Artificial intelligence promotes shared decision-making through recommending tests to febrile pediatric outpatients

BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.

Bi-level model for shared parking decision-making based on parking lot assignment simulation

In order to carry out comprehensive decision-making of multi-class shared parking measures within a region, a bilevel model assisting decision-making is proposed. The upper level selects parkers＇ average satisfaction and the violation rate during peak hours as indices in object function, and sets probability distribution models describing dynamic parking demand of each site, the feasibility of shared parking scenarios and occupancy requirements during peak hours of each parking lot as restrictions. The simulation model in the lower level sets up rules to assign each parker in the random parking demand series to the proper parking lot. An iterative method is proposed to confirm the state of each parking lot at the start of formal simulations. Besides, two patterns linking initialization and formal simulation are presented to acquire multiple solutions. The results of the numerical examples indicate the effectiveness of the model and solution methods.

Decision-Making in Driver-Automation Shared Control:A Review and Perspectives

Shared control schemes allow a human driver to work with an automated driving agent in driver-vehicle systems while retaining the driver’s abilities to control.The human driver,as an essential agent in the driver-vehicle shared control systems,should be precisely modeled regarding their cognitive processes,control strategies,and decision-making processes.The interactive strategy design between drivers and automated driving agents brings an excellent challenge for human-centric driver assistance systems due to the inherent characteristics of humans.Many open-ended questions arise,such as what proper role of human drivers should act in a shared control scheme?How to make an intelligent decision capable of balancing the benefits of agents in shared control systems?Due to the advent of these attentions and questions,it is desirable to present a survey on the decision making between human drivers and highly automated vehicles,to understand their architectures,human driver modeling,and interaction strategies under the driver-vehicle shared schemes.Finally,we give a further discussion on the key future challenges and opportunities.They are likely to shape new potential research directions.

The concept of narrative evidence-based medicine and shared decision-making in traditional Chinese medical practice

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.

Older Patients’ Involvement in Shared Decision-Making—A Systematic Review

Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado,United States:Real-world data

BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.

Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

Conditions for autonomous choice： a qualitative study of older adults＇ experience of decision-making in TAVR

Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.

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.

Developing Skills in Intra-Workplace Rehabilitation Education: I

Japan has an advanced healthcare system, on par with any developed country;at the same time, it is challenged by a rapidly aging population. In line with other countries, medical and paramedical training differs from college or university to when the graduates start working in the hospital wards;it seems like a new career to freshmen. Rehabilitation draws together the most varied professional teams treating patients from a range of specialists, and physical therapists generally receive very little intra-workplace skills training. The aim of this paper is to develop the first of a two-part educational model that is useful for the professional development of therapists working in rehabilitation medicine, by incorporating, at least, Shared Decision-Making and Narrative-Based Medicine. The most productive systems of analysis are Bloom’s psychomotor taxonomy and the Japanese DIKW system. The Japanese DIKW model of “chishin”, which is based on Data, Information, Knowledge, and Wisdom, is similar to the professional attitude and rehabilitative mindset in the healthcare system, the convalescent rehabilitation wards. The individual, departmental, and hospital levels could all benefit from aspects of these systems. Rehabilitative medicine in Japanese terms is presented as a holistic medical care that heals the body and mind and restores dignity, such as personality and self-confidence, and it is also a place where unique Japanese cultural concepts such as “Ikigai” (reason to live) and “Omotenashi” (hospitality) can be nurtured as professional awareness.

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.

医患共同决策在妇产科的应用与探讨

临床共同决策是医患双方共同参与,医务人员充分告知决策利弊,权衡风险,基于患者个人意愿、偏好及价值观念,发挥患者在医疗决策中的主观能动性,主动反映决策中自身的观点,最终达到医患双方决策的一致性。本文就临床共同决策在妇产科中的应用进行论述,明确临床共同决策在妇产科疾病中的应用价值。

Mobile and Context-Aware GeoBI Applications: A Multilevel Model for Structuring and Sharing of Contextual Information

With the requirements for high performance results in the today’s mobile, global, highly competitive, and technology-based business world, business professionals have to get supported by convenient mobile decision support systems (DSS). To give an improved support to mobile business professionals, it is necessary to go further than just allowing a simple remote access to a Business Intelligence platform. In this paper, the need for actual context-aware mobile Geospatial Business Intelligence (GeoBI) systems that can help capture, filter, organize and structure the user mobile context is exposed and justified. Furthermore, since capturing, structuring, and modeling mobile contextual information is still a research issue, a wide inventory of existing research work on context and mobile context is provided. Then, step by step, we methodologically identify relevant contextual information to capture for mobility purposes as well as for BI needs, organize them into context-dimensions, and build a hierarchical mobile GeoBI context model which (1) is geo-spatial-extended, (2) fits with human perception of mobility, (3) takes into account the local context interactions and information-sharing with remote contexts, and (4) matches with the usual hierarchical aggregated structure of BI data.

Patient-centered care through internal and external participation in medical rehabilitation

Patient-centeredness is one of the most important quality and outcome criteria in health care. Health care organizations are continually searching for approaches that will enable them to establish sustainable patient-centeredness in their daily practice. Existing approaches frequently focus on interaction between patient and health care professional (external participation). However, this is often not sufficient;other elements, such as good teamwork among the health care professionals (internal participation), are also essential. The model of integrated patient-centeredness differentiates between these two participations forms, both of which are explored from a patient and health care professional perspective in our study. The aim of the study was to confirm the model from the viewpoint of staff and patients. To this end we conducted a multi-center cross-sectional study consisting of a patient and staff survey to assess internal and external participation and patient-centeredness. A total of 15 rehabilitation clinics were involved, with 272 staff members and 536 patients included in the final analysis. Although evaluation was positive (mainly slightly above the middle of the scale), there was potential for improvement for both types of participation. Internal and external rating differed between patients and health care staff, with the first group assessing internal significantly better and external lower than the second group. The low to middle correlation of both types, as well as the correlation and regression with patient-centeredness, confirmed the model of integrated patient-centeredness. The model underlines the importance of both participation forms for patient-centeredness, as well as their interdependence. Further studies are needed in order to verify the impact of internal and external participation, as well as that of further possible dimensions of patient-centeredness, on clinical and functional outcome criteria.