Calibrating variant-scoring methods for clinical decision making.
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ABSTRACT:
SUBMITTER: Benevenuta S
PROVIDER: S-EPMC8023678 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:INTRODUCTION:The objective of this study was to determine whether decision-based procedural mapping demonstrates differences in attendings versus residents. METHODS:Attendings and residents were interviewed about operative decision-making in laparoscopic cholecystectomy (LC) using a cognitive task analysis framework. Interviews were converted into procedural maps. Operative steps, patient factors, and surgeon factors noted by attendings and residents were compared. Two scoring methods were used to compare map structures of attendings versus residents. RESULTS:Six attendings and six residents were interviewed. There were no significant differences in the number of patient or surgeon factors identified. Attendings had significantly more operative steps (29.67?±?1.9 vs. 23.3?±?1.9, p?=?0.04) and crosslinks (3.2?±?0.5 vs. 1?±?0.4, p?=?0.005) in their maps and a higher total score (90.2?±?8.4 vs. 63.2?±?3.8, p?=?0.015) than residents. CONCLUSION:LC procedural map scoring for attendings and residents demonstrated significant differences in structural complexity and may provide a useful framework for assessing decision making.
| S-EPMC6581213 | biostudies-literature
Project description:Plasmatic microRNA sequencing was conducted in specific matched subgroups of subjects (n = 53) with and without OSA using HTG EdgeSeq miRNA WTA Assay technology.
2024-04-01 | GSE229362 | GEO
Project description:BackgroundNutritional manipulation with functional nutrients like polyunsaturated fatty acids can boost milk production efficiency in dairy farming. It is important to consider the animal's physiological periods, especially the second half of the first pregnancy for mammary gland development.ObjectivesBy considering multiple factors and comparing them, multi-attribute decision-making (MADM) can be utilized to conduct further assessments and select the best diet for the animals.MethodsForty primiparous Saanen does, from the last 2 months of pregnancy up to 4 months of lactation, have been assigned to four iso-energetic and iso-nitrogenous diets. Four dietary groups included: no external sources of fat (negative control, CT), saturated palm oil (positive control), roasted soybeans (omega-6, SB) and extruded flaxseed (omega-3, FS). Twenty-two performance criteria such as feed intake, milk yield and composition, body weight, blood metabolites and hormones, the milk fatty acid profile, as well as morphological and histological measurements of the mammary gland, in the form of least-square means, were considered.ResultsA decision-making tool was used to select the best form of fat supplements in late pregnancy and early lactation diets, to improve lactation performance in Saanen goats. For this purpose, a MADM method was applied to determine the order of preference similarity to the ideal solution. According to the score of this method, the FS group had the highest coefficients (0.689), and the CT group had the lowest coefficients (0.281).ConclusionsIncorporating flaxseed into the diets of Saanen goats during late pregnancy and early lactation is a valuable strategy for enhancing milk performance. This supplement is recommended as a source of fat. Additionally, the implementation of decision-making tools, such as the MADM method in animal science, can significantly improve management decision-making processes by reducing both time and cost. This presents a new avenue for making well-informed decisions.
| S-EPMC10650249 | biostudies-literature
Project description:Extensive coronary artery calcium (CAC) diminishes the accuracy of coronary computed tomography angiography (CCTA). Many imagers adjust CCTA acquisition parameters depending on a preCCTA Agatston CAC score to optimize diagnostic accuracy. Typical preCCTA CAC imaging adds considerably to radiation exposure, partially attributable to imaging beyond the area known for highest CAC, the proximal coronary arteries. We aimed to determine whether a z-axis reduced scan length (RSL) would identify the majority of CAC and provide adequate information to computed tomography angiography providers relative to a standard full-scan length (FSL) preCCTA noncontrast CT. We retrospectively examined 200 subjects. The mean CAC scores detected in RSL and FSL were 77.4 (95% CI 50.6 to 104.3) and 93.9 (95% CI 57.3 to 130.5), respectively. RSL detected 81% of the FSL CAC. Among false negatives, with no CAC detected in RSL, FSL CAC severity was minimal (mean score 2.8). There was high concordance, averaging 88%, between CCTA imaging parameter adjustment decisions made by 2 experienced imagers based on either RSL or FSL. CAC detected and decision concordance decreased with increasing CAC burden. CAC detected was lower, and false negatives were more common in the right coronary artery owing to its anatomic course, placing larger segments outside RSL. Axial scan length and effective dose decreased 59% from FSL (?14.5?cm/?1.1 mSv) to RSL (?5.9?cm/?0.45 mSv). This retrospective study suggests that RSL identifies most CAC, results in similar CCTA acquisition parameter modifications, and reduces radiation exposure. Our colleagues corroborated these results in a recently published prospective study.
| S-EPMC7744187 | biostudies-literature
Project description:Background: Cuproptosis is a newly identified form of non-apoptotic cell death that is associated with the progression and treatment responses in pancreatic adenocarcinoma (PAAD). However, its impact on oncology and tumor microenvironment (TME) remains unclear. Methods: Hub genes were identified using least absolute shrinkage and selection operator (LASSO) Cox regression for 25 newly reported cuproptosis-related regulators and subjected to stepwise regression to obtain cuproptosis-related score (CuRS). Additionally, the clinical significance, functional status, role on TME, and genomic variation of CuRS were further examined systematically. Results: A CuRS model incorporating TRAF2, TRADD, USP21, FAS, MLKL, TNFRSF10B, MAPK8, TRAF5, and RIPK3 was developed. The stability and accuracy of this risk model as an independent prognostic factor for PAAD were confirmed in the training and external validation cohorts. Patients in the high-CuRS group had “cold” tumors with active tumor proliferation and immunosuppression, whereas those in the low-CuRS group comprised “hot” tumors with active immune function and cell killing capacity. Additionally, patients in the high-CuRS group carried fewer genomic copy number variations (CNVs) and greater somatic mutations. Furthermore, patients in the low- and high-CuRS groups exhibited increased sensitivity to immunotherapy and chemotherapy, respectively. Conclusion: We developed and validated a robust CuRS model based on cuproptosis to assess patients’ prognoses and guide clinical decision-making. Overall, the findings of this study are expected to contribute to the comprehensive understanding of cuproptosis and facilitate precise treatment of PAAD.
| S-EPMC9472214 | biostudies-literature
Project description:Relatively little is known about the ease or difficulty with which women decide to have an abortion, and most research uses single-item measurements. We used a mixed methods approach to combine data from the Dutch Abortion and Mental Health Study (DAMHS, n = 325) with data from a qualitative study about the decision process with a small subsample (n = 69) of the DAMHS study. We used the findings from the qualitative study to develop the Dimensions of Abortion Decision Difficulty [DADD] scale, and tested this scale among a larger sample of women who took part in the second wave of the cohort study (n = 264). Qualitative analyses revealed six dimensions of decision difficulty. The DADD scale was based on these six dimensions. Results from the DADD scale at follow-up reduced these to four dimensions: (1) unrealistic fears about the abortion and fantasies about the pregnancy; (2) decision conflict; (3) negative abortion attitudes; and (4) general indecisiveness. Decision conflict was the only dimension related to previous mental disorders. The findings suggest that the concept of decision difficulty seems multidimensional, rather than unidimensional. On a clinical level, it could be important to separate the more general fears, attitudes, and indecisiveness from strong decision conflict, because the latter might involve pressure of others, lack of decision ownership, and might be related to previous mental health.
| S-EPMC6386241 | biostudies-literature
Project description:ObjectivePatients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem.MethodsGuided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and a study-specific questionnaire. Audio-recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA.ResultsPatients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process.ConclusionThis study describes the development of a comprehensible and easy-to-use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341).Level of evidenceNA Laryngoscope, 129:2733-2739, 2019.
| S-EPMC6899876 | biostudies-literature
Project description: Not available
| S-EPMC6710912 | biostudies-literature
Project description:BackgroundThe evidence used to inform health care decision making (HCDM) is typically uncertain. In these situations, the experience of experts is essential to help decision makers reach a decision. Structured expert elicitation (referred to as elicitation) is a quantitative process to capture experts' beliefs. There is heterogeneity in the existing elicitation methodology used in HCDM, and it is not clear if existing guidelines are appropriate for use in this context. In this article, we seek to establish reference case methods for elicitation to inform HCDM.MethodsWe collated the methods available for elicitation using reviews and critique. In addition, we conducted controlled experiments to test the accuracy of alternative methods. We determined the suitability of the methods choices for use in HCDM according to a predefined set of principles for elicitation in HCDM, which we have also generated. We determined reference case methods for elicitation in HCDM for health technology assessment (HTA).ResultsIn almost all methods choices available for elicitation, we found a lack of empirical evidence supporting recommendations. Despite this, it is possible to define reference case methods for HTA. The reference methods include a focus on gathering experts with substantive knowledge of the quantities being elicited as opposed to those trained in probability and statistics, eliciting quantities that the expert might observe directly, and individual elicitation of beliefs, rather than solely consensus methods. It is likely that there are additional considerations for decision makers in health care outside of HTA.ConclusionsThe reference case developed here allows the use of different methods, depending on the decision-making setting. Further applied examples of elicitation methods would be useful. Experimental evidence comparing methods should be generated.
| S-EPMC8777312 | biostudies-literature
Project description:BackgroundElectronic medical records are widely used in family practices across Canada and can improve health outcomes. However, recent reports indicate that physicians using electronic medical records work longer and have less direct patient contact which may contribute to burnout. Therefore, new and innovative digital tools are essential to reduce physician workloads and improve patient-physician interaction to address physician burnout. The objective of this study was to assess the efficiency and accuracy of clinical decision-making when using a new preventive care point-of-care clinical decision support system (CDSS). An estimate of the potential annual time savings was also determined. This study also assessed physician reported perceived usefulness and ease of use of the CDSS.MethodsQuantitative and qualitative data were collected during this study. Each participant evaluated two simulated patient charts and identified which preventive care metrics were due. The participants recorded their decisions and the time required to assess each chart. Participants then completed a Technology Acceptance Model survey regarding the perceived usefulness and ease of use of the CDSS, which included qualitative feedback. The amount of time saved was determined and participants' clinical decision-making accuracy was scored against current Canadian preventive care guidelines. The number of preventive care specific visits completed per year was determined using clinic billing data.ResultsThe preventive care CDSS saved an average of 195.7 s of chart review time (249.5 s vs 445.2 s; P < 0.001). A total of 1520 preventive visits were performed at Primrose and Bruyère Family Medicine Centres. Extrapolated across the organization, implementation of the new tool could save 82.6 h per year. Decision-making accuracy was not affected by the new tool (78.4% vs 80.9%, P > 0.05). Participants rated the perceived ease of use and usefulness to be very high.ConclusionsNew digital tools may reduce providers' workload without impacting clinical decision-making accuracy. Participants indicated that the preventive care CDSS was useful and easy to use. Further software development and clinical studies are required to further improve and characterize the effect this new CDSS has when implemented in clinical practice.
| S-EPMC8588582 | biostudies-literature