Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

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.

Decision aids can decrease decisional conflict in patients with hip or knee osteoarthritis: Randomized controlled trial

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.

Role of decision aids in orthopaedic surgery

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.

Decision Aid Model for Private-owned Electric Vehicles Participating in Frequency Regulation Ancillary Service Market

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.

原发性开角型青光眼患者决策辅助方案的构建及应用

目的探讨决策辅助方案在原发性开角型青光眼患者中的应用效果。方法将100例原发性开角型青光眼患者按住院时间分为对照组与观察组各50例;对照组行常规护理,观察组在常规护理基础上实施决策辅助方案。分别于干预后(出院前)、出院后1、3个月评价干预效果。结果干预后观察组决策困境得分显著低于对照组,决策准备得分显著高于对照组,出院后1、3个月药物依从性得分显著高于对照组,出院后3个月目标眼压达标率显著高于对照组(均P<0.05)。结论决策辅助方案的应用可有效降低原发性开角型青光眼患者决策困境水平,提高决策准备度,增强用药依从性,从而提高目标眼压达标率。

基于问题提示清单和个人决策指导的急性阑尾炎患儿决策辅助干预

目的 探讨基于问题提示清单和个人决策指导的决策辅助干预在急性阑尾炎患儿治疗决策中的应用效果。方法 便利选取急性阑尾炎患儿监护人为研究对象,按照患儿就诊时间分为对照组和干预组各49人。对照组实施常规术前谈话和健康教育,干预组在对照组基础上实施基于问题提示清单和个人决策指导的决策辅助干预。比较两组决策困境、决策准备度和决策参与满意度。结果 干预后,干预组患儿监护人决策困境总分显著低于对照组,决策准备度及决策参与满意度总分显著高于对照组(均P<0.05)。结论 基于问题提示清单和个人决策指导的决策辅助干预,能够降低急性阑尾炎患儿监护人决策困境,提高其决策准备度和决策参与满意度。

New Scenarios for a Shift towards Agroecology in Viticulture

In the light of its negative impacts on the environment and human health, conventional agriculture is currently facing new challenges;for example, reducing pesticide reliance, improving biodiversity, adapting to climate change and reconciling winegrowers with consumers, which require changes to be made to vineyard management. A shift towards more sustainable agriculture via the development of agroecological systems may be key to meeting these environmental, economic and social challenges. This study aimed to evaluate the performance of existing viticultural systems, as well as that of three new scenarios that we built to change conventional vine production systems and their related practices. The end aim is to adopt the principles of agroecology, and more virtuously, to ensure that vine production remains in line with societal expectations. First, thirty-eight different viticultural systems were chosen. Three realistic scenarios for changing these production systems were then built by working with stakeholders and incorporating the best practices that had been identified in the vineyard. Conventional practices were optimised in the first scenario and an agroecological approach was adopted for the other two scenarios: an Agroecological scenario (using synthetic chemicals) and an Agroecological-Bio scenario (organic system). All three scenarios were based on a combination of good practices which contribute to enhancing vineyard biodiversity, and which thus restore biological regulation and in turn reduce pesticides. The viticultural systems performances have been evaluated with a methodology involving multicriteria decision aid using ELECTRE Tri-C and ELECTRE III methods. Seven evaluation criteria were selected which covered socio-economic performance (economic profitability, workload and system complexity) and environmental performance (pesticide pressure, pesticide ecotoxicity, agroecological practices and pesticide drift). The best performances were achieved by the two agroecological scenarios, and this methodology can be adaptable to different production systems everywhere in different viticultural regions.

心房颤动患者抗凝治疗决策冲突现状及影响因素研究

目的调查房颤患者抗凝治疗决策冲突现状,并分析其影响因素。方法采用一般资料调查表、心房颤动知识问卷及决策冲突量表对219例房颤患者进行调查。结果房颤患者抗凝治疗决策冲突总分为(41.47±17.54)分,其中有33例(15.07%)患者不存在决策冲突,90例(41.10%)患者决策冲突处于中等水平,96例(43.83%)患者决策冲突水平较高,存在决策延迟情况。多元线性回归分析显示,患者的年龄、性别、婚姻状况、文化程度、合并症种类、对疾病了解程度是抗凝治疗决策冲突的影响因素(P<0.05,P<0.01)。结论房颤患者抗凝治疗决策冲突水平较高,不容忽视。决策冲突受多种因素影响,医护人员应针对影响因素制定个性化的治疗决策辅助方案,以降低患者决策冲突水平,改善医患关系,提高治疗满意度。

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

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

Early construction cost and time risk assessment and evaluation of large-scale underground cavern construction projects in Singapore

The applicability of the Decision Aids for Tunneling(DAT)as an early construction cost and time predicting tool for large-scale underground cavern construction projects is investigated in this study.For this purpose,three large-scale underground cavern construction projects in Singapore are presented using the proposed framework.The data from Project A,which is already completed,are used to validate the prediction outcomes.The results show that the proposed workflow can well estimate the construction cost and time at the 95%confidence level.The DAT simulation results of the other two projects,which are in the early planning stages,are compared with Project A to assess the accuracy of the predicted cost and time.The results show that the proposed workflow with the DAT as a predictor is a valuable tool in estimating construction cost and time for large-scale underground cavern projects,particularly for feasibility studies.