Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to...Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.展开更多
The importance and complexity of prioritizing construction projects (PCP) in urban road network planning lead to the necessity to develop an aided decision making program (ADMP). Cost benefit ratio model and stage rol...The importance and complexity of prioritizing construction projects (PCP) in urban road network planning lead to the necessity to develop an aided decision making program (ADMP). Cost benefit ratio model and stage rolled method are chosen as the theoretical foundations of the program, and then benefit model is improved to accord with the actuality of urban traffic in China. Consequently, program flows, module functions and data structures are designed, and particularly an original data structure of road ...展开更多
Process planning and scheduling are two major plann in g and control activities that consume significant part of the lead-time, theref ore all attempts are being made to reduce lead-time by automating them. Compute r ...Process planning and scheduling are two major plann in g and control activities that consume significant part of the lead-time, theref ore all attempts are being made to reduce lead-time by automating them. Compute r Aided Process Planning (CAPP) is a step in this direction. Most of the existin g CAPP systems do not consider scheduling while generating a process plan. Sched uling is done separately after the process plan has been generated and therefore , it is possible that a process plan so generated is either not optimal or feasi ble from scheduling point of view. As process plans are generated without consid eration of job shop status, many problems arise within the manufacturing environ ment. Investigations have shown that 20%～30% of all process plans generated are not valid and have to be altered or suffer production delays when production sta rts. There is thus a major need for integration of scheduling with computer aide d process planning for generating more realistic process plans. In doing so, eff iciency of the manufacturing system as a whole is expected to improve. Decision support system performs many functions such as selection of machine too ls, cutting tools, sequencing of operations, determination of optimum cutting pa rameters and checking availability of machine tool before allocating any operati on to a machine tool. The process of transforming component data, process capabi lity and decision rules into computer readable format is still a major obstacle. This paper proposes architecture of a system, which integrates computer aided p rocess-planning system with scheduling using decision support system. A decisio n support system can be defined as " an interactive system that provides the use rs with easy access to decision models in order to support semi-structured or u nstructured decision making tasks".展开更多
Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The pat...Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.展开更多
For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making...For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.展开更多
BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable optio...BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.展开更多
To reduce the difficulty and enhance the enthusiasm of private-owned electric vehicles(EVs) in participating in frequency regulation ancillary service market(FRASM), a decision aid model(DAM) is proposed. This paper p...To reduce the difficulty and enhance the enthusiasm of private-owned electric vehicles(EVs) in participating in frequency regulation ancillary service market(FRASM), a decision aid model(DAM) is proposed. This paper presents three options for EV participating in FRASM, i. e., the base mode(BM), unidirectional charging mode(UCM), and bidirectional charging/discharging mode(BCDM), based on a reasonable simplification of users' participating willingness. In BM, individual EVs will not be involved in FRASM, and DAM will assist users to set the optimal charging schemes based on travel plans under the time-of-use(TOU) price. UCM and BCDM are two modes in which EVs can take part in FRASM. DAM can assist EV users to create their quotation plan, which includes hourly upper and lower reserve capabilities and regulation market mileage prices. In UCM and BCDM, the difference is that only the charging rate can be adjusted in the UCM, and the EVs in BCDM can not only charge but also discharge if necessary. DAM can estimate the expected revenue of all three modes, and EV users can make the final decision based on their preferences. Simulation results indicate that all the three modes of DAM can reduce the cost, while BCDM can get the maximum expected revenue.展开更多
An expert decision support system (EDSS) for multi-bins balance and contro1 of orequality in production ore bins of some large-scale open pit iron mine in China has been developed byexpert svitem tool software VP-EXPE...An expert decision support system (EDSS) for multi-bins balance and contro1 of orequality in production ore bins of some large-scale open pit iron mine in China has been developed byexpert svitem tool software VP-EXPERT and integration software LOTUS 1-2-3 in this paper. Itis known by practicing that a medium-scale EDSS constructed on microcomputer is completcly, feaasible by means of VP-EXEPERT to construct knowledge base system (KBS), LOTUS 1-2-3 tomake decision support system (DSS) and link them with BAT.展开更多
This paper explores a decision making model for a multidisciplinary problem in nature. This problem considers the role of energy use in sustainable development and the potential sources to increase energy efficiency d...This paper explores a decision making model for a multidisciplinary problem in nature. This problem considers the role of energy use in sustainable development and the potential sources to increase energy efficiency during its whole life cycle;it also deals with multicriteria decision making of plastic materials used in a day to day basis. Exergy analysis of plastic materials used to the manufacture of disposable polyethylene bags comparing them with other materials that can be used for substitution will be important to take decisions. We are also interested in plastic poly (ethylene Terephthalate or PET) bottles. The calculation of the incoming and outgoing Exergy flows during the production processes are carried out. The Exergy loss considering the sustainability concept, Green House Gases emissions, real energy flows needed to the chain of processes, material balances in the productions chains and value added, are presented as a set of criteria to make decisions of alternative materials including the actual ones. A case study for Mexico’s market will be developed in order to prove the methodology. It offers some interesting data about consumption and production of bags and bottles.展开更多
Availability of antiretroviral therapy and prevention of mother to child transmission of HIV programmes have increased childbearing decisions in people living with HIV. However, pregnancy decisions of married women li...Availability of antiretroviral therapy and prevention of mother to child transmission of HIV programmes have increased childbearing decisions in people living with HIV. However, pregnancy decisions of married women living with HIV have not been adequately reported in Malawi. In order to provide information to inform the development of antiretroviral and family planning services targeted to the unique needs of women living with HIV, this study explored pregnancy decisions of women living with HIV in rural southern Malawi. Twenty in-depth interviews on married women living with HIV selected purposively were conducted in two antiretroviral clinics of patrilineal Chikhwawa and matrilineal Chiradzulu districts in 2010. With their pregnancy and child rearing experiences, the women who got pregnant after a positive HIV diagnosis decided to never get pregnant again. Their lived experiences of motherhood when living with HIV play a major role in their pregnancy decisions despite free access to antiretroviral therapy, which has improved the quality of their life’s and survival. Societies in Malawi must accept this behavioural change by married women living with HIV and their needs for family planning. Health care workers must be knowledgeable and sensitive about it and assist women living with HIV who are willing to adapt their pregnant decisions based on living experiences.展开更多
Objective:To investigate the levels of zinc-α-2-glycoprotein(ZAG) among Omani AIDS patients receiving combined antiretroviral therapy(cART).Methods:A total of 80 Omani AIDS patients(45 males and 33 females),average a...Objective:To investigate the levels of zinc-α-2-glycoprotein(ZAG) among Omani AIDS patients receiving combined antiretroviral therapy(cART).Methods:A total of 80 Omani AIDS patients(45 males and 33 females),average age of 36 vears.who were receiving cART at the Saltan Qaboos University Hospital(SQUH).Muscat,Oman,were tested for the levels of ZAG.In addition,SO healthy blood donors(46 males and 34 females),average age of 26 years,attending the SOUH Blood Bank,were tested in parallel as a control group.Measurement of the ZAG levels was performed using a competitive enzyme—linked immunosorbent assay and in accordance with the manufacturer's instructions.Results:The ZAG levels were found to he significantly higher among AIDS patients compared to the healthy individuals(P=0.033).A total of 56(70%) of the AIDS patients were found to have higher levels of ZAG and 16(20%) AIDS patients were found to have high ZAG levels,which are significantly(P>0.031) associated with weight loss.Conclusions:ZAG levels are high among Omani AIDS patients on cART and this necessitales the measurement of ZAG on routine basis,as it is associated with weight loss.展开更多
文摘Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.
文摘The importance and complexity of prioritizing construction projects (PCP) in urban road network planning lead to the necessity to develop an aided decision making program (ADMP). Cost benefit ratio model and stage rolled method are chosen as the theoretical foundations of the program, and then benefit model is improved to accord with the actuality of urban traffic in China. Consequently, program flows, module functions and data structures are designed, and particularly an original data structure of road ...
文摘Process planning and scheduling are two major plann in g and control activities that consume significant part of the lead-time, theref ore all attempts are being made to reduce lead-time by automating them. Compute r Aided Process Planning (CAPP) is a step in this direction. Most of the existin g CAPP systems do not consider scheduling while generating a process plan. Sched uling is done separately after the process plan has been generated and therefore , it is possible that a process plan so generated is either not optimal or feasi ble from scheduling point of view. As process plans are generated without consid eration of job shop status, many problems arise within the manufacturing environ ment. Investigations have shown that 20%～30% of all process plans generated are not valid and have to be altered or suffer production delays when production sta rts. There is thus a major need for integration of scheduling with computer aide d process planning for generating more realistic process plans. In doing so, eff iciency of the manufacturing system as a whole is expected to improve. Decision support system performs many functions such as selection of machine too ls, cutting tools, sequencing of operations, determination of optimum cutting pa rameters and checking availability of machine tool before allocating any operati on to a machine tool. The process of transforming component data, process capabi lity and decision rules into computer readable format is still a major obstacle. This paper proposes architecture of a system, which integrates computer aided p rocess-planning system with scheduling using decision support system. A decisio n support system can be defined as " an interactive system that provides the use rs with easy access to decision models in order to support semi-structured or u nstructured decision making tasks".
文摘Medical treatment of patients inherently entails the risk of undesired complication or side effects. It is essential to inform the patient about the expected outcomes, but also the possible undesired outcomes. The patients preference and values regarding the potential outcomes should be involved in the decision making process. Even though many orthopaedic surgeons are positive towards shared decision-making, it is minimally introduced in the orthopaedic daily practice and decision-making is still mostly physician based. Decision aids are designed to support the physician and patient in the shareddecision-making process. By using decision aids, patients can learn more about their condition and treatment options in advance to the decision-making. This will reduce decisional conflict and improve participation and satisfaction.
文摘For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.
文摘BACKGROUND The interest in shared decision making has increased considerably over the last couple of decades.Decision aids(DAs)can help in shared decision making.Especially when there is more than one reasonable option and outcomes between treatments are comparable.AIM To investigate if the use of DAs decreases decisional conflict in patients when choosing treatment for knee or hip osteoarthritis(OA).METHODS In this multi-center unblinded randomized controlled trial of patients with knee or hip OA were included from four secondary and tertiary referral centers.Onehundred-thirty-one patients who consulted an orthopedic surgeon for the first time with knee or hip OA were included between December 2014 and January 2016.After the first consultation,patients were randomly assigned by a computer to the control group which was treated according to standard care,or to the intervention group which was treated with standard care and provided with a DA.After the first consultation,patients were asked to complete questionnaires about decisional conflict(DCS),satisfaction,anxiety(PASS-20),gained knowledge,stage of decision making and preferred treatment.Follow-up was carried out after 26 wk and evaluated decisional conflict,satisfaction,anxiety,health outcomes(HOOS/KOOS),quality of life(EQ5D)and chosen treatment.RESULTS After the first consultation,patients in the intervention group(mean DCS:25 out of 100,SD:13)had significantly(P value:0.00)less decisional conflict compared to patients in the control group(mean DCS:39 out of 100,SD 11).The mean satisfaction score for the given information(7.6 out of 10,SD:1.8 vs 8.6 out of 10,SD:1.1)(P value:0.00),mean satisfaction score with the physician(8.3 out of 10,SD:1.7 vs 8.9 out of 10,SD:0.9)(P value:0.01)and the mean knowledge score(3.3 out of 4,SD:0.9 vs 3.7 out of,SD:0.6)(P value:0.01)were all significantly higher in the intervention group.At 26-wk follow-up,only 75 of 131 patients(57%)were available for analysis.This sample is too small for meaningful analysis.CONCLUSION Providing patients with an additional DA may have a positive effect on decisional conflict after the first consultation.Due to loss to follow-up we are unsure if this effect remains over time.
基金supported in part by the National Natural Science Foundation of China(No.51777065).
文摘To reduce the difficulty and enhance the enthusiasm of private-owned electric vehicles(EVs) in participating in frequency regulation ancillary service market(FRASM), a decision aid model(DAM) is proposed. This paper presents three options for EV participating in FRASM, i. e., the base mode(BM), unidirectional charging mode(UCM), and bidirectional charging/discharging mode(BCDM), based on a reasonable simplification of users' participating willingness. In BM, individual EVs will not be involved in FRASM, and DAM will assist users to set the optimal charging schemes based on travel plans under the time-of-use(TOU) price. UCM and BCDM are two modes in which EVs can take part in FRASM. DAM can assist EV users to create their quotation plan, which includes hourly upper and lower reserve capabilities and regulation market mileage prices. In UCM and BCDM, the difference is that only the charging rate can be adjusted in the UCM, and the EVs in BCDM can not only charge but also discharge if necessary. DAM can estimate the expected revenue of all three modes, and EV users can make the final decision based on their preferences. Simulation results indicate that all the three modes of DAM can reduce the cost, while BCDM can get the maximum expected revenue.
文摘An expert decision support system (EDSS) for multi-bins balance and contro1 of orequality in production ore bins of some large-scale open pit iron mine in China has been developed byexpert svitem tool software VP-EXPERT and integration software LOTUS 1-2-3 in this paper. Itis known by practicing that a medium-scale EDSS constructed on microcomputer is completcly, feaasible by means of VP-EXEPERT to construct knowledge base system (KBS), LOTUS 1-2-3 tomake decision support system (DSS) and link them with BAT.
文摘This paper explores a decision making model for a multidisciplinary problem in nature. This problem considers the role of energy use in sustainable development and the potential sources to increase energy efficiency during its whole life cycle;it also deals with multicriteria decision making of plastic materials used in a day to day basis. Exergy analysis of plastic materials used to the manufacture of disposable polyethylene bags comparing them with other materials that can be used for substitution will be important to take decisions. We are also interested in plastic poly (ethylene Terephthalate or PET) bottles. The calculation of the incoming and outgoing Exergy flows during the production processes are carried out. The Exergy loss considering the sustainability concept, Green House Gases emissions, real energy flows needed to the chain of processes, material balances in the productions chains and value added, are presented as a set of criteria to make decisions of alternative materials including the actual ones. A case study for Mexico’s market will be developed in order to prove the methodology. It offers some interesting data about consumption and production of bags and bottles.
文摘Availability of antiretroviral therapy and prevention of mother to child transmission of HIV programmes have increased childbearing decisions in people living with HIV. However, pregnancy decisions of married women living with HIV have not been adequately reported in Malawi. In order to provide information to inform the development of antiretroviral and family planning services targeted to the unique needs of women living with HIV, this study explored pregnancy decisions of women living with HIV in rural southern Malawi. Twenty in-depth interviews on married women living with HIV selected purposively were conducted in two antiretroviral clinics of patrilineal Chikhwawa and matrilineal Chiradzulu districts in 2010. With their pregnancy and child rearing experiences, the women who got pregnant after a positive HIV diagnosis decided to never get pregnant again. Their lived experiences of motherhood when living with HIV play a major role in their pregnancy decisions despite free access to antiretroviral therapy, which has improved the quality of their life’s and survival. Societies in Malawi must accept this behavioural change by married women living with HIV and their needs for family planning. Health care workers must be knowledgeable and sensitive about it and assist women living with HIV who are willing to adapt their pregnant decisions based on living experiences.
基金Supported by the Research Council of the Sultanate of Oman(RC/MED/MICR/11/01)the College of Medicine and Health Sciences,Sultan Qaboos University(Internal-Grant/2013).Oman
文摘Objective:To investigate the levels of zinc-α-2-glycoprotein(ZAG) among Omani AIDS patients receiving combined antiretroviral therapy(cART).Methods:A total of 80 Omani AIDS patients(45 males and 33 females),average age of 36 vears.who were receiving cART at the Saltan Qaboos University Hospital(SQUH).Muscat,Oman,were tested for the levels of ZAG.In addition,SO healthy blood donors(46 males and 34 females),average age of 26 years,attending the SOUH Blood Bank,were tested in parallel as a control group.Measurement of the ZAG levels was performed using a competitive enzyme—linked immunosorbent assay and in accordance with the manufacturer's instructions.Results:The ZAG levels were found to he significantly higher among AIDS patients compared to the healthy individuals(P=0.033).A total of 56(70%) of the AIDS patients were found to have higher levels of ZAG and 16(20%) AIDS patients were found to have high ZAG levels,which are significantly(P>0.031) associated with weight loss.Conclusions:ZAG levels are high among Omani AIDS patients on cART and this necessitales the measurement of ZAG on routine basis,as it is associated with weight loss.
