, switching from higher to lower priced product, switching from recombinant to plasma-derived products and delaying prophylaxis. Health care reform was generally perceived as positive. Due to the elimination of lifetime caps, 30 of 134 patients (22%) and 28 of 48 HCPs (58%) indicated that they will make treatment modifications by initiating prophylaxis or scheduling routine appointment/surgery sooner. Both patients/caregivers and HCPs reported that the economic downturn had a negative impact on haemophilia A treatment. Suboptimal treatment modifications were made due to the economic downturn. Health care reform, especially the elimination of lifetime caps, was perceived as positive for haemophilia A treatment and as a potential avenue for contributing to more optimal treatment behaviours.

  12. Development of a real-time clinical decision support system upon the web mvc-based architecture for prostate cancer treatment

    PubMed Central

    2011-01-01

    Background A real-time clinical decision support system (RTCDSS) with interactive diagrams enables clinicians to instantly and efficiently track patients' clinical records (PCRs) and improve their quality of clinical care. We propose a RTCDSS to process online clinical informatics from multiple databases for clinical decision making in the treatment of prostate cancer based on Web Model-View-Controller (MVC) architecture, by which the system can easily be adapted to different diseases and applications. Methods We designed a framework upon the Web MVC-based architecture in which the reusable and extractable models can be conveniently adapted to other hospital information systems and which allows for efficient database integration. Then, we determined the clinical variables of the prostate cancer treatment based on participating clinicians' opinions and developed a computational model to determine the pretreatment parameters. Furthermore, the components of the RTCDSS integrated PCRs and decision factors for real-time analysis to provide evidence-based diagrams upon the clinician-oriented interface for visualization of treatment guidance and health risk assessment. Results The resulting system can improve quality of clinical treatment by allowing clinicians to concurrently analyze and evaluate the clinical markers of prostate cancer patients with instantaneous clinical data and evidence-based diagrams which can automatically identify pretreatment parameters. Moreover, the proposed RTCDSS can aid interactions between patients and clinicians. Conclusions Our proposed framework supports online clinical informatics, evaluates treatment risks, offers interactive guidance, and provides real-time reference for decision making in the treatment of prostate cancer. The developed clinician-oriented interface can assist clinicians in conveniently presenting evidence-based information to patients and can be readily adapted to an existing hospital information system and be easily

  13. Seriously Data-Driven Decision Making

    ERIC Educational Resources Information Center

    Casserly, Michael D.

    2011-01-01

    As states approach the funding cliff marking the end of federal stimulus help for education, school districts will be feeling more financial pain than they're experiencing now. But there's good news amid the bad: Big city districts are showing schools nationwide a way to save money and improve efficiency by working together. They've created the…

  14. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK

    PubMed Central

    Durand, Marie-Anne; Bekker, Hilary L.; Casula, Anna; Elias, Robert; Ferraro, Alastair; Lloyd, Amy; van der Veer, Sabine N.; Metcalfe, Wendy; Mooney, Andrew; Thomson, Richard G.; Tomson, Charles R.V.

    2016-01-01

    Background Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. Methods We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90–180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Results Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08–2.80) compared with 0.27 (range, 0.04–1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20. Conclusion Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time. PMID:26985377

  15. TU-G-303-01: Radiomics: Quantitative Imaging in the Service of Improved Treatment Decision Making

    SciTech Connect

    Deasy, J.

    2015-06-15

    ‘Radiomics’ refers to studies that extract a large amount of quantitative information from medical imaging studies as a basis for characterizing a specific aspect of patient health. Radiomics models can be built to address a wide range of outcome predictions, clinical decisions, basic cancer biology, etc. For example, radiomics models can be built to predict the aggressiveness of an imaged cancer, cancer gene expression characteristics (radiogenomics), radiation therapy treatment response, etc. Technically, radiomics brings together quantitative imaging, computer vision/image processing, and machine learning. In this symposium, speakers will discuss approaches to radiomics investigations, including: longitudinal radiomics, radiomics combined with other biomarkers (‘pan-omics’), radiomics for various imaging modalities (CT, MRI, and PET), and the use of registered multi-modality imaging datasets as a basis for radiomics. There are many challenges to the eventual use of radiomics-derived methods in clinical practice, including: standardization and robustness of selected metrics, accruing the data required, building and validating the resulting models, registering longitudinal data that often involve significant patient changes, reliable automated cancer segmentation tools, etc. Despite the hurdles, results achieved so far indicate the tremendous potential of this general approach to quantifying and using data from medical images. Specific applications of radiomics to be presented in this symposium will include: the longitudinal analysis of patients with low-grade gliomas; automatic detection and assessment of patients with metastatic bone lesions; image-based monitoring of patients with growing lymph nodes; predicting radiotherapy outcomes using multi-modality radiomics; and studies relating radiomics with genomics in lung cancer and glioblastoma. Learning Objectives: Understanding the basic image features that are often used in radiomic models. Understanding

  16. Short-term quetiapine treatment alters the use of reinforcement signals during risky decision-making and promotes the choice of negative expected values in healthy adult males.

    PubMed

    Rock, Philippa L; Harmer, Catherine J; McTavish, Sarah F B; Goodwin, Guy M; Rogers, Robert D

    2013-09-25

    Effective decision-making can involve using environmental signals about the possible good and bad outcomes, and their probabilities, to select optimal actions. Problematic decision-making in psychiatric disorders, and particularly bipolar illness, may result from disrupted use of these reinforcement cues, leading to actions that reflect or precipitate pathological changes in mood. Previous experiments indicate that the processing of reinforcement cues while selecting between risky actions can be influenced by dopamine and serotonin activity. Quetiapine is an atypical antipsychotic agent with a complex pharmacology, including antagonist actions at 5-HT2A and, to a lesser extent, D2 receptors. Here, we investigated the effects of (short-term) treatment with quetiapine on the risky decision-making of healthy human adults. Twenty participants received 150 mg of quetiapine XL for 7 d, whereas 20 age- and IQ-matched participants received a placebo. On the eighth day, all participants completed a risky decision-making task that involved making a series of choices between two simultaneously presented gambles that differed in the magnitudes of their possible gains and losses, and the probabilities with which these outcomes were delivered. Quetiapine treatment was associated with a marked tendency to choose options with negative expected values compared with placebo treatment in male but not female participants. Our results demonstrate that antagonism of serotonin and dopamine receptor activity can alter the way individuals use information about gains and losses when selecting between risky actions, possibly reflecting gender-specific differences in risk attitudes. These effects may be beneficial by correcting decision-making biases that feature in mood disorders.

  17. Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones

    PubMed Central

    2011-01-01

    Background Population movements along the Thailand-Cambodia border, particularly among highly mobile and hard-to-access migrant groups from Cambodia and Myanmar, are assumed to play a key role in the spread of artemisinin resistance. Data on treatment-seeking behaviours, knowledge and perceptions about malaria, and use of preventive measures is lacking as characteristics of this population prevent them from being represented in routine surveillance and the lack of a sampling frame makes reliable surveys challenging. Methods A survey of migrant populations from Cambodia and Myanmar was implemented in five selected rural locations in Thailand along the Thai-Cambodian border using respondent driven sampling (RDS) to determine demographic characteristics of the population, migratory patterns, knowledge about malaria, and health-care -seeking behaviours. Results The majority of migrants from Myanmar are long-term residents (98%) with no plans to move back to Myanmar, understand spoken Thai (77%) and can therefore benefit from health messages in Thai, have Thai health insurance (99%) and accessed public health services in Thailand (63%) for their last illness. In comparison, the majority of Cambodian migrants are short-term (72%). Of the short-term Cambodian migrants, 92% work in agriculture, 18% speak Thai, 3.4% have Thai health insurance, and the majority returned to Cambodia for treatment (45%), self-treated (11%), or did not seek treatment for their last illness (27%). Conclusion Most highly mobile migrants along the Thai-Cambodia border are not accessing health messages or health treatment in Thailand, increasing their risk of malaria and facilitating the spread of potentially resistant Plasmodium falciparum as they return to Cambodia to seek treatment. Reaching out to highly mobile migrants with health messaging they can understand and malaria diagnosis and treatment services they can access is imperative in the effort to contain the spread of artemisinin

  18. Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey

    PubMed Central

    Caress, A; Beaver, K; Luker, K; Campbell, M; Woodcock, A

    2005-01-01

    Background: Current healthcare policy advocates patient participation in treatment decision making. However, in asthma there is little evidence regarding patients' views on such involvement. This study explored the preferred and perceived level of involvement in treatment decisions, rationales for role preference, perceived facilitators of/barriers to involvement, and the interrelationship of role preference and demographic variables in a sample of patients with asthma. Methods: A cross sectional survey was performed of 230 adults with clinician diagnosed asthma from 10 primary care sites and one specialist respiratory centre in north-west England. Preferred role in treatment decisions was assessed using the Control Preferences Scale. Results: Fifty five (23.9%) preferred an active role, 82 (35.7%) a collaborative role, and 93 (40.4%) a passive role; 19 (8.2%) perceived their role as active compared with 45 (19.6%) collaborative and 166 (72.2%) passive. Only 33.5% (n = 77) of respondents attained their most preferred role; 55.2% (n = 127) were less involved than they preferred. Patient related, professional related, and organisational factors, especially quality and duration of consultations, facilitated or hampered involvement. Role preferences were not strongly associated with demographic variables or asthma severity. Conclusions: This study in patients with asthma highlights the fact that there is a need for professional and patient education regarding partnership working, skilful communication, and innovative approaches to service delivery. PMID:15741435

  19. Combining Time-Driven Activity-Based Costing with Clinical Outcome in Cost-Effectiveness Analysis to Measure Value in Treatment of Depression

    PubMed Central

    Lindefors, Nils

    2016-01-01

    Background A major challenge of mental health care is to provide safe and effective treatment with limited resources. The main purpose of this study was to examine a value-based approach in clinical psychiatry when evaluating a process improvement initiative. This was accomplished by using the relatively new time driven activity based costing (TDABC) method within the more widely adopted cost-effectiveness analysis framework for economic evaluation of healthcare technologies. The objective was to evaluate the cost-effectiveness of allowing psychologists to perform post-treatment assessment previously performed by psychiatrists at an outpatient clinic treating depression using internet-based cognitive-behavioral therapy (ICBT). Methods Data was collected from 568 adult patients treated with ICBT for depression during 2013–2014. The TDABC methodology was used to estimate total healthcare costs, including development of process maps for the complete cycle of care and estimation of resource use and minute costs of staff, hospital space and materials based on their relative proportions used. Clinical outcomes were measured using the Patient Health Questionnaire depression scale (PHQ-9) before and after treatment and at 6-month follow-up. Cost-effectiveness analyses (CEA) was performed and the results presented as incremental net benefits (INB), cost-effectiveness acceptability curves (CEACs) and confidence ellipses to demonstrate uncertainty around the value of the organizational intervention. Outcomes Taking into account the complete healthcare process (from referral to follow-up assessment), treatment costs decreased from $709 (SD = $130) per patient in 2013 to $659 (SD = $134) in 2014 while treatment effectiveness was maintained; 27% had achieved full remission from depression after treatment (PHQ-9 < 5) during both 2013 and 2014 and an additional 35% and 33% had achieved partial remission in 2013 and 2014, respectively. At follow-up, 42% were in full remission

  20. Implementation of a "Learner-Driven" Curriculum: An Screening, Brief Intervention, and Referral to Treatment (SBIRT) Interdisciplinary Primary Care Model

    ERIC Educational Resources Information Center

    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…

  1. Incorporating Science into Decision-Making

    USGS Publications Warehouse

    Karl, Herman A.; Turner, Christine E.

    2003-01-01

    Alan Leshner's Editorial “Public engagement with science” (14 Feb., p. 977) highlights a conundrum: Why is science often ignored in important societal decisions, even as the call for decisions based on sound science escalates? One reason is that decision-making is often driven by a variety of nonscientific, adversarial, and stakeholder dynamics

  2. Poor prognostic factors guiding treatment decisions in rheumatoid arthritis patients: a review of data from randomized clinical trials and cohort studies.

    PubMed

    Albrecht, Katinka; Zink, Angela

    2017-03-23

    Prognostic factors are used for treatment decisions in rheumatoid arthritis (RA). High disease activity, the early presence of erosions, and autoantibody positivity are the most frequently used poor prognostic factors but other features, such as functional disability, extraarticular disease, or multibiomarkers, are also assessed. Prognostic factors are incorporated in current treatment recommendations for the management of RA and are used as inclusion criteria in randomized controlled trials. They are defined heterogeneously and the relevance of a single or combined presence of poor prognostic factors remains unclear. This review summarizes the current definitions of poor prognostic factors and their use in clinical research. Perspectives on future research are also outlined.

  3. Development of solar-driven electrochemical and photocatalytic water treatment system using a boron-doped diamond electrode and TiO2 photocatalyst.

    PubMed

    Ochiai, Tsuyoshi; Nakata, Kazuya; Murakami, Taketoshi; Fujishima, Akira; Yao, Yanyan; Tryk, Donald A; Kubota, Yoshinobu

    2010-02-01

    A high-performance, environmentally friendly water treatment system was developed. The system consists mainly of an electrochemical and a photocatalytic oxidation unit, with a boron-doped diamond (BDD) electrode and TiO(2) photocatalyst, respectively. All electric power for the mechanical systems and the electrolysis was able to be provided by photovoltaic cells. Thus, this system is totally driven by solar energy. The treatment ability of the electrolysis and photocatalysis units was investigated by phenol degradation kinetics. An observed rate constant of 5.1 x 10(-3)dm(3)cm(-2)h(-1) was calculated by pseudo-first-order kinetic analysis for the electrolysis, and a Langmuir-Hinshelwood rate constant of 5.6 microM(-1)min(-1) was calculated by kinetic analysis of the photocatalysis. According to previous reports, these values are sufficient for the mineralization of phenol. In a treatment test of river water samples, large amounts of chemical and biological contaminants were totally wet-incinerated by the system. This system could provide 12L/day of drinking water from the Tama River using only solar energy. Therefore, this system may be useful for supplying drinking water during a disaster.

  4. Towards personalised intra-arterial treatment of patients with acute ischaemic stroke: a study protocol for development and validation of a clinical decision aid

    PubMed Central

    Mulder, Maxim J H L; Venema, Esmee; Roozenbeek, Bob; Broderick, Joseph P; Yeatts, Sharon D; Khatri, Pooja; Berkhemer, Olvert A; Roos, Yvo B W E M; Majoie, Charles B L M; van Oostenbrugge, Robert J; van Zwam, Wim H; van der Lugt, Aad; Steyerberg, Ewout W; Dippel, Diederik W J; Lingsma, Hester F

    2017-01-01

    Introduction Overall, intra-arterial treatment (IAT) proved to be beneficial in patients with acute ischaemic stroke due to a proximal occlusion in the anterior circulation. However, heterogeneity in treatment benefit may be relevant for personalised clinical decision-making. Our aim is to improve selection of patients for IAT by predicting individual treatment benefit or harm. Methods and analysis We will use data collected in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial to analyse the effect of baseline characteristics on outcome and treatment effect. A multivariable proportional odds model with interaction terms will be developed to predict the outcome for each individual patient, both with and without IAT. Model performance will be expressed as discrimination and calibration, after bootstrap resampling and shrinkage of regression coefficients, to correct for optimism. External validation will be conducted on data of patients in the Interventional Management of Stroke III trial (IMS III). Primary outcome will be the modified Rankin Scale (mRS) at 90 days after stroke. Ethics and dissemination The proposed study will provide an internationally applicable clinical decision aid for IAT. Findings will be disseminated widely through peer-reviewed publications, conference presentations and in an online web application tool. Formal ethical approval was not required as primary data were already collected. Trial registration numbers ISRCTN10888758; Post-results and NCT00359424; Post-resultsc. PMID:28336740

  5. WE-F-BRB-03: Inclusion of Data-Driven Risk Predictions in Radiation Treatment Planning in the Context of a Local Level Learning Health System

    SciTech Connect

    McNutt, T.

    2015-06-15

    Advancements in informatics in radiotherapy are opening up opportunities to improve our ability to assess treatment plans. Models on individualizing patient dose constraints from prior patient data and shape relationships have been extensively researched and are now making their way into commercial products. New developments in knowledge based treatment planning involve understanding the impact of the radiation dosimetry on the patient. Akin to radiobiology models that have driven intensity modulated radiotherapy optimization, toxicity and outcome predictions based on treatment plans and prior patient experiences may be the next step in knowledge based planning. In order to realize these predictions, it is necessary to understand how the clinical information can be captured, structured and organized with ontologies and databases designed for recall. Large databases containing radiation dosimetry and outcomes present the opportunity to evaluate treatment plans against predictions of toxicity and disease response. Such evaluations can be based on dose volume histogram or even the full 3-dimensional dose distribution and its relation to the critical anatomy. This session will provide an understanding of ontologies and standard terminologies used to capture clinical knowledge into structured databases; How data can be organized and accessed to utilize the knowledge in planning; and examples of research and clinical efforts to incorporate that clinical knowledge into planning for improved care for our patients. Learning Objectives: Understand the role of standard terminologies, ontologies and data organization in oncology Understand methods to capture clinical toxicity and outcomes in a clinical setting Understand opportunities to learn from clinical data and its application to treatment planning Todd McNutt receives funding from Philips, Elekta and Toshiba for some of the work presented.

  6. HIV treatment as prevention: principles of good HIV epidemiology modelling for public health decision-making in all modes of prevention and evaluation.

    PubMed

    Delva, Wim; Wilson, David P; Abu-Raddad, Laith; Gorgens, Marelize; Wilson, David; Hallett, Timothy B; Welte, Alex

    2012-01-01

    Public health responses to HIV epidemics have long relied on epidemiological modelling analyses to help prospectively project and retrospectively estimate the impact, cost-effectiveness, affordability, and investment returns of interventions, and to help plan the design of evaluations. But translating model output into policy decisions and implementation on the ground is challenged by the differences in background and expectations of modellers and decision-makers. As part of the PLoS Medicine Collection "Investigating the Impact of Treatment on New HIV Infections"--which focuses on the contribution of modelling to current issues in HIV prevention--we present here principles of "best practice" for the construction, reporting, and interpretation of HIV epidemiological models for public health decision-making on all aspects of HIV. Aimed at both those who conduct modelling research and those who use modelling results, we hope that the principles described here will become a shared resource that facilitates constructive discussions about the policy implications that emerge from HIV epidemiology modelling results, and that promotes joint understanding between modellers and decision-makers about when modelling is useful as a tool in quantifying HIV epidemiological outcomes and improving prevention programming.

  7. A rule-based decision-making diagnosis system to evaluate arteriovenous shunt stenosis for hemodialysis treatment of patients using fuzzy petri nets.

    PubMed

    Chen, Wei-Ling; Kan, Chung-Dann; Lin, Chia-Hung; Chen, Tainsong

    2014-03-01

    This paper proposes a rule-based decision-making diagnosis system to evaluate arteriovenous shunt (AVS) stenosis for long-term hemodialysis treatment of patients using fuzzy petri nets (FPNs). AVS stenoses are often associated with blood sounds, resulting from turbulent flow over the narrowed blood vessel. Phonoangiography provides a noninvasive technique to monitor the sounds of the AVS. Since the power spectra changes in frequency and amplitude with the degree of AVS stenosis, it is difficult to make a human-made decision to judge the degree using a combination of those variances. The Burg autoregressive (AR) method is used to estimate the frequency spectra of a phonoangiographic signal and identify the characteristic frequencies. A rule-based decision-making method, FPNs, is designed as a decision-making system to evaluate the degree of stenosis (DOS) in routine examinations. For 42 long-term follow-up patients, the examination results show the proposed diagnosis system has greater efficiency in evaluating AVS stenosis.

  8. Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool

    PubMed Central

    Streufert, Ben; Reed, Shelby D.; Orlando, Lori A.; Taylor, Dean C.; Huber, Joel C.; Mather, Richard C.

    2017-01-01

    Background: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown. Purpose: To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents’ agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals’ perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation. Results: Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool’s ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents’ treatment choices

  9. Risk management in a developing country context: improving decisions about point-of-use water treatment among the rural poor in Africa.

    PubMed

    Arvai, Joseph; Post, Kristianna

    2012-01-01

    More than 1 billion people, the vast majority of which live in the developing world, lack basic access to clean water for domestic use. For this reason, finding and promoting effective and sustainable solutions for the provision of reliable clean water in developing nations has become a focus of several public health and international development efforts. Even though several means of providing centrally located sources of clean water in developing communities exist, the severity and widespread nature of the water problem has led most development agencies and sanitation experts to strongly advocate the use of point-of-use treatment systems alongside whatever source of water people regularly use. In doing so, however, development practitioners have been careful to point out that any interventions or infrastructure regarding water safety and human health must also adhere to one of the central principles of international development: to facilitate more democratic and participatory models of decision making and governance. To this end, the research reported here focused on the development of a deliberative risk management framework for involving affected stakeholders in decisions about POU water treatment systems. This research, which was grounded in previous studies of structured decision making, took place in two rural villages in the East African nation of Tanzania.

  10. The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions.

    PubMed

    Daley, Peter; Comerford, Adam; Umali, Jurgienne; Penney, Carla

    2016-01-01

    Background. Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment. Objective. To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli. Methods. Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision. Results. 89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct. Discussion. Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results. Conclusion. Direct susceptibility should be discontinued in clinical microbiology laboratories.

  11. The Performance of Direct Disk Diffusion for Community Acquired Bacteremia due to Gram-Negative Bacilli and Its Impact on Physician Treatment Decisions

    PubMed Central

    Daley, Peter; Comerford, Adam; Umali, Jurgienne; Penney, Carla

    2016-01-01

    Background. Direct disk diffusion susceptibility testing provides faster results than standard microtitre susceptibility. The direct result may impact patient outcome in sepsis if it is accurate and if physicians use the information to promptly and appropriately change antibiotic treatment. Objective. To compare the performance of direct disk diffusion with standard susceptibility and to consider physician decisions in response to these early results, for community acquired bacteremia with Gram-negative Bacilli. Methods. Retrospective observational study of all positive blood cultures with Gram-negative Bacilli, collected over one year. Physician antibiotic treatment decisions were assessed by an infectious diseases physician based on information available to the physician at the time of the decision. Results. 89 bottles growing Gram-negative Bacilli were included in the analysis. Direct disk diffusion agreement with standard susceptibility varied widely. In 47 cases (52.8%), the physician should have changed to a narrower spectrum but did not, in 18 cases (20.2%), the physician correctly narrowed from appropriate broad coverage, and in 8 cases (9.0%), the empiric therapy was correct. Discussion. Because inoculum is not standardized, direct susceptibility results do not agree with standard susceptibility results for all drugs. Physicians do not act on direct susceptibility results. Conclusion. Direct susceptibility should be discontinued in clinical microbiology laboratories. PMID:27366172

  12. [Emergency care for patients in palliative situations--algorithm for decision-making and recommendations for treatment].

    PubMed

    Makowski, Corinna; Marung, Hartwig; Callies, Andreas; Knacke, Peter; Kerner, Thoralf

    2013-03-01

    Emergency care for patients in palliative situations is not a rare event, but often difficult to handle, because training in palliative care for emergency physicians is often insufficient. This article proposes an algorithm that should facilitate the decision-making process in such emergencies. In addition, recommendations concerning the management of symptoms in the emergency medical services are presented.

  13. Quantitative measurement of VUV radiation related to polymer pre-treatment in a microwave driven low pressure plasma

    NASA Astrophysics Data System (ADS)

    Mitschker, Felix; Iglesias, Enrique; Fiebrandt, Marcel; Bibinov, Nikita; Awakowicz, Peter; InstituteElectrical Engineering; Plasma Technology Team

    2016-09-01

    Plasma pre-treatment of polymers is used for a wide range of applications, e.g. prior to deposition of thin SiOx barrier films. At this, plasma generated particles and vacuum ultraviolet (VUV) radiation can reach the polymer surface. Both have a severe impact on the polymer interface, resulting in the production of e.g. dangling bonds. These modifications govern subsequent thin film growth. For understanding of pre-treatment processes, VUV radiation has to be quantified. Absolute VUV photon fluences are determined in situ, at the substrate holder, applying sodium salicylate (NaSal) as a scintillator. Therefore, VUV photons are quantified from 50 nm to 325 nm, due to constant quantum efficiency of NaSal, as integrals over defined wavelength ranges (50-110, 110-170, 170-200 and 200-325 nm). The set up allows for measurement with three scintillators. Each is equipped with optical filters. Observation of the fluorescence band is performed by means of optical fibers and a photomultiplier. Quantification is achieved by simultaneous measurement with an absolutely calibrated echelle spectrometer in the spectral range from 200 nm to 325 nm, taking into account observed plasma volumes. VUV photons are quantified for argon and oxygen plasmas as well as mixtures of both. Support by the German Research Foundation (DFG) within the framework of the SFB TRR 87/1 is acknowledged.

  14. Free sulfurous acid (FSA) inhibition of biological thiosulfate reduction (BTR) in the sulfur cycle-driven wastewater treatment process.

    PubMed

    Qian, Jin; Wang, Lianlian; Wu, Yaoguo; Bond, Philip L; Zhang, Yuhan; Chang, Xing; Deng, Baixue; Wei, Li; Li, Qin; Wang, Qilin

    2017-06-01

    A sulfur cycle-based bioprocess for co-treatment of wet flue gas desulfurization (WFGD) wastes with freshwater sewage has been developed. In this process the removal of organic carbon is mainly associated with biological sulfate or sulfite reduction. Thiosulfate is a major intermediate during biological sulfate/sulfite reduction, and its reduction to sulfide is the rate-limiting step. In this study, the impacts of saline sulfite (the ionized form: HSO3(-) + SO3(2-)) and free sulfurous acid (FSA, the unionized form: H2SO3) sourced from WGFD wastes on the biological thiosulfate reduction (BTR) activities were thoroughly investigated. The BTR activity and sulfate/sulfite-reducing bacteria (SRB) populations in the thiosulfate-reducing up-flow anaerobic sludge bed (UASB) reactor decreased when the FSA was added to the UASB influent. Batch experiment results confirmed that FSA, instead of saline sulfite, was the true inhibitor of BTR. And BTR activities dropped by 50% as the FSA concentrations were increased from 8.0 × 10(-8) to 2.0 × 10(-4) mg H2SO3-S/L. From an engineering perspective, the findings of this study provide some hints on how to ensure effective thiosulfate accumulation in biological sulfate/sulfite reduction for the subsequent denitrification/denitritation. Such manipulation would result in higher nitrogen removal rates in this co-treatment process of WFGD wastes with municipal sewage.

  15. Decision making.

    PubMed

    Chambers, David W

    2011-01-01

    A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.

  16. Localized prostate cancer treatment decision-making information online: improving its effectiveness and dissemination for nonprofit and government-supported organizations.

    PubMed

    Silk, Kami J; Perrault, Evan K; Nazione, Samantha; Pace, Kristin; Hager, Polly; Springer, Steven

    2013-12-01

    The current study reports findings from evaluation research conducted to identify how online prostate cancer treatment decision-making information can be both improved and more effectively disseminated to those who need it most. A multi-method, multi-target approach was used and guided by McGuire's Communication Matrix Model. Focus groups (n = 31) with prostate cancer patients and their family members, and in-depth interviews with physicians (n = 8), helped inform a web survey (n = 89). Results indicated that physicians remain a key information source for medical advice and the Internet is a primary channel used to help make informed prostate cancer treatment decisions. Participants reported a need for more accessible information related to treatment options and treatment side effects. Additionally, physicians indicated that the best way for agencies to reach them with new information to deliver to patients is by contacting them directly and meeting with them one-on-one. Advice for organizations to improve their current prostate cancer web offerings and further ways to improve information dissemination are discussed.

  17. [Is conservative treatment of partial or complete anterior cruciate ligament rupture still justified? An analysis of the recent literature and a recommendation for arriving at a decision].

    PubMed

    Rauch, G; Wirth, T; Dörner, P; Griss, P

    1991-01-01

    In a review of the recent literature after conservative treatment of the complete anterior cruciate ligament (acl) rupture good results were found in an average (av) of 56% (12-80%) of all cases. In comparison the conservative treatment of partial tears showed in 84% (60-100%) of all cases good results. 79% (32-100%) of the patients with complete acl ruptures and 90% (66-100%) of the cases with partial acl tears were able to continue their sport activities. Secondary acl replacement or meniscus surgery were later necessary in 20% and 14% of the cases (av) with complete acl ruptures and in only 6% and 5% (av) of the cases with partial tears. Most of the patients who were operated later were young and ambitiously engaged in sports. The results of the mostly retrospective studies display a high variability. For this reason it is necessary to perform more prospective, controlled and randomized studies to verify the preventive effect of an early operative treatment to protect the joint form osteoarthritis and progressive instability. Arthrocopy is essential for all cases of acute hemartrosis. Partial acl tears are predominantly treated conservatively, while complete acl ruptures should be treated following an individual decision regimen. A tree for decision making of the treatment of acute acl-injuries is proposed.

  18. P2Y12 Inhibitor Pre-Treatment in Non-ST-Elevation Acute Coronary Syndrome: A Decision-Analytic Model

    PubMed Central

    Gunton, James; Hartshorne, Trent; Langrish, Jeremy; Chuang, Anthony; Chew, Derek

    2016-01-01

    Current guidelines recommend initiation of a P2Y12 inhibitor for all patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) at the time of diagnosis (pre-treatment); however, there are no randomized trials directly comparing pre-treatment with initiation at the time of angiography to support this practice. We explore clinical and institutional parameters potentially associated with benefit with this strategy in a decision-analytic model based on available evidence from randomised trials. A decision analysis model was constructed comparing three P2Y12 inhibitors in addition to aspirin in patients with NSTE-ACS. Based on clinical trial data, the cumulative probability of 30 day mortality, myocardial infarction (MI) and major bleeding were determined, and used to calculate the net clinical benefit (NCB) with and without pre-treatment. Sensitivity analysis was performed to assess the relationship between NCB and baseline ischemic risk, bleeding risk, time to angiography and local surgical revascularization rates. Pre-treatment with ticagrelor and clopidogrel was associated with a greater than 50% likelihood of providing a >1% increase in 30 day NCB when baseline estimated ischemic risk exceeds 11% and 14%, respectively. Prasugrel pre-treatment did not achieve a greater than 50% probability of an increase in NCB regardless of baseline ischemic risk. Institutional surgical revascularization rates and time to coronary angiography did not correlate with the likelihood of benefit from P2Y12 pre-treatment. In conclusion, pre-treatment with P2Y12 inhibition is unlikely to be beneficial to the majority of patients presenting with NSTE-ACS. A tailored assessment of each patient’s individual ischemic and bleeding risk may identify those likely to benefit. PMID:27548237

  19. When to stop? Decision-making when children’s cancer treatment is no longer curative: a mixed-method systematic review

    PubMed Central

    2014-01-01

    Background Children with cancer, parents, and clinicians, face difficult decisions when cure is no longer possible. Little is known about decision-making processes, how agreement is reached, or perspectives of different actors. Professionals voice concerns about managing parental expectations and beliefs, which can be contrary to their own and may change over time. We conducted the first systematic review to determine what constitutes best medico-legal practice for children under 19 years as context to exploring the perspectives of actors who make judgements and decisions when cancer treatment is no longer curative. Methods Theory-informed mixed-method thematic systematic review with theory development. Results Eight legal/ethical guidelines and 18 studies were included. Whilst there were no unresolved dilemmas, actors had different perspectives and motives. In line with guidelines, the best interests of the individual child informed decisions, although how different actors conceptualized ‘best interests’ when treatment was no longer curative varied. Respect for autonomy was understood as following child/parent preferences, which varied from case to case. Doctors generally shared information so that parents alone could make an informed decision. When parents received reliable information, and personalized interest in their child, they were more likely to achieve shared trust and clearer transition to palliation. Although under-represented in research studies, young people’s perspectives showed some differences to those of parents and professionals. For example, young people preferred to be informed even when prognosis was poor, and they had an altruistic desire to help others by participating in research. Conclusion There needs to be fresh impetus to more effectively and universally implement the ethics of professionalism into daily clinical practice in order to reinforce humanitarian attitudes. Ethical guidelines and regulations attempt to bring

  20. Amatoxin poisoning treatment decision-making: pharmaco-therapeutic clinical strategy assessment using multidimensional multivariate statistic analysis.

    PubMed

    Poucheret, Patrick; Fons, Françoise; Doré, Jean Christophe; Michelot, Didier; Rapior, Sylvie

    2010-06-15

    Ninety percent of fatal higher fungus poisoning is due to amatoxin-containing mushroom species. In addition to absence of antidote, no chemotherapeutic consensus was reported. The aim of the present study is to perform a retrospective multidimensional multivariate statistic analysis of 2110 amatoxin poisoning clinical cases, in order to optimize therapeutic decision-making. Our results allowed to classify drugs as a function of their influence on one major parameter: patient survival. Active principles were classified as first intention, second intention, adjuvant or controversial pharmaco-therapeutic clinical intervention. We conclude that (1) retrospective multidimensional multivariate statistic analysis of complex clinical dataset might help future therapeutic decision-making and (2) drugs such as silybin, N-acetylcystein and putatively ceftazidime are clearly associated, in amatoxin poisoning context, with higher level of patient survival.

  1. MO-G-304-01: FEATURED PRESENTATION: Expanding the Knowledge Base for Data-Driven Treatment Planning: Incorporating Patient Outcome Models

    SciTech Connect

    Robertson, SP; Quon, H; Cheng, Z; Moore, JA; Bowers, M; McNutt, TR

    2015-06-15

    Purpose: To extend the capabilities of knowledge-based treatment planning beyond simple dose queries by incorporating validated patient outcome models. Methods: From an analytic, relational database of 684 head and neck cancer patients, 372 patients were identified having dose data for both left and right parotid glands as well as baseline and follow-up xerostomia assessments. For each existing patient, knowledge-based treatment planning was simulated for by querying the dose-volume histograms and geometric shape relationships (overlap volume histograms) for all other patients. Dose predictions were captured at normalized volume thresholds (NVT) of 0%, 10%, 20, 30%, 40%, 50%, and 85% and were compared with the actual achieved doses using the Wilcoxon signed-rank test. Next, a logistic regression model was used to predict the maximum severity of xerostomia up to three months following radiotherapy. Baseline xerostomia scores were subtracted from follow-up assessments and were also included in the model. The relative risks from predicted doses and actual doses were computed and compared. Results: The predicted doses for both parotid glands were significantly less than the achieved doses (p < 0.0001), with differences ranging from 830 cGy ± 1270 cGy (0% NVT) to 1673 cGy ± 1197 cGy (30% NVT). The modelled risk of xerostomia ranged from 54% to 64% for achieved doses and from 33% to 51% for the dose predictions. Relative risks varied from 1.24 to 1.87, with maximum relative risk occurring at 85% NVT. Conclusions: Data-driven generation of treatment planning objectives without consideration of the underlying normal tissue complication probability may Result in inferior plans, even if quality metrics indicate otherwise. Inclusion of complication models in knowledge-based treatment planning is necessary in order to close the feedback loop between radiotherapy treatments and patient outcomes. Future work includes advancing and validating complication models in the context

  2. A global wave-driven magnetohydrodynamic solar model with a unified treatment of open and closed magnetic field topologies

    SciTech Connect

    Oran, R.; Van der Holst, B.; Landi, E.; Jin, M.; Sokolov, I. V.; Gombosi, T. I.

    2013-12-01

    We describe, analyze, and validate the recently developed Alfvén Wave Solar Model, a three-dimensional global model starting from the top of the chromosphere and extending into interplanetary space (out to 1-2 AU). This model solves the extended, two-temperature magnetohydrodynamics equations coupled to a wave kinetic equation for low-frequency Alfvén waves. In this picture, heating and acceleration of the plasma are due to wave dissipation and to wave pressure gradients, respectively. The dissipation process is described by a fully developed turbulent cascade of counterpropagating waves. We adopt a unified approach for calculating the wave dissipation in both open and closed magnetic field lines, allowing for a self-consistent treatment in any magnetic topology. Wave dissipation is the only heating mechanism assumed in the model; no geometric heating functions are invoked. Electron heat conduction and radiative cooling are also included. We demonstrate that the large-scale, steady state (in the corotating frame) properties of the solar environment are reproduced, using three adjustable parameters: the Poynting flux of chromospheric Alfvén waves, the perpendicular correlation length of the turbulence, and a pseudoreflection coefficient. We compare model results for Carrington rotation 2063 (2007 November-December) with remote observations in the extreme-ultraviolet and X-ray ranges from the Solar Terrestrial Relations Observatory, Solar and Heliospheric Observatory, and Hinode spacecraft and with in situ measurements by Ulysses. The results are in good agreement with observations. This is the first global simulation that is simultaneously consistent with observations of both the thermal structure of the lower corona and the wind structure beyond Earth's orbit.

  3. [Legislation for inpatient treatment in psychiatry and psychotherapy and its demarcation from rehabilitation. Decision of the German Supreme Court for Social Legislation of February 16, 2005].

    PubMed

    Weig, Wolfgang

    2006-07-01

    Changes in the supply of psychiatric services since the reforms in the 1970s resulted in demarcation problems between treatment (especially for inpatients), rehabilitation, and other forms of care (including nursing and methods of reintegration). As the methods used in psychiatry and psychotherapy in different phases of care are almost identical, other criteria are needed for demarcation. Social legislation does not recognize any time limit for inpatient hospital treatment. In Germany, basic principles for these decisions are laid down in the Personalverordnung Psychiatrie (Psych PV) and the Practice Guidelines of the German Psychiatric Association. Important for the acceptance of inpatient hospital treatment are the objectives and necessities resulting from disease course as well as employment of a multiprofessional team under the guidance of a psychiatric consultant. Alternative methods of care can be suggested only if they are really at the patients' disposal and documentation is not too demanding. These principles were strengthened by the decision of the German Federal Supreme Court for Social Legislation of February 16, 2005.

  4. [Euthanasia and other decisions at the end of life (Proposal for a more transparent terminology and some thoughts on the legal framework of medical treatment)].

    PubMed

    Vadász, Gábor

    2010-10-24

    Indication of euthanasia is only one of several medical decisions at the end of life. Precise definition of this topic related to the clinical events happening around the sick-bed is not complete in the legal and medical literature. The present review attempts to classify the different end of life events with the aim of clarifying which of these do not belong to the concept of passive euthanasia. Euthanasia is not a legal category. The everyday expressions of active and passive euthanasia are simplifications, which cover actions of different purposes. Use of these in medical and legal literature can be confusing and misleading. We differentiate decisions at the end of life on basis of their purpose. Based on the definition and category of the Hungarian Doctors' Chamber, euthanasia is the act or the lack of action in order to mercifully shorten or end the life of a suffering fellow-man to help him. Concepts of active, passive and forced euthanasia are defined. The terms of indirect and intermediate euthanasia are not used in order to avoid misunderstanding. Help and participation of non-professionals in the implementation cannot be completely excluded from the concept of euthanasia, and we believe euthanasia is not merely related to doctors. We outline those medical decisions at the end of life which do not belong to the category of passive euthanasia, namely: withdrawal of ineffective and life sustaining treatments, letting go of the patient, contra-indication of therapy escalation, use of palliative therapy, pain-relieving treatment, compromise medicine, consideration of reanimation and choosing cost-effective therapy. We touch upon the subject of the living will, why it cannot be applied, and its relation to active and passive euthanasia. With reference to the legal regulation of life saving and life sustaining treatment, we deal with the expected spirit of medical legislation.

  5. A data-driven acute inflammation therapy

    PubMed Central

    2013-01-01

    Acute inflammation is a severe medical condition defined as an inflammatory response of the body to an infection. Its rapid progression requires quick and accurate decisions from clinicians. Inadequate and delayed decisions makes acute inflammation the 10th leading cause of death overall in United States with the estimated cost of treatment about $17 billion annually. However, despite the need, there are limited number of methods that could assist clinicians to determine optimal therapies for acute inflammation. We developed a data-driven method for suggesting optimal therapy by using machine learning model that is learned on historical patients' behaviors. To reduce both the risk of failure and the expense for clinical trials, our method is evaluated on a virtual patients generated by a mathematical model that emulates inflammatory response. In conducted experiments, acute inflammation was handled with two complimentary pro- and anti-inflammatory medications which adequate timing and doses are crucial for the successful outcome. Our experiments show that the dosage regimen assigned with our data-driven method significantly improves the percentage of healthy patients when compared to results by other methods used in clinical practice and found in literature. Our method saved 88% of patients that would otherwise die within a week, while the best method found in literature saved only 73% of patients. At the same time, our method used lower doses of medications than alternatives. In addition, our method achieved better results than alternatives when only incomplete or noisy measurements were available over time as well as it was less affected by therapy delay. The presented results provide strong evidence that models from the artificial intelligence community have a potential for development of personalized treatment strategies for acute inflammation. PMID:24565439

  6. Power is only skin deep: an institutional ethnography of nurse-driven outpatient psoriasis treatment in the era of clinic web sites.

    PubMed

    Winkelman, Warren J; Halifax, Nancy V Davis

    2007-04-01

    We present an institutional ethnography of hospital-based psoriasis day treatment in the context of evaluating readiness to supplement services and support with a new web site. Through observation, interviews and a critical consideration of documents, forms and other textually-mediated discourses in the day-to-day work of nurses and physicians, we come to understand how the historical gender-determined power structure of nurses and physicians impacts nurses' work. On the one hand, nurses' work can have certain social benefits that would usually be considered untenable in traditional healthcare: nurses as primary decision-makers, nurses as experts in the treatment of disease, physicians as secondary consultants, and patients as co-facilitators in care delivery processes. However, benefits seem to have come at the nurses' expense, as they are required to maintain a cloak of invisibility for themselves and for their workplace, so that the Centre appears like all other outpatient clinics, and the nurses do not enjoy appropriate economic recognition. Implications for this negotiated invisibility on the implementation of new information systems in healthcare are discussed.

  7. Decision technology.

    PubMed

    Edwards, W; Fasolo, B

    2001-01-01

    This review is about decision technology-the rules and tools that help us make wiser decisions. First, we review the three rules that are at the heart of most traditional decision technology-multi-attribute utility, Bayes' theorem, and subjective expected utility maximization. Since the inception of decision research, these rules have prescribed how we should infer values and probabilities and how we should combine them to make better decisions. We suggest how to make best use of all three rules in a comprehensive 19-step model. The remainder of the review explores recently developed tools of decision technology. It examines the characteristics and problems of decision-facilitating sites on the World Wide Web. Such sites now provide anyone who can use a personal computer with access to very sophisticated decision-aiding tools structured mainly to facilitate consumer decision making. It seems likely that the Web will be the mode by means of which decision tools will be distributed to lay users. But methods for doing such apparently simple things as winnowing 3000 options down to a more reasonable number, like 10, contain traps for unwary decision technologists. The review briefly examines Bayes nets and influence diagrams-judgment and decision-making tools that are available as computer programs. It very briefly summarizes the state of the art of eliciting probabilities from experts. It concludes that decision tools will be as important in the 21st century as spreadsheets were in the 20th.

  8. Implementation of a knowledge-based methodology in a decision support system for the design of suitable wastewater treatment process flow diagrams.

    PubMed

    Garrido-Baserba, Manel; Reif, Rubén; Hernández, Francesc; Poch, Manel

    2012-12-15

    In light of rapid global change, the demand for wastewater treatment is increasing rapidly and will continue to do so in the near future. Wastewater management is a complex puzzle for which the proper pieces must be combined to achieve the desired solution, requiring the simultaneous consideration of technical, economic, social and environmental issues. In this context, a knowledge-based methodology (KBM) for the conceptual design of wastewater treatment plant (WWTP) process flow diagrams (PFDs) and its application for two scenarios is presented in this paper. The core of the KBM is composed of two knowledge bases (KBs). The first, a specification knowledge base (S-KB), summarizes the main features of the different treatment technologies: pollutants removal efficiency, operational costs and technical reliability. The second, a compatibility knowledge base (C-KB), contains information about the different interactions amongst the treatment technologies and determines their degree of compatibility. The proposed methodology is based on a decision hierarchy that uses the information contained in both KBs to generate all possible WWTP configurations, screening and selecting appropriate configurations based on user-specified requirements and scenario characteristics. The design of the most adequate treatment train for small and medium sized wastewater treatment plants (2000 and 50,000 p.e. respectively) according to different restrictions (space constraints, operation simplicity and cost optimization) was the example in order to show the usefulness of the KBM.

  9. Prediction of risk of recurrence of venous thromboembolism following treatment for a first unprovoked venous thromboembolism: systematic review, prognostic model and clinical decision rule, and economic evaluation.

    PubMed Central

    Ensor, Joie; Riley, Richard D; Jowett, Sue; Monahan, Mark; Snell, Kym Ie; Bayliss, Susan; Moore, David; Fitzmaurice, David

    2016-01-01

    BACKGROUND Unprovoked first venous thromboembolism (VTE) is defined as VTE in the absence of a temporary provoking factor such as surgery, immobility and other temporary factors. Recurrent VTE in unprovoked patients is highly prevalent, but easily preventable with oral anticoagulant (OAC) therapy. The unprovoked population is highly heterogeneous in terms of risk of recurrent VTE. OBJECTIVES The first aim of the project is to review existing prognostic models which stratify individuals by their recurrence risk, therefore potentially allowing tailored treatment strategies. The second aim is to enhance the existing research in this field, by developing and externally validating a new prognostic model for individual risk prediction, using a pooled database containing individual patient data (IPD) from several studies. The final aim is to assess the economic cost-effectiveness of the proposed prognostic model if it is used as a decision rule for resuming OAC therapy, compared with current standard treatment strategies. METHODS Standard systematic review methodology was used to identify relevant prognostic model development, validation and cost-effectiveness studies. Bibliographic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched using terms relating to the clinical area and prognosis. Reviewing was undertaken by two reviewers independently using pre-defined criteria. Included full-text articles were data extracted and quality assessed. Critical appraisal of included full texts was undertaken and comparisons made of model performance. A prognostic model was developed using IPD from the pooled database of seven trials. A novel internal-external cross-validation (IECV) approach was used to develop and validate a prognostic model, with external validation undertaken in each of the trials iteratively. Given good performance in the IECV approach, a final model was developed using all trials data. A Markov patient-level simulation was used to

  10. Development of a geographic information system-based decision support toolset to assess the feasibility of on-site wastewater treatment and disposal options in low permeability subsoils.

    PubMed

    Dubber, Donata; Pilla, Francesco; Smyth, David; Qazi, Nadeem; McCarthy, Tim; Gill, Laurence W

    2014-01-01

    Traditional on-site wastewater treatment systems have proven to be unsuitable in areas of low permeability subsoils, representing a risk to human health and the environment. With large areas being covered by low permeability tills, Ireland needs to consider alternative treatment and disposal options to be able to allow further development in these areas and to deal with polluting legacy sites. The paper describes the development and structure of a geographic information system (GIS)-based decision support toolset to evaluate possible alternative strategies for these sites. The programme takes as its initial input the location of an existing house located in an area of low permeability subsoils. Through a series of interconnected GIS geoprocesses the model outputs appropriate solutions for a site, ranking them in terms of environmental sustainability and cost. However, the final decisions are still dependent on on-site constraints so that each solution is accompanied by an alert message that provides additional information for the user to refine the output list according to the available local site-specific information.

  11. Frailty Markers and Treatment Decisions in Patients Seen in Oncogeriatric Clinics: Results from the ASRO Pilot Study

    PubMed Central

    de Decker, Laure; Pauly, Vanessa; Rousseau, Frédérique; Bergman, Howard; Molines, Catherine

    2016-01-01

    Background Comprehensive Geriatric Assessment (CGA) is the gold standard to help oncologists select the best cancer treatment for their older patients. Some authors have suggested that the concept of frailty could be a more useful approach in this population. We investigated whether frailty markers are associated with treatment recommendations in an oncogeriatric clinic. Methods This prospective study included 70 years and older patients with solid tumors and referred for an oncogeriatric assessment. The CGA included nine domains: autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls, and social status. Five frailty markers were assessed (nutrition, physical activity, energy, mobility, and strength). Patients were categorized as Frail (three or more frailty markers), pre-frail (one or two frailty markers), or not-frail (no frailty marker). Treatment recommendations were classified into two categories: standard treatment with and without any changes and supportive/palliative care. Multiple logistic regression models were used to analyze factors associated with treatment recommendations. Results 217 patients, mean age 83 years (± Standard deviation (SD) 5.3), were included. In the univariate analysis, number of frailty markers, grip strength, physical activity, mobility, nutrition, energy, autonomy, depression, Eastern Cooperative Oncology Group Scale of Performance Status (ECOG-PS), and falls were significantly associated with final treatment recommendations. In the multivariate analysis, the number of frailty markers and basic Activities of Daily Living (ADL) were significantly associated with final treatment recommendations (p<0.001 and p = 0.010, respectively). Conclusion Frailty markers are associated with final treatment recommendations in older cancer patients. Longitudinal studies are warranted to better determine their use in a geriatric oncology setting. PMID:26918947

  12. Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)

    PubMed Central

    Shergill, Sukhwinder S.; David, Anthony S.; Fonagy, Peter; Zaman, Rashid; Downar, Jonathan; Eliott, Emma; Bhui, Kamaldeep

    2015-01-01

    Summary Suicidal thinking, self-harm and suicidal acts are common, although determining their precise prevalence is complex. Epidemiological work has identified a number of associated demographic and clinical factors, though, with the exception of past acts of self-harm, these are non-specific and weak future predictors. There is a critical need shift focus from managing ‘suicidality-by-proxy’ through general mental health treatments, to better understand the neuropsychology and neurophysiology of such behaviour to guide targeted interventions. The model of the cognitive control of emotion (MCCE) offers such a paradigm, with an underlying pan-diagnostic pathophysiology of a hypoactive prefrontal cortex failing to suitably inhibit an overactive threat-responding limbic system. The result is a phenotype – from any number of causative gene–environment interactions – primed to impulsively self-harm. We argue that such neural dysconnectivity is open to potential therapeutic modification from repetitive transcranial magnetic stimulation (rTMS). The current evidence base for this is undoubtedly extremely limited, but the societal and clinical burden self-harm and suicide pose warrants such investigation. Declaration of interest K.B. is the Editor of BJPsych Open, but had no editorial involvement in the review or decision process regarding this paper. Copyright and usage © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence. PMID:27703728

  13. Bacillus Calmette-Guérin (BCG) Treatment Failures with Non-Muscle Invasive Bladder Cancer: A Data-Driven Definition for BCG Unresponsive Disease.

    PubMed

    Steinberg, Ryan L; Thomas, Lewis J; Mott, Sarah L; O'Donnell, Michael A

    2016-04-27

    Objective: To create the first data-driven definition for those unlikely to benefit from further BCG treatment. Materials and Methods: The database created for the Phase 2 BCG-Interferon-α 2B (IFN) study was queried and BCG failure patients were identified (n = 334). Full study protocols have previously been published. Separate models were constructed for analysis of patients with any CIS (pure or concomitant) and pure papillary disease. Variables considered included age, gender, stage, grade, tumor size and focality (for papillary only), number of prior BCG courses, and prior BCG failure interval. Results: Patients with recurrent CIS within 6 months of their most recent prior BCG course (HR 2.56, p <  0.01) and ≥2 prior BCG failures (HR 1.54, p <  0.01) responded worst to repeat intravesical therapy. Those with CIS recurrence at 6-12 months did not differ from those recurring within 6 months (HR = 0.88, p = 0.71). Patients with recurrent papillary disease within 6 months (HR 1.82, p = 0.02), ≥2 BCG failures (HR 1.54, p = 0.03), and multifocal disease (HR 2.05, p <  0.01) responded worst to therapy. Patients with T1 disease remained disease free in 38% of cases (24-51% 95% CI) at 2 years with low rates of progression. Conclusions: Patients who fail two courses of BCG with either persistent or recurrent multifocal papillary disease within 6 months or CIS within 12 months of their prior BCG should be considered BCG unresponsive. Recurrent T1 disease respond reasonably well to another course with low progression rates but further investigation is warranted.

  14. Bacillus Calmette-Guérin (BCG) Treatment Failures with Non-Muscle Invasive Bladder Cancer: A Data-Driven Definition for BCG Unresponsive Disease

    PubMed Central

    Steinberg, Ryan L.; Thomas, Lewis J.; Mott, Sarah L.; O’Donnell, Michael A.

    2016-01-01

    Objective: To create the first data-driven definition for those unlikely to benefit from further BCG treatment. Materials and Methods: The database created for the Phase 2 BCG-Interferon-α 2B (IFN) study was queried and BCG failure patients were identified (n = 334). Full study protocols have previously been published. Separate models were constructed for analysis of patients with any CIS (pure or concomitant) and pure papillary disease. Variables considered included age, gender, stage, grade, tumor size and focality (for papillary only), number of prior BCG courses, and prior BCG failure interval. Results: Patients with recurrent CIS within 6 months of their most recent prior BCG course (HR 2.56, p <  0.01) and ≥2 prior BCG failures (HR 1.54, p <  0.01) responded worst to repeat intravesical therapy. Those with CIS recurrence at 6–12 months did not differ from those recurring within 6 months (HR = 0.88, p = 0.71). Patients with recurrent papillary disease within 6 months (HR 1.82, p = 0.02), ≥2 BCG failures (HR 1.54, p = 0.03), and multifocal disease (HR 2.05, p <  0.01) responded worst to therapy. Patients with T1 disease remained disease free in 38% of cases (24–51% 95% CI) at 2 years with low rates of progression. Conclusions: Patients who fail two courses of BCG with either persistent or recurrent multifocal papillary disease within 6 months or CIS within 12 months of their prior BCG should be considered BCG unresponsive. Recurrent T1 disease respond reasonably well to another course with low progression rates but further investigation is warranted. PMID:27376140

  15. Organizational Decisions.

    DTIC Science & Technology

    1982-03-01

    240 finance departments of county, city and state governments’ promotion decisions, Halabv (1976) obtained evidence that the analysis of the decision...oper- ations research techniques and practicing finance managers avoid complex mathematical models in favor of a few simple rules in investment decision...likely its managers to spend time with outside organizations. Similarly, organizations that depend on outside financing select more outside members

  16. Decisions and desire.

    PubMed

    Morse, Gardiner

    2006-01-01

    When we make decisions, we're not always in charge. One moment we hotheadedly let our emotions get the better of us; the next, we're paralyzed by uncertainty. Then we'll pull a brilliant decision out of thin air--and wonder how we did it. Though we may have no idea how decision making happens, neuroscientists peering deep into our brains are beginning to get the picture. What they're finding may not be what you want to hear, but it's worth listening. We have dog brains, basically, with human cortexes stuck on top. By watching the brain in action as it deliberates and decides, neuroscientists are finding that not a second goes by that our animal brains aren't conferring with our modern cortexes to influence their choices. Scientists have discovered, for example, that the "reward" circuits in the brain that activate in response to cocaine, chocolate, sex, and music also find pleasure in the mere anticipation of making money--or getting revenge. And the "aversion" circuits that react to the threat of physical pain also respond with disgust when we feel cheated by a partner. In this article, HBR senior editor Gardiner Morse describes the experiments that illuminate the aggressive participation of our emotion-driven animal brains in decision making. This research also shows that our emotional brains needn't always operate beneath our radar. While our dog brains sometimes hijack our higher cognitive functions to drive bad, or at least illogical, decisions, they play an important part in rational decision making as well. The more we understand about how we make decisions, the better we can manage them.

  17. Electroencephalogy (EEG) Feedback in Decision-Making

    DTIC Science & Technology

    2015-08-26

    purpose     Our approach to exploring whether an Electroencephalogy-driven Decision Aid (EEG-DA) can be used to enhance training has two...encouraging, as high false alarm rates can lead users to distrust automated decision aids . (Parasuraman & Wickens, 2008). Table  3   Hit % FA % A’ d

  18. Factors that influence clinicians' decisions to offer intravenous alteplase in acute ischemic stroke patients with uncertain treatment indication: Results of a discrete choice experiment.

    PubMed

    De Brún, Aoife; Flynn, Darren; Ternent, Laura; Price, Christopher I; Rodgers, Helen; Ford, Gary A; Rudd, Matthew; Lancsar, Emily; Simpson, Stephen; Teah, John; Thomson, Richard G

    2017-01-01

    Background Treatment with intravenous alteplase for eligible patients with acute ischemic stroke is underused, with variation in treatment rates across the UK. This study sought to elucidate factors influencing variation in clinicians' decision-making about this thrombolytic treatment. Methods A discrete choice experiment using hypothetical patient vignettes framed around areas of clinical uncertainty was conducted with UK-based clinicians. Mixed logit regression analyses were conducted on the data. Results A total of 138 clinicians completed the discrete choice experiment. Seven patient factors were individually predictive of increased likelihood of immediately offering IV alteplase (compared to reference levels in brackets): stroke onset time 2 h 30 min [50 min]; pre-stroke dependency mRS 3 [mRS 4]; systolic blood pressure 185 mm/Hg [140 mm/Hg]; stroke severity scores of NIHSS 5 without aphasia, NIHSS 14 and NIHSS 23 [NIHSS 2 without aphasia]; age 85 [68]; Afro-Caribbean [white]. Factors predictive of withholding treatment with IV alteplase were: age 95 [68]; stroke onset time of 4 h 15 min [50 min]; severe dementia [no memory problems]; SBP 200 mm/Hg [140 mm/Hg]. Three clinician-related factors were predictive of an increased likelihood of offering IV alteplase (perceived robustness of the evidence for IV alteplase; thrombolyzing more patients in the past 12 months; and high discomfort with uncertainty) and one with a decreased likelihood (high clinician comfort with treating patients outside the licensing criteria). Conclusions Both patient- and clinician-related factors have a major influence on the use of alteplase to treat patients with acute ischemic stroke. Clinicians' views of the evidence, comfort with uncertainty and treating patients outside the license criteria are important factors to address in programs that seek to reduce variation in care quality regarding treatment with IV alteplase. Further research is needed to further understand

  19. Development of a hypermedia program designed to assist patients with localized prostate cancer in making treatment decisions.

    PubMed

    Jenkinson, J; Wilson-Pauwels, L; Jewett, M A; Woolridge, N

    1998-01-01

    The Prostate Centre, a hypermedia program integrating CD-ROM and Internet technology, was developed to help patients with localized prostate cancer access detailed and current information about available treatment options. Personal interviews with ten patients confirmed the need for more specific information examining the diagnosis and treatment of prostate cancer, as well as the suitability of computers for conveying this information. Sample screen designs effectively determined patients' visual preferences and were a useful springboard for conversation about a number of other relevant topics. Pilot testing of the resulting prototype elicited a positive response about the program from this sample audience. Patients regarded the program as useful, relevant to their needs, and navigable. Although the small sample size limited the study's generalizability, the method of involving patients in the design process successfully guided the program's development toward a greater fit with the users' needs.

  20. Treatment of Chronic Hepatitis C in the Aged – Does It Impact Life Expectancy? A Decision Analysis

    PubMed Central

    Maor, Yaakov; Malnick, Stephen D. H.; Melzer, Ehud; Leshno, Moshe

    2016-01-01

    Background and Aims Recent studies have demonstrated that the efficacy of interferon-free direct-acting antiviral agents (DAAs) in patients over 70 is similar to that of younger age groups. Evidence continues to mount that life expectancy (LE) increases with successful treatment of hepatitis C (HCV) patients with advanced fibrosis. The evidence in older people is more limited. Our aim was to estimate the life year (LY) and quality-adjusted life year (QALY) gained by treatment of naïve patients with HCV as a function of patient's age and fibrosis stage. Methods We constructed a Markov model of HCV progression toward advanced liver disease. The primary outcome was LY and QALY saved. The model and the sustained virological response of HCV infected subjects treated with a fixed-dose combination of the NS5B polymerase inhibitor Sofosbuvir and the NS5A replication complex inhibitor Ledipasvir were based on the published literature and expert opinion. Results Generally, both the number of LY gained and QALY gained gradually decreased with advancing age but the rate of decline was slower with more advanced fibrosis stage. For patients with fibrosis stage F1, F2 and F3, LY gained dropped below six months if treated by the age of 55, 65 or 70 years, respectively, while for a patient with fibrosis stage F4, the gain was one LY if treated by the age of 75. The QALY gained for treated over untreated elderly were reasonably high even for those treated at early fibrosis stage. Conclusions There is a significant life expectancy benefit to HCV treatment in patients up to age 75 with advanced-stage fibrosis. PMID:27410963

  1. From consumerism to active dependence: Patterns of medicines use and treatment decisions among patients with atopic dermatitis.

    PubMed

    Nørreslet, M; Bissell, P; Traulsen, J M

    2010-01-01

    In this article, findings from in-depth interviews with 12 people diagnosed with atopic dermatitis (AD) are described. The findings describe the range of strategies used to manage atopic dermatitis, including use of conventional medicines. A strong theme identified in informants' accounts centred on concerns about the risks of illness and long-term use of conventional medicines, which acted as a strong incentive for patients to seek alternatives to conventional treatments. However, despite their significant efforts to do so, patients were eventually forced to return to and rely on conventional medicines because of their efficacy in alleviating and treating symptoms. These findings are discussed in relation to the sociological literature on consumerism, risk and reflexivity in health. We argue that our findings exemplify how living with and managing a chronic illness may not be straightforward and the choices of treatment at hand may be limited. Consequently, this may limit the potential opportunities accruing from adopting a reflexive or consumerist approach to managing illness.

  2. Gaps in Incorporating Germline Genetic Testing Into Treatment Decision-Making for Early-Stage Breast Cancer.

    PubMed

    Kurian, Allison W; Li, Yun; Hamilton, Ann S; Ward, Kevin C; Hawley, Sarah T; Morrow, Monica; McLeod, M Chandler; Jagsi, Reshma; Katz, Steven J

    2017-04-12

    Purpose Genetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on treatment. Methods A population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients' attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use. Results Six hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical treatment, patients without private insurance more often experienced delays. Approximately half of patients (57% at higher pretest risk, 42% at average risk) discussed results with a genetic counselor. Patients with pathogenic mutations in BRCA1/2 or another gene had the highest rates of BLM (higher risk, 80%; average risk, 85%); however, BLM was also common among patients with genetic variants of uncertain significance (VUS; higher risk, 43%; average risk, 51%). Surgeons' confidence in discussing testing increased with volume of patients with breast cancer, but many surgeons (higher volume, 24%; lower volume, 50%) managed patients with BRCA1/2 VUS the same as patients with BRCA1/2 pathogenic mutations. Conclusion Many patients with breast cancer are tested without ever seeing a genetic counselor. Half of average-risk patients with VUS undergo BLM, suggesting a limited understanding of results that some surgeons share. These findings emphasize the need to address challenges in personalized communication

  3. The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment.

    PubMed

    Venkat, Arvind; Becker, Julianna

    2014-01-01

    While the ethics and critical care literature is replete with discussion of medical futility and the ethics of end-of-life care decisions in the intensive care unit, little attention is paid to the effect of statutory limitations on the authority of substitute decision makers during the course of treatment of patients in the critical care setting. In many jurisdictions, a clear distinction is made between the authority of a health care power of attorney, who is legally designated by a competent adult to make decisions regarding withholding or withdrawing life-sustaining treatment, and of next-of-kin, who are limited in this regard. However, next-of-kin are often relied upon to consent to necessary procedures to advance a patient's medical care. When conflicts arise between critical care physicians and family members regarding projected patient outcome and functional status, these statutory limitations on decision-making authority by next of kin can cause paralysis in the medical care of severely ill patients, leading to practical and ethical impasses. In this article, we will provide case examples of how statutory limitations on substitute decision making authority for next of kin can impede the care of patients. We will also review the varying jurisdictional limitations on the authority of substitute decision makers and explore their implications for patient care in the critical care setting. Finally, we will review possible ethical and legal solutions to resolve these impasses.

  4. A unified framework for addiction: Vulnerabilities in the decision process

    PubMed Central

    Redish, A. David; Jensen, Steve; Johnson, Adam

    2013-01-01

    The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) changing allostatic set points, (3) euphorigenic “reward-like” signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual’s susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment. PMID:18662461

  5. Effect of rapid influenza diagnostic testing on antiviral treatment decisions for patients with influenza-like illness: southwestern U.S., May-December 2009.

    PubMed

    Suryaprasad, Anil; Redd, John T; Ricks, Philip M; Podewils, Laura Jean; Brett, Meghan; Oski, Jane; Minenna, Wanda; Armao, Frank; Vize, Barbara J; Cheek, James E

    2014-01-01

    Rapid influenza diagnostic tests (RIDTs) had low test sensitivity for detecting 2009 pandemic influenza A (H1N1pdm09) infection, causing public health authorities to recommend that treatment decisions be based primarily upon risk for influenza complications. We used multivariate Poisson regression analysis to estimate the contribution of RIDT results and risk for H1N1pdm09 complications to receipt of early antiviral (AV) treatment among 290 people with influenza-like illness (ILI) who received an RIDT ≤48 hours after symptom onset from May to December 2009 at four southwestern U.S. facilities. RIDT results had a stronger association with receipt of early AVs (rate ratio [RR] = 3.3, 95% confidence interval [CI] 2.4, 4.6) than did the presence of risk factors for H1N1pdm09 complications (age <5 years or high-risk medical conditions) (RR=1.9, 95% CI 1.3, 2.7). Few at-risk people (28/126, 22%) who had a negative RIDT received early AVs, suggesting the need for sustained efforts by public health to influence clinician practices.

  6. Effect of Rapid Influenza Diagnostic Testing on Antiviral Treatment Decisions for Patients with Influenza-Like Illness: Southwestern U.S., May–December 2009

    PubMed Central

    Redd, John T.; Ricks, Philip M.; Podewils, Laura Jean; Brett, Meghan; Oski, Jane; Minenna, Wanda; Armao, Frank; Vize, Barbara J.; Cheek, James E.

    2014-01-01

    Rapid influenza diagnostic tests (RIDTs) had low test sensitivity for detecting 2009 pandemic influenza A (H1N1pdm09) infection, causing public health authorities to recommend that treatment decisions be based primarily upon risk for influenza complications. We used multivariate Poisson regression analysis to estimate the contribution of RIDT results and risk for H1N1pdm09 complications to receipt of early antiviral (AV) treatment among 290 people with influenza-like illness (ILI) who received an RIDT ≤48 hours after symptom onset from May to December 2009 at four southwestern U.S. facilities. RIDT results had a stronger association with receipt of early AVs (rate ratio [RR] = 3.3, 95% confidence interval [CI] 2.4, 4.6) than did the presence of risk factors for H1N1pdm09 complications (age <5 years or high-risk medical conditions) (RR=1.9, 95% CI 1.3, 2.7). Few at-risk people (28/126, 22%) who had a negative RIDT received early AVs, suggesting the need for sustained efforts by public health to influence clinician practices. PMID:24982534

  7. Using the pathology report in initial treatment decisions for diffuse large B-cell lymphoma: time for a precision medicine approach.

    PubMed

    Friedberg, Jonathan W

    2015-01-01

    Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non Hodgkin lymphoma in the Western world, and is potentially curable with standard R-CHOP chemoimmunotherapy. Historically, clinical risk assessments provided prognostic information, but did not define treatment approach. We are now in an era where the heterogeneity of DLBCL is defined genetically and molecularly, and rational subset-specific therapeutic targets are guiding clinical trials. Primary mediastinal DLBCL is a unique clinicopathologic entity, and alternatives to R-CHOP may confer superior outcome. Rearrangement of the myc oncogene occurs in ~10% of patients with DLBCL, and confers a very poor prognosis with standard R-CHOP, particularly when there is concomitant rearrangement of bcl-2, a condition referred to as "double-hit" DLBCL. A larger subset of DLBCL demonstrates overexpression of both myc and bcl-2 by immunohistochemistry. Cell of origin, determined by gene expression analysis, immunohistochemistry algorithms, or a novel Lymph2Cx platform, provides prognostic information, and guides therapeutic decisions in both relapsed and de novo disease. This article will define specific subsets of DLBCL and provide subtype-specific treatment options, including novel approaches under investigation. Understanding these key features of the pathology report, and limitations of these assays defining subsets of DLBCL, allows for an evolving precision medicine approach to this disease.

  8. Perceptions of Radiation Oncologists and Urologists on Sources and Type of Evidence to Inform Prostate Cancer Treatment Decisions

    SciTech Connect

    Han, Leona C.; Delpe, Sophia; Shah, Nilay D.; Ziegenfuss, Jeanette Y.; Tilburt, Jon C.; Karnes, R. Jeffrey; Nguyen, Paul L.; Gross, Cary P.; Yu, James B.; Trinh, Quoc-Dien; Sun, Maxine; Ranasinghe, Weranja K.B.; Kim, Simon P.

    2014-06-01

    Purpose: To perform a national survey of radiation oncologists and urologists about the type of resources used and the level of evidence needed to change clinical practice in localized prostate cancer. Methods and Materials: From a random sample, 1422 physicians were mailed a survey assessing the types of information used and what level of evidence could alter their clinical practice in prostate cancer. Multivariable logistic regression models were used to identify differences in physician characteristics for each outcome. Results: Survey response rates were similar for radiation oncologists and urologists (44% vs 46%; P=.46). Specialty-specific journals represented the most commonly used resource for informing the clinical practice for radiation oncologists (65%) and urologists (70%). Relative to radiation oncologists, urologists were less likely to report utilizing top-tier medical journals (25% vs 39%; adjusted odds ratio [OR] 0.50; P=.01) or cancer journals (22% vs 51%; adjusted OR 0.50; P<.001) but more likely to rely on clinical guidelines (46% vs 38%; adjusted OR 1.6; P=.006). Both radiation oncologists and urologists most commonly reported large randomized, clinical trials as the level of evidence to change treatment recommendations for localized prostate cancer (85% vs 77%; P=.009). Conclusions: Both specialties rely on their own specialty-specific journals and view randomized, clinical trials as the level of evidence needed to change clinical practice. Our study provides a context on meaningful ways of disseminating evidence for localized prostate cancer.

  9. Treatment for HIV

    MedlinePlus

    ... and Public Home » Treatment » Treatment Decisions and HIV HIV/AIDS Menu Menu HIV/AIDS HIV/AIDS Home ... here Enter ZIP code here Treatment Decisions and HIV for Veterans and the Public Treatment for HIV: ...

  10. Shared Decision Making in Cancer Care

    ERIC Educational Resources Information Center

    Butow, Phyllis; Tattersall, Martin

    2005-01-01

    Cancer treatment outcomes have improved over the past 20 years, but treatment decision making in this context remains complex. There are often a number of reasonable treatment alternatives, including no treatment in some circumstances. Patients and doctors often have to weigh up uncertain benefits against uncertain costs. Shared decision making…

  11. Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

    PubMed Central

    Boyd, Kathleen A; Jones, Rob J; Paul, Jim; Birrell, Fiona; Briggs, Andrew H; Leung, Hing Y

    2015-01-01

    Objective To determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC). Design Cost-utility analysis using decision analytic modelling by a Markov model. Setting and methods Compared SC and androgen deprivation therapy (ADT) in a cohort of patients with RRPC (biopsy proven local recurrence, no evidence of metastatic disease). A literature review captured published data to inform the decision model, and resource use data were from the Scottish Prostate Cryotherapy Service. The model was run in monthly cycles for RRPC men, mean age of 70 years. The model was run over the patient lifetime, to assess changes in patient health states and the associated quality of life, survival and cost impacts. Results are reported in terms of the discounted incremental costs and discounted incremental quality-adjusted life years (QALYs) gained between the 2 alternative interventions. Probabilistic sensitivity analysis used a 10 000 iteration Monte Carlo simulation. Results SC has a high upfront treatment cost, but delays the ongoing monthly cost of ADT. SC is the dominant strategy over the patient lifetime; it is more effective with an incremental 0.56 QALY gain (95% CI 0.28 to 0.87), and less costly with a reduced lifetime cost of £29 719 (€37 619) (95% CI −51 985 to −9243). For a ceiling ratio of £30 000, SC has a 100% probability to be cost-effective. The cost neutral point was at 3.5 years, when the upfront cost of SC (plus any subsequent cumulative cost of side effects and ADT) equates the cumulative cost in the ADT arm. Limitations of our model may arise from its insensitivity to parameter or structural uncertainty. Conclusions The platform for SC versus ADT cost-effective analysis can be employed to evaluate other treatment modalities or strategies in RRPC. SC is the dominant strategy, costing less over a patient's lifetime with improvements in QALYs. Trial registration number This economic analysis

  12. Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making

    PubMed Central

    Luby, Marie; Warach, Steven J; Albers, Gregory W; Baron, Jean-Claude; Cognard, Christophe; Dávalos, Antoni; Donnan, Geoffrey A; Fiebach, Jochen B; Fiehler, Jens; Hacke, Werner; Lansberg, Maarten G; Liebeskind, David S; Mattle, Heinrich P; Oppenheim, Catherine; Schellinger, Peter D; Wardlaw, Joanna M; Wintermark, Max

    2016-01-01

    Background and Purpose The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials. Methods STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials. Results We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27–28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy. Conclusions Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62–87%) across all clinical vignettes and time windows

  13. A prospective study comparing the predictions of doctors versus models for treatment outcome of lung cancer patients: a step towards individualized care and shared decision making

    PubMed Central

    Oberije, Cary; Nalbantov, Georgi; Dekker, Andre; Boersma, Liesbeth; Borger, Jacques; Reymen, Bart; van Baardwijk, Angela; Wanders, Rinus; De Ruysscher, Dirk; Steyerberg, Ewout; Dingemans, Anne-Marie; Lambin, Philippe

    2015-01-01

    Background Decision Support Systems, based on statistical prediction models, have the potential to change the way medicine is being practiced, but their application is currently hampered by the astonishing lack of impact studies. Showing the theoretical benefit of using these models could stimulate conductance of such studies. In addition, it would pave the way for developing more advanced models, based on genomics, proteomics and imaging information, to further improve the performance of the models. Purpose In this prospective single-center study, previously developed and validated statistical models were used to predict the two-year survival (2yrS), dyspnea (DPN), and dysphagia (DPH) outcomes for lung cancer patients treated with chemo radiation. These predictions were compared to probabilities provided by doctors and guideline-based recommendations currently used. We hypothesized that model predictions would significantly outperform predictions from doctors. Materials and Methods Experienced radiation oncologists (ROs) predicted all outcomes at two timepoints: 1) after the first consultation of the patient, and 2) after the radiation treatment plan was made. Differences in the performances of doctors and models were assessed using Area under the Curve (AUC) analysis. Results A total number of 155 patients were included. At timepoint #1 the differences in AUCs between the ROs and the models were 0.15, 0.17, and 0.20 (for 2yrS, DPN, and DPH respectively), with p-values of 0.02, 0.07, and 0.03. Comparable differences at timepoint #2 were not statistically significant due to the limited number of patients. Comparison to guideline-based recommendations also favored the models. Conclusions The models substantially outperformed ROs’ predictions and guideline-based recommendations currently used in clinical practice. Identification of risk groups on the basis of the models facilitates individualized treatment, and should be further investigated in clinical impact

  14. Using decision analysis to determine the cost-effectiveness of intensity-modulated radiation therapy in the treatment of intermediate risk prostate cancer

    SciTech Connect

    Konski, Andre . E-mail: andre.konski@fccc.edu; Watkins-Bruner, Deborah; Feigenberg, Steven; Hanlon, Alexandra; Kulkarni, Sachin M.S.; Beck, J. Robert; Horwitz, Eric M.; Pollack, Alan

    2006-10-01

    Background: The specific aim of this study is to evaluate the cost-effectiveness of intensity-modulated radiation therapy (IMRT) compared with three-dimensional conformal radiation therapy (3D-CRT) in the treatment of a 70-year-old with intermediate-risk prostate cancer. Methods: A Markov model was designed with the following states; posttreatment, hormone therapy, chemotherapy, and death. Transition probabilities from one state to another were calculated from rates derived from the literature for IMRT and 3D-CRT. Utility values for each health state were obtained from preliminary studies of preferences conducted at Fox Chase Cancer Center. The analysis took a payer's perspective. Expected mean costs, cost-effectiveness scatterplots, and cost acceptability curves were calculated with commercially available software. Results: The expected mean cost of patients undergoing IMRT was $47,931 with a survival of 6.27 quality-adjusted life years (QALYs). The expected mean cost of patients having 3D-CRT was $21,865 with a survival of 5.62 QALYs. The incremental cost-effectiveness comparing IMRT with CRT was $40,101/QALYs. Cost-effectiveness acceptability curve analysis revealed a 55.1% probability of IMRT being cost-effective at a $50,000/QALY willingness to pay. Conclusion: Intensity-modulated radiation therapy was found to be cost-effective, however, at the upper limits of acceptability. The results, however, are dependent on the assumptions of improved biochemical disease-free survival with fewer patients undergoing subsequent salvage therapy and improved quality of life after the treatment. In the absence of prospective randomized trials, decision analysis can help inform physicians and health policy experts on the cost-effectiveness of emerging technologies.

  15. Social Capital in Data-Driven Community College Reform

    ERIC Educational Resources Information Center

    Kerrigan, Monica Reid

    2015-01-01

    The current rhetoric around using data to improve community college student outcomes with only limited research on data-driven decision-making (DDDM) within postsecondary education compels a more comprehensive understanding of colleges' capacity for using data to inform decisions. Based on an analysis of faculty and administrators' perceptions and…

  16. Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion.

    PubMed

    Willems, Paul

    2013-02-01

    for the outcome of fusion. A systematic review of the literature supplemented with a prospective cohort study was performed (Study III) in order to assess the value of a pantaloon cast in surgical decision-making. It appeared that only in CLBP patients with no prior spine surgery, a pantaloon cast test with substantial pain relief suggests a favorable outcome of lumbar fusion compared to conservative treatment. In patients with prior spine surgery the test is of no value. It is believed by many spine surgeons that provocative discography, unlike plain radiographs or magnetic resonance imaging, is a physiologic test that can truly determine whether a disc is painful and relevant in a patient's pain syndrome, irrespective of the morphology of the disc. It has been suggested that in order to achieve a successful clinical outcome of lumbar fusion, suspect discs should be painful and adjacent control discs should elicit no pain on provocative discography. For this reason, a cohort of patients in whom the decision to perform lumbar fusion was based on an external fixation (TETF) trial, was analysed retrospectively in Study IV. The results of preoperative discography of solely the levels adjacent to the fusion were compared with the clinical results after spinal fusion. It appeared that in this select group of patients the discographic status of discs adjacent to a lumbar fusion did not have any effect on the clinical outcome. The most feared complication of lumbar discography is discitis. Although low in incidence, this is a serious complication for a diagnostic procedure and prevention by the use of prophylactic antibiotics has been advocated. In search for clinical guidelines, the risk of postdiscography discitis was assessed in Study V by means of a systematic literature review and a cohort of 200 consecutive patients. Without the use of prophylactic antibiotics, an overall incidence of postdiscography discitis of 0.25% was found. To prove that antibiotics would actually

  17. Evaluation of Sound Therapy Tinnitus Treatments with Concurrent Counseling in Active Duty Military Personnel

    DTIC Science & Technology

    2014-07-04

    Tinnitus Retraining Therapy (TRT). Identifying the course of treatment or intervention is multifactorial. This decision is often driven by factors such...levels (F = 16.71, p = .003). For this treatment group, pre- and post- intervention measures of both disturbance levels and BBNMML measures failed to...failed to reveal a statistically significant effect of time (i.e. use of treatment at pre- and post- intervention ) for either device used

  18. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

    PubMed

    Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

    2011-01-01

    In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

  19. Stochastic decision analysis

    NASA Technical Reports Server (NTRS)

    Lacksonen, Thomas A.

    1994-01-01

    Small space flight project design at NASA Langley Research Center goes through a multi-phase process from preliminary analysis to flight operations. The process insures that each system achieves its technical objectives with demonstrated quality and within planned budgets and schedules. A key technical component of early phases is decision analysis, which is a structure procedure for determining the best of a number of feasible concepts based upon project objectives. Feasible system concepts are generated by the designers and analyzed for schedule, cost, risk, and technical measures. Each performance measure value is normalized between the best and worst values and a weighted average score of all measures is calculated for each concept. The concept(s) with the highest scores are retained, while others are eliminated from further analysis. This project automated and enhanced the decision analysis process. Automation of the decision analysis process was done by creating a user-friendly, menu-driven, spreadsheet macro based decision analysis software program. The program contains data entry dialog boxes, automated data and output report generation, and automated output chart generation. The enhancements to the decision analysis process permit stochastic data entry and analysis. Rather than enter single measure values, the designers enter the range and most likely value for each measure and concept. The data can be entered at the system or subsystem level. System level data can be calculated as either sum, maximum, or product functions of the subsystem data. For each concept, the probability distributions are approximated for each measure and the total score for each concept as either constant, triangular, normal, or log-normal distributions. Based on these distributions, formulas are derived for the probability that the concept meets any given constraint, the probability that the concept meets all constraints, and the probability that the concept is within a given

  20. Impact of Pretreatment Combined {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging on Radiation Therapy Treatment Decisions in Locally Advanced Breast Cancer

    SciTech Connect

    Ng, Sweet Ping; David, Steven; Alamgeer, Muhammad; Ganju, Vinod

    2015-09-01

    Purpose: To assess the diagnostic performance of pretreatment {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography ({sup 18}F-FDG PET/CT) and its impact on radiation therapy treatment decisions in patients with locally advanced breast cancer (LABC). Methods and Materials: Patients with LABC with Eastern Cooperative Oncology Group performance status <2 and no contraindication to neoadjuvant chemotherapy, surgery, and adjuvant radiation therapy were enrolled on a prospective trial. All patients had pretreatment conventional imaging (CI) performed, including bilateral breast mammography and ultrasound, bone scan, and CT chest, abdomen, and pelvis scans performed. Informed consent was obtained before enrolment. Pretreatment whole-body {sup 18}F-FDG PET/CT scans were performed on all patients, and results were compared with CI findings. Results: A total of 154 patients with LABC with no clinical or radiologic evidence of distant metastases on CI were enrolled. Median age was 49 years (range, 26-70 years). Imaging with PET/CT detected distant metastatic disease and/or locoregional disease not visualized on CI in 32 patients (20.8%). Distant metastatic disease was detected in 17 patients (11.0%): 6 had bony metastases, 5 had intrathoracic metastases (pulmonary/mediastinal), 2 had distant nodal metastases, 2 had liver metastases, 1 had pulmonary and bony metastases, and 1 had mediastinal and distant nodal metastases. Of the remaining 139 patients, nodal disease outside conventional radiation therapy fields was detected on PET/CT in 15 patients (10.8%), with involvement of ipsilateral internal mammary nodes in 13 and ipsilateral level 5 cervical nodes in 2. Conclusions: Imaging with PET/CT provides superior diagnostic and staging information in patients with LABC compared with CI, which has significant therapeutic implications with respect to radiation therapy management. Imaging with PET/CT should be considered in all patients undergoing primary

  1. Development of a Post-Intensive Care Unit Storytelling Intervention for Surrogates Involved in Decisions to Limit Life-Sustaining Treatment

    PubMed Central

    Schenker, Yael; Dew, Mary Amanda; Reynolds, Charles F.; Arnold, Robert M.; Tiver, Greer A.; Barnato, Amber E.

    2014-01-01

    Objectives Surrogates involved in decisions to limit life-sustaining treatment for a loved one in the intensive care unit (ICU) are at increased risk for adverse psychological outcomes lasting months to years after the ICU experience. Post-ICU interventions to reduce surrogate distress have not been developed. We sought to 1) describe a conceptual framework underlying the beneficial mental health effects of storytelling and 2) present formative work developing a storytelling intervention to reduce distress for recently bereaved surrogates. Methods An interdisciplinary team conceived the idea for a storytelling intervention based upon evidence from narrative theory that storytelling reduces distress from traumatic events through emotional disclosure, cognitive processing, and social connections. We developed an initial storytelling guide based upon this theory and the clinical perspectives of team members. We then conducted a case series with recently bereaved surrogates to iteratively test and modify the guide. Results The storytelling guide covered three key domains of the surrogate's experience of the patient's illness and death: antecedents, ICU experience, and aftermath. The facilitator focused on parts of the story that appeared to generate strong emotions and used non-judgmental statements to attend to these emotions. Between September 2012 and May 2013 we identified 28 eligible surrogates from 1 medical ICU and consented 20 for medical record review and recontact; 10 became eligible of whom 6 consented and completed the storytelling intervention. The single-session storytelling intervention lasted 40-92 minutes. All storytelling participants endorsed the intervention as acceptable, and 5 of 6 reported that it was helpful. Significance of Results Surrogate storytelling is an innovative and acceptable post-ICU intervention for recently bereaved surrogates and should be evaluated further. PMID:24524736

  2. VenUS IV (Venous leg Ulcer Study IV) - compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomised controlled trial, mixed-treatment comparison and decision-analytic model.

    PubMed Central

    Ashby, Rebecca L; Gabe, Rhian; Ali, Shehzad; Saramago, Pedro; Chuang, Ling-Hsiang; Adderley, Una; Bland, J Martin; Cullum, Nicky A; Dumville, Jo C; Iglesias, Cynthia P; Kang'ombe, Arthur R; Soares, Marta O; Stubbs, Nikki C; Torgerson, David J

    2014-01-01

    BACKGROUND Compression is an effective and recommended treatment for venous leg ulcers. Although the four-layer bandage (4LB) is regarded as the gold standard compression system, it is recognised that the amount of compression delivered might be compromised by poor application technique. Also the bulky nature of the bandages might reduce ankle or leg mobility and make the wearing of shoes difficult. Two-layer compression hosiery systems are now available for the treatment of venous leg ulcers. Two-layer hosiery (HH) may be advantageous, as it has reduced bulk, which might enhance ankle or leg mobility and patient adherence. Some patients can also remove and reapply two-layer hosiery, which may encourage self-management and could reduce costs. However, little robust evidence exists about the effectiveness of two-layer hosiery for ulcer healing and no previous trials have compared two-layer hosiery delivering 'high' compression with the 4LB. OBJECTIVES Part I To compare the clinical effectiveness and cost-effectiveness of HH and 4LB in terms of time to complete healing of venous leg ulcers. Part II To synthesise the relative effectiveness evidence (for ulcer healing) of high-compression treatments for venous leg ulcers using a mixed-treatment comparison (MTC). Part III To construct a decision-analytic model to assess the cost-effectiveness of high-compression treatments for venous leg ulcers. DESIGN Part I A multicentred, pragmatic, two-arm, parallel, open randomised controlled trial (RCT) with an economic evaluation. Part II MTC using all relevant RCT data - including Venous leg Ulcer Study IV (VenUS IV). Part III A decision-analytic Markov model. SETTINGS Part I Community nurse teams or services, general practitioner practices, leg ulcer clinics, tissue viability clinics or services and wound clinics within England and Northern Ireland. PARTICIPANTS Part I Patients aged ≥ 18 years with a venous leg ulcer, who were willing and able to tolerate high

  3. A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology.

    PubMed

    Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T

    2017-01-30

    Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.

  4. Current understanding of decision-making in adolescents with cancer: A narrative systematic review

    PubMed Central

    Day, Emma; Jones, Louise; Langner, Richard; Bluebond-Langner, Myra

    2016-01-01

    Background: Policy guidance and bioethical literature urge the involvement of adolescents in decisions about their healthcare. It is uncertain how roles and expectations of adolescents, parents and healthcare professionals influence decision-making and to what extent this is considered in guidance. Aims: To identify recent empirical research on decision-making regarding care and treatment in adolescent cancer: (1) to synthesise evidence to define the role of adolescents, parents and healthcare professionals in the decision-making process and (2) to identify gaps in research. Design: A narrative systematic review of qualitative, quantitative and mixed-methods research. We adopted a textual approach to synthesis, using a theoretical framework of interactionism to interpret findings. Data Sources: The databases MEDLINE, PsycINFO, SCOPUS, EMBASE and CINHAL were searched from 2001 through May 2015 for publications on decision-making for adolescents (13–19 years) with cancer. Results: Twenty-eight articles were identified. Adolescents and parents initially find it difficult to participate in decision-making due to a lack of options in the face of protocol-driven care. Parent and adolescent preferences for information and response to loss of control vary between individuals and over time. No studies indicate parental or adolescent preference for a high degree of independence in decision-making. Conclusion: Striving to make parents and adolescents fully informed or urge them towards more independence than they prefer may add to distress and confusion. This may interfere with their ability to participate in their preferred way in decisions about care and treatment. Future research should include analysis of on-ground interactions among parents, adolescents and clinicians across the trajectory. PMID:27160700

  5. Bilastine in allergic rhinoconjunctivitis and urticaria: a practical approach to treatment decisions based on queries received by the medical information department

    PubMed Central

    Leceta, Amalia; Sologuren, Ander; Valiente, Román; Campo, Cristina; Labeaga, Luis

    2017-01-01

    Background Bilastine is a safe and effective commonly prescribed non-sedating H1-antihistamine approved for symptomatic treatment in patients with allergic disorders such as rhinoconjunctivitis and urticaria. It was evaluated in many patients throughout the clinical development required for its approval, but clinical trials generally exclude many patients who will benefit in everyday clinical practice (especially those with coexisting diseases and/or being treated with concomitant drugs). Following its introduction into clinical practice, the Medical Information Specialists at Faes Farma have received many practical queries regarding the optimal use of bilastine in different circumstances. Data sources and methods Queries received by the Medical Information Department and the responses provided to senders of these queries. Results The most frequent questions received by the Medical Information Department included the potential for drug-drug interactions with bilastine and commonly used agents such as anticoagulants (including the novel oral anticoagulants), antiretrovirals, antituberculosis regimens, corticosteroids, digoxin, oral contraceptives, and proton pump inhibitors. Most of these medicines are not usually allowed in clinical trials, and so advice needs to be based upon the pharmacological profiles of the drugs involved and expert opinion. The pharmacokinetic profile of bilastine appears favourable since it undergoes negligible metabolism and is almost exclusively eliminated via renal excretion, and it neither induces nor inhibits the activity of several isoenzymes from the CYP 450 system. Consequently, bilastine does not interact with cytochrome metabolic pathways. Other queries involved specific patient groups such as subjects with renal impairment, women who are breastfeeding or who are trying to become pregnant, and patients with other concomitant diseases. Interestingly, several questions related to topics that are well covered in the Summary of Product

  6. Decision making in neonatologia.

    PubMed

    Paterlini, G; Tagliabue, P

    2010-06-01

    The field of neonatology presents a fascinating context in which hugely important decisions have to be made on the basis of physicians' assessments of the long term consequences of various possible choices. In many cases such assessments cannot be derived from a consensual professional opinion; the situation is characterized by a high level of uncertainty. A sample of neonatologists in different countries received a questionnaire including vignette cases for which no clear consensus exists regarding the (probabilistic) prognosis. They were asked to (I) assess the probability of various outcomes (death, severe impairment) and (II) choose a treatment to be offered to the parents. Information on the physicians' professional and socio-demographic characteristics and their ethical "values" was also collected. The goal of this international survey is to understand the prognosis and to analyze decision making by professionals in the context of life and death in medicine. The availability of an identical technology in different social and institutional contexts should help identifying the convergences and differences under consideration. Seventy percent of those invited responded to the questionnaire (International 60-80%). Italian neonatologists seem to be quite pessimistic about the prognosis of infants at high risk of death or long term disabilities, they show a pro-life attitude, but in a certain proportion are willing to change their minds if requested by parents. Furthermore personal opinions predominate in the decision-making process and the contribution of team meeting and/or ethic consultation seem not significantly modify the decisions.

  7. Treatment of Necrotic Teeth Using Two Engine-Driven Systems and Patient’s Postoperative Pain: A Double-Blind Clinical Trial

    PubMed Central

    Zand, Vahid; Milani, Amin Salem; Hassani Dehkharghani, Ayla; Rahbar, Mahdi; Tehranchi, Pardis

    2016-01-01

    Introduction: One of the most important reasons for postoperative pain is the extrusion of debris from the apical foramen during preparation and shaping of root canals. The aim of this clinical trial was to evaluate the severity of postoperative pain with the use of two different engine-driven NiTi systems. Methods and Materials: Ninety mandibular molars were randomly divided into two groups (n=45), and root canal cleaning and shaping was done using either RaCe or Reciproc instruments. The severity of postoperative pain was determined with visual analogue scale (VAS) at 4-, 12-, 24-, 48- and 72 h and 1-week intervals and postoperative pain was compared between the two groups. The chi-squared test and repeated-measures analysis were used to compare the data between the two groups. Results: Based on the results of the statistical analyses, the two groups were matched regarding the age and gender, with no significant differences. In addition, except for 4- and 24-h and 1-week intervals, postoperative pain was significantly less in the RaCe group compared to the Reciproc group (P<0.001). Conclusion: Based on the results of the present study, use of RaCe files for cleaning and shaping of root canals in necrotic mandibular molars resulted in less severe postoperative pain compared to Reciproc files. PMID:27790254

  8. Histone deacetylase inhibitor-temozolomide co-treatment inhibits melanoma growth through suppression of Chemokine (C-C motif) ligand 2-driven signals

    PubMed Central

    Cesare, Michelandrea De; Arrighetti, Noemi; Manenti, Giacomo; Ciusani, Emilio; Verderio, Paolo; Ciniselli, Chiara M.; Cominetti, Denis; Carenini, Nives; Corna, Elisabetta; Zaffaroni, Nadia; Rodolfo, Monica; Rivoltini, Licia

    2014-01-01

    Target-specific agents used in melanoma are not curative, and chemokines are being implicated in drug-resistance to target-specific agents. Thus, the use of conventional agents in rationale combinations may result in optimization of therapy. Because histone deacetylases participate in tumor development and progression, the combination of the pan-inhibitor SAHA and temozolomide might provide a therapeutic advantage. Here, we show synergism between the two drugs in mutant BRAF cell lines, in association with decreased phosphorylation of cell survival proteins (e.g., C-Jun-N-terminal-kinase, JNK). In the spontaneous ret transgenic mouse melanoma model, combination therapy produced a significant disease onset delay and down-regulation of Chemokine (C-C motif) ligand 2 (CCL2), JNK, and of Myeloid-derived suppressor cell recruitment. Co-incubation with a CCL2-blocking-antibody enhanced in vitro cell sensitivity to temozolomide. Conversely, recombinant CCL2 activated JNK in human tumor melanoma cells. In keeping with these results, the combination of a JNK-inhibitor with temozolomide was synergistic. By showing that down-regulation of CCL2-driven signals by SAHA and temozolomide via JNK contributes to reduce melanoma growth, we provide a rationale for the therapeutic advantage of the drug combination. This combination strategy may be effective because of interference both with tumor cell and tumor microenvironment. PMID:24980831

  9. Decision making under uncertain categorization

    PubMed Central

    Chen, Stephanie Y.; Ross, Brian H.; Murphy, Gregory L.

    2014-01-01

    Two experiments investigated how category information is used in decision making under uncertainty and whether the framing of category information influences how it is used. Subjects were presented with vignettes in which the categorization of a critical item was ambiguous and were asked to choose among a set of actions with the goal of attaining the desired outcome for the main character in the story. The normative decision making strategy was to base the decision on all possible categories; however, research on a related topic, category-based induction, has found that people often only consider a single category when making predictions when categorization is uncertain. These experiments found that subjects tend to consider multiple categories when making decisions, but do so both when it is and is not appropriate, suggesting that use of multiple categories is not driven by an understanding of whether categories are relevant to the decision. Similarly, although a framing manipulation increased the rate of multiple-category use, it did so in situations in which multiple-category use both was and was not appropriate. PMID:25309475

  10. The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study: intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare

    PubMed Central

    Peiris, David; Usherwood, Tim; Panaretto, Katie; Harris, Mark; Hunt, Jenny; Patel, Bindu; Zwar, Nicholas; Redfern, Julie; MacMahon, Stephen; Colagiuri, Stephen; Hayman, Noel; Patel, Anushka

    2012-01-01

    Background Large gaps exist in the implementation of guideline recommendations for cardiovascular disease (CVD) risk management. Electronic decision support (EDS) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia. We have developed HealthTracker, a multifaceted EDS and quality improvement intervention to improve the management of CVD risk. Methods/design It is hypothesised that the use of HealthTracker over a 12-month period will result in: (1) an increased proportion of patients receiving guideline-indicated measurements of CVD risk factors and (2) an increased proportion of patients at high risk will receive guideline-indicated prescriptions for lowering their CVD risk. Sixty health services (40 general practices and 20 Aboriginal Community Controlled Health Services (ACCHSs) will be randomised in a 1:1 allocation to receive either the intervention package or continue with usual care, stratified by service type, size and participation in existing quality improvement initiatives. The intervention consists of point-of-care decision support; a risk communication interface; a clinical audit tool to assess performance on CVD-related indicators; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance. The control arm will continue with usual care without access to these intervention components. Quantitative data will be derived from cross-sectional samples at baseline and end of study via automated data extraction. Detailed process and economic evaluations will also be conducted. Ethics and dissemination The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee (HREC) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC. Formal agreements with each of the participating sites have been signed. In addition to the usual scientific forums

  11. Impact of loss of BH3-only proteins on the development and treatment of MLL-fusion gene-driven AML in mice

    PubMed Central

    Bilardi, Rebecca A; Anstee, Natasha S; Glaser, Stefan P; Robati, Mikara; Vandenberg, Cassandra J; Cory, Suzanne

    2016-01-01

    Inhibition of the apoptosis pathway controlled by opposing members of the Bcl-2 protein family plays a central role in cancer development and resistance to therapy. To investigate how pro-apoptotic Bcl-2 homology domain 3 (BH3)-only proteins impact on acute myeloid leukemia (AML), we generated mixed lineage leukemia (MLL)-AF9 and MLL-ENL AMLs from BH3-only gene knockout mice. Disease development was not accelerated by loss of Bim, Puma, Noxa, Bmf, or combinations thereof; hence these BH3-only proteins are apparently ineffectual as tumor suppressors in this model. We tested the sensitivity of MLL-AF9 AMLs of each genotype in vitro to standard chemotherapeutic drugs and to the proteasome inhibitor bortezomib, with or without the BH3 mimetic ABT-737. Loss of Puma and/or Noxa increased resistance to cytarabine, daunorubicin and etoposide, while loss of Bim protected against cytarabine and loss of Bmf had no impact. ABT-737 increased sensitivity to the genotoxic drugs but was not dependent on any BH3-only protein tested. The AML lines were very sensitive to bortezomib and loss of Noxa conveyed significant resistance. In vivo, several MLL-AF9 AMLs responded well to daunorubicin and this response was highly dependent on Puma and Noxa but not Bim. Combination therapy with ABT-737 provided little added benefit at the daunorubicin dose trialed. Bortezomib also extended survival of AML-bearing mice, albeit less than daunorubicin. In summary, our genetic studies reveal the importance of Puma and Noxa for the action of genotoxics currently used to treat MLL-driven AML and suggest that, while addition of ABT-737-like BH3 mimetics might enhance their efficacy, new Noxa-like BH3 mimetics targeting Mcl-1 might have greater potential. PMID:27584789

  12. Placebo analgesia as a case of a cognitive style driven by prior expectation.

    PubMed

    Morton, Debbie L; El-Deredy, Wael; Watson, Alison; Jones, Anthony K P

    2010-11-04

    Placebo analgesia has been shown to be driven by expectations of treatment effects. We suggest that the expectation of treatment creates uncertainty about the sensory information of pain. We tested the hypothesis that in placebo responders uncertainty generated by expectations generalizes to other cognitive processes by recruiting participants for a placebo study who had previously taken part in a visual cue-picture decision making perceptual task. The task investigated how participants utilised prior cues against discrepant and uncertain sensory information. Participants were selected based on their degree of acquiescence in the cue-picture task. The placebo experiment was split into three blocks of pre-treatment, treatment and post-treatment. Participants were told that they may or may not receive an anaesthetic cream on one arm. However, all participants received inactive cream paired with non-painful stimuli during the treatment block. Electroencephalography (EEG) was used to measure pain evoked potentials to laser heat to determine if the behavioural misperception of pain translated into a physiological response. Regression models showed that both behavioural and physiological placebo responses could be predicted by participants' scores of acquiescence in the cue-picture decision making task. Placebo analgesia seems to be influenced by a cognitive style that assimilates responses to expectations increasing the chances of error when detecting discrepant sensory information.

  13. Promoting the value and practice of shared decision-making in mental health care.

    PubMed

    Schauer, Carole; Everett, Anita; del Vecchio, Paolo; Anderson, Leigh

    2007-01-01

    Active consumer participation is critical in contemporary mental health care and treatment planning and has been a staple of the field of psychiatric rehabilitation for the last three decades. Providing the opportunity for consumers to chose interventions that fit personal preferences and recovery increase the likelihood that these interventions will enhance personal meaning, satisfaction and quality of life (Improving the Quality of Health Care for Mental and Substance Use Conditions, 2006). Similarly, self-determination and shared decision-making are critical components of recovery. As stated in the President's New Freedom Commission on Mental Health Final Report, recovery from mental illnesses should be the expectation in mental health care with services and treatments that are consumer and family-driven. Mental health care should be planned and delivered to ensure that consumers and families with children with mental health problems receive real and meaningful choices about treatment options and providers. The purpose of this paper is to explore the value and use of shared decision-making in health and mental health care, briefly examine the advantages and disadvantages of shared decision making and propose next steps in advancing use of shared decision-making in mental health care.

  14. A Mathematical Framework for Statistical Decision Confidence.

    PubMed

    Hangya, Balázs; Sanders, Joshua I; Kepecs, Adam

    2016-09-01

    Decision confidence is a forecast about the probability that a decision will be correct. From a statistical perspective, decision confidence can be defined as the Bayesian posterior probability that the chosen option is correct based on the evidence contributing to it. Here, we used this formal definition as a starting point to develop a normative statistical framework for decision confidence. Our goal was to make general predictions that do not depend on the structure of the noise or a specific algorithm for estimating confidence. We analytically proved several interrelations between statistical decision confidence and observable decision measures, such as evidence discriminability, choice, and accuracy. These interrelationships specify necessary signatures of decision confidence in terms of externally quantifiable variables that can be empirically tested. Our results lay the foundations for a mathematically rigorous treatment of decision confidence that can lead to a common framework for understanding confidence across different research domains, from human and animal behavior to neural representations.

  15. MO-F-CAMPUS-T-03: Data Driven Approaches for Determination of Treatment Table Tolerance Values for Record and Verification Systems

    SciTech Connect

    Gupta, N; DiCostanzo, D; Fullenkamp, M

    2015-06-15

    Purpose: To determine appropriate couch tolerance values for modern radiotherapy linac R&V systems with indexed patient setup. Methods: Treatment table tolerance values have been the most difficult to lower, due to many factors including variations in patient positioning and differences in table tops between machines. We recently installed nine linacs with similar tables and started indexing every patient in our clinic. In this study we queried our R&V database and analyzed the deviation of couch position values from the acquired values at verification simulation for all patients treated with indexed positioning. Mean and standard deviations of daily setup deviations were computed in the longitudinal, lateral and vertical direction for 343 patient plans. The mean, median and standard error of the standard deviations across the whole patient population and for some disease sites were computed to determine tolerance values. Results: The plot of our couch deviation values showed a gaussian distribution, with some small deviations, corresponding to setup uncertainties on non-imaging days, and SRS/SRT/SBRT patients, as well as some large deviations which were spot checked and found to be corresponding to indexing errors that were overriden. Setting our tolerance values based on the median + 1 standard error resulted in tolerance values of 1cm lateral and longitudinal, and 0.5 cm vertical for all non- SRS/SRT/SBRT cases. Re-analizing the data, we found that about 92% of the treated fractions would be within these tolerance values (ignoring the mis-indexed patients). We also analyzed data for disease site based subpopulations and found no difference in the tolerance values that needed to be used. Conclusion: With the use of automation, auto-setup and other workflow efficiency tools being introduced into radiotherapy workflow, it is very essential to set table tolerances that allow safe treatments, but flag setup errors that need to be reassessed before treatments.

  16. Data-Driven Decision-Making: Data Pioneers

    ERIC Educational Resources Information Center

    Briggs, Linda L.

    2006-01-01

    Everyone on your campus needs information, and if your institution is like most schools, you have plenty of it to share. But which types of data warehousing and business intelligence systems you choose, and how accessible, usable, and meaningful those tools make all of that information, remain the big questions for many technologists and…

  17. Clinical decision support foundations.

    PubMed

    Pradhan, Malcolm; Liaw, Siaw Teng

    2010-01-01

    This chapter gives an educational overview of: * The elements of a clinical decision; * The elements of decision making: prior probability, evidence (likelihood), posterior probability, actions, utility (value); * A framework for decision making, and support, encompassing validity, utility, importance and certainty; and * The required elements of a clinical decision support system. * The role of knowledge management in the construction and maintenance of clinical decision support.

  18. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism.

    PubMed

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

    2015-09-01

    Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with an adult-directed ABA approach on disruptive behavior during language intervention in the public schools. A randomized clinical trial design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior.

  19. A Randomized Clinical Trial Comparison Between Pivotal Response Treatment (PRT) and Adult-Driven Applied Behavior Analysis (ABA) Intervention on Disruptive Behaviors in Public School Children with Autism

    PubMed Central

    Mohammadzaheri, Fereshteh; Koegel, Lynn Kern; Rezaei, Mohammad; Bakhshi, Enayatolah

    2015-01-01

    Children with autism often demonstrate disruptive behaviors during demanding teaching tasks. Language intervention can be particularly difficult as it involves social and communicative areas, which are challenging for this population. The purpose of this study was to compare two intervention conditions, a naturalistic approach, Pivotal Response Treatment (PRT) with a structured ABA approach on disruptive behavior during language intervention in the public schools. A Randomized Clinical Trial (RCT) design was used with two groups of children, matched according to age, sex and mean length of utterance. The data showed that the children demonstrated significantly lower levels of disruptive behavior during the PRT condition. The results are discussed with respect to antecedent manipulations that may be helpful in reducing disruptive behavior. PMID:25953148

  20. Electrically Driven Technologies for Radioactive Aerosol Abatement

    SciTech Connect

    David W. DePaoli; Ofodike A. Ezekoye; Costas Tsouris; Valmor F. de Almeida

    2003-01-28

    The purpose of this research project was to develop an improved understanding of how electriexecy driven processes, including electrocoalescence, acoustic agglomeration, and electric filtration, may be employed to efficiently treat problems caused by the formation of aerosols during DOE waste treatment operations. The production of aerosols during treatment and retrieval operations in radioactive waste tanks and during thermal treatment operations such as calcination presents a significant problem of cost, worker exposure, potential for release, and increased waste volume.

  1. Information gap decision support for contaminant remediation

    NASA Astrophysics Data System (ADS)

    Vesselinov, V. V.; O'Malley, D.

    2013-12-01

    stakeholders make decisions related to site characterization, monitoring design, and remedial activities based on data- and model-driven decision-support analyses exploiting high-performance computing.

  2. The clinical decision analysis using decision tree.

    PubMed

    Bae, Jong-Myon

    2014-01-01

    The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.

  3. The clinical decision analysis using decision tree

    PubMed Central

    Bae, Jong-Myon

    2014-01-01

    The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients’ value. PMID:25358466

  4. Large-scale deployment of seed treatments has driven rapid increase in use of neonicotinoid insecticides and preemptive pest management in US field crops.

    PubMed

    Douglas, Margaret R; Tooker, John F

    2015-04-21

    Neonicotinoids are the most widely used class of insecticides worldwide, but patterns of their use in the U.S. are poorly documented, constraining attempts to understand their role in pest management and potential nontarget effects. We synthesized publicly available data to estimate and interpret trends in neonicotinoid use since their introduction in 1994, with a special focus on seed treatments, a major use not captured by the national pesticide-use survey. Neonicotinoid use increased rapidly between 2003 and 2011, as seed-applied products were introduced in field crops, marking an unprecedented shift toward large-scale, preemptive insecticide use: 34-44% of soybeans and 79-100% of maize hectares were treated in 2011. This finding contradicts recent analyses, which concluded that insecticides are used today on fewer maize hectares than a decade or two ago. If current trends continue, neonicotinoid use will increase further through application to more hectares of soybean and other crop species and escalation of per-seed rates. Alternatively, our results, and other recent analyses, suggest that carefully targeted efforts could considerably reduce neonicotinoid use in field crops without yield declines or economic harm to farmers, reducing the potential for pest resistance, nontarget pest outbreaks, environmental contamination, and harm to wildlife, including pollinator species.

  5. Critical decisions.

    PubMed

    Bates, Kyle David

    2009-08-01

    As a responder, your actions within the first few moments of arriving on the scene of a motor vehicle crash are crucial to the success of managing the situation. Within these moments, you must size up the situation, mitigate as many hazards as possible, establish incident command, rapidly triage patients and ultimately assess, treat and extricate patients from the scene. In doing so, you must decide when to extricate a patient and what treatment is essential to improve the patient's chances of survival, based on your knowledge, previous experience and a problem-based assessment algorithm.

  6. Treatment

    MedlinePlus

    ... Ban For Clinicians Clinical Recognition Specimen Collection Treatment Smallpox Vaccine Guidance Infection Control: Hospital Infection Control: Home ... Mouth Infection) Poxvirus and Rabies Branch Travelers’ Health: Smallpox & Other Orthopoxvirus-Associated Infections Poxvirus Treatment Recommend on ...

  7. Laser-Driven Fusion.

    ERIC Educational Resources Information Center

    Gibson, A. F.

    1980-01-01

    Discusses the present status and future prospects of laser-driven fusion. Current research (which is classified under three main headings: laser-matter interaction processes, compression, and laser development) is also presented. (HM)

  8. Genes involved in pericyte-driven tumor maturation predict treatment benefit of first-line FOLFIRI plus bevacizumab in patients with metastatic colorectal cancer.

    PubMed

    Volz, N B; Stintzing, S; Zhang, W; Yang, D; Ning, Y; Wakatsuki, T; El-Khoueiry, R E; Li, J E; Kardosh, A; Loupakis, F; Cremolini, C; Falcone, A; Scherer, S J; Lenz, H-J

    2015-02-01

    Pericytes are crucial for angiogenesis. The impact of pericyte function to bevacizumab efficacy in mCRC treatment has not been comprehensively examined. This retrospective study investigated germline polymorphisms in genes related to early pericyte maturation to predict bevacizumab efficacy in 424 patients of two clinical trials treated first line with FOLFIRI+bevacizumab. Eight single-nucleotide polymorphisms (SNPs) were tested for potential biomarker value: RGS5 (regulator of G-protein signaling 5; rs1056515, rs2661280), PDGFR-β (platelet-derived growth factor receptor-β; rs2229562, rs2302273), CSPG4 (chondroitin sulfate proteoglycan NG2; rs8023621, rs1127648) and RALBP1 (RalA binding protein 1; rs10989, rs329007). For progression-free survival (PFS), PDGFR-β (rs2302273) was able to define significantly different patient cohorts in uni- and multivariate testing. RALPB1 (rs329007) showed predictive value for tumor response. The C allele in RGS5 (rs2661280) predicted longer overall survival and CSPG4 rs1127648 was associated with differences in PFS, but for both value was lost when multivariate analysis was applied. A comprehensive statistical analysis revealed that the biomarker value of the SNPs was dependent on primary tumor location. This is the first study to identify pericyte germline polymorphisms associated with clinical outcome in mCRC patients treated first line with FOLFIRI+bevacizumab. The differences seen with regard to primary tumor location may lead to further research to understand the clinical outcome differences seen in right- and left-sided colon cancer.

  9. A decision-supported outpatient practice system.

    PubMed Central

    Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

    1996-01-01

    We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

  10. Decision making in ruminant orthopedics.

    PubMed

    Fessler, J F; Adams, S B

    1996-03-01

    Decision making in ruminant orthopedics is determined by many factors, the most of important of which is age, size, and value of the patient, the nature of the injury, the prognosis for effective treatment and satisfactory healing, the intentions of the client, and the experiences of the veterinarian. Ruminant orthopedics currently is expanding to include the treatment of llamas and small ruminants as companion animals in addition to the treatment of valuable livestock. The future promises increasing sophistication in treatments and an ever higher quality of patient care.

  11. Differential treatment response of subtypes of patients with borderline personality organization, as assessed with theory-driven profiles of the Dutch short form of the MMPI: a naturalistic follow-up study.

    PubMed

    Eurelings-Bontekoe, Elisabeth H M; Peen, Jaap; Noteboom, Annemieke; Alkema, Marieke; Dekker, Jack

    2012-01-01

    We investigated the validity of different subtypes of borderline personality organization (BPO) as assessed by theory-driven profiles of the Minnesota Multiphasic Personality Disorder (MMPI; Hathaway & McKinley, 1943 ) Dutch Short Form (DSFM; Eurelings-Bontekoe, Onnink, Williams, & Snellen, 2008 ) in a naturalistic follow-up study among 2,062 psychiatric outpatients who received 6 months of ambulatory treatment. Patients were assessed at intake (T1) and 6 months later (T2). At T2, both patients and therapists rated the level of improvement, using the Global Assessment of Improvement. Patients with the high-level BPO profile showed the largest increase in well-being and the largest decrease in severity of symptomatology, whereas severity of symptomatology and well-being of patients with psychotic BPO profiles did not change over time. Agreement between patients and therapists about improvement was good for the internalizing immature BPO and high-level BPO patients, but poor for the externalizing low-level BPO and narcissistic patients.

  12. The anatomy of clinical decision-making in multidisciplinary cancer meetings

    PubMed Central

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

    2016-01-01

    Abstract In the UK, treatment recommendations for patients with cancer are routinely made by multidisciplinary teams in weekly meetings. However, their performance is variable. The aim of this study was to explore the underlying structure of multidisciplinary decision-making process, and examine how it relates to team ability to reach a decision. This is a cross-sectional observational study consisting of 1045 patient reviews across 4 multidisciplinary cancer teams from teaching and community hospitals in London, UK, from 2010 to 2014. Meetings were chaired by surgeons. We used a validated observational instrument (Metric for the Observation of Decision-making in Cancer Multidisciplinary Meetings) consisting of 13 items to assess the decision-making process of each patient discussion. Rated on a 5-point scale, the items measured quality of presented patient information, and contributions to review by individual disciplines. A dichotomous outcome (yes/no) measured team ability to reach a decision. Ratings were submitted to Exploratory Factor Analysis and regression analysis. The exploratory factor analysis produced 4 factors, labeled “Holistic and Clinical inputs” (patient views, psychosocial aspects, patient history, comorbidities, oncologists’, nurses’, and surgeons’ inputs), “Radiology” (radiology results, radiologists’ inputs), “Pathology” (pathology results, pathologists’ inputs), and “Meeting Management” (meeting chairs’ and coordinators’ inputs). A negative cross-loading was observed from surgeons’ input on the fourth factor with a follow-up analysis showing negative correlation (r = −0.19, P < 0.001). In logistic regression, all 4 factors predicted team ability to reach a decision (P < 0.001). Hawthorne effect is the main limitation of the study. The decision-making process in cancer meetings is driven by 4 underlying factors representing the complete patient profile and contributions to case review by all core

  13. Plastic neo-vaginal construction in Mayer-Rokitansky-Küster-Hauser syndrome: an expert opinion paper on the decision-making treatment process

    PubMed Central

    Torres-de la Roche, Luz Angela; Devassy, Rajesh; Gopalakrishnan, Sreelatha; de Wilde, Maya Sophie; Herrmann, Anja; Larbig, Angelika; De Wilde, Rudy Leon

    2016-01-01

    Vaginal agenesis is a congenital anomaly that affects the life of one of each four thousand women around the world. There is a trend that patients request immediate surgical correction, instead of passive vaginal dilatation. Therefore a differentiated counselling should be provided. We present a comparative chart, based on published evidence, with aspect to the available techniques, which will facilitate the decision-making process in the clinical practice. From our point of view, the best results are achieved with techniques that combine the advantages of the minimal-invasive surgery with those derived of the use of peritoneum as covering tissue of the neovagina. Nevertheless there is a lack on interdisciplinary consensus about the best option to restore the physical and sexual quality of life. PMID:26904393

  14. How information about the time requirements and legacy effects of treatments influence decision-making in patients with diabetes and hypertension

    PubMed Central

    Laiteerapong, Neda; Fairchild, Paige C; Nathan, Aviva G; Quinn, Michael T; Huang, Elbert S

    2016-01-01

    Objective When deciding about diabetes treatments, patients are typically uninformed about how much time is required before (time requirements), or for how long treatments change outcomes (legacy effects). However, patients may be motivated to adopt treatments with time-related treatment information. We explored whether this information alters a patients' likelihood of starting medications. Research design and methods We conducted semistructured interviews with 60 adults with type 2 diabetes for <10 years and hypertension on oral medications. We measured change in likelihood of starting medications after receiving time requirement (diabetes, 10 years; hypertension, 3 years) and legacy effect (diabetes, 10 additional years; hypertension, none) information. Responses were analyzed for themes about time-related treatment information. Results At baseline, 70% of participants reported being very likely to start a recommended medication. Nearly half (40%) were less likely to start a diabetes medication after being informed of time requirements; but after being informed of legacy effects, 32% reported being more likely. Fewer participants changed likelihoods of starting antihypertensives with time-related information. Many participants expressed that medications' benefits were important to them regardless of time-related information. Participants considered time requirements for diabetes medications too long and compared them to their life expectancy. Many participants were interested in legacy effects of diabetes medications because they looked forward to discontinuing medications, although some expressed doubt that benefits could persist after stopping medications. Conclusions While prolonged time requirements may dissuade patients from adopting treatments, the promise of legacy effects may motivate patients to commit to diabetes treatments. PMID:27158521

  15. Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care: in UK primary care: a real-world, retrospective, observational

    PubMed Central

    Gruffydd-Jones, Kevin; Brusselle, Guy; Jones, Rupert; Miravitlles, Marc; Baldwin, Michael; Stewart, Rebecca; Rigazio, Anna; Davis, Emily; Keininger, Dorothy L; Price, David

    2016-01-01

    Prescribing patterns in chronic obstructive pulmonary disease (COPD) are often inconsistent with published guidelines. This retrospective, observational study utilised data from the Optimum Patient Care Research Database to examine the changes in COPD prescribing patterns over time and to identify predictors of physician treatment choice for patients newly diagnosed with COPD. Initial therapy was defined as the treatment(s) prescribed at or within 1 year before COPD diagnosis. Changes over time were assessed in three cohorts based on the date of diagnosis: (1) 1997–2001; (2) 2002–2006; and (3) 2007–2010. Factors affecting the odds of being prescribed any initial therapy or any initial maintenance therapy were identified by univariable and multivariable logistic regression. The analysis included 20,154 patients, 45% of whom were prescribed an initial regimen containing an inhaled corticosteroid (ICS), whereas 28% received no initial pharmacological treatment. Prescribing of ICS monotherapy decreased over time, as did the proportion of patients receiving no therapy at or within 1 year before diagnosis. Comorbid asthma, a high exacerbation rate, increased symptoms and poor lung function each increased the likelihood of being prescribed any initial therapy or initial maintenance therapy; comorbid asthma and an annual rate of ⩾3 exacerbations were the strongest predictors. In conclusion, our analyses revealed major differences between actual prescribing behaviour and guideline recommendations for patients with newly diagnosed COPD, with many patients receiving no treatment and large numbers of patients receiving ICS-containing regimens. Predictors of initial therapy were identified. PMID:28358398

  16. Shared decision making, paternalism and patient choice.

    PubMed

    Sandman, Lars; Munthe, Christian

    2010-03-01

    In patient centred care, shared decision making is a central feature and widely referred to as a norm for patient centred medical consultation. However, it is far from clear how to distinguish SDM from standard models and ideals for medical decision making, such as paternalism and patient choice, and e.g., whether paternalism and patient choice can involve a greater degree of the sort of sharing involved in SDM and still retain their essential features. In the article, different versions of SDM are explored, versions compatible with paternalism and patient choice as well as versions that go beyond these traditional decision making models. Whenever SDM is discussed or introduced it is of importance to be clear over which of these different versions are being pursued, since they connect to basic values and ideals of health care in different ways. It is further argued that we have reason to pursue versions of SDM involving, what is called, a high level dynamics in medical decision-making. This leaves four alternative models to choose between depending on how we balance between the values of patient best interest, patient autonomy, and an effective decision in terms of patient compliance or adherence: Shared Rational Deliberative Patient Choice, Shared Rational Deliberative Paternalism, Shared Rational Deliberative Joint Decision, and Professionally Driven Best Interest Compromise. In relation to these models it is argued that we ideally should use the Shared Rational Deliberative Joint Decision model. However, when the patient and professional fail to reach consensus we will have reason to pursue the Professionally Driven Best Interest Compromise model since this will best harmonise between the different values at stake: patient best interest, patient autonomy, patient adherence and a continued care relationship.

  17. Computer Based Decision Support in Dentistry.

    ERIC Educational Resources Information Center

    Wagner, Ina-Veronika; Schneider, Werner

    1991-01-01

    The paper discusses computer-based decision support in the following areas: the dental patient record system; diagnosis and treatment of diseases of the oral mucosa; treatment strategy in complex clinical situations; diagnosis and treatment of functional disturbances of the masticatory system; and patient recall. (DB)

  18. Cost-effectiveness analysis of antimuscarinics in the treatment of patients with overactive bladder in Spain: A decision-tree model

    PubMed Central

    2011-01-01

    Background Fesoterodine, a new once daily antimuscarinic, has proven to be an effective, safe, and well-tolerated treatment in patients with overactive bladder (OAB). To date, no analysis has evaluated the economic costs and benefits associated with fesoterodine, compared to antimuscarinics in Spain. The purpose of this analysis was to assess the economic value of OAB treatment with fesoterodine relative to extended release tolterodine and solifenacin, from the societal perspective. Methods The economic model was based on data from two 12-week, randomized, double-blind, and multicenter trials comparing fesoterodine and tolterodine extended released (ER). Treatment response rates for solifenacin were extracted from the published literature. Discontinuation and efficacy were based on the results of a 12-week multinational randomized clinical trial extrapolated to 52 weeks. Changes in health related quality of life were assessed with the King's Health Questionnaire, which was transformed into preference-based utility values. Medical costs included (expressed in € 2010) were antimuscarinics, physician visits, laboratory tests, incontinence pads and the costs of OAB-related comorbidities, fractures, skin infections, urinary tract infections, depression, and nursing home admissions associated with incontinence. Time lost from work was also considered. Univariate sensitivity analyses were also performed. Results At week 12, continents accounted for 50.6%, 40.6% and 47.2% of patients in the fesoterodine, tolterodine, and solifenacin groups, respectively. By week 52, the projected proportions of patients remaining on therapy were 33.1%, 26.5% and 30.8%, respectively. The projected quality- adjusted life years (QALY) gain (compared to baseline) over the 52-week simulation period were 0.01014, 0.00846 and 0.00957, respectively. The overall treatment cost was estimated at €1,937, €2,089 and €1,960 for fesoterodine, tolterodine and solifenacin, respectively. Therefore

  19. Families of Children with Serious Emotional Disorder: Maternal Reports on the Decision and Impact of Their Child's Placement in Residential Treatment

    ERIC Educational Resources Information Center

    Tahhan, Julia; St. Pierre, Jeff; Stewart, Shannon L.; Leschied, Alan W.; Cook, Steve

    2010-01-01

    Findings are reported regarding maternal experiences of their seriously emotionally disordered child both prior to and following a stay in a residential children's mental health treatment facility. Prior to placement, these parents had exhausted all nonresidential forms of intervention and, increasingly, became concerned not only for their…

  20. Cost-Effectiveness of Immunotherapy in the Treatment of Seasonal Allergic Rhinitis: Identifying Product-Specific Parameters of Relevance for Health Care Decision-Makers and Clinicians.

    PubMed

    Bachert, Claus; Noergaard Andreasen, Jakob

    2015-01-01

    Pharmacotherapy is widely used to manage allergic rhinitis (AR), but often does not adequately control symptoms. Allergy immunotherapy (AIT) should be considered for patients who are not adequately controlled on symptomatic treatment. AIT is gaining attention because of its potential to improve symptom relief and quality of life, and to provide sustained effect after the end of treatment by modifying the course of disease. However, evidence of efficacy needs to be shown for each individual AIT product, based on state-of-the-art studies. The majority of products cannot truly claim efficacy and disease-modifying potential, as evidence of such an effect from robust randomized double-blind, placebo-controlled long-term trials is lacking. The potential of a specific immunotherapy product should be evaluated against four levels of benefit defined by the European Medicines Agency (EMA) guideline on clinical development of AIT products. These clearly distinguish between efficacy of symptom relief in the first year, efficacy over 2-3 treatment years, sustained efficacy and disease modification treatment ends, and sustained absence of allergic symptoms in posttreatment years. The clinician's choice of a specific AIT product should take the level of evidence and risk/benefit into account, as the patient's quality of life and the product's potential long-term effect are important components of its overall cost-effectiveness. Without evidence of maintained clinical benefit and disease modification after the end of treatment, claims of long-term economic benefit of specific AIT products cannot be justified. This paper discusses the evidence that is essential for critical evaluation of product claims in health economic analysis comparing AIT products.

  1. Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis.

    PubMed

    Rochau, Ursula; Kluibenschaedl, Martina; Stenehjem, David; Kuan-Ling, Kuo; Radich, Jerald; Oderda, Gary; Brixner, Diana; Siebert, Uwe

    2015-01-01

    Currently several tyrosine kinase inhibitors (TKIs) are approved for treatment of chronic myeloid leukemia (CML). Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT), and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs)) for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs) for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR) of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay.

  2. Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis

    PubMed Central

    Rochau, Ursula; Kluibenschaedl, Martina; Stenehjem, David; Kuan-Ling, Kuo; Radich, Jerald; Oderda, Gary; Brixner, Diana; Siebert, Uwe

    2015-01-01

    Currently several tyrosine kinase inhibitors (TKIs) are approved for treatment of chronic myeloid leukemia (CML). Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT), and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs)) for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs) for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR) of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay. PMID:26783469

  3. Notification Event Architecture for Traveler Screening: Predictive Traveler Screening Using Event Driven Business Process Management

    ERIC Educational Resources Information Center

    Lynch, John Kenneth

    2013-01-01

    Using an exploratory model of the 9/11 terrorists, this research investigates the linkages between Event Driven Business Process Management (edBPM) and decision making. Although the literature on the role of technology in efficient and effective decision making is extensive, research has yet to quantify the benefit of using edBPM to aid the…

  4. The Driven Spinning Top

    ERIC Educational Resources Information Center

    Grosu, Ioan; Featonby, David

    2016-01-01

    This driven top is quite a novelty and can, with some trials, be made using the principles outlined here. This new top has many applications in developing both understanding and skills and these are detailed in the article. Depending on reader's available time and motivation they may feel an urge to make one themselves, or simply invest a few…

  5. Electrically Driven Prosthetic Elbow.

    DTIC Science & Technology

    The invention relates to an improved electrically driven prosthetic elbow wherein the elbow is capable of being rigidly locked into place in any...desired position, and upon driving the arm to the fully extended position, the elbow is automatically unlocked.

  6. Argument-Driven Inquiry

    ERIC Educational Resources Information Center

    Sampson, Victor; Grooms, Jonathon; Walker, Joi

    2009-01-01

    Argument-Driven Inquiry (ADI) is an instructional model that enables science teachers to transform a traditional laboratory activity into a short integrated instructional unit. To illustrate how the ADI instructional model works, this article describes an ADI lesson developed for a 10th-grade chemistry class. This example lesson was designed to…

  7. Automation: Decision Aid or Decision Maker?

    NASA Technical Reports Server (NTRS)

    Skitka, Linda J.

    1998-01-01

    This study clarified that automation bias is something unique to automated decision making contexts, and is not the result of a general tendency toward complacency. By comparing performance on exactly the same events on the same tasks with and without an automated decision aid, we were able to determine that at least the omission error part of automation bias is due to the unique context created by having an automated decision aid, and is not a phenomena that would occur even if people were not in an automated context. However, this study also revealed that having an automated decision aid did lead to modestly improved performance across all non-error events. Participants in the non- automated condition responded with 83.68% accuracy, whereas participants in the automated condition responded with 88.67% accuracy, across all events. Automated decision aids clearly led to better overall performance when they were accurate. People performed almost exactly at the level of reliability as the automation (which across events was 88% reliable). However, also clear, is that the presence of less than 100% accurate automated decision aids creates a context in which new kinds of errors in decision making can occur. Participants in the non-automated condition responded with 97% accuracy on the six "error" events, whereas participants in the automated condition had only a 65% accuracy rate when confronted with those same six events. In short, the presence of an AMA can lead to vigilance decrements that can lead to errors in decision making.

  8. An integrated in silico 3D model-driven discovery of a novel, potent, and selective amidosulfonamide 5-HT1A agonist (PRX-00023) for the treatment of anxiety and depression.

    PubMed

    Becker, Oren M; Dhanoa, Dale S; Marantz, Yael; Chen, Dongli; Shacham, Sharon; Cheruku, Srinivasa; Heifetz, Alexander; Mohanty, Pradyumna; Fichman, Merav; Sharadendu, Anurag; Nudelman, Raphael; Kauffman, Michael; Noiman, Silvia

    2006-06-01

    We report the discovery of a novel, potent, and selective amidosulfonamide nonazapirone 5-HT1A agonist for the treatment of anxiety and depression, which is now in Phase III clinical trials for generalized anxiety disorder (GAD). The discovery of 20m (PRX-00023), N-{3-[4-(4-cyclohexylmethanesulfonylaminobutyl)piperazin-1-yl]phenyl}acetamide, and its backup compounds, followed a new paradigm, driving the entire discovery process with in silico methods and seamlessly integrating computational chemistry with medicinal chemistry, which led to a very rapid discovery timeline. The program reached clinical trials within less than 2 years from initiation, spending less than 6 months in lead optimization with only 31 compounds synthesized. In this paper we detail the entire discovery process, which started with modeling the 3D structure of 5-HT1A using the PREDICT methodology, and then performing in silico screening on that structure leading to the discovery of a 1 nM lead compound (8). The lead compound was optimized following a strategy devised based on in silico 3D models and realized through an in silico-driven optimization process, rapidly overcoming selectivity issues (affinity to 5-HT1A vs alpha1-adrenergic receptor) and potential cardiovascular issues (hERG binding), leading to a clinical compound. Finally we report key in vivo preclinical and Phase I clinical data for 20m tolerability, pharmacokinetics, and pharmacodynamics and show that these favorable results are a direct outcome of the properties that were ascribed to the compound during the rational structure-based discovery process. We believe that this is one of the first examples for a Phase III drug candidate that was discovered and optimized, from start to finish, using in silico model-based methods as the primary tool.

  9. Geno2pheno[HCV] – A Web-based Interpretation System to Support Hepatitis C Treatment Decisions in the Era of Direct-Acting Antiviral Agents

    PubMed Central

    Kalaghatgi, Prabhav; Sikorski, Anna Maria; Knops, Elena; Rupp, Daniel; Sierra, Saleta; Heger, Eva; Neumann-Fraune, Maria; Beggel, Bastian; Walker, Andreas; Timm, Jörg; Walter, Hauke; Obermeier, Martin; Kaiser, Rolf; Bartenschlager, Ralf; Lengauer, Thomas

    2016-01-01

    The face of hepatitis C virus (HCV) therapy is changing dramatically. Direct-acting antiviral agents (DAAs) specifically targeting HCV proteins have been developed and entered clinical practice in 2011. However, despite high sustained viral response (SVR) rates of more than 90%, a fraction of patients do not eliminate the virus and in these cases treatment failure has been associated with the selection of drug resistance mutations (RAMs). RAMs may be prevalent prior to the start of treatment, or can be selected under therapy, and furthermore they can persist after cessation of treatment. Additionally, certain DAAs have been approved only for distinct HCV genotypes and may even have subtype specificity. Thus, sequence analysis before start of therapy is instrumental for managing DAA-based treatment strategies. We have created the interpretation system geno2pheno[HCV] (g2p[HCV]) to analyse HCV sequence data with respect to viral subtype and to predict drug resistance. Extensive reviewing and weighting of literature related to HCV drug resistance was performed to create a comprehensive list of drug resistance rules for inhibitors of the HCV protease in non-structural protein 3 (NS3-protease: Boceprevir, Paritaprevir, Simeprevir, Asunaprevir, Grazoprevir and Telaprevir), the NS5A replicase factor (Daclatasvir, Ledipasvir, Elbasvir and Ombitasvir), and the NS5B RNA-dependent RNA polymerase (Dasabuvir and Sofosbuvir). Upon submission of up to eight sequences, g2p[HCV] aligns the input sequences, identifies the genomic region(s), predicts the HCV geno- and subtypes, and generates for each DAA a drug resistance prediction report. g2p[HCV] offers easy-to-use and fast subtype and resistance analysis of HCV sequences, is continuously updated and freely accessible under http://hcv.geno2pheno.org/index.php. The system was partially validated with respect to the NS3-protease inhibitors Boceprevir, Telaprevir and Simeprevir by using data generated with recombinant, phenotypic

  10. Geno2pheno[HCV] - A Web-based Interpretation System to Support Hepatitis C Treatment Decisions in the Era of Direct-Acting Antiviral Agents.

    PubMed

    Kalaghatgi, Prabhav; Sikorski, Anna Maria; Knops, Elena; Rupp, Daniel; Sierra, Saleta; Heger, Eva; Neumann-Fraune, Maria; Beggel, Bastian; Walker, Andreas; Timm, Jörg; Walter, Hauke; Obermeier, Martin; Kaiser, Rolf; Bartenschlager, Ralf; Lengauer, Thomas

    2016-01-01

    The face of hepatitis C virus (HCV) therapy is changing dramatically. Direct-acting antiviral agents (DAAs) specifically targeting HCV proteins have been developed and entered clinical practice in 2011. However, despite high sustained viral response (SVR) rates of more than 90%, a fraction of patients do not eliminate the virus and in these cases treatment failure has been associated with the selection of drug resistance mutations (RAMs). RAMs may be prevalent prior to the start of treatment, or can be selected under therapy, and furthermore they can persist after cessation of treatment. Additionally, certain DAAs have been approved only for distinct HCV genotypes and may even have subtype specificity. Thus, sequence analysis before start of therapy is instrumental for managing DAA-based treatment strategies. We have created the interpretation system geno2pheno[HCV] (g2p[HCV]) to analyse HCV sequence data with respect to viral subtype and to predict drug resistance. Extensive reviewing and weighting of literature related to HCV drug resistance was performed to create a comprehensive list of drug resistance rules for inhibitors of the HCV protease in non-structural protein 3 (NS3-protease: Boceprevir, Paritaprevir, Simeprevir, Asunaprevir, Grazoprevir and Telaprevir), the NS5A replicase factor (Daclatasvir, Ledipasvir, Elbasvir and Ombitasvir), and the NS5B RNA-dependent RNA polymerase (Dasabuvir and Sofosbuvir). Upon submission of up to eight sequences, g2p[HCV] aligns the input sequences, identifies the genomic region(s), predicts the HCV geno- and subtypes, and generates for each DAA a drug resistance prediction report. g2p[HCV] offers easy-to-use and fast subtype and resistance analysis of HCV sequences, is continuously updated and freely accessible under http://hcv.geno2pheno.org/index.php. The system was partially validated with respect to the NS3-protease inhibitors Boceprevir, Telaprevir and Simeprevir by using data generated with recombinant, phenotypic

  11. The culture of education in a large dialysis organization: informing patient-centered decision making on treatment options for renal replacement therapy.

    PubMed

    Mollicone, Debra; Pulliam, Joseph; Lacson, Eduardo

    2013-01-01

    Challenged by the observation that newly admitted dialysis patients were often unaware of their treatment options, Fresenius Medical Care, North America developed a program to improve information delivered to chronic kidney disease (CKD) patients prior to their need for renal replacement therapy. Six years ago, the Treatment Options Program (TOPs) was established utilizing a standardized approach to educate individuals with CKD Stages 3 and 4. The program education focuses on modality and vascular access options. A key component includes follow-up at predetermined intervals, offering additional education and patient reminders to continue to work with their physician in selecting a preferred renal replacement modality. Since program inception, over 73,000 individuals have been educated through TOPs. Home therapy utilization as first treatment is higher in the patient population that received TOPs education. Similarly, participants had a higher rate of permanent vascular access with decreased use of hemodialysis catheters upon admission. Avoiding hemodialysis catheter use and expanding home therapy utilization both offer potential benefits to all stakeholders: patients, providers, and payors, particularly as we move toward accountable healthcare systems. The ability to expand the TOPs program relies on seeing patients early enough to allow each patient time to process the information and work with their physician to select the modality and access that best meets their healthcare and lifestyle needs. Educating our patients facilitates empowerment and active participation in their therapy, a much coveted component of patient-centered health care for the renal provider community as we look to the future.

  12. Student decision making in large group discussion

    NASA Astrophysics Data System (ADS)

    Kustusch, Mary Bridget; Ptak, Corey; Sayre, Eleanor C.; Franklin, Scott V.

    2015-04-01

    It is increasingly common in physics classes for students to work together to solve problems and perform laboratory experiments. When students work together, they need to negotiate the roles and decision making within the group. We examine how a large group of students negotiates authority as part of their two week summer College Readiness Program at Rochester Institute of Technology. The program is designed to develop metacognitive skills in first generation and Deaf and hard-of-hearing (DHH) STEM undergraduates through cooperative group work, laboratory experimentation, and explicit reflection exercises. On the first full day of the program, the students collaboratively developed a sign for the word ``metacognition'' for which there is not a sign in American Sign Language. This presentation will focus on three aspects of the ensuing discussion: (1) how the instructor communicated expectations about decision making; (2) how the instructor promoted student-driven decision making rather than instructor-driven policy; and (3) one student's shifts in decision making behavior. We conclude by discussing implications of this research for activity-based physics instruction.

  13. Impulse-driven Micromechanism Capsule

    NASA Astrophysics Data System (ADS)

    Ito, Takahiro; Ishimori, Shohei; Hayashi, Teru

    We have developed a traveling small capsule, which has a smooth outer surface and is driven by inertia force and friction force. Measuring only 7 mm in diameter and 12 mm in length, it is sufficiently small to be placed in the human gullet or intestines. The capsule contains a small magnet and a coil, and an electric pulse drives the magnet to move the capsule. We performed an experimental investigation on making our capsule travel on a plastic material, which has similar elasticity characteristics to the living body. We also showed that it can travel on the surface of a pig's intestine. Our capsule may be useful for medical treatments such as inspection, drug delivery and operation.

  14. Development and Testing of a Computerized Decision Support System to Facilitate Brief Tobacco Cessation Treatment in the Pediatric Emergency Department: Proposal and Protocol

    PubMed Central

    Dexheimer, Judith W; Khoury, Jane C; Miller, Julie A; Gordon, Judith S

    2016-01-01

    Background Tobacco smoke exposure (TSE) is unequivocally harmful to children's health, yet up to 48% of children who visit the pediatric emergency department (PED) and urgent care setting are exposed to tobacco smoke. The incorporation of clinical decision support systems (CDSS) into the electronic health records (EHR) of PED patients may improve the rates of screening and brief TSE intervention of caregivers and result in decreased TSE in children. Objective We propose a study that will be the first to develop and evaluate the integration of a CDSS for Registered Nurses (RNs) into the EHR of pediatric patients to facilitate the identification of caregivers who smoke and the delivery of TSE interventions to caregivers in the urgent care setting. Methods We will conduct a two-phase project to develop, refine, and integrate an evidence-based CDSS into the pediatric urgent care setting. RNs will provide input on program content, function, and design. In Phase I, we will develop a CDSS with prompts to: (1) ASK about child TSE and caregiver smoking, (2) use a software program, Research Electronic Data Capture (REDCap), to ADVISE caregivers to reduce their child's TSE via total smoking home and car bans and quitting smoking, and (3) ASSESS their interest in quitting and ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (eg, Quitline, SmokefreeTXT, or SmokefreeGOV) during the urgent care visit. We will create reports to provide feedback to RNs on their TSE counseling behaviors. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our CDSS on changes in RNs’ TSE-related behaviors, and child and caregiver outcomes. Results This trial is currently underway with funding support from the National Institutes of Health/National Cancer Institute. We have completed Phase I. The CDSS has been developed with input from our advisory panel and RNs, and pilot tested. We are nearing completion of

  15. Decision-Making in Breast Cancer Surgery: Where Do Patients Go for Information?

    PubMed

    Schmidt, Hank; Cohen, Almog; Mandeli, John; Weltz, Christina; Port, Elisa R

    2016-05-01

    Patient decision-making regarding breast cancer surgery is multifactorial, and patients derive information on surgical treatment options from a variety of sources which may have an impact on choice of surgery. We investigated the role of different information sources in patient decision-making regarding breast cancer surgery. Two hundred and sixty-eight patients with breast cancer, eligible for breast-conserving therapy were surveyed in the immediate preoperative period, and clinical data were also collected. This survey evaluated the scope and features of patient-driven research regarding their ultimate choice of surgical treatment. The two most common sources of information used by patients were written material from surgeons (199/268-74%) and the Internet (184/268-69%). There was a trend for women who chose bilateral mastectomy to use the Internet more frequently than those choosing unilateral mastectomy (P = 0.056). Number of surgeons consulted, genetic testing, and MRI were significant predictors of patient choice of mastectomy over breast-conserving therapy. Multivariate analysis showed that the number of surgeons consulted (P < 0.001) and genetic testing (P < 0.001) were independent predictors of choosing mastectomy, whereas MRI was not. In conclusions, understanding factors driving patient decision-making may promote more effective education for patients requiring breast cancer surgery.

  16. Decisions for Industry

    ERIC Educational Resources Information Center

    Atthill, Charles

    1974-01-01

    The main aim of the Decisions projects is to illustrate, through group work, some of the features of decision making in the business world. The exercises take as their starting point real problems confronting an oil company, and use real data as the basis for problem solving and decision making. (Author)

  17. Sustainability Based Decision Making

    EPA Science Inventory

    With sustainability as the “true north” for EPA research, a premium is placed on the ability to make decisions under highly complex and uncertain conditions. The primary challenge is reconciling disparate criteria toward credible and defensible decisions. Making decisions on on...

  18. Measurement Decision Theory.

    ERIC Educational Resources Information Center

    Rudner, Lawrence M.

    This paper describes and evaluates the use of decision theory as a tool for classifying examinees based on their item response patterns. Decision theory, developed by A. Wald (1947) and now widely used in engineering, agriculture, and computing, provides a simple model for the analysis of categorical data. Measurement decision theory requires only…

  19. Laser driven radiography

    SciTech Connect

    Perry, M.D.; Sefcik, J.; Cowan, T.

    1997-12-20

    Intense laser (> 1021 W/cm{sup 3}) driven hard x-ray sources offer a new alternative to conventional electron accelerator Bremsstrahlung sources. These laser driven sources offer considerable simplicity in design and potential cost advantage for multiple axis views. High spatial and temporal resolution is achievable as a result of the very small source size (<100 um) and short-duration of the laser pulse. We have begun a series of experiments with the Petawatt laser at LLNL to determine the photon flux achievable with these sources and assess their potential for Stewardship applications. Additionally, we are developing a conceptual design and cost estimate of a multi-pulse, multi-axis (up to five) radiographic facility utilizing the Contained Firing Facility at site 300 and existing laser hardware.

  20. Electrically driven optical antennas

    NASA Astrophysics Data System (ADS)

    Kern, Johannes; Kullock, René; Prangsma, Jord; Emmerling, Monika; Kamp, Martin; Hecht, Bert

    2015-09-01

    Unlike radiowave antennas, so far optical nanoantennas cannot be fed by electrical generators. Instead, they are driven by light or indirectly via excited discrete states in active materials in their vicinity. Here we demonstrate the direct electrical driving of an in-plane optical antenna by the broadband quantum-shot noise of electrons tunnelling across its feed gap. The spectrum of the emitted photons is determined by the antenna geometry and can be tuned via the applied voltage. Moreover, the direction and polarization of the light emission are controlled by the antenna resonance, which also improves the external quantum efficiency by up to two orders of magnitude. The one-material planar design offers facile integration of electrical and optical circuits and thus represents a new paradigm for interfacing electrons and photons at the nanometre scale, for example for on-chip wireless communication and highly configurable electrically driven subwavelength photon sources.

  1. Sparsity driven ultrasound imaginga)

    PubMed Central

    Tuysuzoglu, Ahmet; Kracht, Jonathan M.; Cleveland, Robin O.; C¸etin, Müjdat; Karl, W. Clem

    2012-01-01

    An image formation framework for ultrasound imaging from synthetic transducer arrays based on sparsity-driven regularization functionals using single-frequency Fourier domain data is proposed. The framework involves the use of a physics-based forward model of the ultrasound observation process, the formulation of image formation as the solution of an associated optimization problem, and the solution of that problem through efficient numerical algorithms. The sparsity-driven, model-based approach estimates a complex-valued reflectivity field and preserves physical features in the scene while suppressing spurious artifacts. It also provides robust reconstructions in the case of sparse and reduced observation apertures. The effectiveness of the proposed imaging strategy is demonstrated using experimental data. PMID:22352501

  2. Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery.

    PubMed

    Cordoba, Octavi; Perez-Ceresuela, Francesc; Espinosa-Bravo, Martin; Cortadellas, Tomas; Esgueva, Antonio; Rodriguez-Revuelto, Robert; Peg, Vicente; Reyes, Victoria; Xercavins, Jordi; Rubio, Isabel T

    2014-08-01

    Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence is still controversial. The objective of this study is to evaluate the feasibility of the sentinel lymph node in breast cancer recurrence (SLNBR) and whether the positivity had impact in the adjuvant treatment. Between 2008 and 2012 we performed SLNBR in patients with ipsilateral breast tumor recurrence. We included 53 patients in a prospective study. Forty-three patients (81%) had a previous axillary lymph node dissection (ALND) and ten (19%) had a previous sentinel lymph node biopsy (SLNB). Identification rate after SLNB was 50% and after ALND was 60.5% (p = 0.4). Nine patients (26%) had a positive SLNBR. Adjuvant systemic treatment was given to all the patients with a positive SLNBR and to 23 (85%) with a negative SLNBR (p = 0.29). Six patients (66%) with positive SLNBR and 4 patients (14%) with negative SLNBR underwent radiation therapy (p < 0.01). As conclusions of our study we conclude that sentinel lymph node biopsy in breast tumor recurrence is feasible and significant differences were found in the use of radiation therapy in patients with a positive SLNBR.

  3. Novel BRCA1 and BRCA2 Tumor Test as Basis for Treatment Decisions and Referral for Genetic Counselling of Patients with Ovarian Carcinomas

    PubMed Central

    Weren, Robbert D.A.; Mensenkamp, Arjen R.; Simons, Michiel; Eijkelenboom, Astrid; Sie, Aisha S.; Ouchene, Hicham; van Asseldonk, Monique; Gomez‐Garcia, Encarna B.; Blok, Marinus J.; de Hullu, Joanne A.; Nelen, Marcel R.; Hoischen, Alexander; Bulten, Johan; Tops, Bastiaan B.J.; Hoogerbrugge, Nicoline

    2016-01-01

    ABSTRACT With the recent introduction of Poly(ADP‐ribose) polymerase inhibitors, a promising novel therapy has become available for ovarian carcinoma (OC) patients with inactivating BRCA1 or BRCA2 mutations in their tumor. To select patients who may benefit from these treatments, assessment of the mutation status of BRCA1 and BRCA2 in the tumor is required. For reliable evaluation of germline and somatic mutations in these genes in DNA derived from formalin‐fixed, paraffin‐embedded (FFPE) tissue, we have developed a single‐molecule molecular inversion probe (smMIP)‐based targeted next‐generation sequencing (NGS) approach. Our smMIP‐based NGS approach provides analysis of both strands of the open reading frame of BRCA1 and BRCA2, enabling the discrimination between real variants and formalin‐induced artefacts. The single molecule tag enables compilation of unique reads leading to a high analytical sensitivity and enabling assessment of the reliability of mutation‐negative results. Multiplex ligation‐dependent probe amplification (MLPA) and Methylation‐specific multiplex ligation‐dependent probe amplification (MS‐MLPA) were used to detect exon deletions of BRCA1 and methylation of the BRCA1 promoter, respectively. Here, we show that this combined approach allows the rapid and reliable detection of both germline and somatic aberrations affecting BRCA1 and BRCA2 in DNA derived from FFPE OCs, enabling improved hereditary cancer risk assessment and clinical treatment of ovarian cancer patients. PMID:27767231

  4. Automated control of hierarchical systems using value-driven methods

    NASA Technical Reports Server (NTRS)

    Pugh, George E.; Burke, Thomas E.

    1990-01-01

    An introduction is given to the Value-driven methodology, which has been successfully applied to solve a variety of difficult decision, control, and optimization problems. Many real-world decision processes (e.g., those encountered in scheduling, allocation, and command and control) involve a hierarchy of complex planning considerations. For such problems it is virtually impossible to define a fixed set of rules that will operate satisfactorily over the full range of probable contingencies. Decision Science Applications' value-driven methodology offers a systematic way of automating the intuitive, common-sense approach used by human planners. The inherent responsiveness of value-driven systems to user-controlled priorities makes them particularly suitable for semi-automated applications in which the user must remain in command of the systems operation. Three examples of the practical application of the approach in the automation of hierarchical decision processes are discussed: the TAC Brawler air-to-air combat simulation is a four-level computerized hierarchy; the autonomous underwater vehicle mission planning system is a three-level control system; and the Space Station Freedom electrical power control and scheduling system is designed as a two-level hierarchy. The methodology is compared with rule-based systems and with other more widely-known optimization techniques.

  5. Gas-driven microturbine

    SciTech Connect

    Sniegowski, J.J.; Rodgers, M.S.; McWhorter, P.J.; Aeschliman, D.P.; Miller, W.M.

    1996-06-27

    This paper describes an invention which relates to microtechnology and the fabrication process for developing microelectrical systems. It describes a means for fabricating a gas-driven microturbine capable of providing autonomous propulsion in which the rapidly moving gases are directed through a micromachined turbine to power devices by direct linkage or turbo-electric generators components in a domain ranging from tenths of micrometers to thousands of micrometers.

  6. An Integrated Model for Identifying Linkages Between the Management of Fuel Treatments, Fire and Ecosystem Services

    NASA Astrophysics Data System (ADS)

    Bart, R. R.; Anderson, S.; Moritz, M.; Plantinga, A.; Tague, C.

    2015-12-01

    Vegetation fuel treatments (e.g. thinning, prescribed burning) are a frequent tool for managing fire-prone landscapes. However, predicting how fuel treatments may affect future wildfire risk and associated ecosystem services, such as forest water availability and streamflow, remains a challenge. This challenge is in part due to the large range of conditions under which fuel treatments may be implemented, as response is likely to vary with species type, rates of vegetation regrowth, meteorological conditions and physiographic properties of the treated site. It is also due to insufficient understanding of how social factors such as political pressure, public demands and economic constraints affect fuel management decisions. To examine the feedbacks between ecological and social dimensions of fuel treatments, we present an integrated model that links a biophysical model that simulates vegetation and hydrology (RHESSys), a fire spread model (WMFire) and an empirical fuel treatment model that accounts for agency decision-making. We use this model to investigate how management decisions affect landscape fuel loads, which in turn affect fire severity and ecosystem services, which feedback to management decisions on fuel treatments. We hypothesize that this latter effect will be driven by salience theory, which predicts that fuel treatments are more likely to occur following major wildfire events. The integrated model provides a flexible framework for answering novel questions about fuel treatments that span social and ecological domains, areas that have previously been treated separately.

  7. Driven superconducting quantum circuits

    NASA Astrophysics Data System (ADS)

    Nakamura, Yasunobu

    2014-03-01

    Driven nonlinear quantum systems show rich phenomena in various fields of physics. Among them, superconducting quantum circuits have very attractive features such as well-controlled quantum states with design flexibility, strong nonlinearity of Josephson junctions, strong coupling to electromagnetic driving fields, little internal dissipation, and tailored coupling to the electromagnetic environment. We have investigated properties and functionalities of driven superconducting quantum circuits. A transmon qubit coupled to a transmission line shows nearly perfect spatial mode matching between the incident and scattered microwave field in the 1D mode. Dressed states under a driving field are studied there and also in a semi-infinite 1D mode terminated by a resonator containing a flux qubit. An effective Λ-type three-level system is realized under an appropriate driving condition. It allows ``impedance-matched'' perfect absorption of incident probe photons and down conversion into another frequency mode. Finally, the weak signal from the qubit is read out using a Josephson parametric amplifier/oscillator which is another nonlinear circuit driven by a strong pump field. This work was partly supported by the Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST), Project for Developing Innovation Systems of MEXT, MEXT KAKENHI ``Quantum Cybernetics,'' and the NICT Commissioned Research.

  8. Water-driven micromotors.

    PubMed

    Gao, Wei; Pei, Allen; Wang, Joseph

    2012-09-25

    We demonstrate the first example of a water-driven bubble-propelled micromotor that eliminates the requirement for the common hydrogen peroxide fuel. The new water-driven Janus micromotor is composed of a partially coated Al-Ga binary alloy microsphere prepared via microcontact mixing of aluminum microparticles and liquid gallium. The ejection of hydrogen bubbles from the exposed Al-Ga alloy hemisphere side, upon its contact with water, provides a powerful directional propulsion thrust. Such spontaneous generation of hydrogen bubbles reflects the rapid reaction between the aluminum alloy and water. The resulting water-driven spherical motors can move at remarkable speeds of 3 mm s(-1) (i.e., 150 body length s(-1)), while exerting large forces exceeding 500 pN. Factors influencing the efficiency of the aluminum-water reaction and the resulting propulsion behavior and motor lifetime, including the ionic strength and environmental pH, are investigated. The resulting water-propelled Al-Ga/Ti motors move efficiently in different biological media (e.g., human serum) and hold considerable promise for diverse biomedical or industrial applications.

  9. Older patient considering treatment for advanced renal disease: protocol for a scoping review of the information available for shared decision-making

    PubMed Central

    Frandsen, Mai; Jose, Matthew

    2016-01-01

    Introduction Older adults constitute the largest group of patients on dialysis in most parts of the world. Management of advanced renal disease in the older adult is complex; treatment outcomes and prognosis can be markedly different from younger patients. Clinical teams caring for such patients are often called on to provide information regarding prognosis and outcomes with treatment—particularly, the comparison between having dialysis treatment versus not having dialysis. These discussions can be difficult for clinicians because they have to contend with incomplete or nascent data regarding prognosis and outcomes in this age group. We aim to summarise the currently available information regarding the prognosis and outcomes of advanced renal disease in the older adult by means of a scoping review of the literature. This article discusses our protocol. Methods This scoping review will be undertaken in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A directed search will look for relevant articles in English (within electronic databases and the grey literature), written between 2000 and 2016, which have studied older patients with advanced renal disease (estimated glomerular filtration rate <30 mL/min/1.73 m2). After screening by two independent reviewers, selected articles will be analysed using a data charting tool. Reporting will include descriptions, analysis of themes using qualitative software and display of information using charts. Ethics and dissemination This scoping review will analyse previously collected data, and so does not require ethical approval. Results will be disseminated through academic journals, conferences and seminars. We anticipate that our summary of the currently available knowledge regarding the older adult with advanced renal disease will be a repository of information for clinicians in the field. We expect to identify areas of study that are suited to systematic reviews. Our findings can also be

  10. Stop making plans; start making decisions.

    PubMed

    Mankins, Michael C; Steele, Richard

    2006-01-01

    Many executives have grown skeptical of strategic planning. Is it any wonder? Despite all the time and energy that go into it, strategic planning most often acts as a barrier to good decision making and does little to influence strategy. Strategic planning fails because of two factors: It typically occurs annually, and it focuses on individual business units. As such, the process is completely at odds with the way executives actually make important strategy decisions, which are neither constrained by the calendar nor defined by unit boundaries. Thus, according to a survey of 156 large companies, senior executives often make strategic decisions outside the planning process, in an ad hoc fashion and without rigorous analysis or productive debate. But companies can fix the process if they attack its root problems. A few forward-looking firms have thrown out their calendar-driven, business-unit-focused planning procedures and replaced them with continuous, issues-focused decision making. In doing so, they rely on several basic principles: They separate, but integrate, decision making and plan making. They focus on a few key themes. And they structure strategy reviews to produce real decisions. When companies change the timing and focus of strategic planning, they also change the nature of senior management's discussions about strategy--from "review and approve" to "debate and decide," in which top executives actively think through every major decision and its implications for the company's performance and value. The authors have found that these companies make more than twice as many important strategic decisions per year as companies that follow the traditional planning model.

  11. Make better decisions.

    PubMed

    Davenport, Thomas H

    2009-11-01

    Traditionally, decision making in organizations has rarely been the focus of systematic analysis. That may account for the astounding number of recent poor calls, such as decisions to invest in and securitize subprime mortgage loans or to hedge risk with credit default swaps. Business books are rich with insights about the decision process, but organizations have been slow to adopt their recommendations. It's time to focus on decision making, Davenport says, and he proposes four steps: (1) List and prioritize the decisions that must be made; (2) assess the factors that go into each, such as who plays what role, how often the decision must be made, and what information is available to support it; (3) design the roles, processes, systems, and behaviors your organization needs; and (4) institutionalize decision tools and assistance. The Educational Testing Service and The Stanley Works, among others, have succeeded in improving their decisions. ETS established a centralized deliberative body to make evidence-based decisions about new-product offerings, and Stanley has a Pricing Center of Excellence with internal consultants dedicated to its various business units. Leaders should bring multiple perspectives to their decision making, beware of analytical models that managers don't understand, be clear about their assumptions, practice "model management," and--because only people can revise decision criteria over time--cultivate human backups.

  12. Awareness about antiretroviral treatment, intentions to use condoms, and decisions to have an HIV test among rural Northern Lowland Thai and ethnic minority young adults.

    PubMed

    Srithanaviboonchai, Kriengkrai; Celentano, David D; Visaruratana, Surasing; Kawichai, Surinda; Wichajarn, Monjun; Genberg, Becky; Chariyalertsak, Chonlisa; Kulich, Michal; Chariyalertsak, Suwat

    2010-04-01

    Young adults aged 18 to 32 years were randomly selected from a household probability sample participating in Project Accept in the remote areas of Chiang Mai province in northern Thailand in 2005. Among 2989 respondents, 44.4% had never heard of antiretroviral treatment (ART). Lack of awareness of ART was independently associated with having had no formal education compared with some formal education and being an ethnic minority compared with being Thai. In all, 57% of the respondents who had ever heard of ART stated that if ART were easily available in their communities it would affect their intentions to be tested for HIV, whereas only 36% stated that this would affect their intentions to use condoms. Younger participants were less likely to intend to get an HIV test as compared with older individuals, and ethnic minorities were less likely to report that they would get an HIV test compared with Thai lowlanders. Single individuals and people who lived separately from their spouses were more likely to have the intention to use condoms if ART were available.

  13. Individualizing treatment targets for elderly patients with type 2 diabetes: factors influencing clinical decision making in the 24-week, randomized INTERVAL study.

    PubMed

    Strain, W David; Agarwal, Abhijit S; Paldánius, Päivi M

    2017-03-05

    We tested the feasibility of setting individualized glycemic goals and factors influencing targets set in a clinical trial in elderly patients with type 2 diabetes.A 24-week, randomized, double-blind, placebo-controlled study was conducted in 45 outpatient centers in seven European countries. 278 drug-naïve or inadequately controlled (mean HbA1c 7.9%) patients with type 2 diabetes aged ≥70 years with HbA1c levels ≥7.0% and ≤10.0% were enrolled. Investigator-defined individualized HbA1c targets and the impact of baseline characteristics on individualized treatment targets was evaluated.The average individualized HbA1c target was set at 7.0%. HbA1c at baseline predicted a target setting such that higher the HbA1c, more aggressive was the target (P<0.001). Men were more likely to be set aggressive targets than women (P=0.026). Frailty status of patients showed a trend towards significance (P=0.068), whereas diabetes duration, age, or polypharmacy did not. There was heterogeneity between countries regarding how baseline factors were viewed.Despite training and guidance to individualize HbA1c goals, targets were still set in line with conventional values. A strong influence of country-specific guidelines on target setting was observed; confirming the importance of further education to implement new international guidelines in older adults.

  14. Life cycle and human health risk assessments as tools for decision making in the design and implementation of nanofiltration in drinking water treatment plants.

    PubMed

    Ribera, G; Clarens, F; Martínez-Lladó, X; Jubany, I; V Martí; Rovira, M

    2014-01-01

    A combined methodology using life cycle assessment (LCA) and human health risk assessment (HHR) is proposed in order to select the percentage of water in drinking water treatment plants (DWTP) that should be nanofiltered (NF). The methodological approach presented here takes into account environmental and social benefit criteria evaluating the implementation of new processes into conventional ones. The inclusion of NF process improves drinking water quality, reduces HHR but, in turn, increases environmental impacts as a result of energy and material demand. Results from this study lead to balance the increase of the impact in various environmental categories with the reduction in human health risk as a consequence of the respective drinking water production and consumption. From an environmental point of view, the inclusion of NF and recommended pretreatments to produce 43% of the final drinking water means that the environmental impact is nearly doubled in comparison with conventional plant in impact categories severely related with electricity production, like climate change. On the other hand, the carcinogenic risk (HHR) associated to trihalomethane formation potential (THMFP) decreases with the increase in NF percentage use. Results show a reduction of one order of magnitude for the carcinogenic risk index when 100% of drinking water is produced by NF.

  15. System Driven Workarounds

    NASA Technical Reports Server (NTRS)

    Connell, Linda; Wichner, David; Jakey, Abegael Marie

    2013-01-01

    The Aviation Safety Reporting System (ASRS) in a partnership between the National Aeronautics and Space Administration (NASA), the Federal Aviation Administration (FAA), participating carriers, and labor organizations. It is designed to improve the National Airspace System by collecting and studying reports detailing unsafe conditions and events in the aviation industry. Employees are able to report safety issues or concerns with confidentiality and without fear of discipline. Safety reports highlighting system driven workarounds for the aviation community highlight the human workaround for the complex aviation system.

  16. Electrostatically Driven Nanoballoon Actuator.

    PubMed

    Barzegar, Hamid Reza; Yan, Aiming; Coh, Sinisa; Gracia-Espino, Eduardo; Dunn, Gabriel; Wågberg, Thomas; Louie, Steven G; Cohen, Marvin L; Zettl, Alex

    2016-11-09

    We demonstrate an inflatable nanoballoon actuator based on geometrical transitions between the inflated (cylindrical) and collapsed (flattened) forms of a carbon nanotube. In situ transmission electron microscopy experiments employing a nanoelectromechanical manipulator show that a collapsed carbon nanotube can be reinflated by electrically charging the nanotube, thus realizing an electrostatically driven nanoballoon actuator. We find that the tube actuator can be reliably cycled with only modest control voltages (few volts) with no apparent wear or fatigue. A complementary theoretical analysis identifies critical parameters for nanotube nanoballoon actuation.

  17. Information-Driven Inspections

    SciTech Connect

    Laughter, Mark D; Whitaker, J Michael; Lockwood, Dunbar

    2010-01-01

    New uranium enrichment capacity is being built worldwide in response to perceived shortfalls in future supply. To meet increasing safeguards responsibilities with limited resources, the nonproliferation community is exploring next-generation concepts to increase the effectiveness and efficiency of safeguards, such as advanced technologies to enable unattended monitoring of nuclear material. These include attribute measurement technologies, data authentication tools, and transmission and security methods. However, there are several conceptual issues with how such data would be used to improve the ability of a safeguards inspectorate such as the International Atomic Energy Agency (IAEA) to reach better safeguards conclusions regarding the activities of a State. The IAEA is pursuing the implementation of information-driven safeguards, whereby all available sources of information are used to make the application of safeguards more effective and efficient. Data from continuous, unattended monitoring systems can be used to optimize on-site inspection scheduling and activities at declared facilities, resulting in fewer, better inspections. Such information-driven inspections are the logical evolution of inspection planning - making use of all available information to enhance scheduled and randomized inspections. Data collection and analysis approaches for unattended monitoring systems can be designed to protect sensitive information while enabling information-driven inspections. A number of such inspections within a predetermined range could reduce inspection frequency while providing an equal or greater level of deterrence against illicit activity, all while meeting operator and technology holder requirements and reducing inspector and operator burden. Three options for using unattended monitoring data to determine an information-driven inspection schedule are to (1) send all unattended monitoring data off-site, which will require advances in data analysis techniques to

  18. [Decision-making in a physician's practice].

    PubMed

    Shaposhnikov, A V

    2006-01-01

    The article covers modern principles of the decision-making method, used in medicine and gastroenterology, in particular. These principles are based upon taking into consideration psychosocial features of a doctor and a patient, types of doctor's thinking and pathologic processes, as well as the effect of a range of negative factors, such as conformism, engageness of a doctor, neurotism etc. The author pioneers the treatment of decision-making in medicine.

  19. THERMALLY DRIVEN ATMOSPHERIC ESCAPE

    SciTech Connect

    Johnson, Robert E.

    2010-06-20

    Accurately determining the escape rate from a planet's atmosphere is critical for determining its evolution. A large amount of Cassini data is now available for Titan's upper atmosphere and a wealth of data is expected within the next decade on escape from Pluto, Mars, and extra-solar planets. Escape can be driven by upward thermal conduction of energy deposited well below the exobase, as well as by nonthermal processes produced by energy deposited in the exobase region. Recent applications of a model for escape driven by upward thermal conduction, called the slow hydrodynamic escape model, have resulted in surprisingly large loss rates for the atmosphere of Titan, Saturn's largest moon. Based on a molecular kinetic simulation of the exobase region, these rates appear to be orders of magnitude too large. Therefore, the slow hydrodynamic model is evaluated here. It is shown that such a model cannot give a reliable description of the atmospheric temperature profile unless it is coupled to a molecular kinetic description of the exobase region. Therefore, the present escape rates for Titan and Pluto must be re-evaluated using the atmospheric model described here.

  20. Heat driven pulse pump

    NASA Technical Reports Server (NTRS)

    Benner, Steve M (Inventor); Martins, Mario S. (Inventor)

    2000-01-01

    A heat driven pulse pump includes a chamber having an inlet port, an outlet port, two check valves, a wick, and a heater. The chamber may include a plurality of grooves inside wall of the chamber. When heated within the chamber, a liquid to be pumped vaporizes and creates pressure head that expels the liquid through the outlet port. As liquid separating means, the wick, disposed within the chamber, is to allow, when saturated with the liquid, the passage of only liquid being forced by the pressure head in the chamber, preventing the vapor from exiting from the chamber through the outlet port. A plurality of grooves along the inside surface wall of the chamber can sustain the liquid, which is amount enough to produce vapor for the pressure head in the chamber. With only two simple moving parts, two check valves, the heat driven pulse pump can effectively function over the long lifetimes without maintenance or replacement. For continuous flow of the liquid to be pumped a plurality of pumps may be connected in parallel.

  1. Data-driven healthcare: from patterns to actions.

    PubMed

    Grossglauser, M; Saner, H

    2014-11-01

    The era of big data opens up new opportunities in personalised medicine, preventive care, chronic disease management and in telemonitoring and managing of patients with implanted devices. The rich data accumulating within online services and internet companies provide a microscope to study human behaviour at scale, and to ask completely new questions about the interplay between behavioural patterns and health. In this paper, we shed light on a particular aspect of data-driven healthcare: autonomous decision-making. We first look at three examples where we can expect data-driven decisions to be taken autonomously by technology, with no or limited human intervention. We then discuss some of the technical and practical challenges that can be expected, and sketch the research agenda to address them.

  2. GPS Decision Analysis Process

    DTIC Science & Technology

    2005-06-23

    712 A/B: GPS Decision Analysis Process Revised title:___________________________________________________________________ Presented in (input and Bold...JUN 2005 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE GPS Decision Analysis Process 5a. CONTRACT NUMBER 5b. GRANT NUMBER...Prescribed by ANSI Std Z39-18 GPS Decision Analysis Process Nisha Shah The Boeing Company 73rd MORS Symposium US Military Academy – West Point 21-23

  3. Decision Making in Action

    NASA Technical Reports Server (NTRS)

    Orasanu, Judith; Statler, Irving C. (Technical Monitor)

    1994-01-01

    The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication

  4. Systemic Data-Based Decision Making: A Systems Approach for Using Data in Schools

    ERIC Educational Resources Information Center

    Walser, Tamara M.

    2009-01-01

    No Child Left Behind has increased data collection and reporting, the development of data systems, and interest in using data for decision-making in schools and classrooms. Ends-driven decision making has become common educational practice, where the ends justify the means at all costs, and short-term results trump longer-term outcomes and the…

  5. Decision-Support Data Analysis: Examining Consistency among Teachers in Writing Assessment

    ERIC Educational Resources Information Center

    Archbald, Doug

    2011-01-01

    Education leaders and much literature exhort teachers and school leaders to use data more often and more effectively to guide planning and decision making--called, "data driven decision making." This term is ubiquitous in literature and reform discourse, but "on the ground," so to speak, practitioners face significant challenges in analyzing,…

  6. Developing a habitat-driven approach to CWWT design

    USGS Publications Warehouse

    Sartoris, James J.; Thullen, Joan S.

    1998-01-01

    A habitat-driven approach to CWWT design is defined as designing the constructed wetland to maximize habitat values for a given site within the constraints of meeting specified treatment criteria. This is in contrast to the more typical approach of designing the CWWT to maximize treatment efficiency, and then, perhaps, adding wildlife habitat features. The habitat-driven approach is advocated for two reasons: (1) because good wetland habitat is critically lacking, and (2) because it is hypothesized that well-designed habitat will result in good, sustainable wastewater treatment.

  7. Decisions about Drug Use. Adolescent Decisions Curriculum.

    ERIC Educational Resources Information Center

    Brion-Meisels, Steven; And Others

    This teacher's manual for drug abuse education is one volume of a six volume curriculum for the secondary level, designed to provide a systematic, group-oriented approach to decision-making in areas crucial to adolescent development: drug (substance) use and abuse, sexuality and social relationships, juvenile law, work and people and government.…

  8. Steady Capillary Driven Flow

    NASA Technical Reports Server (NTRS)

    Weislogel, Mark M.

    1996-01-01

    A steady capillary driven flow is developed for a liquid index in a circular tube which is partially coated with a surface modifier to produce a discontinuous wetting condition from one side of the tube to the other. The bulk flow is novel in that it is truly steady, and controlled solely by the physics associated with dynamic wetting. The influence of gravity on the flow is minimized through the use of small diameter tubes approximately O(1 mm) tested horizontally in a laboratory and larger tubes approximately O(10 mm) tested in the low gravity environment of a drop tower. Average steady velocities are predicted and compared against a large experimental data set which includes the effects of tube dimensions and fluid properties. The sensitivity of the velocity to surface cleanliness is dramatic and the advantages of experimentation in a microgravity environment are discussed.

  9. Multilane driven diffusive systems

    NASA Astrophysics Data System (ADS)

    Curatolo, A. I.; Evans, M. R.; Kafri, Y.; Tailleur, J.

    2016-03-01

    We consider networks made of parallel lanes along which particles hop according to driven diffusive dynamics. The particles also hop transversely from lane to lane, hence indirectly coupling their longitudinal dynamics. We present a general method for constructing the phase diagram of these systems which reveals that in many cases their physics reduce to that of single-lane systems. The reduction to an effective single-lane description legitimizes, for instance, the use of a single TASEP to model the hopping of molecular motors along the many tracks of a single microtubule. Then, we show how, in quasi-2D settings, new phenomena emerge due to the presence of non-zero transverse currents, leading, for instance, to strong ‘shear localization’ along the network.

  10. Soliton driven angiogenesis

    NASA Astrophysics Data System (ADS)

    Bonilla, L. L.; Carretero, M.; Terragni, F.; Birnir, B.

    2016-08-01

    Angiogenesis is a multiscale process by which blood vessels grow from existing ones and carry oxygen to distant organs. Angiogenesis is essential for normal organ growth and wounded tissue repair but it may also be induced by tumours to amplify their own growth. Mathematical and computational models contribute to understanding angiogenesis and developing anti-angiogenic drugs, but most work only involves numerical simulations and analysis has lagged. A recent stochastic model of tumour-induced angiogenesis including blood vessel branching, elongation, and anastomosis captures some of its intrinsic multiscale structures, yet allows one to extract a deterministic integropartial differential description of the vessel tip density. Here we find that the latter advances chemotactically towards the tumour driven by a soliton (similar to the famous Korteweg-de Vries soliton) whose shape and velocity change slowly. Analysing these collective coordinates paves the way for controlling angiogenesis through the soliton, the engine that drives this process.

  11. Temperature-Driven Convection

    NASA Astrophysics Data System (ADS)

    Bohan, Richard J.; Vandegrift, Guy

    2003-02-01

    Warm air aloft is stable. This explains the lack of strong winds in a warm front and how nighttime radiative cooling can lead to motionless air that can trap smog. The stability of stratospheric air can be attributed to the fact that it is heated from above as ultraviolet radiation strikes the ozone layer. On the other hand, fluid heated from below is unstable and can lead to Bernard convection cells. This explains the generally turbulent nature of the troposphere, which receives a significant fraction of its heat directly from the Earth's warmer surface. The instability of cold fluid aloft explains the violent nature of a cold front, as well as the motion of Earth's magma, which is driven by radioactive heating deep within the Earth's mantle. This paper describes how both effects can be demonstrated using four standard beakers, ice, and a bit of food coloring.

  12. Pressure driven particulate flows

    SciTech Connect

    Ingher, M.S.; Mondy, L.A.

    1996-03-01

    Numerical simulations of pressure-driven particulate Stokes flows are performed in cylindrical and rectangular conduits using a parallel boundary element code. Spherical particles are randomly placed in the conduits and a pressure drop between the ends of the conduits is imposed by the boundary conditions to induce a Poiseuille-like flow field. The instantaneous velocities of the particles are then calculated, as well as the additional pressure drop necessary to maintain a constant flow rate. Because the results depend on the spatial distribution of the particles, several random configurations of particles are examined for each case. Depending on two different interpretations of the numerical results, the solid phase can be represented as either leading or lagging the fluid phase. Both of the analyses and interpretations are presented.

  13. Consistent model driven architecture

    NASA Astrophysics Data System (ADS)

    Niepostyn, Stanisław J.

    2015-09-01

    The goal of the MDA is to produce software systems from abstract models in a way where human interaction is restricted to a minimum. These abstract models are based on the UML language. However, the semantics of UML models is defined in a natural language. Subsequently the verification of consistency of these diagrams is needed in order to identify errors in requirements at the early stage of the development process. The verification of consistency is difficult due to a semi-formal nature of UML diagrams. We propose automatic verification of consistency of the series of UML diagrams originating from abstract models implemented with our consistency rules. This Consistent Model Driven Architecture approach enables us to generate automatically complete workflow applications from consistent and complete models developed from abstract models (e.g. Business Context Diagram). Therefore, our method can be used to check practicability (feasibility) of software architecture models.

  14. Muscle-driven nanogenerators

    DOEpatents

    Wang, Zhong L [Marietta, GA; Yang, Rusen [Atlanta, GA

    2011-03-01

    In a method of generating electricity, a plurality of living cells are grown on an array of piezoelectric nanowires so that the cells engage the piezoelectric nanowires. Induced static potentials are extracted from at least one of the piezoelectric nanowires when at least one of the cells deforms the at least one of the piezoelectric nanowires. A cell-driven electrical generator that includes a substrate and a plurality of spaced-apart piezoelectric nanowires disposed on the substrate. A plurality of spaced-apart conductive electrodes interact with the plurality of piezoelectric nanowires. A biological buffer layer that is configured to promote growth of cells is disposed on the substrate so that cells placed on the substrate will grow and engage the piezoelectric nanowires.

  15. Participative Decision-Making.

    ERIC Educational Resources Information Center

    Lindelow, John; And Others

    Chapter 6 in a volume on school leadership, this chapter makes a case for the use of participative decision-making (PDM) at the school-site level, outlines guidelines for its implementation, and describes the experiences of some schools with PDM systems. It begins by citing research indicating the advantages of PDM, including better decisions,…

  16. Improving Decision Making.

    ERIC Educational Resources Information Center

    Mehallis, Mantha, Ed.

    1981-01-01

    This collection of essays focuses on the importance of accurate and timely information for effective decision making. First, Ivan Lach considers the proliferation of statewide planning and policy formation and discusses problems with and ways to improve statewide research. Next, Cheryl Opacinch focuses on decision making for federal postsecondary…

  17. Consumer Decisions. Student Manual.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Div. of Vocational Education.

    This student manual covers five areas relating to consumer decisions. Titles of the five sections are Consumer Law, Consumer Decision Making, Buying a Car, Convenience Foods, and Books for Preschool Children. Each section may contain some or all of these materials: list of objectives, informative sections, questions on the information and answers,…

  18. Decision Points in Cataloging.

    ERIC Educational Resources Information Center

    Bright, Franklyn F.

    Libraries are frequently faced with policy decisions which can affect the quality and cost of library services for years to come. This point can be illustrated by citing examples of decisions made at the University of Wisconsin Library in the areas of: (1) conforming to national cataloging standards; (2) producing catalog cards in-house; and (3)…

  19. Understanding The Lau Decision.

    ERIC Educational Resources Information Center

    Gounaris, Marilyn

    In a question and answer format, this booklet describes the Lau v. Nichols decision in which the Supreme Court ruled that the San Francisco Unified School District was guilty of discrimination because non-English speaking students were not given special language instruction. The booklet presents the basis for the Lau decision, describing a…

  20. Designing for Decision Making

    ERIC Educational Resources Information Center

    Jonassen, David H.

    2012-01-01

    Decision making is the most common kind of problem solving. It is also an important component skill in other more ill-structured and complex kinds of problem solving, including policy problems and design problems. There are different kinds of decisions, including choices, acceptances, evaluations, and constructions. After describing the centrality…

  1. Improving Educational Administrative Decisions.

    ERIC Educational Resources Information Center

    Wolfe, A. E.

    This paper discusses the financial crisis facing public education in the United States today and argues that the most effective response to this crisis is to improve the decision-making skills of educational administrators. Based on a review of the literature on administrative decision-making and organizational change, the author examines several…

  2. Doc, What Would You Do If You Were Me? On Self-Other Discrepancies in Medical Decision Making

    ERIC Educational Resources Information Center

    Garcia-Retamero, Rocio; Galesic, Mirta

    2012-01-01

    Doctors often make decisions for their patients and predict their patients' preferences and decisions to customize advice to their particular situation. We investigated how doctors make decisions about medical treatments for their patients and themselves and how they predict their patients' decisions. We also studied whether these decisions and…

  3. Understanding consumer decisions using behavioral economics.

    PubMed

    Zandstra, Elizabeth H; Miyapuram, Krishna P; Tobler, Philippe N

    2013-01-01

    Consumers make many decisions in everyday life involving finances, food, and health. It is known from behavioral economics research that people are often driven by short-term gratification, that is, people tend to choose the immediate, albeit smaller reward. But choosing the delayed reward, that is, delaying the gratification, can actually be beneficial. How can we motivate consumers to resist the "now" and invest in their future, leading to sustainable or healthy habits? We review recent developments from behavioral and neuroimaging studies that are relevant for understanding consumer decisions. Further, we present results from our field research that examined whether we can increase the perceived value of a (delayed) environmental benefit using tailored communication, that is, change the way it is framed. More specifically, we investigated whether we can boost the value of an abstract, long-term "green" claim of a product by expressing it as a concrete, short-term benefit. This is a new application area for behavioral economics.

  4. Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

    PubMed

    Siminoff, L A; Sandberg, D E

    2015-05-01

    Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach.

  5. Data-Driven Decision Making in Out-of-School Time Programs. Part 6 in a Series on Implementing Evidence-Based Practices in Out-of-School Time Programs: The Role of Organization-Level Activities. Research-to-Results Brief. Publication #2009-34

    ERIC Educational Resources Information Center

    Bandy, Tawana; Burkhauser, Mary; Metz, Allison J. R.

    2009-01-01

    Although many program managers look to data to inform decision-making and manage their programs, high-quality program data may not always be available. Yet such data are necessary for effective program implementation. The use of high-quality data facilitates program management, reduces reliance on anecdotal information, and ensures that data are…

  6. FENTON-DRIVEN REGENERATION OF GRANULAR ACTIVATED CARBON: A TECHNOLOGY OVERVIEW

    EPA Science Inventory

    A Fenton-driven mechanism for regenerating spent granular activated carbon (GAC) involves the combined, synergistic use of two reliable and well established treatment technologies - adsorption onto activated carbon and Fenton oxidation. During carbon adsorption treatment, enviro...

  7. Allocating resources in a data-driven college of nursing.

    PubMed

    Stuart, Gail W; Erkel, Elizabeth A; Shull, Lynn H

    2010-01-01

    Three years ago our college of nursing faced a critical strategic planning question: How could the college initiate and offer a Doctor of Nursing Practice (DNP) degree program without additional human and financial resources? This article describes the process used to open a new educational program with no new resources by suspending educational programs that were not financially viable. While the process was difficult, shared governance and data-driven decision-making fostered trust and openness that allowed faculty members to make critical decisions, assuring the viability and future growth of the college. At the end of this process, faculty members were united in their decisions and actively and energetically engaged in the development of a new DNP curriculum that built upon their strengths and expertise.

  8. Rapid Decisions From Experience

    PubMed Central

    Zeigenfuse, Matthew D.; Pleskac, Timothy J.; Liu, Taosheng

    2014-01-01

    In many everyday decisions, people quickly integrate noisy samples of information to form a preference among alternatives that offer uncertain rewards. Here, we investigated this decision process using the Flash Gambling Task (FGT), in which participants made a series of choices between a certain payoff and an uncertain alternative that produced a normal distribution of payoffs. For each choice, participants experienced the distribution of payoffs via rapid samples updated every 50 ms. We show that people can make these rapid decisions from experience and that the decision process is consistent with a sequential sampling process. Results also reveal a dissociation between these preferential decisions and equivalent perceptual decisions where participants had to determine which alternatives contained more dots on average. To account for this dissociation, we developed a sequential sampling rank-dependent utility model, which showed that participants in the FGT attended more to larger potential payoffs than participants in the perceptual task despite being given equivalent information. We discuss the implications of these findings in terms of computational models of preferential choice and a more complete understanding of experience-based decision making. PMID:24549141

  9. Quantum decision tree classifier

    NASA Astrophysics Data System (ADS)

    Lu, Songfeng; Braunstein, Samuel L.

    2013-11-01

    We study the quantum version of a decision tree classifier to fill the gap between quantum computation and machine learning. The quantum entropy impurity criterion which is used to determine which node should be split is presented in the paper. By using the quantum fidelity measure between two quantum states, we cluster the training data into subclasses so that the quantum decision tree can manipulate quantum states. We also propose algorithms constructing the quantum decision tree and searching for a target class over the tree for a new quantum object.

  10. Invention-driven marketing

    NASA Technical Reports Server (NTRS)

    Carlson, William E.

    1994-01-01

    Suppose you have just created a revolutionary bicycle suspension which allows a bike to be ridden over rough terrain at 60 miles per hour. In addition, suppose that you are deeply concerned about the plight of hungry children. Which should you do: be sure all hungry children have bicycles; transfer the technology for your new suspension to bicycle manufacturers worldwide; or start a company to supply premium sports bicycle based on your patented technology, and donate the profits to a charity which feeds hungry children? Woven through this somewhat trivial example is the paradox of technology transfer - the supplier (owner) may want to transfer technology; but to succeed, he or she must reformulate the problem as a user need for which there is a new and better solution. Successful technology transfer is little more than good marketing applied to an existing invention, process, or capability. You must identify who needs the technology, why they need it, why the new technology is better than alternatives, how much the customers are willing and able to pay for these benefits, and how to distribute products based on the technology tc the target customers. In market-driven development, the term 'technology transfer' is rarely used. The developers focus on studying user needs and designing solution They may have technology needs, but they don't have technology in search of a use.

  11. Compositionally Driven Dynamos

    NASA Astrophysics Data System (ADS)

    Soderlund, K. M.; Schubert, G.

    2014-12-01

    It is generally believed that compositional convection driven by inner core solidification is the main driver of the geodynamo. Thermal evolution considerations make it likely that compositional convection is also behind the present dynamos of Mercury and Ganymede as well as the early dynamos in the Moon, Mars and smaller solar system bodies. Compositional buoyancy can arise in several different ways, for example, through inner core solidification and FeS flotation with upward mixing and through freezing out and sinking of iron snow near the core-mantle boundary or deeper within the core. The mode of core cooling and freezing depends on conditions of temperature and pressure in the core and the concentration of light elements such as sulfur. Different distributions of compositional buoyancy will give rise to different patterns of core convection and dynamo magnetic fields. We report here the first results of a systematic study of the distribution of compositional buoyancy on the dynamo-generated magnetic fields, with an emphasis on Mars' core evolution due to iron rain.

  12. Electromagnetically driven liquid iris

    NASA Astrophysics Data System (ADS)

    Jang, Deasung; Jeong, Jin Won; Lee, Dae Young; Kim, Dae Geun; Chung, Sang Kug

    2016-11-01

    This paper describes a tunable liquid iris driven by electromagnetic actuation for miniature cameras. To examine the magnetic effect on a ferrofluid, the contact angle modification of a sessile ferrofluid droplet is tested using a neodymium magnet and an electric coil which 2.5 A current is applied to. The contact angle variations of the ferrofluid droplet for each test are 21.3 and 18.1 degrees, respectively. As a proof of concept, a pretest of a tunable iris actuated by electromagnetic effect is performed by using a hollow cylinder cell. As applying the current, the aperture diameter is adjusted from 4.06 mm at 0A to 3.21 mm at 2.0A. Finally, a tunable liquid iris (9 x 9 x 2 mm3) , consisting of two connected circular microchannels, is realized using MEMS technology. the aperture diameter of the tunable liquid iris is able to be modified from 1.72 mm at 0 A to 1.15 mm at 2.6 A. This tunable optical iris has potential applications not only for portable electronic devices but also in biomedical fields such as optical coherence tomography and microsurgery. This work was supported by 2016 Research Fund of Myongji University.

  13. Driven Boson Sampling

    NASA Astrophysics Data System (ADS)

    Barkhofen, Sonja; Bartley, Tim J.; Sansoni, Linda; Kruse, Regina; Hamilton, Craig S.; Jex, Igor; Silberhorn, Christine

    2017-01-01

    Sampling the distribution of bosons that have undergone a random unitary evolution is strongly believed to be a computationally hard problem. Key to outperforming classical simulations of this task is to increase both the number of input photons and the size of the network. We propose driven boson sampling, in which photons are input within the network itself, as a means to approach this goal. We show that the mean number of photons entering a boson sampling experiment can exceed one photon per input mode, while maintaining the required complexity, potentially leading to less stringent requirements on the input states for such experiments. When using heralded single-photon sources based on parametric down-conversion, this approach offers an ˜e -fold enhancement in the input state generation rate over scattershot boson sampling, reaching the scaling limit for such sources. This approach also offers a dramatic increase in the signal-to-noise ratio with respect to higher-order photon generation from such probabilistic sources, which removes the need for photon number resolution during the heralding process as the size of the system increases.

  14. Fluid driven recipricating apparatus

    SciTech Connect

    Whitehead, John C.

    1997-01-01

    An apparatus comprising a pair of fluid driven pump assemblies in a back-to-back configuration to yield a bi-directional pump. Each of the pump assemblies includes a piston or diaphragm which divides a chamber therein to define a power section and a pumping section. An intake-exhaust valve is connected to each of the power sections of the pump chambers, and function to direct fluid, such as compressed air, into the power section and exhaust fluid therefrom. At least one of the pistons or diaphragms is connected by a rod assembly which is constructed to define a signal valve, whereby the intake-exhaust valve of one pump assembly is controlled by the position or location of the piston or diaphragm in the other pump assembly through the operation of the rod assembly signal valve. Each of the pumping sections of the pump assemblies are provided with intake and exhaust valves to enable filling of the pumping section with fluid and discharging fluid therefrom when a desired pressure has been reached.

  15. Fluid driven reciprocating apparatus

    SciTech Connect

    Whitehead, J.C.

    1997-04-01

    An apparatus is described comprising a pair of fluid driven pump assemblies in a back-to-back configuration to yield a bi-directional pump. Each of the pump assemblies includes a piston or diaphragm which divides a chamber therein to define a power section and a pumping section. An intake-exhaust valve is connected to each of the power sections of the pump chambers, and function to direct fluid, such as compressed air, into the power section and exhaust fluid therefrom. At least one of the pistons or diaphragms is connected by a rod assembly which is constructed to define a signal valve, whereby the intake-exhaust valve of one pump assembly is controlled by the position or location of the piston or diaphragm in the other pump assembly through the operation of the rod assembly signal valve. Each of the pumping sections of the pump assemblies are provided with intake and exhaust valves to enable filling of the pumping section with fluid and discharging fluid therefrom when a desired pressure has been reached. 13 figs.

  16. Wind driven air pump

    SciTech Connect

    Beisel, V.A.

    1983-05-31

    An improved pump for lifting water from an underground source utilizes a wind motor for driving an oil-less air compressor eliminating oil contamination of ground water which is forced to the surface. The wind motor is movable to face the wind by means of a novel swivel assembly which also eliminates the formation and freezing of condensate within the airline from the compressor. The propeller blades of the wind motor and the tail section are formed from a pair of opposed convex air foil shaped surfaces which provide the propeller blades and the tail section with fast sensitivity to slight changes in wind direction and speed. A novel well tower for supporting the wind motor and compressor and for lifting the water from the underground source is an optional modification which requires no welding and eliminates the problem of condensate freezing in the airline going to the well. The wind driven air pump disclosed is lightweight, can be easily installed, is relatively inexpensive to produce and is virtually maintenance-free and capable of operating in winds exceeding 100 miles per hour.

  17. Gradient Driven Fluctuations

    NASA Technical Reports Server (NTRS)

    Cannell, David

    2005-01-01

    We have worked with our collaborators at the University of Milan (Professor Marzio Giglio and his group-supported by ASI) to define the science required to measure gradient driven fluctuations in the microgravity environment. Such a study would provide an accurate test of the extent to which the theory of fluctuating hydrodynamics can be used to predict the properties of fluids maintained in a stressed, non-equilibrium state. As mentioned above, the results should also provide direct visual insight into the behavior of a variety of fluid systems containing gradients or interfaces, when placed in the microgravity environment. With support from the current grant, we have identified three key systems for detailed investigation. These three systems are: 1) A single-component fluid to be studied in the presence of a temperature gradient; 2) A mixture of two organic liquids to be studied both in the presence of a temperature gradient, which induces a steady-state concentration gradient, and with the temperature gradient removed, but while the concentration gradient is dying by means of diffusion; 3) Various pairs of liquids undergoing free diffusion, including a proteidbuffer solution and pairs of mixtures having different concentrations, to allow us to vary the differences in fluid properties in a controlled manner.

  18. Exchange-driven growth.

    PubMed

    Ben-Naim, E; Krapivsky, P L

    2003-09-01

    We study a class of growth processes in which clusters evolve via exchange of particles. We show that depending on the rate of exchange there are three possibilities: (I) Growth-clusters grow indefinitely, (II) gelation-all mass is transformed into an infinite gel in a finite time, and (III) instant gelation. In regimes I and II, the cluster size distribution attains a self-similar form. The large size tail of the scaling distribution is Phi(x) approximately exp(-x(2-nu)), where nu is a homogeneity degree of the rate of exchange. At the borderline case nu=2, the distribution exhibits a generic algebraic tail, Phi(x) approximately x(-5). In regime III, the gel nucleates immediately and consumes the entire system. For finite systems, the gelation time vanishes logarithmically, T approximately [lnN](-(nu-2)), in the large system size limit N--> infinity. The theory is applied to coarsening in the infinite range Ising-Kawasaki model and in electrostatically driven granular layers.

  19. Early and reliable detection of herpes simplex virus type 1 and varicella zoster virus DNAs in oral fluid of patients with idiopathic peripheral facial nerve palsy: Decision support regarding antiviral treatment?

    PubMed

    Lackner, Andreas; Kessler, Harald H; Walch, Christian; Quasthoff, Stefan; Raggam, Reinhard B

    2010-09-01

    Idiopathic peripheral facial nerve palsy has been associated with the reactivation of herpes simplex virus type 1 (HSV-1) or varicella zoster virus (VZV). In recent studies, detection rates were found to vary strongly which may be caused by the use of different oral fluid collection devices in combination with molecular assays lacking standardization. In this single-center pilot study, liquid phase-based and absorption-based oral fluid collection was compared. Samples were collected with both systems from 10 patients with acute idiopathic peripheral facial nerve palsy, 10 with herpes labialis or with Ramsay Hunt syndrome, and 10 healthy controls. Commercially available IVD/CE-labeled molecular assays based on fully automated DNA extraction and real-time PCR were employed. With the liquid phase-based oral fluid collection system, three patients with idiopathic peripheral facial nerve palsy tested positive for HSV-1 DNA and another two tested positive for VZV DNA. All patients with herpes labialis tested positive for HSV-1 DNA and all patients with Ramsay Hunt syndrome tested positive for VZV DNA. With the absorption-based oral fluid collection system, detections rates and viral loads were found to be significantly lower when compared to those obtained with the liquid phase-based collection system. Collection of oral fluid with a liquid phase-based system and the use of automated and standardized molecular methods allow early and reliable detection of HSV-1 and VZV DNAs in patients with acute idiopathic peripheral facial nerve palsy and may provide a valuable decision support regarding start of antiviral treatment at the first clinical visit.

  20. The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project: Development and Testing of Electronic Decision Support System and Formative Research to Understand Perceptions about Mental Health in Rural India

    PubMed Central

    Maulik, Pallab K; Tewari, Abha; Devarapalli, Siddhardha; Kallakuri, Sudha; Patel, Anushka

    2016-01-01

    Introduction Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India’s vast mobile network to support such workers using mobile-based applications. We propose an intervention to implement such an approach that incorporates the use of mobile-based electronic decision support systems (EDSS) to provide mental health services for CMD, combined with a community-based anti-stigma campaign. This will be implemented and evaluated across 42 villages in Andhra Pradesh, a south Indian state. This paper discusses the development and testing of the EDSS, and the formative research that informed the anti-stigma campaign. Materials and Methods The development of the EDSS used an iterative process that was validated against clinical diagnosis. A mixed methods approach tested the user acceptability of the EDSS. Focus group discussions and in-depth interviews provided community-level perceptions about mental health. This study involved 3 villages and one primary health centre. Results The EDSS application was found to be acceptable, but some modifications were needed. The community lacked adequate knowledge about CMD and its treatment and there was stigma associated with mental illness. Faith and traditional healers were considered to be important mental health service providers. Discussion A number of barriers and facilitators were identified in implementing the intervention analysed in a framework using Andersen’s behavioural model of health services use. Conclusion The findings assisted with refining the intervention prior to large-scale implementation and evaluation. PMID:27732652

  1. Soft Decision Analyzer

    NASA Technical Reports Server (NTRS)

    Lansdowne, Chatwin; Steele, Glen; Zucha, Joan; Schlesinger, Adam

    2013-01-01

    We describe the benefit of using closed-loop measurements for a radio receiver paired with a counterpart transmitter. We show that real-time analysis of the soft decision output of a receiver can provide rich and relevant insight far beyond the traditional hard-decision bit error rate (BER) test statistic. We describe a Soft Decision Analyzer (SDA) implementation for closed-loop measurements on single- or dual- (orthogonal) channel serial data communication links. The analyzer has been used to identify, quantify, and prioritize contributors to implementation loss in live-time during the development of software defined radios. This test technique gains importance as modern receivers are providing soft decision symbol synchronization as radio links are challenged to push more data and more protocol overhead through noisier channels, and software-defined radios (SDRs) use error-correction codes that appro