Development of a Decision Aid for Cardiopulmonary Resuscitation Involving Intensive Care Unit Patients' and Health Professionals' Participation Using User-Centered Design and a Wiki Platform for Rapid Prototyping: A Research Protocol

Science.gov (United States)

Heyland, Daren Keith; Ebell, Mark H; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; Légaré, France; Archambault, Patrick Michel

2016-01-01

Background Cardiopulmonary resuscitation (CPR) is an intervention used in cases of cardiac arrest to revive patients whose heart has stopped. Because cardiac arrest can have potentially devastating outcomes such as severe neurological deficits even if CPR is performed, patients must be involved in determining in advance if they want CPR in the case of an unexpected arrest. Shared decision making (SDM) facilitates discussions about goals of care regarding CPR in intensive care units (ICUs). Patient decision aids (DAs) are proven to support the implementation of SDM. Many patient DAs about CPR exist, but they are not universally implemented in ICUs in part due to lack of context and cultural adaptation. Adaptation to local context is an important phase of implementing any type of knowledge tool such as patient DAs. User-centered design supported by a wiki platform to perform rapid prototyping has previously been successful in creating knowledge tools adapted to the needs of patients and health professionals (eg, asthma action plans). This project aims to explore how user-centered design and a wiki platform can support the adaptation of an existing DA for CPR to the local context. Objective The primary objective is to use an existing DA about CPR to create a wiki-based DA that is adapted to the context of a single ICU and tailorable to individual patient’s risk factors while employing user-centered design. The secondary objective is to document the use of a wiki platform for the adaptation of patient DAs. Methods This study will be conducted in a mixed surgical and medical ICU at Hôtel-Dieu de Lévis, Quebec, Canada. We plan to involve all 5 intensivists and recruit at least 20 alert and oriented patients admitted to the ICU and their family members if available. In the first phase of this study, we will observe 3 weeks of daily interactions between patients, families, intensivists, and other allied health professionals. We will specifically observe 5 dyads of

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

Science.gov (United States)

Hoffman, Aubri S; Llewellyn-Thomas, Hilary A; Tosteson, Anna N A; O'Connor, Annette M; Volk, Robert J; Tomek, Ivan M; Andrews, Steven B; Bartels, Stephen J

2014-12-12

Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web

AIDS: Administrative Decisions and Constitutional Rights.

Science.gov (United States)

Greenlaw, Paul S.; Kohl, John P.

1993-01-01

Review of case law in educational administration, hospitals, correctional institutions, and the military shows that, when risk of AIDS transmission is high, courts will support public sector administrators' decisions. Low risk means such decisions as mandatory blood testing will usually be struck down. (SK)

Analytical evaluation of computer-based decision aids

International Nuclear Information System (INIS)

Kisner, R.A.

1985-01-01

This paper introduces a method for evaluating decision aids for nuclear power plant operators. The method involves a two-stage process of classification and analytical evaluation of display form and content. The classification scheme relates each specific aid to one or more general decision-making tasks. Evaluation then proceeds using a normative top-down design process based on the classification scheme by determining or deducing how various design issues associated with this process were resolved by the designer. The result is an assessment of the ''understandability'' of the aid as well as identification of the training and display features necessary to ensure understandability. 7 refs., 4 figs., 1 tab

Nurse aide decision making in nursing homes: factors affecting empowerment.

Science.gov (United States)

Chaudhuri, Tanni; Yeatts, Dale E; Cready, Cynthia M

2013-09-01

To evaluate factors affecting structural empowerment among nurse aides in nursing homes. Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment. © 2013 Blackwell Publishing Ltd.

Decision aids that support decisions about prenatal testing for Down syndrome: an environmental scan.

Science.gov (United States)

Leiva Portocarrero, Maria Esther; Garvelink, Mirjam M; Becerra Perez, Maria Margarita; Giguère, Anik; Robitaille, Hubert; Wilson, Brenda J; Rousseau, François; Légaré, France

2015-09-24

Prenatal screening tests for Down syndrome (DS) are routine in many developed countries and new tests are rapidly becoming available. Decisions about prenatal screening are increasingly complex with each successive test, and pregnant women need information about risks and benefits as well as clarity about their values. Decision aids (DAs) can help healthcare providers support women in this decision. Using an environmental scan, we aimed to identify publicly available DAs focusing on prenatal screening/diagnosis for Down syndrome that provide effective support for decision making. Data sources searched were the Decision Aids Library Inventory (DALI) of the Ottawa Patient Decision Aids Research Group at the Ottawa Health Research Institute; Google searches on the internet; professional organizations, academic institutions and other experts in the field; and references in existing systematic reviews on DAs. Eligible DAs targeted pregnant women, focused on prenatal screening and/or diagnosis, applied to tests for fetal abnormalities or aneuploidies, and were in French, English, Spanish or Portuguese. Pairs of reviewers independently identified eligible DAs and extracted characteristics including the presence of practical decision support tools and features to aid comprehension. They then performed quality assessment using the 16 minimum standards established by the International Patient Decision Aids Standards (IPDASi v4.0). Of 543 potentially eligible DAs (512 in DALI, 27 from experts, and four on the internet), 23 were eligible and 20 were available for data extraction. DAs were developed from 1996 to 2013 in six countries (UK, USA, Canada, Australia, Sweden, and France). Five DAs were for prenatal screening, three for prenatal diagnosis and 12 for both). Eight contained values clarification methods (personal worksheets). The 20 DAs scored a median of 10/16 (range 6-15) on the 16 IPDAS minimum standards. None of the 20 included DAs met all 16 IPDAS minimum standards

Rade-aid: an operational tool for decision-makers

International Nuclear Information System (INIS)

Wagenaar, G.; van den Bosch, C.J.H.; Ehrhardt, J.; Steinhauer, C.; Morrey, M.; Robinson, C.A.

1991-01-01

If an accidental release of radionuclides occurs, decisions on countermeasures are required. Since the making of a decision involves many competing factors (for instance, the health risk versus the costs relating to a countermeasure), the decision-maker faces a problem. The aim of the RADE-AID (Radiological Accident DEcision AIDing) project is the development of a computer decision support system which can be used in the formulation of decisions. The theoretical background of the decision technique and its methods are outlined, together with the practical application of the technique in the form of the software package developed. Both the benefits of formal techniques and computerized tools in this field are discussed. In order to explore the appropriateness of the decision technique for the management of radiological emergencies, illustrative, but stylized, applications were carried out. Conclusions from these applications are discussed

A novel technique for presurgical nasoalveolar molding using computer-aided reverse engineering and rapid prototyping.

Science.gov (United States)

Yu, Quan; Gong, Xin; Wang, Guo-Min; Yu, Zhe-Yuan; Qian, Yu-Fen; Shen, Gang

2011-01-01

To establish a new method of presurgical nasoalveolar molding (NAM) using computer-aided reverse engineering and rapid prototyping technique in infants with unilateral cleft lip and palate (UCLP). Five infants (2 males and 3 females with mean age of 1.2 w) with complete UCLP were recruited. All patients were subjected to NAM before the cleft lip repair. The upper denture casts were recorded using a three-dimensional laser scanner within 2 weeks after birth in UCLP infants. A digital model was constructed and analyzed to simulate the NAM procedure with reverse engineering software. The digital geometrical data were exported to print the solid model with rapid prototyping system. The whole set of appliances was fabricated based on these solid models. Laser scanning and digital model construction simplified the NAM procedure and estimated the treatment objective. The appliances were fabricated based on the rapid prototyping technique, and for each patient, the complete set of appliances could be obtained at one time. By the end of presurgical NAM treatment, the cleft was narrowed, and the malformation of nasoalveolar segments was aligned normally. We have developed a novel technique of presurgical NAM based on a computer-aided design. The accurate digital denture model of UCLP infants could be obtained with laser scanning. The treatment design and appliance fabrication could be simplified with a computer-aided reverse engineering and rapid prototyping technique.

Developing an Android-Based Patient Decision Aid Based on Ottawa Standards for Patients After Kidney Transplant and Its Usability Evaluation.

Science.gov (United States)

Zare Moayedi, Mahboobeh; Aslani, Azam; Fakhrahmad, Mostafa; Ezzatzadegan J, Shahrokh

2018-01-01

This study was conducted to develop an android based patient decision aid (PDA) as a self-care instrument for patients after kidney transplant and its usability evaluation. In this study, the systematic development process of Android-based self-care application for patients after kidney transplant based on Ottawa standard was included: scoping, assemble steering group, analysis of requirements, designing, develop of a prototype and system evaluation. The PDA is a self-triage system that will help early identification of risk symptoms in patients, and help manage them. System recommendations for risk signs are: Refer to the nearest hospital or healthcare center without delay, refer to the doctor and tell your doctor in the next visit. To identify patient care needs, a semi-structured interview with members of steering group, including patients and clinical experts, was conducted by the researchers. A prototype of the decision aid was made according to identified needs in the previous step. Finally, in order to evaluate its usability rate by using the System Usability Scale (SUS) questionnaire, it was used by exerts and patients. This study identified information needs, risk signs and steps that patients need to make appropriate decisions about them. The main capabilities of the decision aid are features such as reminders for appointment/test, time of taking medication, registration of symptoms, weight, blood pressure, body temperature, advising to patient in case of signs of risk, weight, blood pressure, body temperature and test results which were reported in the diagram. The mean score of system's usability evaluated by medical informatics specialists, clinicians, and patients were 88.33, 95, and 91. PDAs was usable and desirable from the point of view of medical informatics specialists, clinicians and patients.

Tactical Decision Aids High Bandwidth Links Using Autonomous Vehicles

Science.gov (United States)

2004-01-01

1 Tactical Decision Aids (High Bandwidth Links Using Autonomous Vehicles ) A. J. Healey, D. P. Horner, Center for Autonomous Underwater Vehicle...SUBTITLE Tactical Decision Aids (High Bandwidth Links Using Autonomous Vehicles ) 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Decision aid for women considering breast cancer screening

DEFF Research Database (Denmark)

Pasternack, Iris; Saalasti-Koskinen, Ulla; Mäkelä, Marjukka

2011-01-01

OBJECTIVES: The aim of this study was to describe the process and challenges of developing a decision aid for the national public breast cancer screening program in Finland. METHODS: An expert team with stakeholder representation used European guidelines and other literature as basis for selecting...... relevant content and format for the decision aid for breast cancer screening. Feedback from women was sought for the draft documents. RESULTS: A decision aid attached to the invitation letter for screening was considered the best way to ensure access to information. In addition, tailored letter templates...... information for women invited to breast cancer screening is demanding and requires careful planning. Professionals and service providers need to be engaged in the HTA process to ensure proper dissemination and implementation of the information. End user participation is essential in the formulation...

Decision aids for patients facing a surgical treatment decision: a systematic review and meta-analysis

NARCIS (Netherlands)

Knops, Anouk M.; Legemate, Dink A.; Goossens, Astrid; Bossuyt, Patrick M. M.; Ubbink, Dirk T.

2013-01-01

To summarize the evidence available on the effects of decision aids in surgery. When consenting to treatment, few patients adequately understand their treatment options. To help patients make deliberate treatment choices, decision aids provide evidence-based information on the disease, treatment

Decision aids for people considering taking part in clinical trials.

Science.gov (United States)

Gillies, Katie; Cotton, Seonaidh C; Brehaut, Jamie C; Politi, Mary C; Skea, Zoe

2015-11-27

Several interventions have been developed to promote informed consent for participants in clinical trials. However, many of these interventions focus on the content and structure of information (e.g. enhanced information or changes to the presentation format) rather than the process of decision making. Patient decision aids support a decision making process about medical options. Decision aids support the decision process by providing information about available options and their associated outcomes, alongside information that enables patients to consider what value they place on particular outcomes, and provide structured guidance on steps of decision making. They have been shown to be effective for treatment and screening decisions but evidence on their effectiveness in the context of informed consent for clinical trials has not been synthesised. To assess the effectiveness of decision aids for clinical trial informed consent compared to no intervention, standard information (i.e. usual practice) or an alternative intervention on the decision making process. We searched the following databases and to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; MEDLINE (OvidSP) (from 1950); EMBASE (OvidSP) (from 1980); PsycINFO (OvidSP) (from 1806); ASSIA (ProQuest) (from 1987); WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/); ClinicalTrials.gov; ISRCTN Register (http://www.controlled-trials.com/isrctn/). We also searched reference lists of included studies and relevant reviews. We contacted study authors and other experts. There were no language restrictions. We included randomised and quasi-randomised controlled trials comparing decision aids in the informed consent process for clinical trials alone, or in conjunction with standard information (such as written or verbal) or alongside alternative interventions (e.g. paper-based versus web-based decision aids). Included trials involved

The Military Decision-Making Process (MDMP): A Prototype Training Product

National Research Council Canada - National Science Library

Wampler, Richard

1998-01-01

...): A Prototype Training Product. The MDMP product is a computer-based, stand alone training support package to assist individuals and staffs of light infantry brigades in learning to participate in the military decision-making process...

Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

Science.gov (United States)

Hoffman, Aubri S; Abhyankar, Purva; Sheridan, Stacey; Bekker, Hilary; LeBlanc, Annie; Levin, Carrie; Ropka, Mary; Shaffer, Victoria; Stacey, Dawn; Stalmeier, Peep; Vo, Ha; Wills, Celia; Thomson, Richard

2018-01-01

This Explanation and Elaboration (E&E) article expands on the 26 items in the Standards for UNiversal reporting of Decision Aid Evaluations guidelines. The E&E provides a rationale for each item and includes examples for how each item has been reported in published papers evaluating patient decision aids. The E&E focuses on items key to reporting studies evaluating patient decision aids and is intended to be illustrative rather than restrictive. Authors and reviewers may wish to use the E&E broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items. PMID:29467235

Development of a Prototype Web-Based Decision Support System for Watershed Management

Directory of Open Access Journals (Sweden)

Dejian Zhang

2015-02-01

Full Text Available Using distributed hydrological models to evaluate the effectiveness of reducing non-point source pollution by applying best management practices (BMPs is an important support to decision making for watershed management. However, complex interfaces and time-consuming simulations of the models have largely hindered the applications of these models. We designed and developed a prototype web-based decision support system for watershed management (DSS-WMRJ, which is user friendly and supports quasi-real-time decision making. DSS-WMRJ is based on integrating an open-source Web-based Geographical Information Systems (Web GIS tool (Geoserver, a modeling component (SWAT, Soil and Water Assessment Tool, a cloud computing platform (Hadoop and other open source components and libraries. In addition, a private cloud is used in an innovative manner to parallelize model simulations, which are time consuming and computationally costly. Then, the prototype DSS-WMRJ was tested with a case study. Successful implementation and testing of the prototype DSS-WMRJ lay a good foundation to develop DSS-WMRJ into a fully-fledged tool for watershed management. DSS-WMRJ can be easily customized for use in other watersheds and is valuable for constructing other environmental decision support systems, because of its performance, flexibility, scalability and economy.

Community Pharmacists' Perspectives of a Decision Aid for Managing Type 2 Diabetes in Ontario.

Science.gov (United States)

Verweel, Lee; Gionfriddo, Michael R; MacCallum, Lori; Dolovich, Lisa; Rosenberg-Yunger, Zahava R S

2017-12-01

Decision aids are tools designed to help patients make choices about their health care. We explored pharmacists' perceptions of an evidence-based diabetes decision aid developed by the Mayo Clinic, Diabetes Medication Choice (DMC). Using DMC as a reference, we aimed to explore pharmacists' perspectives on decision aids, their place in a community pharmacy setting and the implementing of a decision aid, such as DMC, in Ontario. We used semistructured interviews with a convenience sample of community pharmacists from Ontario. We applied a thematic analysis to the data. We conducted 16 interviews with pharmacists, of whom 9 were certified diabetes educators, and 10 were female. Three themes emerged from the data: pharmacists' knowledge and awareness of decision aids; pharmacists' perceptions of the DMC decision aids, and implementation of the DMC decision aids in Ontario pharmacies. Participants discussed their limited experience with and training in the use of decision aids. Although many participants agreed that the DMC decision aids may contribute to patient-centred care, all agreed that significant changes were needed to be made to implement this tool in practice. Pharmacists felt that the use of decision aids in community pharmacies in Ontario may improve patient-centred care. Modifications, however, are needed to improve the applicability to their context and fit into their workflow. Empirical data concerning the impact of decision aids in community pharmacy is needed. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Probability of Survival Decision Aid (PSDA)

National Research Council Canada - National Science Library

Xu, Xiaojiang; Amin, Mitesh; Santee, William R

2008-01-01

A Probability of Survival Decision Aid (PSDA) is developed to predict survival time for hypothermia and dehydration during prolonged exposure at sea in both air and water for a wide range of environmental conditions...

Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

Science.gov (United States)

Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

2016-02-01

Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses

Science.gov (United States)

Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-01

Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however

Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.

Science.gov (United States)

Syrowatka, Ania; Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn

2016-01-26

Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than

Empirical Evaluation of a Decision-Analytic Aid.

Science.gov (United States)

1980-05-01

Morris, Smallwood , Lansford, and Gibbons (1980) state: "In the traditional paradigm, the decision-maker must decide to accept or reject the model. If he... Smallwood , R. D., Langford, R. K., & Gibbons, R. S. Analytic Procedures for Evaluating Decision Aids. Applied Decision Analysis, Inc. (Menlo Park, CA...Menlo Park, CA 94025 Department of Psychology University of Oklahoma Dr. Jesse Orlansky 455 West Lindsey Institute for Defense Analyses Norman , OK 73069

Development of a decision aid for children faced with the decision to undergo dental treatment with sedation or general anaesthesia.

Science.gov (United States)

Hulin, Joe; Baker, Sarah R; Marshman, Zoe; Albadri, Sondos; Rodd, Helen D

2017-09-01

Decision aids are tools used to help individuals faced with difficult healthcare decisions. They help patients further understand the treatment options available and encourage the sharing of information between patients and clinicians. To develop a decision aid for young patients faced with the decision to undergo dental treatment with inhalation sedation, intravenous sedation, or general anaesthesia (GA). Qualitative interviews with dental patients (aged 10-16 years), and their parents/guardians were used to inform the content of a draft decision aid. Following further revisions, a pilot evaluation of the decision aid was conducted. Patients referred for dental treatment with sedation or GA were recruited from a UK dental hospital. Patients (n = 15) and parents/guardians (n = 13) assigned to the intervention group received the decision aid and routine clinical counselling, whereas patients (n = 17) and parents/guardians (n = 13) in the control group only received routine clinical counselling. Participants completed measures of knowledge, decisional conflict, and dental anxiety. Knowledge scores were significantly higher for participants who received the decision aid when compared to standard care. There were no other significant differences between groups. A decision aid was successfully developed, and initial findings suggest such tools could be beneficial to dental sedation or GA patients and their parents/guardians. Further research is required on the use of such tools in primary care settings, with particular attention to the impact of the decision aid on attendance and completion rates of treatment. © 2016 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Refining a brief decision aid in stable CAD: cognitive interviews

OpenAIRE

Kelly-Blake, Karen; Clark, Stacie; Dontje, Katherine; Olomu, Adesuwa; Henry, Rebecca C; Rovner, David R; Rothert, Marilyn L; Holmes-Rovner, Margaret

2014-01-01

Background We describe the results of cognitive interviews to refine the “Making Choices©” Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). Methods We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the “think aloud” interview techniq...

A prototype nuclear emergency response decision making expert system

International Nuclear Information System (INIS)

Chang, C.; Shih, C.; Hong, M.; Yu, W.; Su, M.; Wang, S.

1990-01-01

A prototype of emergency response expert system developed for nuclear power plants, has been fulfilled by Institute of Nuclear Energy Research. Key elements that have been implemented for emergency response include radioactive material dispersion assessment, dynamic transportation evacuation assessment, and meteorological parametric forecasting. A network system consists of five 80386 Personal Computers (PCs) has been installed to perform the system functions above. A further project is still continuing to achieve a more complicated and fanciful computer aid integral emergency response expert system

Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet

Directory of Open Access Journals (Sweden)

Torvaldsen Siranda

2010-04-01

Full Text Available Abstract Background Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation. Methods We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, ≥ 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making and behavioural outcomes (intention and analgesia use to assess the impact of the decision aid, which were assessed before labour. Results 596 women were randomised (395 decision aid group, 201 pamphlet group. There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40. There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07, or anxiety (mean difference 0.3, 95% CI -2.15, 1.50. The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95. There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use. Conclusions This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making. Trial Registration Trial registration no: ISRCTN52287533

An ERP analysis of recognition and categorization decisions in a prototype-distortion task.

Science.gov (United States)

Tunney, Richard J; Fernie, Gordon; Astle, Duncan E

2010-04-12

Theories of categorization make different predictions about the underlying processes used to represent categories. Episodic theories suggest that categories are represented in memory by storing previously encountered exemplars in memory. Prototype theories suggest that categories are represented in the form of a prototype independently of memory. A number of studies that show dissociations between categorization and recognition are often cited as evidence for the prototype account. These dissociations have compared recognition judgements made to one set of items to categorization judgements to a different set of items making a clear interpretation difficult. Instead of using different stimuli for different tests this experiment compares the processes by which participants make decisions about category membership in a prototype-distortion task and with recognition decisions about the same set of stimuli by examining the Event Related Potentials (ERPs) associated with them. Sixty-three participants were asked to make categorization or recognition decisions about stimuli that either formed an artificial category or that were category non-members. We examined the ERP components associated with both kinds of decision for pre-exposed and control participants. In contrast to studies using different items we observed no behavioural differences between the two kinds of decision; participants were equally able to distinguish category members from non-members, regardless of whether they were performing a recognition or categorisation judgement. Interestingly, this did not interact with prior-exposure. However, the ERP data demonstrated that the early visual evoked response that discriminated category members from non-members was modulated by which judgement participants performed and whether they had been pre-exposed to category members. We conclude from this that any differences between categorization and recognition reflect differences in the information that participants

An ergonomics prototype of adjustable chin stands aid for visual mechanical inspection at electronic manufacturing-based company in Kuantan, Malaysia

Science.gov (United States)

Elias, Nurainaa; Mat Yahya, Nafrizuan

2018-04-01

Chin stands aid is a device designed to reduce fatigue on the chin during the Visual Mechanical Inspection (VMI) task for operators in TT Electronic Sdn Bhd, Kuantan, Malaysia. It is also used to reduce cycle time and also improve employee well-being in terms of comfort. In this project, a 3D model of chin stands aid with an ergonomics approach is created using SOLIDWORKS software. Two different concepts were designed and the best one is chosen based on the Pugh concept selection method, concept screening and also concept scoring. After the selection of concepts is done, a prototype of chin stands aid will be developed and a simulation of the prototype is performed. The simulation has been executed by using Workbench ANSYS software as a tool. Stress analysis, deformation analysis, and fatigue analysis have been done to know the strength and lifespan of the product. The prototype also has been tested to know the functionality and also comfortability for the user to use the chin stands aid.

Rade-aid a decision support system to evaluate countermeasures after a radiological accident

International Nuclear Information System (INIS)

Wagenaar, G.; Van Den Bosch, C.J.H.; Weger, D. de.

1990-01-01

After Chernobyl the authorities in many countries were overwhelmed by the enormous amount of information that was being generated by measuring and monitoring programs. In making decisions, this information had to be combined with the results of specific countermeasures, in order to determine the optimal strategy with respect to a large number of consequences. The development of RADE-AID, the Radiological Accident Decision AIDing system, is aimed at providing a powerful tool in the decision-making process. RADE-AID is developed by TNO (The Netherlands) in a joint contract with KfK (FRG) and NRPB (UK). In the first phase a demonstration system will be built, called RADE-AID/D. RADE-AID/D will be used as a decision support system in the intermediate and late phase after a radiological accident. RADE-AID/D will consider countermeasures with respect to external exposure and internal exposure by food ingestion. Countermeasures are evaluated considering reduction in doses and in numbers of health effects, costs, and social effects. The paper covers the structure of the program, presentation of data and results, and the decision analysis technique that is being used. This decision analysis part is an important feature of the system; an advanced decision analysis technique is used, that is able to compare data of varying nature. Furthermore the place of RADE-AID in the decision-making process will be treated. RADE-AID/D is an interactive computer program, that offers the user the possibility to enter relevant data and to have data and results displayed in a variety of ways. Furthermore the system contains an advanced decision analysis technique, that is able to compare data of varying nature. Input data for the decision analysis calculations are provided by models from UFOMOD and MARC-codes

PSAD, a prototype for monitoring and aid to diagnosis of French PWRs; PSAD, un systeme prototype pour la surveillance et l`aide au diagnostic des centrales REP Francaises

Energy Technology Data Exchange (ETDEWEB)

Jousselin, A.; Bourgeois, P. [Electricite de France (EDF), 78 - Chatou (France); Busquet, J.L.; Monnier, B. [Electricite de France (EDF), 75 - Paris (France); Mouhamed, B. [SEMA Group France, 37 - Meylan (France)

1996-03-01

In order to improve safety and availability in its nuclear power plants, EDF has designed a new generation of monitoring systems integrated into a workstation for monitoring and aid to diagnosis (PSAD). These systems perform on-line monitoring of the main power plant components and PSAD stations provide homogenous aids ro diagnosis which enable plant personnel to diagnose the mechanical behavior of plant equipments. The objective of PSAD is to provide them with high-efficiency and user-friendly tools which can considerably free them from routine tasks. PSAD has a flexible architecture, guaranteeing optimum distribution of computing power to make it available where it is needed, thus enhancing the quality of the information. Its architecture includes diagnosis support software based on artificial intelligence technology which can dialogue with real-time or deferred-time processing software and a relational database. The first version of the prototype is working on a french plant at Tricastin. This version includes the software for the host structure and two monitoring functions: the reactor coolant pumps and the turbo-generator monitoring functions. Internal Structures Monitoring function (ISM) and Loose Parts Detection function (LPD) are under development and should be integrated into PSAD prototype in 1996. (author). 5 refs., 6 figs.

A Framework for Evaluating the Cost-Effectiveness of Patient Decision Aids: A Case Study Using Colorectal Cancer Screening

Science.gov (United States)

Cantor, Scott B.; Rajan, Tanya; Linder, Suzanne K.; Volk, Robert J.

2017-01-01

Objective Patient decision aids are important tools for facilitating balanced, evidence-based decision making. However, the potential of decision aids to lower health care utilization and costs is uncertain; few studies have investigated the cost-effectiveness of decision aids that change patient behavior. Using an example of a decision aid for colorectal cancer screening, we provide a framework for analyzing the cost-effectiveness of decision aids. Methods A decision-analytic model with two strategies (decision aid or no decision aid) was used to calculate expected costs in U.S. dollars and benefits measured in life-years saved (LYS). Data from a systematic review of ten studies about decision aid effectiveness was used to calculate the percentage increase in the number of people choosing screening instead of no screening. We then calculated the incremental cost per LYS with the use of the decision aid. Results The no decision aid strategy had an expected cost of $3,023 and yielded 18.19 LYS. The decision aid strategy cost $3,249 and yielded 18.20 LYS. The incremental cost-effectiveness ratio for the decision aid strategy was $36,126 per LYS. Results were sensitive to the cost of the decision aid and the percentage change in behavior caused by the decision aid. Conclusions This study provides proof-of-concept evidence for future studies examining the cost-effectiveness of decision aids. The results suggest that decision aids can be beneficial and cost-effective. PMID:25979678

arriba-lib: evaluation of an electronic library of decision aids in primary care physicians

Directory of Open Access Journals (Sweden)

Hirsch Oliver

2012-06-01

Full Text Available Abstract Background The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. The aim of our study was to evaluate the acceptance of arriba-lib in primary care physicians. Methods We conducted an evaluation study in which 29 primary care physicians included 192 patients. The physician questionnaire contained information on which module was used, how extensive steps of the shared decision making process were discussed, who made the decision, and a subjective appraisal of consultation length. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Only a minority of consultations (8.9% was considered to be unacceptably extended. In 90.6% of consultations, physicians said that a decision could be made. A shared decision was perceived by physicians in 57.1% of consultations. Physicians said that a decision was more likely to be made when therapeutic options were discussed “detailed”. Prior experience with decision aids was not a critical variable for implementation within our sample of primary care physicians. Conclusions Our study showed that it might be feasible to apply our electronic library of decision aids (arriba-lib in the primary care context. Evidence-based decision aids offer support for physicians in the management of medical information. Future studies should monitor the long-term adoption of

Supporting informed decision making online in 20 minutes: an observational web-log study of a PSA test decision aid.

NARCIS (Netherlands)

Joseph-Williams, N.; Evans, R.; Edwards, A.; Newcombe, R.G.; Wright, P.; Grol, R.P.T.M.; Elwyn, G.

2010-01-01

BACKGROUND: Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this

Patient Decision Aids Improve Decision Quality and Patient Experience and Reduce Surgical Rates in Routine Orthopaedic Care: A Prospective Cohort Study.

Science.gov (United States)

Sepucha, Karen; Atlas, Steven J; Chang, Yuchiao; Dorrwachter, Janet; Freiberg, Andrew; Mangla, Mahima; Rubash, Harry E; Simmons, Leigh H; Cha, Thomas

2017-08-02

Patient decision aids are effective in randomized controlled trials, yet little is known about their impact in routine care. The purpose of this study was to examine whether decision aids increase shared decision-making when used in routine care. A prospective study was designed to evaluate the impact of a quality improvement project to increase the use of decision aids for patients with hip or knee osteoarthritis, lumbar disc herniation, or lumbar spinal stenosis. A usual care cohort was enrolled before the quality improvement project and an intervention cohort was enrolled after the project. Participants were surveyed 1 week after a specialist visit, and surgical status was collected at 6 months. Regression analyses adjusted for clustering of patients within clinicians and examined the impact on knowledge, patient reports of shared decision-making in the visit, and surgical rates. With 550 surveys, the study had 80% to 90% power to detect a difference in these key outcomes. The response rates to the 1-week survey were 70.6% (324 of 459) for the usual care cohort and 70.2% (328 of 467) for the intervention cohort. There was no significant difference (p > 0.05) in any patient characteristic between the 2 cohorts. More patients received decision aids in the intervention cohort at 63.6% compared with the usual care cohort at 27.3% (p = 0.007). Decision aid use was associated with higher knowledge scores, with a mean difference of 18.7 points (95% confidence interval [CI], 11.4 to 26.1 points; p < 0.001) for the usual care cohort and 15.3 points (95% CI, 7.5 to 23.0 points; p = 0.002) for the intervention cohort. Patients reported more shared decision-making (p = 0.009) in the visit with their surgeon in the intervention cohort, with a mean Shared Decision-Making Process score (and standard deviation) of 66.9 ± 27.5 points, compared with the usual care cohort at 62.5 ± 28.6 points. The majority of patients received their preferred treatment, and this did not differ

Geo-Spatial Tactical Decision Aid Systems: Fuzzy Logic for Supporting Decision Making

National Research Council Canada - National Science Library

Grasso, Raffaele; Giannecchini, Simone

2006-01-01

.... This paper describes a tactical decision aid system based on fuzzy logic reasoning for data fusion and on current Open Geospatial Consortium specifications for interoperability, data dissemination...

Assessing the Utility of the Willingness/Prototype Model in Predicting Help-Seeking Decisions

Science.gov (United States)

Hammer, Joseph H.; Vogel, David L.

2013-01-01

Prior research on professional psychological help-seeking behavior has operated on the assumption that the decision to seek help is based on intentional and reasoned processes. However, research on the dual-process prototype/willingness model (PWM; Gerrard, Gibbons, Houlihan, Stock, & Pomery, 2008) suggests health-related decisions may also…

Decision aiding model for the evaluation of agricultural countermeasures after an accidental release of radionuclides to the environment

International Nuclear Information System (INIS)

Turcanu, C.

2009-01-01

Implementation of remedial actions after a radiological contamination of the environment has to take into account, alongside with radiological and feasibility criteria, also the acceptability of the countermeasures, ethical and environmental considerations, as well as the spatial variation and the needs of people in urban, rural and industrial environments. This highlights multi-criteria analysis as a suitable tool, since it is able to structure discussions and to facilitate a common understanding of the decision problem, with the values and priorities of the actors involved. The related theoretical framework, multi-criteria decision aid (MCDA), has emerged from the operational research field as an answer given to a couple of important questions encountered in complex decision problems. Firstly, the aim is not to replace the decision maker with a mathematical model, but to support him to construct his solution by describing and evaluating his options. Secondly, instead of using a unique criterion capturing all aspects of the problem, in MCDA one seeks to build multiple criteria, representing several points of view. The methods belonging to MCDA can be classified as multi-attribute utility/value methods, outranking methods and interactive methods. Past attempts to apply multi-criteria analysis in the context of nuclear emergency management have highlighted however the need to better integrate the operational and socio-political context of the decision-making process into the tools and models developed for decision-support. This PhD project had two main objectives: 1) to develop a multi-criteria decision aid model for the decision problem on countermeasures for contaminated milk, that better accommodates the nuclear crisis management context in Belgium and 2) to build prototype tools implementing and demonstrating the methodology developed

Aiding Lay Decision Making Using a Cognitive Competencies Approach.

Science.gov (United States)

Maule, A J; Maule, Simon

2015-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions.

Acceptance of shared decision making with reference to an electronic library of decision aids (arriba-lib) and its association to decision making in patients: an evaluation study.

Science.gov (United States)

Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

2011-07-07

Decision aids based on the philosophy of shared decision making are designed to help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes. A patient decision aid can be regarded as a complex intervention because it consists of several presumably relevant components. Decision aids have rarely been field tested to assess patients' and physicians' attitudes towards them. It is also unclear what effect decision aids have on the adherence to chosen options. The electronic library of decision aids (arriba-lib) to be used within the clinical encounter has a modular structure and contains evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. We conducted an evaluation study in which 29 primary care physicians included 192 patients. After the consultation, patients filled in questionnaires and were interviewed via telephone two months later. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Patients were highly satisfied with arriba-lib and the process of shared decision making. Two-thirds of patients reached in the telephone interview wanted to be counselled again with arriba-lib. There was a high congruence between preferred and perceived decision making. Of those patients reached in the telephone interview, 80.7% said that they implemented the decision, independent of gender and education. Elderly patients were more likely to say that they implemented the decision. Shared decision making with our multi-modular electronic library of decision aids (arriba-lib) was accepted by a high number of patients. It has positive associations to general aspects of decision making in patients. It can be used for patient groups with a wide range of individual

PSAD, a prototype for monitoring and aid to diagnosis of French PWRs

International Nuclear Information System (INIS)

Jousselin, A.; Bourgeois, P.; Busquet, J.L.; Monnier, B.; Mouhamed, B.

1996-01-01

In order to improve safety and availability in its nuclear power plants, EDF has designed a new generation of monitoring systems integrated into a workstation for monitoring and aid to diagnosis (PSAD). These systems perform on-line monitoring of the main power plant components and PSAD stations provide homogenous aids ro diagnosis which enable plant personnel to diagnose the mechanical behavior of plant equipments. The objective of PSAD is to provide them with high-efficiency and user-friendly tools which can considerably free them from routine tasks. PSAD has a flexible architecture, guaranteeing optimum distribution of computing power to make it available where it is needed, thus enhancing the quality of the information. Its architecture includes diagnosis support software based on artificial intelligence technology which can dialogue with real-time or deferred-time processing software and a relational database. The first version of the prototype is working on a french plant at Tricastin. This version includes the software for the host structure and two monitoring functions: the reactor coolant pumps and the turbo-generator monitoring functions. Internal Structures Monitoring function (ISM) and Loose Parts Detection function (LPD) are under development and should be integrated into PSAD prototype in 1996. (author). 5 refs., 6 figs

Assessing Practitioners’ and Patients’ Needs Regarding Shared Decision-Making and Decision Aids

Directory of Open Access Journals (Sweden)

Michiel Hageman

2016-04-01

Full Text Available Background: As part of the process of developing a decision aid for carpal tunnel syndrome (CTS according to the Ottawa Decision Support Framework, we were interested in the level of ‘decisional conflict’ of hand surgeons and patients with CTS. This study addresses the null hypothesis that there is no difference between surgeon and patient decisional conflict with respect to test and treatment options for CTS. Secondary analyses assess the impact of patient and physician demographics and the strength of the patient-physician relationship on decisional conflict.   Methods: One-hundred-twenty-three observers of the Science of Variation Group (SOVG and 84 patients with carpal tunnel syndrome completed a survey regarding the Decisional Conflict Scale. Patients also filled out the Pain Self-efficacy Questionnaire (PSEQ and the Patient Doctor Relationship Questionnaire (PDRQ-9.   Results: On average, patients had significantly greater decision conflict and scored higher on most subscales of the decisional conflict scale than hand surgeons.Factors associated with greater decision conflict were specific hand surgeon, less self-efficacy (confidence that one can achieve one’s goals in spite of pain, and higher PDRQ (relationship between patient and doctor. Surgeons from Europe have--on average--significantly more decision conflict than surgeons in the United States of America.   Conclusions: Patients with CTS have more decision conflict than hand surgeons. Decision aids might help narrow this gap in decisional conflict.

onlineDeCISion.org: a web-based decision aid for DCIS treatment.

Science.gov (United States)

Ozanne, Elissa M; Schneider, Katharine H; Soeteman, Djøra; Stout, Natasha; Schrag, Deborah; Fordis, Michael; Punglia, Rinaa S

2015-11-01

Women diagnosed with DCIS face complex treatment decisions and often do so with inaccurate and incomplete understanding of the risks and benefits involved. Our objective was to create a tool to guide these decisions for both providers and patients. We developed a web-based decision aid designed to provide clinicians with tailored information about a patient’s recurrence risks and survival outcomes following different treatment strategies for DCIS. A theoretical framework, microsimulation model (Soeteman et al., J Natl Cancer 105:774–781, 2013) and best practices for web-based decision tools guided the development of the decision aid. The development process used semi-structured interviews and usability testing with key stakeholders, including a diverse group of multidisciplinary clinicians and a patient advocate. We developed onlineDeCISion.​org to include the following features that were rated as important by the stakeholders: (1) descriptions of each of the standard treatment options available; (2) visual projections of the likelihood of time-specific (10-year and lifetime) breast-preservation, recurrence, and survival outcomes; and (3) side-by-side comparisons of down-stream effects of each treatment choice. All clinicians reviewing the decision aid in usability testing were interested in using it in their clinical practice. The decision aid is available in a web-based format and is planned to be publicly available. To improve treatment decision making in patients with DCIS, we have developed a web-based decision aid onlineDeCISion.​org that conforms to best practices and that clinicians are interested in using in their clinics with patients to better inform treatment decisions.

Right choice, right time: Evaluation of an online decision aid for youth depression.

Science.gov (United States)

Simmons, Magenta B; Elmes, Aurora; McKenzie, Joanne E; Trevena, Lyndal; Hetrick, Sarah E

2017-08-01

Appropriate treatment for youth depression is an important public health priority. Shared decision making has been recommended, yet no decision aids exist to facilitate this. The main objective of this study was to evaluate an online decision aid for youth depression. An uncontrolled cohort study with pre-decision, immediately post-decision and follow-up measurements. Young people (n=66) aged 12-25 years with mild, mild-moderate or moderate-severe depression were recruited from two enhanced primary care services. Online decision aid with evidence communication, preference elicitation and decision support components. The main outcome measures were ability to make a decision; whether the decision was in line with clinical practice guidelines, personal preferences and values; decisional conflict; perceived involvement; satisfaction with decision; adherence; and depression scores at follow-up. After using the decision aid, clients were more likely to make a decision in line with guideline recommendations (93% vs 70%; P=.004), were more able to make a decision (97% vs 79%; P=.022), had significantly reduced decisional conflict (17.8 points lower (95% CI: 13.3-22.9 points lower) on the Decisional Conflict Scale (range 0-100)) and felt involved and satisfied with their decision. At follow-up, clients had significantly reduced depression symptoms (2.7 points lower (95% CI: 1.3-4.0 points lower) on the Patient Health Questionnaire nine-item scale (range 0-27)) and were adherent to 88% (95% CI: 82%-94%) of treatment courses. A decision aid for youth depression can help ensure evidence-based, client-centred care, promoting collaboration in this often difficult to engage population. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Studies and Analyses of Vulnerabilities in Aided Adversarial Decision Making

National Research Council Canada - National Science Library

Llinas, James

1998-01-01

.... The aid" in the analysis (i.e., an automated decision aid) focuses upon a generic data fusion processor that estimates situation and threat states based on multisensor/multisource-based data assessments...

Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making.

Science.gov (United States)

Schroy, Paul C; Mylvaganam, Shamini; Davidson, Peter

2014-02-01

Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identify a preferred screening option, but the extent to which such tools facilitate shared decision making (SDM) from the perspective of the provider is less well established. Our goal was to elicit provider feedback regarding the impact of a CRC screening decision aid on SDM in the primary care setting. Cross-sectional survey. Primary care providers participating in a clinical trial evaluating the impact of a novel CRC screening decision aid on SDM and adherence. Perceptions of the impact of the tool on decision-making and implementation issues. Twenty-nine of 42 (71%) eligible providers responded, including 27 internists and two nurse practitioners. The majority (>60%) felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients' desire to get screened. Respondents were more neutral is their assessment of whether the tool improved the overall quality of the patient visit or patient satisfaction. Fewer than 50% felt that the tool would be easy to implement into their practices or that it would be widely used by their colleagues. Decision aids for CRC screening can improve the quality and efficiency of SDM from the provider perspective but future use is likely to depend on the extent to which barriers to implementation can be addressed. © 2011 John Wiley & Sons Ltd.

Constructing a relevant decision aid for parents of children with bronchopulmonary dysplasia.

Science.gov (United States)

Skibo, M; Guillen, U; Zhang, H; Munson, D; Mackley, A; Nilan, K; Kirpalani, H

2017-12-01

To develop and test a decision aid for counseling parents of children with bronchopulmonary dysplasia (BPD).Local problem:Parental education about complex conditions is not standardized and communication and understanding may not be adequate. Semi-structured interviews were conducted with 33 neonatal clinicians and 12 parents of children with BPD using a qualitative research design. The interviews were used to identify education topics that were felt to be important in BPD education. These topics were then used to create a visual decision aid to be used in counseling sessions with parents. The decision aid was then used in mock counseling sessions with 15 'experienced' participants and 7 'naïve' participants to assess its efficacy. The participants completed a pre and post test to assess change in knowledge as well as an 11-question Likert style acceptability survey. Implementation of a decision aid while educating parents about BPD. Topics identified during the interviews were used to create eight educational cards which included pictures, pictographs and statistics. Overall, participants thought the decision aid contained an appropriate amount of information, were easy to understand and improved their knowledge about BPD. Testing demonstrated a significant increase in knowledge in both the 'experienced' (Pdecision aid for parents of children with BPD may improve understanding of the condition and help facilitate communication between parents and doctors.

Refining a brief decision aid in stable CAD: cognitive interviews.

Science.gov (United States)

Kelly-Blake, Karen; Clark, Stacie; Dontje, Katherine; Olomu, Adesuwa; Henry, Rebecca C; Rovner, David R; Rothert, Marilyn L; Holmes-Rovner, Margaret

2014-02-13

We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA. Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

Teaching advance care planning to medical students with a computer-based decision aid.

Science.gov (United States)

Green, Michael J; Levi, Benjamin H

2011-03-01

Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n = 60) outperformed the Standard Group (n = 61) in terms of students' knowledge (p satisfaction with their learning experience (p student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients.

Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.

Science.gov (United States)

Kappanayil, Mahesh; Koneti, Nageshwara Rao; Kannan, Rajesh R; Kottayil, Brijesh P; Kumar, Krishna

2017-01-01

Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts" Healthcare applications are currently in evolution. The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs). Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed. Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning. 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

Veterans Like Me: Formative evaluation of a patient decision aid design.

Science.gov (United States)

Gibson, Bryan; Butler, Jorie; Doyon, Katherine; Ellington, Lee; Bray, Bruce E; Zeng, Qing

2017-07-01

Patient decision aids are tools intended to facilitate shared decision-making. Currently development of a patient decision aid is resource intensive: it requires a decision-specific review of the scientific literature by experts to ascertain the potential outcomes under different treatments. The goal of this project was to conduct a formative evaluation of a generalizable, scalable decision aid component we call Veterans Like Me (VLme). VLme mines EHR data to present the outcomes of individuals "like you" on different treatments to the user. These outcome are presented through a combination of an icon array and simulated narratives. Twenty-six patients participated in semi-structured interviews intended to elicit feedback on the tool's functional and interface design. The interview focused on the filters users desired with which to make cases similar to them, the kinds of outcomes they wanted presented, and their envisioned use of the tool. The interview also elicited participants information needs and salient factors related to the therapeutic decision. The interview transcripts were analyzed using an iteratively refined coding schema and content analysis. . Participants generally expressed enthusiasm for the tool's design and functionality. Our analysis identified desired filters for users to view patients like themselves, outcome types that should be included in future iterations of the tool (e.g. patient reported outcomes), and information needs that need to be addressed for patients to effectively participate in shared decision making. Implications for the integration of our findings into the design of patient decision aids are discussed. Published by Elsevier Inc.

Usability testing of ANSWER: a web-based methotrexate decision aid for patients with rheumatoid arthritis.

Science.gov (United States)

Li, Linda C; Adam, Paul M; Townsend, Anne F; Lacaille, Diane; Yousefi, Charlene; Stacey, Dawn; Gromala, Diane; Shaw, Chris D; Tugwell, Peter; Backman, Catherine L

2013-12-01

Decision aids are evidence-based tools designed to inform people of the potential benefit and harm of treatment options, clarify their preferences and provide a shared decision-making structure for discussion at a clinic visit. For patients with rheumatoid arthritis (RA) who are considering methotrexate, we have developed a web-based patient decision aid called the ANSWER (Animated, Self-serve, Web-based Research Tool). This study aimed to: 1) assess the usability of the ANSWER prototype; 2) identify strengths and limitations of the ANSWER from the patient's perspective. The ANSWER prototype consisted of: 1) six animated patient stories and narrated information on the evidence of methotrexate for RA; 2) interactive questionnaires to clarify patients' treatment preferences. Eligible participants for the usability test were patients with RA who had been prescribed methotrexate. They were asked to verbalize their thoughts (i.e., think aloud) while using the ANSWER, and to complete the System Usability Scale (SUS) to assess overall usability (range = 0-100; higher = more user friendly). Participants were audiotaped and observed, and field notes were taken. The testing continued until no new modifiable issues were found. We used descriptive statistics to summarize participant characteristics and the SUS scores. Content analysis was used to identified usability issues and navigation problems. 15 patients participated in the usability testing. The majority were aged 50 or over and were university/college graduates (n = 8, 53.4%). On average they took 56 minutes (SD = 34.8) to complete the tool. The mean SUS score was 81.2 (SD = 13.5). Content analysis of audiotapes and field notes revealed four categories of modifiable usability issues: 1) information delivery (i.e., clarity of the information and presentation style); 2) navigation control (i.e., difficulties in recognizing and using the navigation control buttons); 3) layout (i.e., position of the

Tactical and strategic decision-making aids for nuclear power plant emergency response

International Nuclear Information System (INIS)

Cain, D.G.

1987-01-01

This paper examines the prospective role of computer-based decision aids for nuclear power plant emergency response. The role of these systems is subordinate to human activities, but in a complementary manner these systems process decision logic more accurately and foster a more thorough understanding of emergency situations than might other wise be possible. Within this context two decision support systems being developed are discussed. Both of these systems utilize technology derived from artificial intelligence, focussing on two different facets of emergency response. An automated emergency operating procedures (EOP) tracking expert system is described as a tactical aid for control room operator response. A reactor emergency action level monitor (REALM) expert system is proposed as a strategic decision aid for site emergency response. The discrimination between tactical and strategic decision-making is an intrinsic part of this examination

Feasibility of web-based decision aids in neurological patients

NARCIS (Netherlands)

van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

2010-01-01

Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

Using Prototyping and Simulation as Decision Tools in a Purchased-Software Implementation.

Science.gov (United States)

Haugen, Elliott J.; Nedwek, Brian P.

1988-01-01

The use of prototyping and simulation at St. Louis University to evaluate the implementation decisions and design of a student information system are described with regard to their impact on, and interaction with, institutional policies and procedures. (Author/MLW)

Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee.

Science.gov (United States)

Boland, Laura; Taljaard, Monica; Dervin, Geoffrey; Trenaman, Logan; Tugwell, Peter; Pomey, Marie-Pascale; Stacey, Dawn

2018-02-01

Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-Mantel-Haenszel χ 2 tests and the Breslow-Day test. We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality ( p = 0.09): at the academic site, patients who used the decision aid were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict ( p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites ( p = 0.65). The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable.

Development and testing of a decision aid on goals of care for advanced dementia.

Science.gov (United States)

Einterz, Seth F; Gilliam, Robin; Lin, Feng Chang; McBride, J Marvin; Hanson, Laura C

2014-04-01

Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making. Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up. Two NHs in North Carolina. Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker. (1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team. Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

A theory-based decision aid for patients with cancer: results of feasibility and acceptability testing of DecisionKEYS for cancer.

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Hollen, Patricia J; Gralla, Richard J; Jones, Randy A; Thomas, Christopher Y; Brenin, David R; Weiss, Geoffrey R; Schroen, Anneke T; Petroni, Gina R

2013-03-01

Appropriate utilization of treatment is a goal for all patients undergoing cancer treatment. Proper treatment maximizes benefit and limits exposure to unnecessary measures. This report describes findings of the feasibility and acceptability of implementing a short, clinic-based decision aid and presents an in-depth clinical profile of the participants. This descriptive study used a prospective, quantitative approach to obtain the feasibility and acceptability of a decision aid (DecisionKEYS for Balancing Choices) for use in clinical settings. It combined results of trials of patients with three different common malignancies. All groups used the same decision aid series. Participants included 80 patients with solid tumors (22 with newly diagnosed breast cancer, 19 with advanced prostate cancer, and 39 with advanced lung cancer) and their 80 supporters as well as their physicians and nurses, for a total of 160 participants and 10 health professionals. The decision aid was highly acceptable to patient and supporter participants in all diagnostic groups. It was feasible for use in clinic settings; the overall value was rated highly. Of six physicians, all found the interactive format with the help of the nurse as feasible and acceptable. Nurses also rated the decision aid favorably. This intervention provides the opportunity to enhance decision making about cancer treatment and warrants further study including larger and more diverse groups. Strengths of the study included a theoretical grounding, feasibility testing of a practical clinic-based intervention, and summative evaluation of acceptability of the intervention by patient and supporter pairs. Further research also is needed to test the effectiveness of the decision aid in diverse clinical settings and to determine if this intervention can decrease overall costs.

Decision aids for improved accuracy and standardization of mammographic diagnosis

International Nuclear Information System (INIS)

D'Orsi, C.J.; Getty, D.J.; Swets, J.A.; Pickett, R.M.; Seltzer, S.E.; McNeil, B.J.

1990-01-01

This paper examines the gains in the accuracy of mammographic diagnosis of breast cancer achievable from a pair of decision aids. Twenty-three potentially relevant perceptual features of mammograms were identified through interviews, psychometric tests, and consensus meetings with mammography specialists. Statistical analyses determined the 12 independent features that were most information diagnostically and assigned a weight to each according to its importance. Two decision aids were developed: a checklist that solicits a scale value from the radiologist for each feature and a computer program that merges those values optimally in an advisory estimate of the probability of malignancy. Six radiologists read a set of 150 cases, first in their usual way and later with the aids

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

Science.gov (United States)

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. © Georg Thieme Verlag KG Stuttgart · New York.

Virtual environment and computer-aided technologies used for system prototyping and requirements development

Science.gov (United States)

Logan, Cory; Maida, James; Goldsby, Michael; Clark, Jim; Wu, Liew; Prenger, Henk

1993-01-01

The Space Station Freedom (SSF) Data Management System (DMS) consists of distributed hardware and software which monitor and control the many onboard systems. Virtual environment and off-the-shelf computer technologies can be used at critical points in project development to aid in objectives and requirements development. Geometric models (images) coupled with off-the-shelf hardware and software technologies were used in The Space Station Mockup and Trainer Facility (SSMTF) Crew Operational Assessment Project. Rapid prototyping is shown to be a valuable tool for operational procedure and system hardware and software requirements development. The project objectives, hardware and software technologies used, data gained, current activities, future development and training objectives shall be discussed. The importance of defining prototyping objectives and staying focused while maintaining schedules are discussed along with project pitfalls.

A decision-aiding system: DACFOOD

International Nuclear Information System (INIS)

Despres, A.; Heymes, P.

1994-01-01

The DACFOOD (Decision Aiding for Contaminated FOODstuffs) system provides decision makers with necessary data for the implementation of optimized protection measures in case of radioactive contamination of foodstuffs. The system evaluates the dose impact due to ingestion of these products, calculates the dose reduction after implementation of specific actions and, by combining these actions, assesses several strategies by using their cost-effectiveness ratios. Such evaluations need the description of contamination as radionuclide activities in each foodstuff, and the description of consumers' groups according to their dietary habits. Then it is possible to define areas in which the doses received are reasonably homogeneous in different age classes. If deposition occurs at a period of the year without harvest, the system applies dynamic transfer models to calculate the concentration in future productions. (authors). 2 refs

Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

Directory of Open Access Journals (Sweden)

Annie LeBlanc

Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

Online, Interactive Option Grid Patient Decision Aids and their Effect on User Preferences.

Science.gov (United States)

Scalia, Peter; Durand, Marie-Anne; Kremer, Jan; Faber, Marjan; Elwyn, Glyn

2018-01-01

Randomized trials have shown that patient decision aids can modify users' preferred healthcare options, but research has yet to identify the attributes embedded in these tools that cause preferences to shift. The aim of this study was to investigate people's preferences as they used decision aids for 5 health decisions and, for each of the following: 1) determine if using the interactive Option Grid led to a pre-post shift in preferences; 2) determine which frequently asked questions (FAQs) led to preference shifts; 3) determine the FAQs that were rated as the most important as users compared options. Interactive Option Grid decision aids enable users to view attributes of available treatment or screening options, rate their importance, and specify their preferred options before and after decision aid use. The McNemar-Bowker paired test was used to compare stated pre-post preferences. Multinomial logistic regressions were conducted to investigate possible associations between covariates and preference shifts. Overall, 626 users completed the 5 most-used tools: 1) Amniocentesis test: yes or no? ( n = 73); 2) Angina: treatment options ( n = 88); 3) Breast cancer: surgical options ( n = 265); 4) Prostate Specific Antigen (PSA) test: yes or no? ( n = 82); 5) Statins for heart disease risk: yes or no? ( n = 118). The breast cancer, PSA, and statins Option Grid decision aids generated significant preference shifts. Generally, users shifted their preference when presented with the description of the available treatment options, and the risk associated with each option. The use of decision aids for some, but not all health decisions, was accompanied by a shift in user preferences. Users typically valued information associated with risks, and chose more risk averse options after completing the interactive tool.

Aiding Lay Decision Making Using a Cognitive Competencies Approach

OpenAIRE

Maule, A. J.; Maule, Simon

2016-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical pr...

Trustworthy patient decision aids: a qualitative analysis addressing the risk of competing interests

NARCIS (Netherlands)

Elwyn, G.; Dannenberg, M.; Blaine, A.; Poddar, U.; Durand, M.A.

2016-01-01

OBJECTIVE: Our aim in this study was to examine the competing interest policies and procedures of organisations who develop and maintain patient decision aids. DESIGN: Descriptive and thematic analysis of data collected from a cross-sectional survey of patient decision aid developer's competing

Selecting a risk-based tool to aid in decision making

Energy Technology Data Exchange (ETDEWEB)

Bendure, A.O.

1995-03-01

Selecting a risk-based tool to aid in decision making is as much of a challenge as properly using the tool once it has been selected. Failure to consider customer and stakeholder requirements and the technical bases and differences in risk-based decision making tools will produce confounding and/or politically unacceptable results when the tool is used. Selecting a risk-based decisionmaking tool must therefore be undertaken with the same, if not greater, rigor than the use of the tool once it is selected. This paper presents a process for selecting a risk-based tool appropriate to a set of prioritization or resource allocation tasks, discusses the results of applying the process to four risk-based decision-making tools, and identifies the ``musts`` for successful selection and implementation of a risk-based tool to aid in decision making.

Rough set and rule-based multicriteria decision aiding

Directory of Open Access Journals (Sweden)

Roman Slowinski

2012-08-01

Full Text Available The aim of multicriteria decision aiding is to give the decision maker a recommendation concerning a set of objects evaluated from multiple points of view called criteria. Since a rational decision maker acts with respect to his/her value system, in order to recommend the most-preferred decision, one must identify decision maker's preferences. In this paper, we focus on preference discovery from data concerning some past decisions of the decision maker. We consider the preference model in the form of a set of "if..., then..." decision rules discovered from the data by inductive learning. To structure the data prior to induction of rules, we use the Dominance-based Rough Set Approach (DRSA. DRSA is a methodology for reasoning about data, which handles ordinal evaluations of objects on considered criteria and monotonic relationships between these evaluations and the decision. We review applications of DRSA to a large variety of multicriteria decision problems.

Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation

Science.gov (United States)

Cox, Christopher E.; Lewis, Carmen L.; Hanson, Laura C.; Hough, Catherine L.; Kahn, Jeremy M.; White, Douglas B.; Song, Mi-Kyung; Tulsky, James A.; Carson, Shannon S.

2013-01-01

Objective Shared decision making is inadequate in intensive care units (ICUs). Decision aids can improve decision making quality, though their role in an ICU setting is unclear. We aimed to develop and pilot test a decision aid for shared decision makers of patients undergoing prolonged mechanical ventilation. Setting ICUs at three medical centers. Subjects 53 surrogate decision makers and 58 physicians. Design and interventions We developed the decision aid using defined methodological guidelines. After an iterative revision process, formative cognitive testing was performed among surrogate-physician dyads. Next, we compared the decision aid to usual care control in a prospective, before/after design study. Measurements and main results Primary outcomes were physician-surrogate discordance for expected patient survival, comprehension of relevant medical information, and the quality of communication. Compared to control, the intervention group had lower surrogate-physician discordance (7 [10] vs 43 [21]), greater comprehension (11.4 [0.7] vs 6.1 [3.7]), and improved quality of communication (8.7 [1.3] vs 8.4 [1.3]) (all ppost-intervention. Hospital costs were lower in the intervention group ($110,609 vs $178,618; p=0.044); mortality did not differ by group (38% vs 50%, p=0.95). 94% of surrogates and 100% of physicians reported that the decision aid was useful in decision making. Conclusion We developed a prolonged mechanical ventilation decision aid that is feasible, acceptable, and associated with both improved decision making quality and less resource utilization. Further evaluation using a randomized controlled trial design is needed to evaluate the decision aid's effect on long-term patient and surrogate outcomes. PMID:22635048

Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.

Science.gov (United States)

Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne

2014-03-01

Patient decision aids are known to positively impact outcomes critical to shared decision making (SDM), such as gist knowledge and decision preparedness. However, research on the potential improvement of these and other important outcomes through cultural targeting and tailoring of decision aids is very limited. This is the case despite extensive evidence supporting use of cultural targeting and tailoring to improve the effectiveness of health communications. Building on prominent psychological theory, we propose a two-stage framework incorporating cultural concepts into the design process for screening and treatment decision aids. The first phase recommends use of cultural constructs, such as collectivism and individualism, to differentially target patients whose cultures are known to vary on these dimensions. Decision aid targeting is operationalized through use of symbols and values that appeal to members of the given culture. Content dimensions within decision aids that appear particularly appropriate for targeting include surface level visual characteristics, language, beliefs, attitudes and values. The second phase of the framework is based on evidence that individuals vary in terms of how strongly cultural norms influence their approach to problem solving and decision making. In particular, the framework hypothesizes that differences in terms of access to cultural mindsets (e.g., access to interdependent versus independent self) can be measured up front and used to tailor decision aids. Thus, the second phase in the framework emphasizes the importance of not only targeting decision aid content, but also tailoring the information to the individual based on measurement of how strongly he/she is connected to dominant cultural mindsets. Overall, the framework provides a theory-based guide for researchers and practitioners who are interested in using cultural targeting and tailoring to develop and test decision aids that move beyond a "one-size fits all" approach

Prototype of a Web-based Participative Decision Support Platform in Natural Hazards and Risk Management

Directory of Open Access Journals (Sweden)

Zar Chi Aye

2015-07-01

Full Text Available This paper presents the current state and development of a prototype web-GIS (Geographic Information System decision support platform intended for application in natural hazards and risk management, mainly for floods and landslides. This web platform uses open-source geospatial software and technologies, particularly the Boundless (formerly OpenGeo framework and its client side software development kit (SDK. The main purpose of the platform is to assist the experts and stakeholders in the decision-making process for evaluation and selection of different risk management strategies through an interactive participation approach, integrating web-GIS interface with decision support tool based on a compromise programming approach. The access rights and functionality of the platform are varied depending on the roles and responsibilities of stakeholders in managing the risk. The application of the prototype platform is demonstrated based on an example case study site: Malborghetto Valbruna municipality of North-Eastern Italy where flash floods and landslides are frequent with major events having occurred in 2003. The preliminary feedback collected from the stakeholders in the region is discussed to understand the perspectives of stakeholders on the proposed prototype platform.

The Pathways fertility preservation decision aid website for women with cancer: development and field testing.

Science.gov (United States)

Woodard, Terri L; Hoffman, Aubri S; Covarrubias, Laura A; Holman, Deborah; Schover, Leslie; Bradford, Andrea; Hoffman, Derek B; Mathur, Aakrati; Thomas, Jerah; Volk, Robert J

2018-02-01

To improve survivors' awareness and knowledge of fertility preservation counseling and treatment options, this study engaged survivors and providers to design, develop, and field-test Pathways: a fertility preservation patient decision aid website for young women with cancer©. Using an adapted user-centered design process, our stakeholder advisory group and research team designed and optimized the Pathways patient decision aid website through four iterative cycles of review and revision with clinicians (n = 21) and survivors (n = 14). Field-testing (n = 20 survivors) assessed post-decision aid scores on the Fertility Preservation Knowledge Scale, feasibility of assessing women's decision-making values while using the website, and website usability/acceptability ratings. Iterative stakeholder engagement optimized the Pathways decision aid website to meet survivors' and providers' needs, including providing patient-friendly information and novel features such as interactive value clarification exercises, testimonials that model shared decision making, financial/referral resources, and a printable personal summary. Survivors scored an average of 8.2 out of 13 (SD 1.6) on the Fertility Preservation Knowledge Scale. They rated genetic screening and having a biological child as strong factors in their decision-making, and 71% indicated a preference for egg freezing. Most women (> 85%) rated Pathways favorably, and all women (100%) said they would recommend it to other women. The Pathways decision aid is a usable and acceptable tool to help women learn about fertility preservation. The Pathways decision aid may help women make well-informed values-based decisions and prevent future infertility-related distress.

Prototype of a diagnostic decision support tool for structural damage in masonry

NARCIS (Netherlands)

De Vent, I.A.E.

2011-01-01

This prototype of a diagnostic decision support tool for structural damage in traditional masonry is the result of a PhD research project. The research project has aimed to improve and facilitate the diagnostic process by offering support in the initial phase in which hypotheses are generated. The

A comparison of web-based versus print-based decision AIDS for prostate cancer screening: participants' evaluation and utilization.

Science.gov (United States)

Tomko, Catherine; Davis, Kimberly M; Luta, George; Krist, Alexander H; Woolf, Steven H; Taylor, Kathryn L

2015-01-01

Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits. To describe participants' evaluation and utilization of print-based and web-based prostate cancer screening decision aids that were found to improve decisional outcomes in a prior randomized controlled trial. Men completed brief telephone interviews at baseline, one month, and 13 months post-randomization. Participants were primary care patients, 45-70 years old, who received the print-based (N = 628) or web-based decision aid (N = 625) and completed the follow-up assessments. We assessed men's baseline preference for web-based or print-based materials, time spent using the decision aids, comprehension of the overall message, and ratings of the content. Decision aid use was self-reported by 64.3 % (web) and 81.8 % (print) of participants. Significant predictors of decision aid use were race (white vs. non-white, OR = 2.43, 95 % CI: 1.77, 3.35), higher education (OR = 1.68, 95 % CI: 1.06, 2.70) and trial arm (print vs. web, OR = 2.78, 95 % CI: 2.03, 3.83). Multivariable analyses indicated that web-arm participants were more likely to use the website when they preferred web-based materials (OR: 1.91, CI: 1.17, 3.12), whereas use of the print materials was not significantly impacted by a preference for print-based materials (OR: 0.69, CI: 0.38, 1.25). Comprehension of the decision aid message (i.e., screening is an individual decision) did not significantly differ between arms in adjusted analyses (print: 61.9 % and web: 68.2 %, p = 0.42). Decision aid use was independently influenced by race, education, and the decision aid medium, findings consistent with the 'digital divide.' These results suggest that when it is not possible to provide this age cohort with their preferred decision aid medium, print materials will be more highly used than web-based materials. Although there are many advantages to web-based decision aids, providing an option for

Offering online recommendations with minimum customer input through conjoint-based decision aids

NARCIS (Netherlands)

De Bruyn, Arnaud; Liechty, John C.; Huizingh, Eelko K. R. E.; Lilien, Gary L.

2008-01-01

In their purchase decisions, online customers seek to improve decision quality while limiting search efforts. In practice, many merchants have understood the importance of helping customers in the decision-making process and provide online decision aids to their visitors. In this paper, we show how

Decision aids for respite service choices by carers of people with dementia: development and pilot RCT

Directory of Open Access Journals (Sweden)

Stirling Christine

2012-03-01

Full Text Available Abstract Background Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options. However, they are rarely utilised to help those with chronic or age related conditions to make decisions about care services. Decision aids should also be useful for carers of people with decreased decisional capacity. These carers' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns, while relying on information from health professionals. This paper reports on a study that both developed and pilot tested a decision aid aimed at assisting carers to make evaluative judgements of community services, particularly respite care. Methods A mixed method sequential study, involving qualitative development and a pilot randomised controlled trial, was conducted in Tasmania, Australia. We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid. For the randomised control trial we randomly assigned 31 carers of people with dementia to either receive the service decision aid at the start or end of the study. The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid. Pilot data was collected from carers using interviewer-administered questionnaires at the commencement of the project, two weeks and 12 weeks later. Results The qualitative data strongly suggest that the intervention provides carers with needed decision support. Most carers felt that the decision aid was useful. The trial data demonstrated that, using the mean change between baseline and three month follow-up, the intervention group had less increase in burden, a decrease in decisional conflict and increased knowledge compared to control group participants. Conclusions While these results must be interpreted with

Arriba-lib: association of an evidence-based electronic library of decision aids with communication and decision-making in patients and primary care physicians.

Science.gov (United States)

Hirsch, Oliver; Keller, Heidemarie; Krones, Tanja; Donner-Banzhoff, Norbert

2012-03-01

In shared decision-making, patients are empowered to actively ask questions and participate in decisions about their healthcare based on their preferences and values. Decision aids should help patients make informed choices among diagnostic or treatment options by delivering evidence-based information on options and outcomes; however, they have rarely been field tested, especially in the primary care context. We therefore evaluated associations between the use of an interactive, transactional and evidence-based library of decision aids (arriba-lib) and communication and decision-making in patients and physicians in the primary care context. Our electronic library of decision aids ('arriba-lib') includes evidence-based modules for cardiovascular prevention, diabetes, coronary heart disease, atrial fibrillation and depression. Twenty-nine primary care physicians recruited 192 patients. We used questionnaires to ask patients and physicians about their experiences with and attitudes towards the programme. Patients were interviewed via telephone 2 months after the consultation. Data were analysed by general estimation equations, cross tab analyses and by using effect sizes. Only a minority (8.9%) of the consultations were felt to be too long because physicians said consultations were unacceptably extended by arriba-lib. We found a negative association between the detailedness of the discussion of the clinical problem's definition and the age of the patients. Physicians discuss therapeutic options in less detail with patients who have a formal education of less than 8 years. Patients who were counselled by a physician with no experience in using a decision aid more often reported that they do not remember being counselled with the help of a decision aid or do not wish to be counselled again with a decision aid. Arriba-lib has positive associations to the decision-making process in patients and physicians. It can also be used with older age groups and patients with less

Shared decision making and patient decision aids: knowledge, attitudes, and practices among Hawai'i physicians.

Science.gov (United States)

Alden, Dana L; Friend, John; Chun, Maria B J

2013-11-01

As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai'i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai'i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai'i physicians are promising.

Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment

Directory of Open Access Journals (Sweden)

Mahesh Kappanayil

2017-01-01

Conclusions: 3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program

OpenAIRE

Belkora, Jeff; Volz, Shelley; Loth, Meredith; Teng, Alexandra; Zarin-Pass, Margot; Moore, Dan; Esserman, Laura

2015-01-01

Background Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based br...

DASS: A decision aid integrating the safety parameter display system and emergency functional recovery procedures. Final report

International Nuclear Information System (INIS)

Johnson, S.E.

1984-08-01

Using a stand-alone developmental test-bed consisting of a minicomputer and a high-resolution color graphics computer, displays and supporting software incorporating advanced on-line decision-aid concepts were developed and evaluated. The advanced concepts embodied in displays designed for the operating crew of a PWR plant include: (1) an integrated display format which supports a top-down approach to problem detection, recovery planning, and control; (2) introduction of nonobservable plant parameters derived from first principles mass and energy balances as part of the displayed information; and (3) systematic processing and display of key success path (plant safety system) attributes. The prototype system, referred to as the PWR-DASS (Disturbance Analysis and Surveillance System), consists of 18 displays targeted for principal use by the control room systems manager. PWR-DASS was conceived to fulfill an operational void not fully supported by safety parameter display systems or reformulated emergency procedure guidelines. The results from the evaluation by licensed operators suggest that organization and display of desired critical safety function and success path information as incorporated in the PWR-DASS prototype can support the systems manager's overview. The results also point to the need for several refinements required for a field grade system, and to the need for a simulator-based evaluation of the prototype or its successor. (author)

Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations.

NARCIS (Netherlands)

Evans, R.; Edwards, A.; Brett, J.; Bradburn, M.; Watson, E.; Austoker, J.; Elwyn, G.

2005-01-01

A man's decision to have a prostate-specific antigen (PSA) test should be an informed one. We undertook a systematic review to identify and appraise PSA decision aids and evaluations. We searched 15 electronic databases and hand-searched key journals. We also contacted key authors and organisations.

Modelling elderly cardiac patients decision making using Cognitive Work Analysis: identifying requirements for patient decision aids.

Science.gov (United States)

Dhukaram, Anandhi Vivekanandan; Baber, Chris

2015-06-01

Patients make various healthcare decisions on a daily basis. Such day-to-day decision making can have significant consequences on their own health, treatment, care, and costs. While decision aids (DAs) provide effective support in enhancing patient's decision making, to date there have been few studies examining patient's decision making process or exploring how the understanding of such decision processes can aid in extracting requirements for the design of DAs. This paper applies Cognitive Work Analysis (CWA) to analyse patient's decision making in order to inform requirements for supporting self-care decision making. This study uses focus groups to elicit information from elderly cardiovascular disease (CVD) patients concerning a range of decision situations they face on a daily basis. Specifically, the focus groups addressed issues related to the decision making of CVD in terms of medication compliance, pain, diet and exercise. The results of these focus groups are used to develop high level views using CWA. CWA framework decomposes the complex decision making problem to inform three approaches to DA design: one design based on high level requirements; one based on a normative model of decision-making for patients; and the third based on a range of heuristics that patients seem to use. CWA helps in extracting and synthesising decision making from different perspectives: decision processes, work organisation, patient competencies and strategies used in decision making. As decision making can be influenced by human behaviour like skills, rules and knowledge, it is argued that patients require support to different types of decision making. This paper also provides insights for designers in using CWA framework for the design of effective DAs to support patients in self-management. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

Science.gov (United States)

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real

Coaching patients in the use of decision and communication aids: RE-AIM evaluation of a patient support program.

Science.gov (United States)

Belkora, Jeff; Volz, Shelley; Loth, Meredith; Teng, Alexandra; Zarin-Pass, Margot; Moore, Dan; Esserman, Laura

2015-05-28

Decision aids educate patients about treatment options and outcomes. Communication aids include question lists, consultation summaries, and audio-recordings. In efficacy studies, decision aids increased patient knowledge, while communication aids increased patient question-asking and information recall. Starting in 2004, we trained successive cohorts of post-baccalaureate, pre-medical interns to coach patients in the use of decision and communication aids at our university-based breast cancer clinic. From July 2005 through June 2012, we used the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance of our interventions. 1. Reach: Over the study period, our program sent a total of 5,153 decision aids and directly administered 2,004 communication aids. In the most recent program year (2012), out of 1,524 eligible patient appointments, we successfully contacted 1,212 (80%); coached 1,110 (73%) in the self-administered use of decision and communication aids; sent 958 (63%) decision aids; and directly administered communication aids for 419 (27%) patients. In a 2010 survey, coached patients reported self-administering one or more communication aids in 81% of visits 2. Effectiveness: In our pre-post comparisons, decision aids were associated with increased patient knowledge and decreased decisional conflict. Communication aids were associated with increased self-efficacy and number of questions; and with high ratings of patient preparedness and satisfaction 3. Adoption: Among visitors sent decision aids, 82% of survey respondents reviewed some or all; among those administered communication aids, 86% reviewed one or more after the visit 4. Through continuous quality adaptations, we increased the proportion of available staff time used for patient support (i.e. exploitation of workforce capacity) from 29% in 2005 to 84% in 2012 5. Maintenance: The main barrier to sustainability was the cost of paid intern labor. We addressed this by

Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?

NARCIS (Netherlands)

Portocarrero, M.E.; Giguere, A.M.; Lepine, J.; Garvelink, M.M.; Robitaille, H.; Delanoe, A.; Levesque, I.; Wilson, B.J.; Rousseau, F.; Legare, F.

2017-01-01

BACKGROUND: Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors

A study on spatial decision support systems for HIV/AIDS prevention based on COM GIS technology

Science.gov (United States)

Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli

2007-06-01

Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.

A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting.

Science.gov (United States)

Cuypers, Maarten; Lamers, Romy Ed; Kil, Paul Jm; The, Regina; Karssen, Klemens; van de Poll-Franse, Lonneke V; de Vries, Marieke

2017-07-01

Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting. After analyses of the original decision aid and routines in Dutch prostate cancer care, adjustments to the decision aid structure and content were made. Subsequent usability testing (N = 11) resulted in 212 comments. Care providers mainly provided feedback on medical content, and patients commented most on usability and summary layout. All participants reported that the decision aid was comprehensible and well-structured and would recommend decision aid use. After usability testing, final adjustments to the decision aid were made. The presented methods could be useful for cultural adaptation of pre-existing tools into other languages and settings, ensuring optimal usage of previous scientific and practical efforts and allowing for a global, incremental decision aid development process.

Comparison of safety measures with a multicriteria decision aiding technique

International Nuclear Information System (INIS)

Lombard, J.

1985-01-01

Attributes such as political, social and psychological factors have to be taken into account for the decision-making process. Multiattribute decision-aiding techniques are used to cope with this multidimensionality of the risk management process. A simple example will be given to illustrate how such method can be helpful for the selection of proper safety measures in a rational way. (orig./HP) [de

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study.

Science.gov (United States)

Reumkens, Kelly; Tummers, Marly H E; Gietel-Habets, Joyce J G; van Kuijk, Sander M J; Aalfs, Cora M; van Asperen, Christi J; Ausems, Margreet G E M; Collée, Margriet; Dommering, Charlotte J; Kets, C Marleen; van der Kolk, Lizet E; Oosterwijk, Jan C; Tjan-Heijnen, Vivianne C G; van der Weijden, Trudy; de Die-Smulders, Christine E M; van Osch, Liesbeth A D M

2018-05-30

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples' decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest-posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.

Clinical use of patient decision-making aids for stone patients.

Science.gov (United States)

Lim, Amy H; Streeper, Necole M; Best, Sara L; Penniston, Kristina L; Nakada, Stephen Y

2017-08-01

Patient decision-making aids (PDMAs) help patients make informed healthcare decisions and improve patient satisfaction. The utility of PDMAs for patients considering treatments for urolithiasis has not yet been published. We report our experience using PDMAs developed at our institution in the outpatient clinical setting in patients considering a variety of treatment options for stones. Patients with radiographically confirmed urolithiasis were given PDMAs regarding treatment options for their stone(s) based on their clinical profile. We assessed patients' satisfaction, involvedness, and feeling of making a more informed decision with utilization of the PDMAs using a Likert Scale Questionnaire. Information was also collected regarding previous stone passage, history and type of surgical intervention for urolithiasis, and level of education. Patients (n = 43; 18 males, 23 females and two unknown) 53 +/- 14years old were included. Patients reported that they understood the advantages and disadvantages outlined in the PDMAs (97%), that the PDMAs helped them make a more informed decision (83%) and felt more involved in the decision making process (88%). Patients reported that the aids were presented in a balanced manner and used up-to-date scientific information (100%, 84% respectively). Finally, a majority of the patients prefer an expert's opinion when making a treatment decision (98%) with 73% of patients preferring to form their own opinion based on available information. Previous stone surgery was associated with patients feeling more involved with the decision making process (p = 0.0465). PDMAs have a promising role in shared decision-making in the setting of treatment options for nephrolithiasis.

Decision aids for familial breast cancer: exploring women's views using focus groups.

NARCIS (Netherlands)

Rapport, F.; Iredale, R.; Jones, W.; Sivell, S.; Edwards, A.; Gray, J.; Elwyn, G.

2006-01-01

BACKGROUND: There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

Directory of Open Access Journals (Sweden)

Peat Brian

2004-12-01

Full Text Available Abstract Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first at term; external cephalic version (ECV – the turning of a breech baby to a head-down position and/or planned caesarean section (CS. Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that

Protocol for the evaluation of a decision aid for women with a breech-presenting baby [ISRCTN14570598

Science.gov (United States)

Roberts, Christine L; Nassar, Natasha; Barratt, Alexandra; Raynes-Greenow, Camille H; Peat, Brian; Henderson-Smart, David

2004-01-01

Background There is now good evidence about the management options for pregnant women with a breech presentation (buttocks or feet rather than head-first) at term; external cephalic version (ECV) – the turning of a breech baby to a head-down position and/or planned caesarean section (CS). Each of these options has benefits and risks and the relative importance of these vary for each woman, subject to her personal values and preferences, a situation where a decision aid may be helpful. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. The ECV decision aid was developed using the Ottawa Decision Support Framework, including a systematic review of the evidence about the benefits and risks of the options for breech pregnancy. It comprises an audiotape with a supplementary booklet and worksheet, a format that can be taken home and discussed with a partner. This project aims to evaluate the ECV decision aid for women with a breech presenting baby in late pregnancy. Study design We aim to evaluate the effectiveness of the decision aid compared with usual care in a randomised controlled trial in maternity hospitals that offer ECV. The study group will receive the decision aid in addition to usual care and the control group will receive standard information on management options for breech presentation from their usual pregnancy care provider. Approximately 184 women with a single breech-presenting baby at greater than 34 weeks gestation and who are clinically eligible for ECV will be recruited for the trial. The primary outcomes of the study are knowledge, decisional conflict, anxiety and satisfaction with decision-making that will be assessed using

Value assessment aid to complex decision making. Final report

International Nuclear Information System (INIS)

Humphress, G.; Lewis, E.

1982-07-01

Value assessment (VA) is a new decision aid that can improve the performance of decisionmakers confronted with multiple attributes and conflicting objectives. Managers who are not supported by formal decision aids turn to various ''satisficing'' or effort-reducing biases that can lead to serious errors in the decisionmaking process. Value assessment, on the other hand, is an optimizing approach to problem-solving behavior. VA helps decisionmakers overcome the tendency to turn to effort-reducing biases by reducing the complexity of making tradeoffs and weighing all available information. Many of the issues which confront modern electric utility managements are complex, multiple attribute problems which must be viewed from engineering, financial and socio-political perspectives simultaneously. Added to this are the complications contributed by factors like uncertainty, risk, incomplete information and conflicting objectives among the public it serves. This is the complex decisionmaking arena which VA is intended to support

Decision aids: when 'nudging' patients to make a particular choice is more ethical than balanced, nondirective content.

Science.gov (United States)

Blumenthal-Barby, J S; Cantor, Scott B; Russell, Heidi Voelker; Naik, Aanand D; Volk, Robert J

2013-02-01

Patient decision aids, such as instructional leaflets describing treatment options for prostate cancer, are designed to help educate patients so that they can share in decisions about their care. Developers of these decision aids strive for balance, aiming to be as neutral, unbiased, and nondirective as possible. We argue that balance should not always be a goal, and we identify three situations where it should not be. For example, men diagnosed with early-stage prostate cancer frequently are not advised by their physicians that active surveillance is a reasonable alternative to immediate surgery or radiation. It may be desirable to design decision aids that promote active surveillance as an option. We recognize that the arguments put forth in this article are controversial. But they are also justified. We challenge medical decision makers and decision aid developers to determine if and when patients should be "nudged" toward one option or another.

Design document for landfill capping Prototype Decision Support System

International Nuclear Information System (INIS)

Stone, J.J.; Paige, G.; Hakonson, T.E.; Lane, L.J.

1994-01-01

The overall objective of the Prototype Decision Support System for shallow land burial project is to ''Develop a Decision Support System tool which incorporates simulation modeling and multi-objective decision theory for the purpose of designing and evaluating alternative trench cap designs for mixed waste landfill covers. The goal is to improve the quality of technical information used by the risk manager to select landfill cover designs while taking into account technological, economical, and regulatory factors.'' The complexity of the technical and non-technical information, and how the information varies in importance across sites, points to the need for decision analysis tools that provide a common basis for integrating, synthesizing, and valuing the decision input. Because the cost of remediating thousands of contaminated DOE sites is projected to be in the 10's--100's of billions of dollars, methods will be needed to establish cleanup priorities and to help in the selection and evaluation of cost effective remediation alternatives. Even at this early stage in DOE's cleanup program, it is certain that capping technologies will be heavily relied upon to remediate the 3000+ landfills on DOE property. Capping is favored in remediating most DOE landfills because, based on preliminary baseline risk assessments, human and ecological risks are considered to be low at most of these sites and the regulatory requirements for final closure of old landfills can be met using a well designed cap to isolate the buried waste. This report describes a program plan to design, develop, and test a decision support system (DSS) for assisting the DOE risk manager in evaluating capping alternatives for radioactive and hazardous waste landfills. The DOE DSS will incorporate methods for calculating, integrating and valuing technical, regulatory, and economic criteria

User-centered design and the development of patient decision aids: protocol for a systematic review.

Science.gov (United States)

Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

2015-01-26

Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations.

Science.gov (United States)

Quigley, Matthew; Dillon, Michael P; Fatone, Stefania

2018-02-01

Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important

Intra-annual wave resource characterization for energy exploitation: A new decision-aid tool

International Nuclear Information System (INIS)

Carballo, R.; Sánchez, M.; Ramos, V.; Fraguela, J.A.; Iglesias, G.

2015-01-01

Highlights: • A decision-aid tool is developed for computing the monthly performance of WECs. • It allows the generation of high-resolution monthly characterization matrices. • The decision-aid tool is implemented to the Death Coast (N Spain). • The monthly matrices can be obtained at any coastal location within the Death Coast. • The tool is applied to a coastal location of a proposed wave farm. - Abstract: The wave energy resource is usually characterized by a significant variability throughout the year. In estimating the power performance of a Wave Energy Converter (WEC) it is fundamental to take into account this variability; indeed, an estimate based on mean annual values may well result in a wrong decision making. In this work, a novel decision-aid tool, iWEDGE (intra-annual Wave Energy Diagram GEnerator) is developed and implemented to a coastal region of interest, the Death Coast (Spain), one of the regions in Europe with the largest wave resource. Following a comprehensive procedure, and based on deep water wave data and high-resolution numerical modelling, this tool provides the monthly high-resolution characterization matrices (or energy diagrams) for any location of interest. In other words, the information required for the accurate computation of the intra-annual performance of any WEC at any location within the region covered is made available. Finally, an application of iWEDGE to the site of a proposed wave farm is presented. The results obtained highlight the importance of the decision-aid tool herein provided for wave energy exploitation

Promoting the dissemination of decision aids: an odyssey in a dysfunctional health care financing system.

Science.gov (United States)

Billings, John

2004-01-01

The usefulness of patient decision aids (PtDAs) is well documented, yet they are not in widespread use. Barriers include assuring balance and fairness (auspices matter), the cost of producing and maintaining them, and getting them into the hands of patients at the right time. The Foundation for Informed Medical Decision Making and its for-profit partner, Health Dialog, have developed a creative business model that helps overcome these barriers and has greatly expanded the reach of decision aids.

Prototype of a web - based participative decision support platform in natural hazards and risk management

NARCIS (Netherlands)

Aye, Z.C.; Jaboyedoff, M.; Derron, M.H.; van Westen, C.J.

2015-01-01

This paper presents the current state and development of a prototype web-GIS (Geographic Information System) decision support platform intended for application in natural hazards and risk management, mainly for floods and landslides. This web platform uses open-source geospatial software and

Use of a decision aid for prenatal testing of fetal abnormalities to improve women's informed decision making: a cluster randomised controlled trial [ISRCTN22532458].

Science.gov (United States)

Nagle, C; Gunn, J; Bell, R; Lewis, S; Meiser, B; Metcalfe, S; Ukoumunne, O C; Halliday, J

2008-02-01

To evaluate the effectiveness of a decision aid for prenatal testing of fetal abnormalities compared with a pamphlet in supporting women's decision making. A cluster randomised controlled trial. Primary health care. Women in early pregnancy consulting a GP. GPs were randomised to provide women with either a decision aid or a pamphlet. The decision aid was a 24-page booklet designed using the Ottowa Decision Framework. The pamphlet was an existing resource available in the trial setting. Validated scales were used to measure the primary outcomes, informed choice and decisional conflict, and the secondary outcomes, anxiety, depression, attitudes to the pregnancy/fetus and acceptability of the resource. Outcomes were measured at 14 weeks of gestation from questionnaires that women completed and returned by post. Women in the intervention group were more likely to make an informed decision 76% (126/165) than those in the control group 65% (107/165) (adjusted OR 2.08; 95% CI 1.14-3.81). A greater proportion of women in the intervention group 88% (147/167) had a 'good' level of knowledge than those in the control group 72% (123/171) (adjusted OR 3.43; 95% CI 1.79-6.58). Mean (SD) decisional conflict scores were low in both groups, decision aid 1.71 (0.49), pamphlet 1.65 (0.55) (adjusted mean difference 0.10; 95% CI -0.02 to 0.22). There was no strong evidence of differences between the trial arms in the measures of psychological or acceptability outcomes. A tailored prenatal testing decision aid plays an important role in improving women's knowledge of first and second trimester screening tests and assisting them to make decisions about screening and diagnostic tests that are consistent with their values.

Balancing the presentation of information and options in patient decision aids: an updated review.

Science.gov (United States)

Abhyankar, Purva; Volk, Robert J; Blumenthal-Barby, Jennifer; Bravo, Paulina; Buchholz, Angela; Ozanne, Elissa; Vidal, Dale Colins; Col, Nananda; Stalmeier, Peep

2013-01-01

Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals' knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration's review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined "balance"; the definition of "balance" that emerged is as follows: "The complete and unbiased presentation of the relevant options and the information about those options-in content and in format-in a way that enables individuals to process this information without bias". Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users' or patients' perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was

[Evaluation of the decision aid "Entscheidungshilfe Prostatakrebs" from the patients' view : Results from the first three months].

Science.gov (United States)

Groeben, C; Ihrig, A; Hölscher, T; Krones, T; Kessler, E; Kliesch, S; Wülfing, C; Koch, R; Wirth, M P; Huber, J

2016-12-01

The decision aid "Entscheidungshilfe Prostatakrebs" is available online free of charge since June 2016. It is designed to support patients with their treatment decision-making and to lighten the burden on their treating urologists. This study evaluates usage data from the first 3 months. The ICHOM standard set was applied to allow a personalised presentation and to collect relevant data for subsequent counselling. Additionally, personal preferences and psychological burden were assessed amongst others. We collected anonymous data. A multivariate model evaluated predictors for high user satisfaction. From June through August 2016 a total of 319 patients used the decision aid, showing a continuous monthly increase in the number of users. There were n = 219 (68.7%) complete questionnaires. Median age was 66.1 ± 8.0 years. The oncological risk was low in 30.3%, intermediate in 43.6% and high in 26.1%. A majority of 57.5% used the decision aid together with their partner, 35.1% alone and 5.5% with their children. In all, 54.8% were "very satisfied" and 32.0% were "satisfied" with the decision aid for a total satisfaction rate of about 87%. The only predictors of total satisfaction were the usage mode and reported distress level. As shown by the continuously increasing number of users this decision aid is becoming well established in German urology. Patients' overall ratings are very positive. The majority of patients use the decision aid with their partner. This represents a significant advantage of a multimedia approach compared to print media.

Evaluation of a decision aid for women with breech presentation at term: a randomised controlled trial [ISRCTN14570598

Science.gov (United States)

Nassar, N; Roberts, CL; Raynes-Greenow, CH; Barratt, A; Peat, B

2007-01-01

Objectives To evaluate the effectiveness of a decision aid for women with a breech presentation compared with usual care. Design Randomised controlled trial. Setting Tertiary obstetric hospitals offering external cephalic version (ECV). Population Women with a singleton pregnancy were diagnosed antenatally with a breech presentation at term, and were clinically eligible for ECV. Methods Women were randomised to either receive a decision aid about the management options for breech presentation in addition to usual care or to receive usual care only with standard counselling from their usual pregnancy care provider. The decision aid comprised a 24-page booklet supplemented by a 30-minute audio-CD and worksheet that was designed for women to take home and review with a partner. Main outcome measures Decisional conflict (uncertainty), knowledge, anxiety and satisfaction with decision making, and were assessed using self-administered questionnaires. Results Compared with usual care, women reviewing the decision aid experienced significantly lower decisional conflict (mean difference −8.92; 95% CI −13.18, −4.66) and increased knowledge (mean difference 8.40; 95% CI 3.10, 13.71), were more likely to feel that they had enough information to make a decision (RR 1.30; 95% CI 1.14, 1.47), had no increase in anxiety and reported greater satisfaction with decision making and overall experience of pregnancy and childbirth. In contrast, 19% of women in the usual care group reported they would have made a different decision about their care. Conclusions A decision aid is an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation. Please cite this paper as: Nassar N, Roberts C, Raynes-Greenow C, Barratt A, Peat B, on behalf of the Decision Aid for Breech Presentation Trial Collaborators. Evaluation of a decision aid for women with breech presentation at term: a randomised controlled

The effect of patient narratives on information search in a web-based breast cancer decision aid: an eye-tracking study.

Science.gov (United States)

Shaffer, Victoria A; Owens, Justin; Zikmund-Fisher, Brian J

2013-12-17

Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on

A Prototype for Content-Rich Decision-Making Support in NOAA using Data as an Asset

Science.gov (United States)

Austin, M.; Peng, G.

2015-12-01

Data Producers and Data Providers do not always collaborate to ensure that the data meets the needs of a broad range of user communities. User needs are not always considered in the beginning of the data production and delivery phases. Often data experts are required to explain or create custom output so that the data can be used by decision makers. Lack of documentation and quality information can result in poor user acceptance or data misinterpretation. This presentation will describe how new content integration tools have been created by NOAA's National Environmental Satellite, Data, and Information Service (NESDIS) to improve quality throughout the data management lifecycle. The prototype integrates contents into a decision-making support tool from NOAA's Observing System Integrated Assessment (NOSIA) Value Tree, NOAA's Data Catalog/Digital Object Identifier (DOI) projects (collection-level metadata) and Data/Stewardship Maturity Matrices (Data and Stewardship Quality Rating Information). The National Centers for Environmental Information's (NCEI) Global Historical Climatology Network-Monthly (GHCN) dataset is used as a case study to formulate/develop the prototype tool and demonstrate its power with the content-centric approach in addition to completeness of metadata elements. This demonstrates the benefits of the prototype tool in both bottom roll-up and top roll-down fashion. The prototype tool delivers a standards based methodology that allows users to determine the quality and value of data that is fit for purpose. It encourages data producers and data providers/stewards to consider users' needs prior to data creation and dissemination resulting in user driven data requirements increasing return on investment.

Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups

Directory of Open Access Journals (Sweden)

Newton David

2010-07-01

Full Text Available Abstract Background Osteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care. Methods The conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology. Results Of the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in

Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial

NARCIS (Netherlands)

Oostendorp, L.J.M.; Ottevanger, P.B.; Donders, A.R.T.; Wouw, A.J. van de; Schoenaker, I.J.; Smilde, T.J.; Graaf, W.T.A. van der; Stalmeier, P.F.M.

2017-01-01

BACKGROUND: There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information

Aid to Families with Dependent Children Quality Control Review Panel Decisions

Data.gov (United States)

U.S. Department of Health & Human Services — Decisions issued by the Aid to Families with Dependent Children (AFDC) Quality Control Review Panel of the Departmental Appeals Board concerning the AFDC program...

A global, incremental development method for a web-based prostate cancer treatment decision aid and usability testing in a Dutch clinical setting

NARCIS (Netherlands)

Cuypers, M.; Lamers, R.E.D.; Kil, P.J.M.; The, R.; Karssen, K.; van de Poll-Franse, L.V.; de Vries, M.

2018-01-01

Many new decision aids are developed while aspects of existing decision aids could also be useful, leading to a sub-optimal use of resources. To support treatment decision-making in prostate cancer patients, a pre-existing evidence-based Canadian decision aid was adjusted to Dutch clinical setting.

Decision aids for multiple-decision disease management as affected by weather input errors.

Science.gov (United States)

Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

2011-06-01

Many disease management decision support systems (DSSs) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation, or estimation from off-site sources, may affect model calculations and management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

Intelligent decision aids for abnormal events in nuclear power plants

International Nuclear Information System (INIS)

Kafka, P.; Polke, H.

1988-01-01

German nuclear power plants are characterized by a high degree of automation, not only for normal operation but also for abnormal events. Therefore the role of the operating personnel is mainly a supervisory function. Nevertheless, for a spectrum of unexpected events the operating personnel have to react with manual recovery actions. In order to minimize human error in such recovery actions, different kinds of intelligent decision aid support the operators today. In this paper such aids are discussed and one of them is described in more detail. (author)

Expert system aided operator's mental activities training

International Nuclear Information System (INIS)

Gieci, A.; Macko, J.; Mosny, J.; Gese, A.

1994-01-01

The operator's mental activity is the most important part of his work. A processing of a large amount of the information by the operator is possible only if he/she possesses appropriate cognitive skills. To facilitate the novice's acquisition of the experienced operator's cognitive skills of the decision-making process a special type of the expert system was developed. The cognitive engineering's models and problem-solving methodology constitutes the basis of this expert system. The article gives an account of the prototype of the mentioned expert system developed to aid the whole mental activity of the nuclear power plant operator during his decision-making process. (author). 6 refs, 6 figs

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai'i.

Science.gov (United States)

Volandes, Angelo E; Paasche-Orlow, Michael K; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-09-01

Advance care planning (ACP) seeks to promote care delivery that is concordant with patients' informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. The city of Hilo in Hawai'i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) (P Hilo patients was $3,458 (95 % CI $3,051 to 3,865) lower per patient after the intervention when compared to the control region. Implementing ACP video decision aids was associated with improved ACP documentation, greater use of hospice, and decreased costs. Decision aids that promote ACP offer a scalable and cost-efficient medium to place patients at the center of their care.

Decision support aids with anthropomorphic characteristics influence trust and performance in younger and older adults.

Science.gov (United States)

Pak, Richard; Fink, Nicole; Price, Margaux; Bass, Brock; Sturre, Lindsay

2012-01-01

This study examined the use of deliberately anthropomorphic automation on younger and older adults' trust, dependence and performance on a diabetes decision-making task. Research with anthropomorphic interface agents has shown mixed effects in judgments of preferences but has rarely examined effects on performance. Meanwhile, research in automation has shown some forms of anthropomorphism (e.g. etiquette) have effects on trust and dependence on automation. Participants answered diabetes questions with no-aid, a non-anthropomorphic aid or an anthropomorphised aid. Trust and dependence in the aid was measured. A minimally anthropomorphic aide primarily affected younger adults' trust in the aid. Dependence, however, for both age groups was influenced by the anthropomorphic aid. Automation that deliberately embodies person-like characteristics can influence trust and dependence on reasonably reliable automation. However, further research is necessary to better understand the specific aspects of the aid that affect different age groups. Automation that embodies human-like characteristics may be useful in situations where there is under-utilisation of reasonably reliable aids by enhancing trust and dependence in that aid. Practitioner Summary: The design of decision-support aids on consumer devices (e.g. smartphones) may influence the level of trust that users place in that system and their amount of use. This study is the first step in articulating how the design of aids may influence user's trust and use of such systems.

Investigational Clinical Trial of a Prototype Optoelectronic Computer-Aided Navigation Device for Dental Implant Surgery.

Science.gov (United States)

Jokstad, Asbjørn; Winnett, Brenton; Fava, Joseph; Powell, David; Somogyi-Ganss, Eszter

New digital technologies enable real-time computer-aided (CA) three-dimensional (3D) guidance during dental implant surgery. The aim of this investigational clinical trial was to demonstrate the safety and effectiveness of a prototype optoelectronic CA-navigation device in comparison with the conventional approach for planning and effecting dental implant surgery. Study participants with up to four missing teeth were recruited from the pool of patients referred to the University of Toronto Graduate Prosthodontics clinic. The first 10 participants were allocated to either a conventional or a prototype device study arm in a randomized trial. The next 10 participants received implants using the prototype device. All study participants were restored with fixed dental prostheses after 3 (mandible) or 6 (maxilla) months healing, and monitored over 12 months. The primary outcome was the incidence of any surgical, biologic, or prosthetic adverse events or device-related complications. Secondary outcomes were the incidence of positioning of implants not considered suitable for straightforward prosthetic restoration (yes/no); the perception of the ease of use of the prototype device by the two oral surgeons, recorded by use of a Likert-type questionnaire; and the clinical performance of the implant and superstructure after 1 year in function. Positioning of the implants was appraised on periapical radiographs and clinical photographs by four independent blinded examiners. Peri-implant bone loss was measured on periapical radiographs by a blinded examiner. No adverse events occurred related to placing any implants. Four device-related complications led to a switch from using the prototype device to the conventional method. All implants placed by use of the prototype device were in a position considered suitable for straightforward prosthetic restoration (n = 21). The qualitative evaluation by the surgeons was generally positive, although ergonomic challenges were identified

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

Science.gov (United States)

Zhao, Yufeng; Liu, Bo; He, Liyun; Bai, Wenjing; Yu, Xueyun; Cao, Xinyu; Luo, Lin; Rong, Peijing; Zhao, Yuxue; Li, Guozheng; Liu, Baoyan

2017-09-01

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 byWestern 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.

Development of a decision aid for energy resource management for the Navajo Nation incorporating environmental cultural values

Science.gov (United States)

Necefer, Len Edward

Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided

Using linguistic descriptions with multi-criteria decision aid approaches in urban energy systems

OpenAIRE

Afsordegan, Arayeh; Sánchez Soler, Monica; Agell Jané, Núria; Gamboa Jimenez, Gonzalo; Cremades Oliver, Lázaro Vicente

2015-01-01

Multi-Criteria Decision Aid (MCDA) methods include various collections of mathematical techniques related to decision support systems in non-deterministic environments to support such applications as facility management, disaster management and urban planning. This paper applies MCDA approaches based on qualitative reasoning techniques with linguistic labels assessment. The aim of this method is ranking multi-attribute alternatives in group decision-making with qualitative labels. Finally ...

Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

NARCIS (Netherlands)

Brouwer, E.; Ozbugday, F.C.

2011-01-01

This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

NARCIS (Netherlands)

Brouwer, E.; Ozbugday, F.C.

2010-01-01

This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

Decision aiding in public policy generation and implementation: a multicriteria approach to evaluate territorial resilience

Directory of Open Access Journals (Sweden)

Maria Franca Norese

2016-12-01

Full Text Available A decision aid process should be the result of an interaction between analysts, decision makers and stakeholders. Decision aiding is sometimes required when the problem situation is new and a formal decision system does not exist. Its role becomes that of facilitating the Intelligence phase of a decision process. In other situations, a criticism of certain policy making processes and their use of data, which may be available in institutional databases or are required as indicators for the decision process, motivates an intervention oriented towards structure knowledge and improvements of these processes. A preliminary study, which includes modelling and application of multi-criteria methods, can clarify a complex and new situation, propose a consistent approach for the later phases of a decision process or propose a different and more effective use of the data. A case study is proposed here to describe this methodological approach in relation to the disaster resilience of municipalities near the mbrone River, in Tuscany (Italy.

Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice

Directory of Open Access Journals (Sweden)

Tulledge-Scheitel Sidna M

2009-12-01

Full Text Available Abstract Background Bisphosphonates can reduce fracture risk in patients with osteoporosis, but many at-risk patients do not start or adhere to these medications. The aims of this study are to: (1 preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid (OSTEOPOROSIS CHOICE for postmenopausal women at risk for osteoporotic fractures; and (2 assess the feasibility and validity (i.e., absence of contamination of patient-level randomization (vs. cluster randomization in pilot trials of decision aid efficacy. Methods/Design This is a protocol for a parallel, 2-arm, randomized trial to compare an intervention group receiving OSTEOPOROSIS CHOICE to a control group receiving usual primary care. Postmenopausal women with bone mineral density T-scores of STEOPOROSIS CHOICE on five outcomes: (a patient knowledge regarding osteoporosis risk factors and treatment; (b quality of the decision-making process for both the patient and clinician; (c patient and clinician acceptability and satisfaction with the decision aid; (d rate of bisphosphonate use and adherence, and (e trial processes (e.g., ability to recruit participants, collect patient outcomes. To capture these outcomes, we will use patient and clinician surveys following each visit and video recordings of the clinical encounters. These video recordings will also allow us to determine the extent to which clinicians previously exposed to the decision aid were able to recreate elements of the decision aid with control patients (i.e., contamination. Pharmacy prescription profiles and follow-up phone interviews will assess medication start and adherence at 6 months. Discussion This pilot trial will provide evidence of feasibility, validity of patient randomization, and preliminary efficacy of a novel approach -- decision aids -- to improving medication adherence for postmenopausal women at risk of osteoporotic fractures. The results will inform

Prototype of Decision Support System Development in Determining Raskin Recipients Candidate

Directory of Open Access Journals (Sweden)

D. Desriyanti

2017-10-01

Full Text Available Decision-making support systems for beneficiaries deserving of the poor are a decision support system that can be used as a tool for assessing the feasibility of providing assistance. The established system only knows the rankings of the population proposals, the population data that has not been stored in the population database, the population data that has not been integrated with the data category, the criteria data, and value data so it requires the process of data input. In the process of data collection methods used are Interviews, Observation, Documentation, Literature Review while the software development methodology used is Prototype. The process of making software by using Macromedia Dreamweaver, language programming used is PHP, Javascript, HTML, and Cascading Style Sheet (CSS. This research aims 1 Make the development of decision support system in giving assistance for the poor in Cekok Ponorogo. 2 Conduct the mapping for proposed poor family and received assistance in graphic form. The conclusions of the development of decision support systems are; 1 Population data stored in the form of database that facilitate the process of searching data. 2 The Recorded of the proposed data and who received assistance for each hamlet in Kelurahan Cekok Ponorogo in the form of a graph. 3 Reduce errors in the submission the proposed data of potential beneficiaries

Regional Climate Change and Development of Public Health Decision Aids

Science.gov (United States)

Hegedus, A. M.; Darmenova, K.; Grant, F.; Kiley, H.; Higgins, G. J.; Apling, D.

2011-12-01

According to the World Heath Organization (WHO) climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations. Worldwide, the occurrence of some diseases and other threats to human health depend predominantly on local climate patterns. Rising average temperatures, in combination with changing rainfall patterns and humidity levels, alter the lifecycle and regional distribution of certain disease-carrying vectors, such as mosquitoes, ticks and rodents. In addition, higher surface temperatures will bring heat waves and heat stress to urban regions worldwide and will likely increase heat-related health risks. A growing body of scientific evidence also suggests an increase in extreme weather events such as floods, droughts and hurricanes that can be destructive to human health and well-being. Therefore, climate adaptation and health decision aids are urgently needed by city planners and health officials to determine high risk areas, evaluate vulnerable populations and develop public health infrastructure and surveillance systems. To address current deficiencies in local planning and decision making with respect to regional climate change and its effect on human health, our research is focused on performing a dynamical downscaling with the Weather Research and Forecasting (WRF) model to develop decision aids that translate the regional climate data into actionable information for users. WRF model is initialized with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model simulations forced with the Special Report on Emissions (SRES) A1B emissions scenario. Our methodology involves development of climatological indices of extreme weather, quantifying the risk of occurrence of water/rodent/vector-borne diseases as well as developing various heat stress related decision aids. Our results indicate that the downscale simulations provide the necessary

Exploring the use of Option Grid™ patient decision aids in a sample of clinics in Poland.

Science.gov (United States)

Scalia, Peter; Elwyn, Glyn; Barr, Paul; Song, Julia; Zisman-Ilani, Yaara; Lesniak, Monika; Mullin, Sarah; Kurek, Krzysztof; Bushell, Matt; Durand, Marie-Anne

2018-05-29

Research on the implementation of patient decision aids to facilitate shared decision making in clinical settings has steadily increased across Western countries. A study which implements decision aids and measures their impact on shared decision making has yet to be conducted in the Eastern part of Europe. To study the use of Option Grid TM patient decision aids in a sample of Grupa LUX MED clinics in Warsaw, Poland, and measure their impact on shared decision making. We conducted a pre-post interventional study. Following a three-month period of usual care, clinicians from three Grupa LUX MED clinics received a one-hour training session on how to use three Option Grid TM decision aids and were provided with copies for use for four months. Throughout the study, all eligible patients were asked to complete the three-item CollaboRATE patient-reported measure of shared decision making after their clinical encounter. CollaboRATE enables patients to assess the efforts clinicians make to: (i) inform them about their health issues; (ii) listen to 'what matters most'; (iii) integrate their treatment preference in future plans. A Hierarchical Logistic Regression model was performed to understand which variables had an effect on CollaboRATE. 2,048 patients participated in the baseline phase; 1,889 patients participated in the intervention phase. Five of the thirteen study clinicians had a statistically significant increase in their CollaboRATE scores (pOption Grid TM helped some clinicians practice shared decision making as reflected in CollaboRATE scores, but most clinicians did not have a significant increase in their scores. Our study indicates that the effect of these interventions may be dependent on clinic contexts and clinician engagement. Copyright © 2018. Published by Elsevier GmbH.

Breast cancer anxiety's associations with responses to a chemoprevention decision aid.

Science.gov (United States)

Dillard, Amanda J; Scherer, Laura; Ubel, Peter A; Smith, Dylan M; Zikmund-Fisher, Brian J; McClure, Jennifer B; Greene, Sarah; Stark, Azadeh; Fagerlin, Angela

2013-01-01

Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women's anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes. Copyright © 2012 Elsevier Ltd. All rights reserved.

The second iteration of the Systems Prioritization Method: A systems prioritization and decision-aiding tool for the Waste Isolation Pilot Plant: Volume 2, Summary of technical input and model implementation

Energy Technology Data Exchange (ETDEWEB)

Prindle, N.H.; Mendenhall, F.T.; Trauth, K.; Boak, D.M. [Sandia National Labs., Albuquerque, NM (United States); Beyeler, W. [Science Applications International Corp., Albuquerque, NM (United States); Hora, S. [Hawaii Univ., Hilo, HI (United States); Rudeen, D. [New Mexico Engineering Research Inst., Albuquerque, NM (United States)

1996-05-01

The Systems Prioritization Method (SPM) is a decision-aiding tool developed by Sandia National Laboratories (SNL). SPM provides an analytical basis for supporting programmatic decisions for the Waste Isolation Pilot Plant (WIPP) to meet selected portions of the applicable US EPA long-term performance regulations. The first iteration of SPM (SPM-1), the prototype for SPM< was completed in 1994. It served as a benchmark and a test bed for developing the tools needed for the second iteration of SPM (SPM-2). SPM-2, completed in 1995, is intended for programmatic decision making. This is Volume II of the three-volume final report of the second iteration of the SPM. It describes the technical input and model implementation for SPM-2, and presents the SPM-2 technical baseline and the activities, activity outcomes, outcome probabilities, and the input parameters for SPM-2 analysis.

The second iteration of the Systems Prioritization Method: A systems prioritization and decision-aiding tool for the Waste Isolation Pilot Plant: Volume 2, Summary of technical input and model implementation

International Nuclear Information System (INIS)

Prindle, N.H.; Mendenhall, F.T.; Trauth, K.; Boak, D.M.; Beyeler, W.; Hora, S.; Rudeen, D.

1996-05-01

The Systems Prioritization Method (SPM) is a decision-aiding tool developed by Sandia National Laboratories (SNL). SPM provides an analytical basis for supporting programmatic decisions for the Waste Isolation Pilot Plant (WIPP) to meet selected portions of the applicable US EPA long-term performance regulations. The first iteration of SPM (SPM-1), the prototype for SPM< was completed in 1994. It served as a benchmark and a test bed for developing the tools needed for the second iteration of SPM (SPM-2). SPM-2, completed in 1995, is intended for programmatic decision making. This is Volume II of the three-volume final report of the second iteration of the SPM. It describes the technical input and model implementation for SPM-2, and presents the SPM-2 technical baseline and the activities, activity outcomes, outcome probabilities, and the input parameters for SPM-2 analysis

Aiding the Interpretation of Ancient Documents

DEFF Research Database (Denmark)

Roued-Cunliffe, Henriette

How can Decision Support System (DSS) software aid the interpretation process involved in the reading of ancient documents? This paper discusses the development of a DSS prototype for the reading of ancient texts. In this context the term ‘ancient documents’ is used to describe mainly Greek...... tool it is important first to comprehend the interpretation process involved in reading ancient documents. This is not a linear process but rather a recursive process where the scholar moves between different levels of reading, such as ‘understanding the meaning of a character’ or ‘understanding...

A decision support system for the reading of ancient documents

DEFF Research Database (Denmark)

Roued-Cunliffe, Henriette

2011-01-01

The research presented in this thesis is based in the Humanities discipline of Ancient History and begins by attempting to understand the interpretation process involved in reading ancient documents and how this process can be aided by computer systems such as Decision Support Systems (DSS...... this process in the five areas: remembering complex reasoning, searching huge datasets, international collaboration, publishing editions, and image enhancement. This research contains a large practical element involving the development of a DSS prototype. The prototype is used to illustrate how a DSS......, by remembering complex reasoning, can aid the process of interpretation that is reading ancient documents. It is based on the idea that the interpretation process goes through a network of interpretation. The network of interpretation illustrates a recursive process where scholars move between reading levels...

Long-term health outcomes of a decision aid: data from a randomized trial of adjuvant! In women with localized breast cancer.

Science.gov (United States)

Vickers, Andrew J; Elkin, Elena B; Peele, Pamela B; Dickler, Maura; Siminoff, Laura A

2009-01-01

Women with localized breast cancer face difficult decisions about adjuvant therapy. Several decision aids are available to help women choose between treatment options. Decision aids are known to affect treatment choices and may therefore affect patient survival. The authors aimed to model the effects of the Adjuvant! decision aid on expected survival in women with early stage breast cancer. Data were obtained from a randomized trial of Adjuvant! (n = 395). To calculate the effects of the decision aid on survival, the authors used the Adjuvant! survival predictions as a surrogate endpoint. Data from each arm were entered separately into statistical models to estimate change in survival associated with receiving the Adjuvant! decision aid. Most women (approximately 85%) chose a treatment option that maximized predicted survival. The effects of the decision aid on outcome could not be modeled because a small number of women (n = 12, 3%) chose treatment options associated with a large (5%-14%) loss in survival. These women-most typically estrogen receptor positive but refusing hormonal therapy-were equally divided between Adjuvant! and control groups and were not distinguished by medical or demographic factors. Expected benefit from treatment is a key variable in understanding patient behavior. A small number of women refuse adjuvant treatment associated with large increases in predicted survival, even when they are explicitly informed about the degree of benefit they would forgo. Investigation of the effects of decision aids on cancer survival is unlikely to be fruitful due to power considerations.

Evaluation of a prototype decision support system for selecting trench cap designs

International Nuclear Information System (INIS)

Paige, G.B.; Stone, J.J.; Lane, L.J.

1996-01-01

A computer-based prototype decision support system (PDSS) to assist the risk manager in selecting an appropriate trench cap design for waste disposal sites is evaluated. The selection of the open-quotes bestclose quotes design among feasible alternatives requires consideration of multiple and often conflicting objectives. The methodology used in the selection process consists of. selecting and parameterizing decision variables, using data, simulation models, or expert opinion; selecting feasible trench cap design alternatives; ordering the decision variables and ranking the design alternatives. The simulation models incorporated in the PDSS are the Hydrologic Evaluation of Landfill Performance (HELP) model which is used to simulate the trench cap water balance and the Chemicals, Runoff, and Erosion from Agricultural Management Systems (CREAMS) erosion component that is used to simulate trench cap erosion. The decision model is based on multi-objective decision theory and uses a unique approach to order the decision variables and rank the design alternatives. The PDSS is evaluated using the Hill Air Force Base landfill cover demonstration project. The water balance and surface erosion of four alternative landfill cover designs were monitored for a 4-yr period. Two of the cover designs were used to calibrate and test the simulation models. The results of the PDSS, using both data from all four designs and long-term simulations from two of the designs, illustrate the relative advantages of each of the cover designs and which cover is the open-quotes bestclose quotes alternative for a given set of criteria and a particular importance order of those decision criteria. 22 refs., 6 figs., 4 tabs

Which Cooperative Ownership Model Performs Better? A Financial-Decision Aid Approach

NARCIS (Netherlands)

Kalogeras, N.; Pennings, J.M.E.; Benos, T.; Doumpos, M.

2013-01-01

In this article the financial/ownership structures of agribusiness cooperatives are analyzed to examine whether new cooperative models perform better than the more traditional ones. The assessment procedure introduces a new financial decision-aid approach, which is based on data-analysis techniques

Assessing the quality of decision support technologies using the International Patient Decision Aid Standards instrument (IPDASi.

Directory of Open Access Journals (Sweden)

Glyn Elwyn

Full Text Available To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids.Scale development study, involving construct, item and scale development, validation and reliability testing.There has been increasing use of decision support technologies--adjuncts to the discussions clinicians have with patients about difficult decisions. A global interest in developing these interventions exists among both for-profit and not-for-profit organisations. It is therefore essential to have internationally accepted standards to assess the quality of their development, process, content, potential bias and method of field testing and evaluation.Scale development study, involving construct, item and scale development, validation and reliability testing.Twenty-five researcher-members of the International Patient Decision Aid Standards Collaboration worked together to develop the instrument (IPDASi. In the fourth Stage (reliability study, eight raters assessed thirty randomly selected decision support technologies.IPDASi measures quality in 10 dimensions, using 47 items, and provides an overall quality score (scaled from 0 to 100 for each intervention. Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sampled (n = 30, enabling discrimination. The inter-rater intraclass correlation for the overall quality score was 0.80. Correlations of dimension scores with the overall score were all positive (0.31 to 0.68. Cronbach's alpha values for the 8 raters ranged from 0.72 to 0.93. Cronbach's alphas based on the dimension means ranged from 0.50 to 0.81, indicating that the dimensions, although well correlated, measure different aspects of decision support technology quality. A short version (19 items was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 (CI 0.79 to 0.92.This work

Studies and Analyses of Aided Adversarial Decision Making. Phase 2: Research on Human Trust in Automation

National Research Council Canada - National Science Library

Llinas, James

1998-01-01

.... Given that offensive IW operations may interfere with automated, data-fusion based decision aids, it is necessary to understand how personnel may rely on or trust these aids when appropriate (e.g...

How do patients between the age of 65 and 75 use a web-based decision aid for treatment choice in localized prostate cancer?

Science.gov (United States)

Schrijvers, Jessie; Vanderhaegen, Joke; Van Poppel, Hendrik; Haustermans, Karin; Van Audenhove, Chantal

2013-08-01

This study was designed to evaluate the use of a web-based decision aid by a 65plus patient group in their decision-making process for treatment of localized prostate cancer. Of particular interest was the use of technology features such as patients' statements, comparative tables, and a values clarification tool. One hundred men from the University Hospital of Leuven campus, Gasthuisberg, were invited to use the web-based decision aid in their decision-making process. Twenty-six men were excluded based on non- or limited use of the decision aid. Of the remaining 74 men, user specifications, decision aid surfing characteristics by means of web-log data, and especially the use of technology features were analyzed. Men spent on average 30 minutes on the web-based decision aid. Most time was spent on the pages with information on treatment options. These pages were also most frequently accessed. The use of the feature 'comparative tables' was the highest, followed by the 'values clarification tool'. According to age (70 years) differences were observed for the time spent on the decision aid, the pages accessed, and the use of the technology features. Despite concerns about the usability of a web-based decision aid for elderly patients, these results indicated that the majority of 65plus persons with good internet skills use a web-based decision aid as well as its incorporated technology features. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

A platform independent prototype for data and information exchange between decision support systems

International Nuclear Information System (INIS)

Carle, B.; Baig, S.

2003-01-01

Full text: A survey amongst participants in the Decision Support System network (DSSNET) community showed that the organization dealing with the Information exchange between participants and stakeholders in nuclear emergency is too disparate to be defined in one well defined procedure or analysis. Looking at the organization of the national emergency response organizations, and especially when modelling the information flow, diversity is the most striking finding: originators of the information are different, decision making organisation can be different, the approval and publishing of information to press and wider public is dealt with in different ways and the responsibilities for the information flow to other authorities differ as well. Moreover, the place of decision support systems (DSS) in the emergency response organization varies for the different countries. This variation can be found in the way one of the 'big three' (RODOS, ARGOS and RECASS) systems is implemented, and even more in the way other, often country-specific systems, are in use and function more integrated with the particular emergency response organization of the country. Hence we can conclude that there is a need to structure the information exchange system, but this has to be flexible enough to work with the above described variety of existing organizations and procedures. Though it may not be feasible to agree on all specifications of information to be exchanged, we can define at least a minimal set. A prototype for data and information exchange is being developed under the EC project MODEM (Monitoring data and Information exchange among decision support systems). It establishes links between the decision support systems RODOS, ARGOS and RECASS. For setting up this data exchange, the use of xml-based data specifications allows a flexible integration with existing applications. The power to include metadata in a structured way allows the use of automated transformation tools and limits the

Iteration and Prototyping in Creating Technical Specifications.

Science.gov (United States)

Flynt, John P.

1994-01-01

Claims that the development process for computer software can be greatly aided by the writers of specifications if they employ basic iteration and prototyping techniques. Asserts that computer software configuration management practices provide ready models for iteration and prototyping. (HB)

Psychosocial Factors of Health Professionals' Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study.

Science.gov (United States)

Abbasgholizadeh Rahimi, Samira; Lépine, Johanie; Croteau, Jordie; Robitaille, Hubert; Giguere, Anik Mc; Wilson, Brenda J; Rousseau, François; Lévesque, Isabelle; Légaré, France

2018-04-25

Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women's knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals' intention to use a decision aid. Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk.

Science.gov (United States)

Willis, Amanda M; Smith, Sian K; Meiser, Bettina; Ballinger, Mandy L; Thomas, David M; Tattersall, Martin; Young, Mary-Anne

2018-02-17

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.

Review of Multi-Criteria Decision Aid for Integrated Sustainability Assessment of Urban Water Systems - MCEARD

Science.gov (United States)

Integrated sustainability assessment is part of a new paradigm for urban water decision making. Multi-criteria decision aid (MCDA) is an integrative framework used in urban water sustainability assessment, which has a particular focus on utilising stakeholder participation. Here ...

Perceptions of shared decision making and decision aids among rural primary care clinicians.

Science.gov (United States)

King, Valerie J; Davis, Melinda M; Gorman, Paul N; Rugge, J Bruin; Fagnan, L J

2012-01-01

Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs. To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs. Cross-sectional survey. Setting and Participants Primary care clinicians affiliated with the Oregon Rural Practice-based Research Network. Surveys were returned by 181 of 231 eligible participants (78%); 174 could be analyzed. Two-thirds of participants were physicians, 84% practiced family medicine, and 55% were male. Sixty-five percent of respondents were unfamiliar with the term shared decision making, but following definition, 97% reported that they found the approach useful for conditions with multiple treatment options. Over 90% of clinicians perceived helping patients make decisions regarding chronic pain and health behavior change as moderate/hard in difficulty. Although 69% of respondents preferred that patients play an equal role in making decisions, they estimate that this happens only 35% of the time. Time was reported as the largest barrier to engaging in SDM (63%). Respondents were receptive to using DAs to facilitate SDM in print- (95%) or web-based formats (72%), and topic preference varied by clinician specialty and decision difficulty. Rural clinicians recognized the value of SDM and were receptive to using DAs in multiple formats. Integration of DAs to facilitate SDM in routine patient care may require addressing practice operation and reimbursement.

A decision aid for men with early stage prostate cancer: theoretical basis and a test by surrogate patients

Science.gov (United States)

Feldman‐Stewart, Deb; Brundage, Michael D.; Van Manen, Lori

2008-01-01

Background We developed a decision aid for patients with curable prostate cancer based on Svenson’s DiffCon Theory of Decision Making. This study was designed to determine if surrogate patients using the aid could understand the information presented, complete all tasks, show evidence of differentiation, and arrive at a preferred treatment choice. Methods Men, at least 50 years old and never diagnosed with prostate cancer, were recruited through local advertisements. Participants were asked to imagine that they were a case‐scenario patient. Then they completed the decision aid interview, which included three components: (i) information presentation, with comprehension questions, (ii) exercises to help identify attributes important to the decision, and (iii) value‐clarification exercises. Results Sixty‐nine men volunteered. They had a mean age of 61.2 (range 50–83) years, 37% had no formal education beyond high school, and 87% were living with a partner. All participants completed all aspects of the interview. They answered an average of 10 comprehension questions each, with a mean of 94.7% correct without a prompt. Each attribute in the information presented was identified by at least one participant as important to his decision. Participants identified a median of five attributes as important (ranges 1–14) at each of three points during the interview; 75% changed at least one important attribute during the interview. Forty‐nine per cent of participants also identified attributes as important that were not included in the presented information. Participants showed a wide range of values in each of seven trade‐off exercises. Eighty‐eight per cent of participants showed evidence of differentiation; 75% had a clear treatment preference by the end of the interview. Conclusions Our decision aid appears to meet its goals for surrogate patients and illustrates the strengths of the DiffCon theory. The ability of the aid to accommodate wide

Computer Aided Analysis and Prototype Testing of an Improved Biogas Reactor For Biomass System

Directory of Open Access Journals (Sweden)

Jeremy (Zheng Li

2015-05-01

Full Text Available The alternative fuel resources substituting for conventional fuels are required due to less availability of fuel resources than demand in the market. A large amount of crude oil and petroleum products are required to be imported in many countries over the world. Also the environmental pollution is another serious problem when use petroleum products. Biogas, with the composition of 54.5% CH4, 39.5% CO2, and 6% other elements (i.e., H2, N2, H2S, and O2, is a clear green fuel that can substitute the regular petroleum fuels to reduce the pollutant elements. Biogas can be produced by performing enriching, scrubbing, and bottling processes. The purification process can be further applied to take away the pollutants in biogas. The pure biogas process analyzed in this research is compressed to 2950 psi while being filled into gas cylinder. The daily produced biogas capacity is around 5480 ft3 and the processing efficacy is affected by surrounding environment and other factors. The design and development of this biogas system is assisted through mathematical analysis, 3D modeling, computational simulation, and prototype testing. Both computer aided analysis and prototype testing show close results which validate the feasibility of this biogas system in biomass applications.

Development of a prototype graphic simulation program for severe accident training

International Nuclear Information System (INIS)

Kim, Ko Ryu; Jeong, Kwang Sub; Ha, Jae Joo

2000-05-01

This is a report of the development process and related technologies of severe accident graphic simulators, required in industrial severe accident management and training. Here, we say 'a severe accident graphic simulator' as a graphics add-in system to existing calculation codes, which can show the severe accident phenomena dynamically on computer screens and therefore which can supplement one of main defects of existing calculation codes. With graphic simulators it is fairly easy to see the total behavior of nuclear power plants, where it was very difficult to see only from partial variable numerical information. Moreover, the fast processing and control feature of a graphic simulator can give some opportunities of predicting the severe accident advancement among several possibilities, to one who is not an expert. Utilizing graphic simulators' we expect operators' and TSC members' physical phenomena understanding enhancement from the realistic dynamic behavior of plants. We also expect that severe accident training course can gain better training effects using graphic simulator's control functions and predicting capabilities, and therefore we expect that graphic simulators will be effective decision-aids tools both in sever accident training course and in real severe accident situations. With these in mind, we have developed a prototype graphic simulator having surveyed related technologies, and from this development experiences we have inspected the possibility to build a severe accident graphic simulator. The prototype graphic simulator is developed under IBM PC WinNT environments and is suited to Uljin 3and4 nuclear power plant. When supplied with adequate severe accident scenario as an input, the prototype can provide graphical simulations of plant safety systems' dynamic behaviors. The prototype is composed of several different modules, which are phenomena display module, MELCOR data interface module and graphic database interface module. Main functions of

Rapid prototyping and stereolithography in dentistry

Science.gov (United States)

Nayar, Sanjna; Bhuminathan, S.; Bhat, Wasim Manzoor

2015-01-01

The word rapid prototyping (RP) was first used in mechanical engineering field in the early 1980s to describe the act of producing a prototype, a unique product, the first product, or a reference model. In the past, prototypes were handmade by sculpting or casting, and their fabrication demanded a long time. Any and every prototype should undergo evaluation, correction of defects, and approval before the beginning of its mass or large scale production. Prototypes may also be used for specific or restricted purposes, in which case they are usually called a preseries model. With the development of information technology, three-dimensional models can be devised and built based on virtual prototypes. Computers can now be used to create accurately detailed projects that can be assessed from different perspectives in a process known as computer aided design (CAD). To materialize virtual objects using CAD, a computer aided manufacture (CAM) process has been developed. To transform a virtual file into a real object, CAM operates using a machine connected to a computer, similar to a printer or peripheral device. In 1987, Brix and Lambrecht used, for the first time, a prototype in health care. It was a three-dimensional model manufactured using a computer numerical control device, a type of machine that was the predecessor of RP. In 1991, human anatomy models produced with a technology called stereolithography were first used in a maxillofacial surgery clinic in Viena. PMID:26015715

Rapid prototyping and stereolithography in dentistry.

Science.gov (United States)

Nayar, Sanjna; Bhuminathan, S; Bhat, Wasim Manzoor

2015-04-01

The word rapid prototyping (RP) was first used in mechanical engineering field in the early 1980s to describe the act of producing a prototype, a unique product, the first product, or a reference model. In the past, prototypes were handmade by sculpting or casting, and their fabrication demanded a long time. Any and every prototype should undergo evaluation, correction of defects, and approval before the beginning of its mass or large scale production. Prototypes may also be used for specific or restricted purposes, in which case they are usually called a preseries model. With the development of information technology, three-dimensional models can be devised and built based on virtual prototypes. Computers can now be used to create accurately detailed projects that can be assessed from different perspectives in a process known as computer aided design (CAD). To materialize virtual objects using CAD, a computer aided manufacture (CAM) process has been developed. To transform a virtual file into a real object, CAM operates using a machine connected to a computer, similar to a printer or peripheral device. In 1987, Brix and Lambrecht used, for the first time, a prototype in health care. It was a three-dimensional model manufactured using a computer numerical control device, a type of machine that was the predecessor of RP. In 1991, human anatomy models produced with a technology called stereolithography were first used in a maxillofacial surgery clinic in Viena.

Development and evaluation of a patient decision aid for young people and parents considering fixed orthodontic appliances.

Science.gov (United States)

Marshman, Zoe; Eddaiki, Abdussalam; Bekker, Hilary L; Benson, Philip E

2016-12-01

To develop and evaluate a child-centred patient decision aid for young people, and their parents, supporting shared decision making about fixed orthodontic appliance treatment with dental health professionals, namely the Fixed Appliance Decision Aid (FADA). The studies were undertaken in a UK teaching dental hospital orthodontic department in 2013-2014. The development phase involved an interview study with: (a) 10 patients (12-16 years old), and their parents, receiving orthodontic care to investigate treatment decision making and inform the content of the FADA and (b) 23 stakeholders critiquing the draft decision aid's content, structure and utility. The evaluation phase employed a pre-/post-test study design, with 30 patients (12-16 years old) and 30 parents. Outcomes included the Decisional Conflict Scale; measures of orthodontic treatment expectations and knowledge. Qualitative analysis identified two informational needs: effectiveness of treatment on orthodontic outcomes and treatment consequences for patients' lives. Quantitative analysis found decisional conflict reduced in both patients (mean difference -12.3, SD 15.3, 95% CI 6.6-17.9; p orthodontic treatment increased; expectations about care were unchanged. Using the FADA may enable dental professionals to support patients and their parents, decisions about fixed appliance treatments more effectively, ensuring young people's preferences are integrated into care planning.

Ecological rationality: a framework for understanding and aiding the aging decision maker.

Science.gov (United States)

Mata, Rui; Pachur, Thorsten; von Helversen, Bettina; Hertwig, Ralph; Rieskamp, Jörg; Schooler, Lael

2012-01-01

The notion of ecological rationality sees human rationality as the result of the adaptive fit between the human mind and the environment. Ecological rationality focuses the study of decision making on two key questions: First, what are the environmental regularities to which people's decision strategies are matched, and how frequently do these regularities occur in natural environments? Second, how well can people adapt their use of specific strategies to particular environmental regularities? Research on aging suggests a number of changes in cognitive function, for instance, deficits in learning and memory that may impact decision-making skills. However, it has been shown that simple strategies can work well in many natural environments, which suggests that age-related deficits in strategy use may not necessarily translate into reduced decision quality. Consequently, we argue that predictions about the impact of aging on decision performance depend not only on how aging affects decision-relevant capacities but also on the decision environment in which decisions are made. In sum, we propose that the concept of the ecological rationality is crucial to understanding and aiding the aging decision maker.

Building a prototype using Human-Centered design to engage older adults in healthcare decision-making.

Science.gov (United States)

Kumar, Ajit; Maskara, Sanjeev; Chiang, I-Jen

2014-01-01

The prevalence of chronic diseases and disabilities are higher in older adults, which is one of the key factors of rising health care costs. Health care stakeholders wish older adults to take more control of their health to delay the onset of age-related disabilities and chronic diseases. Engaging older adults in their health care decision making would cut down health care costs and prepare a health care system to be more sustainable. We used the Human-Centered Design approach to propose a prototype that more effectively engages older adults in their health care decision-making. Four participants from four different countries - Taiwan, USA, Austria, and Germany; and two facilitators from the USA participated in this study. The participants interviewed a total of four subjects in their respective countries. This study used the Human-Centered Design approach, which embraced three main phases - observation, identification, and ideation. Each phase involved brainstorming, voting, and consensus among participants. This study derived 14 insights, 20 categories, 4 themes, a conceptual framework, some potential solutions, and a prototype. This study showed that older adults could be engaged in their health care decision-making by offering them health care products and services that were user-friendly and technology enabled. A 'gradual change management plan' could assist older adults to adopt technologies more effectively. The health care products and services should be centered on the needs of older adults. Moreover, the possibilities of older adults maintaining control over their own health may rely on proper timing, a personal approach, right products, and services.

Development of a decision support system for assessing farm animal welfare in relation to husbandry systems: Strategy and prototype

NARCIS (Netherlands)

Bracke, M.B.M.; Metz, J.H.M.; Spruijt, B.M.; Dijkhuizen, A.A.

2001-01-01

Due to increasing empirical information on farm animal welfare since the 1960s, the prospects for sound decisionmaking concerning welfare have improved. This paper describes a strategy to develop a decision-making aid, a decision support system, for assessment of farm-animal welfare based on

Development and testing of a decision aid for women considering delayed breast reconstruction.

Science.gov (United States)

Metcalfe, Kelly; Zhong, Toni; O'Neill, Anne C; McCready, David; Chan, Linda; Butler, Kate; Brennenstuhl, Sarah; Hofer, Stefan O P

2018-03-01

The decision to have post-mastectomy breast reconstruction (PMBR) is highly complex and many women feel ill equipped to make this decision. Decision aids have been advocated to promote patient involvement in decision-making by streamlining and standardizing communication between the patient and the health care professional. In this study, we report on the development and testing of a decision aid (DA) for breast cancer survivors considering delayed PMBR. The DA was developed and evaluated in three phases. The first phase included the development of the DA with input and review by practitioners and key stakeholders. The second phase involved pilot testing of the feasibility and acceptability of the DA with a convenience sample of women with delayed PMBR. The third phase involved a pretest/post-test evaluation of the DA for women who were making decisions about their PMBR options. The DA was developed using the Ottawa Decision Support Framework. In the second phase of the study, 21 women completed the acceptability survey, of whom 100% reported that they would recommend the DA to other women. In the third phase, decisional conflict decreased significantly (p < 0.001) and knowledge increased significantly (p < 0.001) from prior to using the DA to 1-2 weeks after using the DA. The DA is feasible and acceptable to women considering delayed PMBR. Furthermore, the DA is effective at reducing decisional conflict and increasing knowledge about delayed PMBR. The DA is an appropriate tool to be used in addition with standard care in women considering PMBR. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Decision optimization of case-based computer-aided decision systems using genetic algorithms with application to mammography

International Nuclear Information System (INIS)

Mazurowski, Maciej A; Habas, Piotr A; Zurada, Jacek M; Tourassi, Georgia D

2008-01-01

This paper presents an optimization framework for improving case-based computer-aided decision (CB-CAD) systems. The underlying hypothesis of the study is that each example in the knowledge database of a medical decision support system has different importance in the decision making process. A new decision algorithm incorporating an importance weight for each example is proposed to account for these differences. The search for the best set of importance weights is defined as an optimization problem and a genetic algorithm is employed to solve it. The optimization process is tailored to maximize the system's performance according to clinically relevant evaluation criteria. The study was performed using a CAD system developed for the classification of regions of interests (ROIs) in mammograms as depicting masses or normal tissue. The system was constructed and evaluated using a dataset of ROIs extracted from the Digital Database for Screening Mammography (DDSM). Experimental results show that, according to receiver operator characteristic (ROC) analysis, the proposed method significantly improves the overall performance of the CAD system as well as its average specificity for high breast mass detection rates

Identifying design considerations for a shared decision aid for use at the point of outpatient clinical care: An ethnographic study at an inner city clinic.

Science.gov (United States)

Hajizadeh, Negin; Perez Figueroa, Rafael E; Uhler, Lauren M; Chiou, Erin; Perchonok, Jennifer E; Montague, Enid

2013-03-06

Computerized decision aids could facilitate shared decision-making at the point of outpatient clinical care. The objective of this study was to investigate whether a computerized shared decision aid would be feasible to implement in an inner-city clinic by evaluating the current practices in shared decision-making, clinicians' use of computers, patient and clinicians' attitudes and beliefs toward computerized decision aids, and the influence of time on shared decision-making. Qualitative data analysis of observations and semi-structured interviews with patients and clinicians at an inner-city outpatient clinic. The findings provided an exploratory look at the prevalence of shared decision-making and attitudes about health information technology and decision aids. A prominent barrier to clinicians engaging in shared decision-making was a lack of perceived patient understanding of medical information. Some patients preferred their clinicians make recommendations for them rather than engage in formal shared decision-making. Health information technology was an integral part of the clinic visit and welcomed by most clinicians and patients. Some patients expressed the desire to engage with health information technology such as viewing their medical information on the computer screen with their clinicians. All participants were receptive to the idea of a decision aid integrated within the clinic visit although some clinicians were concerned about the accuracy of prognostic estimates for complex medical problems. We identified several important considerations for the design and implementation of a computerized decision aid including opportunities to: bridge clinician-patient communication about medical information while taking into account individual patients' decision-making preferences, complement expert clinician judgment with prognostic estimates, take advantage of patient waiting times, and make tasks involved during the clinic visit more efficient. These findings

Decision aid on breast cancer screening reduces attendance rate: results of a large-scale, randomized, controlled study by the DECIDEO group

Science.gov (United States)

Bourmaud, Aurelie; Soler-Michel, Patricia; Oriol, Mathieu; Regnier, Véronique; Tinquaut, Fabien; Nourissat, Alice; Bremond, Alain; Moumjid, Nora; Chauvin, Franck

2016-01-01

Controversies regarding the benefits of breast cancer screening programs have led to the promotion of new strategies taking into account individual preferences, such as decision aid. The aim of this study was to assess the impact of a decision aid leaflet on the participation of women invited to participate in a national breast cancer screening program. This Randomized, multicentre, controlled trial. Women aged 50 to 74 years, were randomly assigned to receive either a decision aid or the usual invitation letter. Primary outcome was the participation rate 12 months after the invitation. 16 000 women were randomized and 15 844 included in the modified intention-to-treat analysis. The participation rate in the intervention group was 40.25% (3174/7885 women) compared with 42.13% (3353/7959) in the control group (p = 0.02). Previous attendance for screening (RR = 6.24; [95%IC: 5.75-6.77]; p < 0.0001) and medium household income (RR = 1.05; [95%IC: 1.01-1.09]; p = 0.0074) were independently associated with attendance for screening. This large-scale study demonstrates that the decision aid reduced the participation rate. The decision aid activate the decision making process of women toward non-attendance to screening. These results show the importance of promoting informed patient choices, especially when those choices cannot be anticipated. PMID:26883201

A Framework of a Computerized Decision Aid to Improve Group Judgments

Directory of Open Access Journals (Sweden)

Utpal Bose

2009-09-01

Full Text Available In organizations, groups of decision makers often meet to make judgments as a group on issues and tasks such as, hiring a person who best fits an open position. In such tasks called cognitive conflict tasks, where there is no conflict of interest, group members attempting to reach a common solution often differ on their perspectives to the problem. Cognitive conflicts have been studied in the context of Social Judgment Theory, which posits that persons or judges make a set of judgments about a set of events based on observation of a set of cues related to the events. Disagreement arises because the judges fail to understand each other’s judgment making policies. In order to reduce disagreement and move the group towards a group judgment policy that has the consensus of the group members and is applied consistently, a computerized decision aid is proposed that can be built around a Group Support System using cognitive mapping as a method of providing cognitive feedback and the Analytic Hierarchy Process to process the conflicting criteria and help an individual formulate a judgment policy, as well as aggregate the individual policies into a group judgment policy. It is argued that such as decision aid by supporting every decision maker in the group to effectively use information about the task so that they have a good understanding of the judgment policy they form, to communicate their evaluation policies accurately to other members, and by providing an iterative mechanism through which members can arrive at a compromise solution to the task, is expected to improve the quality of group judgments.

Accuracy of using computer-aided rapid prototyping templates for mandible reconstruction with an iliac crest graft

Science.gov (United States)

2014-01-01

Background This study aimed to evaluate the accuracy of surgical outcomes in free iliac crest mandibular reconstructions that were carried out with virtual surgical plans and rapid prototyping templates. Methods This study evaluated eight patients who underwent mandibular osteotomy and reconstruction with free iliac crest grafts using virtual surgical planning and designed guiding templates. Operations were performed using the prefabricated guiding templates. Postoperative three-dimensional computer models were overlaid and compared with the preoperatively designed models in the same coordinate system. Results Compared to the virtual osteotomy, the mean error of distance of the actual mandibular osteotomy was 2.06 ± 0.86 mm. When compared to the virtual harvested grafts, the mean error volume of the actual harvested grafts was 1412.22 ± 439.24 mm3 (9.12% ± 2.84%). The mean error between the volume of the actual harvested grafts and the shaped grafts was 2094.35 ± 929.12 mm3 (12.40% ± 5.50%). Conclusions The use of computer-aided rapid prototyping templates for virtual surgical planning appears to positively influence the accuracy of mandibular reconstruction. PMID:24957053

The Interaction of Decision Aid Usage, Training Methodology, and Personality Construct on Decision Making Among Dyadic Air Crews in a Military Environment

National Research Council Canada - National Science Library

Schipani, Salvatore

2003-01-01

..., processing, and acting upon information is often inadequate. The current research examined two levels of training, decision aiding, and homogeneity on group performance, using a personality concept classified "action orientation...

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

Science.gov (United States)

Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F

2015-03-01

Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for

Ecological Rationality: A Framework for Understanding and Aiding the Aging Decision Maker

Directory of Open Access Journals (Sweden)

Rui eMata

2012-02-01

Full Text Available Ecological rationality sees human rationality as the result of the adaptive fit between the human mind and the environment. The concept of ecological rationality focuses the study of cognition on two key questions: First, what are the environmental regularities to which people’s decision strategies are matched, and how frequently do these regularities occur in natural environments? Second, how well can people adapt their use of specific strategies to particular environments? Research on aging suggests a number of changes in cognitive function, for instance, deficits in learning and memory that may impact decision-making skills. However, it has been shown that simple strategies can work well in many natural environments, which suggests that age-related deficits in strategy use may not necessarily translate into diminished decision performance. Consequently, we argue that predictions about the impact of aging on decision performance depend not only on how aging affects decision-relevant capacities but also on the decision ecology in which decisions are made. In sum, we propose that the concept of the ecological rationality is crucial to understanding and aiding the aging decision maker.

Clinical decision support for whole genome sequence information leveraging a service-oriented architecture: a prototype.

Science.gov (United States)

Welch, Brandon M; Rodriguez-Loya, Salvador; Eilbeck, Karen; Kawamoto, Kensaku

2014-01-01

Whole genome sequence (WGS) information could soon be routinely available to clinicians to support the personalized care of their patients. At such time, clinical decision support (CDS) integrated into the clinical workflow will likely be necessary to support genome-guided clinical care. Nevertheless, developing CDS capabilities for WGS information presents many unique challenges that need to be overcome for such approaches to be effective. In this manuscript, we describe the development of a prototype CDS system that is capable of providing genome-guided CDS at the point of care and within the clinical workflow. To demonstrate the functionality of this prototype, we implemented a clinical scenario of a hypothetical patient at high risk for Lynch Syndrome based on his genomic information. We demonstrate that this system can effectively use service-oriented architecture principles and standards-based components to deliver point of care CDS for WGS information in real-time.

Adaptive Peircean decision aid project summary assessments.

Energy Technology Data Exchange (ETDEWEB)

Senglaub, Michael E.

2007-01-01

This efforts objective was to identify and hybridize a suite of technologies enabling the development of predictive decision aids for use principally in combat environments but also in any complex information terrain. The technologies required included formal concept analysis for knowledge representation and information operations, Peircean reasoning to support hypothesis generation, Mill's's canons to begin defining information operators that support the first two technologies and co-evolutionary game theory to provide the environment/domain to assess predictions from the reasoning engines. The intended application domain is the IED problem because of its inherent evolutionary nature. While a fully functioning integrated algorithm was not achieved the hybridization and demonstration of the technologies was accomplished and demonstration of utility provided for a number of ancillary queries.

Usability evaluation of pharmacogenomics clinical decision support aids and clinical knowledge resources in a computerized provider order entry system: a mixed methods approach.

Science.gov (United States)

Devine, Emily Beth; Lee, Chia-Ju; Overby, Casey L; Abernethy, Neil; McCune, Jeannine; Smith, Joe W; Tarczy-Hornoch, Peter

2014-07-01

Pharmacogenomics (PGx) is positioned to have a widespread impact on the practice of medicine, yet physician acceptance is low. The presentation of context-specific PGx information, in the form of clinical decision support (CDS) alerts embedded in a computerized provider order entry (CPOE) system, can aid uptake. Usability evaluations can inform optimal design, which, in turn, can spur adoption. The study objectives were to: (1) evaluate an early prototype, commercial CPOE system with PGx-CDS alerts in a simulated environment, (2) identify potential improvements to the system user interface, and (3) understand the contexts under which PGx knowledge embedded in an electronic health record is useful to prescribers. Using a mixed methods approach, we presented seven cardiologists and three oncologists with five hypothetical clinical case scenarios. Each scenario featured a drug for which a gene encoding drug metabolizing enzyme required consideration of dosage adjustment. We used Morae(®) to capture comments and on-screen movements as participants prescribed each drug. In addition to PGx-CDS alerts, 'Infobutton(®)' and 'Evidence' icons provided participants with clinical knowledge resources to aid decision-making. Nine themes emerged. Five suggested minor improvements to the CPOE user interface; two suggested presenting PGx information through PGx-CDS alerts using an 'Infobutton' or 'Evidence' icon. The remaining themes were strong recommendations to provide succinct, relevant guidelines and dosing recommendations of phenotypic information from credible and trustworthy sources; any more information was overwhelming. Participants' median rating of PGx-CDS system usability was 2 on a Likert scale ranging from 1 (strongly agree) to 7 (strongly disagree). Usability evaluation results suggest that participants considered PGx information important for improving prescribing decisions; and that they would incorporate PGx-CDS when information is presented in relevant and

Development and Evaluation of the Virtual Prototype of the First Saudi Arabian-Designed Car

Directory of Open Access Journals (Sweden)

Mustufa H. Abidi

2016-10-01

Full Text Available Prototyping and evaluation are imperative phases of the present product design and development process. Although digital modeling and analysis methods are widely employed at various product development stages, still, building a physical prototype makes the present typical process expensive and time consuming. Therefore, it is necessary to implement new technologies, such as virtual prototyping, which can enable industry to have a rapid and more controlled decision making process. Virtual prototyping has come a long way in recent years, where current environments enable stereoscopic visuals, surround sound and ample interaction with the generated models. It is also important to evaluate how representative the developed virtual prototype is when compared to the real-world counterpart and the sense of presence reported by users of the virtual prototype. This paper describes the systematic procedure to develop a virtual prototype of Gazal-1 (i.e., the first car prototype designed by Saudi engineers in a semi-immersive virtual environment. The steps to develop a virtual prototype from CAD (computer-aided design models are explained in detail. Various issues involved in the different phases for the development of the virtual prototype are also discussed comprehensively. The paper further describes the results of the subjective assessment of a developed virtual prototype of a Saudi Arabian-designed automobile. User’s feedback is recorded using a presence questionnaire. Based on the user-based study, it is revealed that the virtual prototype is representative of the real Saudi Arabian car and offers a flexible environment to analyze design features when compared against its physical prototype. The capabilities of the virtual environment are validated with the application of the car prototype. Finally, vital requirements and directions for future research are also presented.

Boosting Quality Registries with Clinical Decision Support Functionality*. User Acceptance of a Prototype Applied to HIV/TB Drug Therapy.

Science.gov (United States)

Wannheden, Carolina; Hvitfeldt-Forsberg, Helena; Eftimovska, Elena; Westling, Katarina; Ellenius, Johan

2017-08-11

The care of HIV-related tuberculosis (HIV/TB) is complex and challenging. Clinical decision support (CDS) systems can contribute to improve quality of care, but more knowledge is needed on factors determining user acceptance of CDS. To analyze physicians' and nurses' acceptance of a CDS prototype for evidence-based drug therapy recommendations for HIV/TB treatment. Physicians and nurses were involved in designing a CDS prototype intended for future integration with the Swedish national HIV quality registry. Focus group evaluation was performed with ten nurses and four physicians, respectively. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to analyze acceptance. We identified several potential benefits with the CDS prototype as well as some concerns that could be addressed by redesign. There was also concern about dependence on physician attitudes, as well as technical, organizational, and legal issues. Acceptance evaluation at a prototype stage provided rich data to improve the future design of a CDS prototype. Apart from design and development efforts, substantial organizational efforts are needed to enable the implementation and maintenance of a future CDS system.

Development of a prototype graphic simulation program for severe accident training

Energy Technology Data Exchange (ETDEWEB)

Kim, Ko Ryu; Jeong, Kwang Sub; Ha, Jae Joo

2000-05-01

This is a report of the development process and related technologies of severe accident graphic simulators, required in industrial severe accident management and training. Here, we say 'a severe accident graphic simulator' as a graphics add-in system to existing calculation codes, which can show the severe accident phenomena dynamically on computer screens and therefore which can supplement one of main defects of existing calculation codes. With graphic simulators it is fairly easy to see the total behavior of nuclear power plants, where it was very difficult to see only from partial variable numerical information. Moreover, the fast processing and control feature of a graphic simulator can give some opportunities of predicting the severe accident advancement among several possibilities, to one who is not an expert. Utilizing graphic simulators' we expect operators' and TSC members' physical phenomena understanding enhancement from the realistic dynamic behavior of plants. We also expect that severe accident training course can gain better training effects using graphic simulator's control functions and predicting capabilities, and therefore we expect that graphic simulators will be effective decision-aids tools both in sever accident training course and in real severe accident situations. With these in mind, we have developed a prototype graphic simulator having surveyed related technologies, and from this development experiences we have inspected the possibility to build a severe accident graphic simulator. The prototype graphic simulator is developed under IBM PC WinNT environments and is suited to Uljin 3and4 nuclear power plant. When supplied with adequate severe accident scenario as an input, the prototype can provide graphical simulations of plant safety systems' dynamic behaviors. The prototype is composed of several different modules, which are phenomena display module, MELCOR data interface module and graphic database

OPTIMIZING USABILITY OF AN ECONOMIC DECISION SUPPORT TOOL: PROTOTYPE OF THE EQUIPT TOOL.

Science.gov (United States)

Cheung, Kei Long; Hiligsmann, Mickaël; Präger, Maximilian; Jones, Teresa; Józwiak-Hagymásy, Judit; Muñoz, Celia; Lester-George, Adam; Pokhrel, Subhash; López-Nicolás, Ángel; Trapero-Bertran, Marta; Evers, Silvia M A A; de Vries, Hein

2018-01-01

Economic decision-support tools can provide valuable information for tobacco control stakeholders, but their usability may impact the adoption of such tools. This study aims to illustrate a mixed-method usability evaluation of an economic decision-support tool for tobacco control, using the EQUIPT ROI tool prototype as a case study. A cross-sectional mixed methods design was used, including a heuristic evaluation, a thinking aloud approach, and a questionnaire testing and exploring the usability of the Return of Investment tool. A total of sixty-six users evaluated the tool (thinking aloud) and completed the questionnaire. For the heuristic evaluation, four experts evaluated the interface. In total twenty-one percent of the respondents perceived good usability. A total of 118 usability problems were identified, from which twenty-six problems were categorized as most severe, indicating high priority to fix them before implementation. Combining user-based and expert-based evaluation methods is recommended as these were shown to identify unique usability problems. The evaluation provides input to optimize usability of a decision-support tool, and may serve as a vantage point for other developers to conduct usability evaluations to refine similar tools before wide-scale implementation. Such studies could reduce implementation gaps by optimizing usability, enhancing in turn the research impact of such interventions.

Consideration of Insulin Pumps or Continuous Glucose Monitors by Adolescents With Type 1 Diabetes and Their Parents: Stakeholder Engagement in the Design of Web-Based Decision Aids.

Science.gov (United States)

Wysocki, Tim; Hirschfeld, Fiona; Miller, Louis; Izenberg, Neil; Dowshen, Steven A; Taylor, Alex; Milkes, Amy; Shinseki, Michelle T; Bejarano, Carolina; Kozikowski, Chelsea; Kowal, Karen; Starr-Ashton, Penny; Ross, Judith L; Kummer, Mark; Carakushansky, Mauri; Lyness, D'Arcy; Brinkman, William; Pierce, Jessica; Fiks, Alexander; Christofferson, Jennifer; Rafalko, Jessica; Lawson, Margaret L

2016-08-01

This article describes the stakeholder-driven design, development, and testing of web-based, multimedia decision aids for youth with type 1 diabetes who are considering the insulin pump or continuous glucose monitoring and their parents. This is the initial phase of work designed to develop and evaluate the efficacy of these decision aids in promoting improved decision-making engagement with use of a selected device. Qualitative interviews of 36 parents and adolescents who had previously faced these decisions and 12 health care providers defined the content, format and structure of the decision aids. Experts in children's health media helped the research team to plan, create, and refine multimedia content and its presentation. A web development firm helped organize the content into a user-friendly interface and enabled tracking of decision aid utilization. Throughout, members of the research team, adolescents, parents, and 3 expert consultants offered perspectives about the website content, structure, and function until the design was complete. With the decision aid websites completed, the next phase of the project is a randomized controlled trial of usual clinical practice alone or augmented by use of the decision aid websites. Stakeholder-driven development of multimedia, web-based decision aids requires meticulous attention to detail but can yield exceptional resources for adolescents and parents contemplating major changes to their diabetes regimens. © 2016 The Author(s).

Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations

Directory of Open Access Journals (Sweden)

Graham Ruth

2007-01-01

Full Text Available Abstract Background Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. Methods A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control with two forms of computer-based decision aids (implicit and explicit versions of DARTS II. Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. Results Median consultation times (quartiles differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26 minutes to work through compared to 31 (16–41 minutes for the implicit tool; and 44 (39–55 minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66% of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%. However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested

Decision aid use during post-biopsy consultations for localized prostate cancer.

Science.gov (United States)

Holmes-Rovner, Margaret; Srikanth, Akshay; Henry, Stephen G; Langford, Aisha; Rovner, David R; Fagerlin, Angela

2018-02-01

Decision Aids (DAs) effectively translate medical evidence for patients but are not routinely used in clinical practice. Little is known about how DAs are used during patient-clinician encounters. To characterize the content and communicative function of high-quality DAs during diagnostic clinic visits for prostate cancer. 252 men newly diagnosed with localized prostate cancer who had received a DA, 45 treating physicians at 4 US Veterans Administration urology clinics. Qualitative analysis of transcribed audio recordings was used to inductively develop categories capturing content and function of all direct references to DAs (booklet talk). The presence or absence of any booklet talk per transcript was also calculated. Booklet talk occurred in 55% of transcripts. Content focused on surgical procedures (36%); treatment choice (22%); and clarifying risk classification (17%). The most common function of booklet talk was patient corroboration of physicians' explanations (42%), followed by either physician or patient acknowledgement that the patient had the booklet. Codes reflected the absence of DA use for shared decision-making. In regression analysis, predictors of booklet talk were fewer years of patient education (P = .027) and more time in the encounter (P = .027). Patient race, DA type, time reading the DA, physician informing quality and physician age did not predict booklet talk. Results show that good decision aids, systematically provided to patients, appeared to function not to open up deliberations about how to balance benefits and harms of competing treatments, but rather to allow patients to ask narrow technical questions about recommended treatments. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Balancing emotion and cognition: a case for decision aiding in conservation efforts.

Science.gov (United States)

Wilson, Robyn S

2008-12-01

Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.

The computer-aided design of a servo system as a multiple-criteria decision problem

NARCIS (Netherlands)

Udink ten Cate, A.J.

1986-01-01

This paper treats the selection of controller gains of a servo system as a multiple-criteria decision problem. In contrast to the usual optimization-based approaches to computer-aided design, inequality constraints are included in the problem as unconstrained objectives. This considerably simplifies

Prototype moving-ring reactor

International Nuclear Information System (INIS)

Smith, A.C. Jr.; Ashworth, C.P.; Abreu, K.E.

1981-01-01

The objective of this work was to design a prototype fusion reactor based on fusion plasmas confined as ''Compact Toruses.' Six major criteria guided the prototype design. The prototype must: (1) produce net electricity decisively (P/sub net/ >70% of P/sub gross/), with P/sub net/ approximately 100 MW(e); (2) have small physical size (low project cost) but commercial plant; (3) have all features required of commerical plants; (4) avoid unreasonable extrapolation of technology; (5) minimize nuclear issues substantially, i.e. accident and waste issues of public concern, and (6) be modular (to permit repetitive fabrication of parts) and be maintainable with low occupational radiological exposures

Operation and validation of the decision aid system 'CAIRE' in complex terrain

International Nuclear Information System (INIS)

De Witt, H.; Nuesser, A.; Brenk, H.D.

1998-01-01

In cases of nuclear emergencies it is the primary task of emergency response forces and decision making authorities to act properly. Based on telemetric surveillance networks, an advanced automatic on-line decision support system named CAIRE (Computer Aided Response to Emergencies) has been developed and is in operation now at 4 sites as a real time emergency response tool. This tool is designed to provide decision makers with precise radiation exposure data for the population at risk. Depending on the individual layout of the connected telemetric networks, CAIRE is able to satisfy the following main requirements: automatic identification of the source location and of the source term, automatic diagnosis of the actual radiological situation and identification of the endangered area, projection of the radiological situation, delivery of all this information in the form computer graphics. (R.P.)

Development and quantitative effect estimation of an integrated decision support system to aid operator's cognitive activities for NPP advanced main control rooms

International Nuclear Information System (INIS)

Lee, Seung Jun

2007-02-01

As digital and computer technologies have grown, human-machine interfaces (HMIs) have evolved. In safety critical systems, especially in nuclear power plants (NPPs), HMIs are important for reducing operational costs, for reducing the number of necessary operators, and for reducing the probability of accident occurrence. Efforts have been made to improve main control room (MCR) interface design and to develop automation or support systems to ensure convenient operation and maintenance. In this paper, an integrated decision support system to aid the cognitive activities of operators is proposed for advanced MCRs in future NPPs. The proposed system supports not merely a particular task, but also the entire operation process based on a human cognitive process model. It supports the operator's entire cognitive process by integrating decision support systems that support each cognitive activity. In this paper, the operator's operation processes are analyzed based on a human cognitive process model and appropriate support systems that support each activity of the human cognitive process are suggested. Two decision support systems were developed in this paper. The first one is the fault diagnosis advisory system (FDAS) which detects faults and diagnoses them. The FDAS provides a list of possible faults and expected causes to operators. It was implemented using two kinds of neural networks for more reliable diagnosis results. The second system is the multifunctional operator support system for operation guidance, which includes the FDAS and the operation guidance system. The operation guidance system is to prevent operator's commission errors and omission errors. Furthermore, the effect of the proposed system was estimated because to evaluate decision support systems in order to validate their efficiency is as important as to design highly reliable decision support systems. The effect estimations were performed theoretically and experimentally. The Bayesian

A study of a Dutch online decision aid for parents of children with ADHD

NARCIS (Netherlands)

Ossebaard, Hans Cornelis; van Gemert-Pijnen, Julia E.W.C.; Sorbi, Marjolijn J.; Seydel, E.R.

2010-01-01

During a three-month study period, visitors to an online decision aid (DA) for attention deficit hyperactivity disorder (ADHD) were invited to complete an online questionnaire before and after working through the DA. Some 75,000 unique visitors found their way to the page on DAs, although fewer than

The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial

Directory of Open Access Journals (Sweden)

Brenner Alison RT

2008-01-01

Full Text Available Abstract Background Decision aids can improve decision making processes, but the amount and type of information that they should attempt to communicate is controversial. We sought to compare, in a pilot randomized trial, two colorectal cancer (CRC screening decision aids that differed in the number of screening options presented. Methods Adults ages 48–75 not currently up to date with screening were recruited from the community and randomized to view one of two versions of our previously tested CRC screening decision aid. The first version included five screening options: fecal occult blood test (FOBT, sigmoidoscopy, a combination of FOBT and sigmoidoscopy, colonoscopy, and barium enema. The second discussed only the two most frequently selected screening options, FOBT and colonoscopy. Main outcomes were differences in screening interest and test preferences between groups after decision aid viewing. Patient test preference was elicited first without any associated out-of-pocket costs (OPC, and then with the following costs: FOBT-$10, sigmoidoscopy-$50, barium enema-$50, and colonoscopy-$200. Results 62 adults participated: 25 viewed the 5-option decision aid, and 37 viewed the 2-option version. Mean age was 54 (range 48–72, 58% were women, 71% were White, 24% African-American; 58% had completed at least a 4-year college degree. Comparing participants that viewed the 5-option version with participants who viewed the 2-option version, there were no differences in screening interest after viewing (1.8 vs. 1.9, t-test p = 0.76. Those viewing the 2-option version were somewhat more likely to choose colonoscopy than those viewing the 5-option version when no out of pocket costs were assumed (68% vs. 46%, p = 0.11, but not when such costs were imposed (41% vs. 42%, p = 1.00. Conclusion The number of screening options available does not appear to have a large effect on interest in colorectal cancer screening. The effect of offering differing

Application of the Consumer Decision-Making Model to Hearing Aid Adoption in First-Time Users.

Science.gov (United States)

Amlani, Amyn M

2016-05-01

Since 1980, hearing aid adoption rates have remained essentially the same, increasing at a rate equal to the organic growth of the population. Researchers have used theoretical models from psychology and sociology to determine those factors or constructs that lead to the adoption of hearing aids by first-time impaired listeners entering the market. In this article, a theoretical model, the Consumer Decision-Making Model (CDM), premised on the neobehavioral approach that considers an individual's psychological and cognitive emphasis toward a product or service, is described. Three theoretical models (i.e., transtheoretical, social model of disability, Health Belief Model), and their relevant findings to the hearing aid market, are initially described. The CDM is then presented, along with supporting evidence of the model's various factors from the hearing aid literature. Future applications of the CDM to hearing health care also are discussed.

Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men.

Science.gov (United States)

Berry, Donna L; Halpenny, Barbara; Bosco, Jaclyn L F; Bruyere, John; Sanda, Martin G

2015-07-24

The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer. P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized. Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid. Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.

Patient‐focussed decision‐making in early‐stage prostate cancer: insights from a cognitively based decision aid

Science.gov (United States)

Feldman‐Stewart, Deb; Brundage, Michael D; Manen, Lori Van; Svenson, Ola

2004-01-01

Abstract Purpose  To study the cognitive processes of early‐stage prostate cancer patients as they determined which treatment they preferred, using our cognitively based decision aid. Method  The aid was a one‐to‐one interview that included the structured presentation of information, listing exercises in which the patient identified attributes important to his decision, and trade‐off exercises to help him weigh and integrate those attributes together. At various points of the interview, patients identified the attributes they felt were important to their decision, rated their treatment options and completed standardized assessments relating to their decision. In addition, patients participated in a follow‐up interview at the time they made their actual treatment decision and again 3 months later. Results  Sixty of 70 (86%) of the invited patients participated in the study. Participating patients identified a median of four important attributes (range 1–10); 36 different attributes were identified at some point in the interview by the group. During the interview, 78% of patients changed which attributes they considered important, and 72% changed their treatment ratings. Stability of treatment choice after the interview and lack of regret after the decision were each positively associated with increasing differentiation between treatment options over time. Conclusions  The decision process appears to be dynamic for the patients with great variability across patients in what is important to the decision. Increasing stability of choice and lack of regret appear to be related positively to increasing difference over time in how attractive the preferred option is over its closest competitor, rather than to the size of the difference at any one point in time. PMID:15117387

A Concurrent Distributed System for Aircraft Tactical Decision Generation

Science.gov (United States)

McManus, John W.

1990-01-01

A research program investigating the use of artificial intelligence (AI) techniques to aid in the development of a Tactical Decision Generator (TDG) for Within Visual Range (WVR) air combat engagements is discussed. The application of AI programming and problem solving methods in the development and implementation of a concurrent version of the Computerized Logic For Air-to-Air Warfare Simulations (CLAWS) program, a second generation TDG, is presented. Concurrent computing environments and programming approaches are discussed and the design and performance of a prototype concurrent TDG system are presented.

3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

Science.gov (United States)

Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

2013-12-01

To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

ADVANCEMENT OF RAPID PROTOTYPING IN AEROSPACE INDUSTRY -A REVIEW

OpenAIRE

Vineet Kumar Vashishtha,; Rahul Makade,; Neeraj Mehla

2011-01-01

Rapid prototyping technology have emerged a new innovation to reduced the time cost of moulds fabrication by creating 3D product directly from computer aided design thus the designer is able to perform design validation and accuracy analysis easily in a virtual environment as if using a physical model. The primary aim of this paper is to give the reader an overview of the current state of the art in rapid prototyping technology .The paper also deal with feature’s of rapid prototyping in Aeros...

The need for decision and communication aids: a survey of breast cancer survivors.

Science.gov (United States)

Belkora, Jeffrey K; Miller, Melissa F; Dougherty, Kasey; Gayer, Christopher; Golant, Mitch; Buzaglo, Joanne S

2015-03-01

Qualitative studies have identified barriers to communication and informed decision making among breast cancer survivors making treatment decisions. The prevalence of these barriers is unknown. To quantify the need for decision support among breast cancer survivors. We surveyed 2,521 breast cancer survivors participating in an online registry hosted by the Cancer Support Community to find out what proportion of breast cancer patients: made decisions during their first visit with a specialist; received satisfactory information before that visit; asked questions and received responses; and endorsed expanded use of decision support. We received 1,017 (41%) responses and analyzed 917 surveys from women who lived in the United States. Most of the respondents recalled making treatment decisions during their first visit (52%). A minority (14%) received information before the first specialist visit. At least 25% of respondents rated their satisfaction below 7 on a scale of 10 for decision-making, information, and questions asked and answered. Respondents endorsed the need for assistance with obtaining information, listing questions, taking notes, and making audio-recordings of visits. The respondent sample skewed younger and had higher-stage cancer compared with all breast cancer survivors. Responses were subject to recall bias. Cancer survivors expressed gaps in their care with respect to reviewing information, asking questions, obtaining answers, and making decisions. Implementing decision and communication aids immediately upon diagnosis, when treatment decisions are being made, would address these gaps. ©2015 Frontline Medical Communications.

Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say?

Science.gov (United States)

Portocarrero, Maria Esther Leiva; Giguère, Anik M C; Lépine, Johanie; Garvelink, Mirjam M; Robitaille, Hubert; Delanoë, Agathe; Lévesque, Isabelle; Wilson, Brenda J; Rousseau, François; Légaré, France

2017-03-20

Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors influencing pregnant women's use of a patient decision aid for deciding about prenatal screening for Down syndrome (DS). This qualitative study was embedded in a sequential mixed-methods research program whose main aim is to implement shared decision-making (SDM) in the context of prenatal screening for DS in the province of Quebec, Canada. We planned to recruit a purposive sample of 45 pregnant women with low-risk pregnancy consulting for prenatal care at three clinical sites. Participating women watched a video depicting a prenatal care follow-up during which a pregnant woman, her partner and a health professional used a PtDA to decide about prenatal screening for DS. The women were then interviewed about factors that would influence the use of this PtDA using questions based on the Theoretical Domains Framework (TDF). We performed content analysis of transcribed verbatim interviews. Out of 216 eligible women, 100 agreed to participate (46% response rate) and 46 were interviewed. Regarding the type of health professional responsible for their prenatal care, 19 participants (41%) reported having made a decision about prenatal screening for DS with an obstetrician-gynecologist, 13 (28%) with a midwife, 12 (26%) with a family physician, and two (4%) decided on their own. We identified 54 factors that were mapped onto nine of the 12 TDF domains. The three most frequently-mentioned were: opinion of the pregnant woman's partner (n = 33, 72%), presentation of the PtDA by health professional and a discussion (n = 27, 72%), and not having encountered a PtDA (n = 26, 57%). This study allowed us to identify factors influencing pregnant women's use of a PtDA for prenatal screening for

On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids : A critical analysis

NARCIS (Netherlands)

Pieterse, A.H.; de Vries, M.

2013-01-01

Background  Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference-sensitive health-care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that

Development and usability testing of a web-based decision support for users and health professionals in psychiatric services.

Science.gov (United States)

Grim, Katarina; Rosenberg, David; Svedberg, Petra; Schön, Ulla-Karin

2017-09-01

Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. This web-based decision aid has the potential to strengthen service users' experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Semiorders, Intervals Orders and Pseudo Orders Preference Structures in Multiple Criteria Decision Aid Methods

Directory of Open Access Journals (Sweden)

Fernández Barberis, Gabriela

2013-06-01

Full Text Available During the last decades, an important number of Multicriteria Decision Aid Methods (MCDA has been proposed to help the decision maker to select the best compromise alternative. Meanwhile, the PROMETHEE (Preference Ranking Organization Method for Enrichment Evaluations family of outranking method and their applications has attracted much attention from academics and practitioners. In this paper, an extension of these methods is presented, consisting of analyze its functioning under New Preference Structures (NPS. The preference structures taken into account are, namely: semiorders, intervals orders and pseudo orders. These structures outstandingly improve the modelization as they give more flexibility, amplitude and certainty at the preferences formulation, since they tend to abandon the Complete Transitive Comparability Axiom of Preferences in order to substitute it by the Partial Comparability Axiom of Preferences. It must be remarked the introduction of Incomparability relations to the analysis and the consideration of preference structures that accept the Indifference intransitivity. The NPS incorporation is carried out in three phases that the PROMETHEE Methodology takes in: preference structure enrichment, dominance relation enrichment and outranking relation exploitation for decision aid, in order to finally arrive at solving the alternatives ranking problem through the PROMETHEE I or the PROMETHEE II utilization, according to whether a partial ranking or a complete one, is respectively required under the NPS

Justification, optimization and decision-aiding in existing exposure situations

International Nuclear Information System (INIS)

Hedemann-Jensen, Per

2004-01-01

The existing ICRP system of radiological protection from 1990 (ICRP Publication 60) can be seen as a binary or dual-line system dealing with protection in exposure situations categorized as either practices or interventions. The distinction between practices and interventions is summarized in the paper with focus on some of the problems experienced in making such a distinction. The protection principles within the existing system of protection are presented with emphasis on the application to de facto or existing exposure situations. Decision on countermeasures to mitigate the consequences of existing exposure situations such as nuclear or radiological accidents and naturally occurring exposure situations include factors or attributes describing benefits from the countermeasure and those describing harm. Some of these attributes are discussed and the general process of justification of intervention and optimization of protection arriving at generic reference levels for implementing protective measures is presented. In addition, the role of radiological protection professionals and other stakeholders in the decision-making process is discussed. Special attention is given to the question whether radiological protection should form only one of many decision-aiding inputs to a broader societal decision-making process or whether societal aspects should be fully integrated into the radiological protection framework. The concepts of practices and interventions, however logical they are, have created some confusion when applied to protection of the public following a nuclear or radiological accident. These problems may be solved in a new set of general ICRP recommendations on radiological protection, which are anticipated to supersede Publication 60 in 2005. The evolution of the basic ICRP principles for radiological protection in existing exposure situations into a new set of ICRP recommendations is briefly discussed based upon the various material that has been presented

Impact of a decision aid about stratified ovarian cancer risk-management on women’s knowledge and intentions: a randomised online experimental survey study

Directory of Open Access Journals (Sweden)

Susanne F. Meisel

2017-11-01

Full Text Available Abstract Background Risk stratification using genetic and other types of personal information could improve current best available approaches to ovarian cancer risk reduction, improving identification of women at increased risk of ovarian cancer and reducing unnecessary interventions for women at lower risk. Amounts of information given to women may influence key informed decision-related outcomes, e.g. knowledge. The primary aim of this study was to compare informed decision-related outcomes between women given one of two versions (gist vs. extended of a decision aid about stratified ovarian cancer risk-management. Methods This was an experimental survey study comparing the effects of brief (gist information with lengthier, more detailed (extended information on cognitions relevant to informed decision-making about participating in risk-stratified ovarian cancer screening. Women with no personal history of ovarian cancer were recruited through an online survey company and randomised to view the gist (n = 512 or extended (n = 519 version of a website-based decision aid and completed an online survey. Primary outcomes were knowledge and intentions. Secondary outcomes included attitudes (values and decisional conflict. Results There were no significant differences between the gist and extended conditions in knowledge about ovarian cancer (time*group interaction: F = 0.20, p = 0.66 or intention to participate in ovarian cancer screening based on genetic risk assessment (t(1029 = 0.43, p = 0.67. There were also no between-groups differences in secondary outcomes. In the sample overall (n = 1031, knowledge about ovarian cancer increased from before to after exposure to the decision aid (from 5.71 to 6.77 out of a possible 10: t = 19.04, p < 0.001, and 74% of participants said that they would participate in ovarian cancer screening based on genetic risk assessment. Conclusions No differences in knowledge or

Addressing health literacy in patient decision aids

Science.gov (United States)

2013-01-01

Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies

Deep learning aided decision support for pulmonary nodules diagnosing: a review.

Science.gov (United States)

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping; He, Jianxing; Liu, Bo

2018-04-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing.

A multi-criteria decision aid methodology to design electric vehicles public charging networks

Directory of Open Access Journals (Sweden)

João Raposo

2015-05-01

Full Text Available This article presents a new multi-criteria decision aid methodology, dynamic-PROMETHEE, here used to design electric vehicle charging networks. In applying this methodology to a Portuguese city, results suggest that it is effective in designing electric vehicle charging networks, generating time and policy based scenarios, considering offer and demand and the city’s urban structure. Dynamic-PROMETHE adds to the already known PROMETHEE’s characteristics other useful features, such as decision memory over time, versatility and adaptability. The case study, used here to present the dynamic-PROMETHEE, served as inspiration and base to create this new methodology. It can be used to model different problems and scenarios that may present similar requirement characteristics.

A multi-criteria decision aid methodology to design electric vehicles public charging networks

Science.gov (United States)

Raposo, João; Rodrigues, Ana; Silva, Carlos; Dentinho, Tomaz

2015-05-01

This article presents a new multi-criteria decision aid methodology, dynamic-PROMETHEE, here used to design electric vehicle charging networks. In applying this methodology to a Portuguese city, results suggest that it is effective in designing electric vehicle charging networks, generating time and policy based scenarios, considering offer and demand and the city's urban structure. Dynamic-PROMETHE adds to the already known PROMETHEE's characteristics other useful features, such as decision memory over time, versatility and adaptability. The case study, used here to present the dynamic-PROMETHEE, served as inspiration and base to create this new methodology. It can be used to model different problems and scenarios that may present similar requirement characteristics.

A single-blind randomised controlled trial of the effects of a web-based decision aid on self-testing for cholesterol and diabetes. study protocol

Directory of Open Access Journals (Sweden)

Ickenroth Martine HP

2012-01-01

Full Text Available Abstract Background Self-tests, tests on body materials to detect medical conditions, are widely available to the general public. Self-testing does have advantages as well as disadvantages, and the debate on whether self-testing should be encouraged or rather discouraged is still ongoing. One of the concerns is whether consumers have sufficient knowledge to perform the test and interpret the results. An online decision aid (DA with information on self-testing in general, and test specific information on cholesterol and diabetes self-testing was developed. The DA aims to provide objective information on these self-tests as well as a decision support tool to weigh the pros and cons of self-testing. The aim of this study is to evaluate the effect of the online decision aid on knowledge on self-testing, informed choice, ambivalence and psychosocial determinants. Methods/Design A single blind randomised controlled trial in which the online decision aid 'zelftestwijzer' is compared to short, non-interactive information on self-testing in general. The entire trial will be conducted online. Participants will be selected from an existing Internet panel. Consumers who are considering doing a cholesterol or diabetes self-test in the future will be included. Outcome measures will be assessed directly after participants have viewed either the DA or the control condition. Weblog files will be used to record participants' use of the decision aid. Discussion Self-testing does have important pros and cons, and it is important that consumers base their decision whether they want to do a self-test or not on knowledge and personal values. This study is the first to evaluate the effect of an online decision aid for self-testing. Trial registration Dutch Trial Register: NTR3149

Impact of a decision aid about stratified ovarian cancer risk-management on women's knowledge and intentions: a randomised online experimental survey study.

Science.gov (United States)

Meisel, Susanne F; Freeman, Maddie; Waller, Jo; Fraser, Lindsay; Gessler, Sue; Jacobs, Ian; Kalsi, Jatinderpal; Manchanda, Ranjit; Rahman, Belinda; Side, Lucy; Wardle, Jane; Lanceley, Anne; Sanderson, Saskia C

2017-11-16

Risk stratification using genetic and other types of personal information could improve current best available approaches to ovarian cancer risk reduction, improving identification of women at increased risk of ovarian cancer and reducing unnecessary interventions for women at lower risk. Amounts of information given to women may influence key informed decision-related outcomes, e.g. knowledge. The primary aim of this study was to compare informed decision-related outcomes between women given one of two versions (gist vs. extended) of a decision aid about stratified ovarian cancer risk-management. This was an experimental survey study comparing the effects of brief (gist) information with lengthier, more detailed (extended) information on cognitions relevant to informed decision-making about participating in risk-stratified ovarian cancer screening. Women with no personal history of ovarian cancer were recruited through an online survey company and randomised to view the gist (n = 512) or extended (n = 519) version of a website-based decision aid and completed an online survey. Primary outcomes were knowledge and intentions. Secondary outcomes included attitudes (values) and decisional conflict. There were no significant differences between the gist and extended conditions in knowledge about ovarian cancer (time*group interaction: F = 0.20, p = 0.66) or intention to participate in ovarian cancer screening based on genetic risk assessment (t(1029) = 0.43, p = 0.67). There were also no between-groups differences in secondary outcomes. In the sample overall (n = 1031), knowledge about ovarian cancer increased from before to after exposure to the decision aid (from 5.71 to 6.77 out of a possible 10: t = 19.04, p type of content for decision aids about stratified ovarian cancer risk-management. This study was registered with the ISRCTN registry; registration number: ISRCTN48627877 .

Development of an appropriate resource information system to support agricultural management at farm enterprise level : a prototype design for a decision support system in Moghan Agro-industrial Complex, Iran

NARCIS (Netherlands)

Sharifi, M.A.

1992-01-01

This thesis describes development of and experimentation with a prototype of an appropriate resource information system that improves decision making processes in farm management The system includes a geographic information system with a powerful process model that forms a decision support

The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

Science.gov (United States)

Barrett, Tyler W; Storrow, Alan B; Jenkins, Cathy A; Abraham, Robert L; Liu, Dandan; Miller, Karen F; Moser, Kelly M; Russ, Stephan; Roden, Dan M; Harrell, Frank E; Darbar, Dawood

2015-03-15

There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

A hierarchical decision aid in a debate on national energy policy

International Nuclear Information System (INIS)

Haemaelaeinen, R.P.; Seppaelaeinen, T.; Oehladt, K.; Ruusunen, J.

1985-12-01

A wide public depate on the future energy policy of Finland has been going on for the past few years, and at the moment the discussion is centered around the question whether a new nuclear power plant should be built or not. To clarify the differences between anti-nuclear and pro-nuclear opinions, a decision analysis of the issue was conducted with a microcomputer-based decision aid which utilizes the Analytic Hierarchy Process. The participants representing the opposite opinions were the Minister of Finance and a chief industrial executive. This paper presents the preference profiles of the participants and sensitivity analyses of the results, and discusses the implications of the results for the depate. Essential sources of opinion differences are pointed out and a deeper understanding of the issue is gained. This enables focusing the depate on the critical questions and elimination of less important criteria, which otherwise might receive disproportonate attention

The pros and cons of funnel plots as an aid to risk communication and patient decision making.

Science.gov (United States)

Rakow, Tim; Wright, Rebecca J; Spiegelhalter, David J; Bull, Catherine

2015-05-01

Funnel plots, which simultaneously display a sample statistic and the corresponding sample size for multiple cases, have a range of applications. In medicine, they are used to display treatment outcome rates and caseload volume by institution, which can inform strategic decisions about health care delivery. We investigated lay people's understanding of such plots and explored their suitability as an aid to individual treatment decisions. In two studies, 172 participants answered objective questions about funnel plots representing the surgical outcomes (survival or mortality rates) of institutions varying in caseload, and indicated their preferred institutions. Accuracy for extracting objective information was high, unless question phrasing was inconsistent with the plot's survival/mortality framing, or participants had low numeracy levels. Participants integrated caseload-volume and outcome-rate data when forming preferences, but were influenced by reference lines on the plot to make inappropriate discriminations between institutions with similar outcome rates. With careful choice of accompanying language, funnel plots can be readily understood and are therefore a useful tool for communicating risk. However, they are less effective as a decision aid for individual patient's treatment decisions, and we recommend refinements to the standard presentation of the plots if they are to be used for that purpose. © 2014 The British Psychological Society.

An expert system prototype for aiding in the development of software functional requirements for NASA Goddard's command management system: A case study and lessons learned

Science.gov (United States)

Liebowitz, Jay

1986-01-01

At NASA Goddard, the role of the command management system (CMS) is to transform general requests for spacecraft opeerations into detailed operational plans to be uplinked to the spacecraft. The CMS is part of the NASA Data System which entails the downlink of science and engineering data from NASA near-earth satellites to the user, and the uplink of command and control data to the spacecraft. Presently, it takes one to three years, with meetings once or twice a week, to determine functional requirements for CMS software design. As an alternative approach to the present technique of developing CMS software functional requirements, an expert system prototype was developed to aid in this function. Specifically, the knowledge base was formulated through interactions with domain experts, and was then linked to an existing expert system application generator called 'Knowledge Engineering System (Version 1.3).' Knowledge base development focused on four major steps: (1) develop the problem-oriented attribute hierachy; (2) determine the knowledge management approach; (3) encode the knowledge base; and (4) validate, test, certify, and evaluate the knowledge base and the expert system prototype as a whole. Backcasting was accomplished for validating and testing the expert system prototype. Knowledge refinement, evaluation, and implementation procedures of the expert system prototype were then transacted.

Development of an integrated decision support system to aid cognitive activities of operators

International Nuclear Information System (INIS)

Lee, Seung Jun; Seong, Poong Hyun

2007-01-01

As digital and computer technologies have grown, Human-Machine Interfaces (HMIs) have evolved. In safety-critical systems, especially in Nuclear Power Plants (NPPs), HMIs are important for reducing operational costs, the number of necessary operators, and the probability of accident occurrence. Efforts have been made to improve Main Control Room (MCR) interface design and to develop automated or decision support systems to ensure convenient operation and maintenance. In this paper, an integrated decision support system to aid operator cognitive processes is proposed for advanced MCRs of future NPPs. This work suggests the design concept of a decision support system which accounts for an operator's cognitive processes. The proposed system supports not only a particular task, but also the entire operation process based on a human cognitive process model. In this paper, the operator's operation processes are analyzed according to a human cognitive process model and appropriate support systems that support each cognitive process activity are suggested

Validation of Reverse-Engineered and Additive-Manufactured Microsurgical Instrument Prototype.

Science.gov (United States)

Singh, Ramandeep; Suri, Ashish; Anand, Sneh; Baby, Britty

2016-12-01

With advancements in imaging techniques, neurosurgical procedures are becoming highly precise and minimally invasive, thus demanding development of new ergonomically aesthetic instruments. Conventionally, neurosurgical instruments are manufactured using subtractive manufacturing methods. Such a process is complex, time-consuming, and impractical for prototype development and validation of new designs. Therefore, an alternative design process has been used utilizing blue light scanning, computer-aided designing, and additive manufacturing direct metal laser sintering (DMLS) for microsurgical instrument prototype development. Deviations of DMLS-fabricated instrument were studied by superimposing scan data of fabricated instrument with the computer-aided designing model. Content and concurrent validity of the fabricated prototypes was done by a group of 15 neurosurgeons by performing sciatic nerve anastomosis in small laboratory animals. Comparative scoring was obtained for the control and study instrument. T test was applied to the individual parameters and P values for force (P direct application of these additive-manufactured instruments in the operating room requires further validation. © The Author(s) 2016.

Evaluation of a Patient Decision Aid for Unicompartmental or Total Knee Arthroplasty for Medial Knee Osteoarthritis.

Science.gov (United States)

de Jesus, Christopher; Stacey, Dawn; Dervin, Geoffrey F

2017-11-01

Many patients with isolated medial compartment osteoarthritis are candidates for either unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). A novel patient decision aid (PDA) was developed to educate patients on both interventions and prepare them for making the decision with their surgeon. The study objective was to evaluate the acceptability and usefulness of a PDA for informing and helping patients reach a surgical preference without increasing decisional conflict. A PDA was developed in accordance with the criteria listed by Ottawa Decision Support Framework and prospectively tested in UKA and TKA patients, who were mailed the PDAs to complete at home along with outcome measures before surgeon consultation. Of 50 patients who consented to participate, 45 patients (26 men, 19 women) used the PDA. Quantitative analysis of acceptability, decisional conflict, knowledge, and preferred surgical option was then performed. Mean patient age was 64.6 years (range, 50-80 years). Patients rated the PDA as acceptable: 84.4% indicated balanced presentation of information and 77.8% asserted that PDA helped them to make decisions between UKA and TKA. Mean knowledge score was 86.6% and total decisional conflict was 19.7 out of 100. Of 45, 33 stated a preferred option (24 UKA; 9 TKA; 12 unsure). Patients understood the majority of the benefits and risks for each surgical option without increasing decisional conflict. The decision aid for advanced medial compartment osteoarthritis is shown to be acceptable and useful for choosing between UKA and TKA. Copyright © 2017 Elsevier Inc. All rights reserved.

Recommendations on future development of decision support systems

DEFF Research Database (Denmark)

MCarthur, Stephen; Chen, Minjiang; Marinelli, Mattia

Deliverable 8.3 reports on the consolidation of experiences from visualisation, decision support prototypes experiments and recommendations on future developments of decision support systems......Deliverable 8.3 reports on the consolidation of experiences from visualisation, decision support prototypes experiments and recommendations on future developments of decision support systems...

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

Science.gov (United States)

2013-01-01

Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and

Assessing the information desire of patients with advanced cancer by providing information with a decision aid, which is evaluated in a randomized trial: a study protocol.

Science.gov (United States)

Oostendorp, Linda J M; Ottevanger, Petronella B; van der Graaf, Winette T A; Stalmeier, Peep F M

2011-02-14

There is a continuing debate on the desirability of informing patients with cancer and thereby involving them in treatment decisions. On the one hand, information uptake may be hampered, and additional stress could be inflicted by involving these patients. On the other hand, even patients with advanced cancer desire information on risks and prognosis. To settle the debate, a decision aid will be developed and presented to patients with advanced disease at the point of decision making. The aid is used to assess the amount of information desired. Factors related to information desire are explored, as well as the ability of the medical oncologist to judge the patient's information desire. The effects of the information on patient well-being are assessed by comparing the decision aid group with a usual care group. This study is a randomized controlled trial of patients with advanced colorectal, breast, or ovarian cancer who have started treatment with first-line palliative chemotherapy. The trial will consist of 100 patients in the decision aid group and 70 patients in the usual care group. To collect complete data of 170 patients, 246 patients will be approached for the study. Patients will complete a baseline questionnaire on sociodemographic data, well-being measures, and psychological measures, believed to predict information desire. The medical oncologist will judge the patient's information desire. After disease progression is diagnosed, the medical oncologist offers the choice between second-line palliative chemotherapy plus best supportive care (BSC) and BSC alone. Randomization will take place to determine whether patients will receive usual care (n = 70) or usual care and the decision aid (n = 100). The aid offers information about the potential risks and benefits of both treatment options, in terms of adverse events, tumour response, and survival. Patients decide for each item whether they desire the information or not. Two follow-up questionnaires will

Examination of skin lesions for cancer : Which clinical decision aids and tools are available in general practice?

NARCIS (Netherlands)

Koelink, Cecile J. L.; Jonkman, Marcel F.; Van der Meer, Klaas; Van der Heide, Wouter K.

2014-01-01

Background While skin cancer incidence is rising throughout Europe, general practitioners (GP) feel unsure about their ability to diagnose skin malignancies. Objectives To evaluate whether the GP has sufficient validated clinical decision aids and tools for the examination of potentially malignant

Tactical decision making under stress (TADMUS) decision support system

OpenAIRE

Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

1996-01-01

A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes and cognitive analysis of the decision making problems faced by Navy tactical officers in a shipboard Combat Information Center. Baseline testing in high intensity, peace keeping, littoral scenarios indicated...

Utilization of virtual prototyping in development of CMM

International Nuclear Information System (INIS)

Raneda, A.; Pessi, P.; Siuko, M.; Handroos, H.; Palmer, J.; Vilenius, M.

2003-01-01

The characteristic advantages of hydraulics (high power density, simple construction and reliability) together with the characteristics of water as the pressure medium (fire and environmentally safe, chemically neutral, not activated nor affected by radiation) are highlighted in critical applications such as remote handling operations in International Thermonuclear Experimental Reactor (ITER). However, component cost and lack of wide selection of water hydraulic components make it difficult to build and to test complex water hydraulic systems. The use of virtual prototyping for the development of water hydraulic tools can be used to address this problem. Rapidly increased computational power has created conditions for extensive numerical calculations, enabling computer aided virtual prototyping to replace physical prototype phases in product development

Evaluating the utility of a patient decision aid for potential participants of a prostate cancer trial (RAVES-TROG 08.03)

International Nuclear Information System (INIS)

Sundaresan, Puma; Turner, Sandra; Kneebone, Andrew; Pearse, Maria; Butow, Phyllis

2011-01-01

Randomised controlled trials (RCTs) can be hampered by poor patient accrual and retention. Decision aids (DAs) containing simple, evidence-based information, may assist patients with decision-making regarding trial participation. The current DA was of use for 95% of participants. Further evaluation of the DA in a RCT is currently underway.

A decision aid to assist decisions on disclosure of mental health status to an employer: protocol for the CORAL exploratory randomised controlled trial

Directory of Open Access Journals (Sweden)

Henderson Claire

2012-08-01

Full Text Available Abstract Background The UK Equality Act 2010 makes it unlawful for employers to ask health questions before making an offer of employment except in certain circumstances. While the majority of employers would prefer applicants to disclose a mental illness at the application stage, many people either wait until they have accepted the job and then disclose to an occupational health professional, or do not do so at all due to the anticipation of discrimination or a wish for privacy. However, non disclosure precludes the ability to request reasonable adjustments in the workplace or to make a claim of direct discrimination. Disclosure to employers is therefore a difficult decision. A recent pilot study by our group of the CORAL decision aid showed that it helped mental health service users clarify their needs and values regarding disclosure and led to reduction in decisional conflict. The present proof of concept trial aims to determine whether a full scale randomised controlled trial (RCT is justifiable and feasible, and to optimise its design. Methods In this single blind exploratory RCT in London, a total of 80 participants (inclusion criteria: age ≥18 years, on the caseload of a specialist employment adviser working with people with mental illness; referred to the adviser either from primary care via Improving Access to Psychological Therapies or secondary mental health service; currently seeking or interested in either paid or voluntary employment, and a Decisional Conflict Scale score of 37.5 or greater and stage of decision score 1–5 will be recruited from vocational advice services. After completing a baseline assessment, participants will be randomly assigned to one of two conditions (1 Use of the CORAL Decision Aid (DA in addition to treatment as usual or (2 Treatment as usual. Those allocated to the DA condition will be given it to read and complete, and the researcher will be present to record the time taken and any content that

Decision analysis multicriteria analysis

International Nuclear Information System (INIS)

Lombard, J.

1986-09-01

The ALARA procedure covers a wide range of decisions from the simplest to the most complex one. For the simplest one the engineering judgement is generally enough and the use of a decision aiding technique is therefore not necessary. For some decisions the comparison of the available protection option may be performed from two or a few criteria (or attributes) (protection cost, collective dose,...) and the use of rather simple decision aiding techniques, like the Cost Effectiveness Analysis or the Cost Benefit Analysis, is quite enough. For the more complex decisions, involving numerous criteria or for decisions involving large uncertainties or qualitative judgement the use of these techniques, even the extended cost benefit analysis, is not recommended and appropriate techniques like multi-attribute decision aiding techniques are more relevant. There is a lot of such particular techniques and it is not possible to present all of them. Therefore only two broad categories of multi-attribute decision aiding techniques will be presented here: decision analysis and the outranking analysis

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial.

Science.gov (United States)

Schwartz, Peter H; Perkins, Susan M; Schmidt, Karen K; Muriello, Paul F; Althouse, Sandra; Rawl, Susan M

2017-08-01

Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a "nudge" towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Patients viewing the quantitative module were more likely to be screened than those who did not ( P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not ( P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not ( P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT ( P = 0.028) than did those who did not. The limitations of this study were the limited sample size and single healthcare system. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.

Decision aiding techniques for site remediation

Energy Technology Data Exchange (ETDEWEB)

Van de Walle, B

1996-09-18

Decision making problems in the nuclear domain are known for their complexity since they usually involve a wide range of technical, social, and political considerations. Site restoration is a typical example of a complex nuclear decision problem, and more and more decision makers realize that they need new tools to assist in the decision making process. This paper reports on multi-criteria decision analysis, a powerful tool for handling complex decisions involving multiple criteria. The motivation to use multi-criteria decision analysis in the domain of site restoration is illustrated. New developments and challenges in this field are addressed.

Decision aiding techniques for site remediation

International Nuclear Information System (INIS)

Van de Walle, B.

1996-01-01

Decision making problems in the nuclear domain are known for their complexity since they usually involve a wide range of technical, social, and political considerations. Site restoration is a typical example of a complex nuclear decision problem, and more and more decision makers realize that they need new tools to assist in the decision making process. This paper reports on multi-criteria decision analysis, a powerful tool for handling complex decisions involving multiple criteria. The motivation to use multi-criteria decision analysis in the domain of site restoration is illustrated. New developments and challenges in this field are addressed

Mismatch between health-care professionals' and patients' views on a diabetes patient decision aid: a qualitative study.

Science.gov (United States)

Lee, Ping Yein; Khoo, Ee Ming; Low, Wah Yun; Lee, Yew Kong; Abdullah, Khatijah Lim; Azmi, Syahidatul Akmal; Ng, Chirk Jenn

2016-04-01

Malaysia is an Asian country with population of diverse culture and health perceptions. Patient decision aid (PDA) is a new tool in Malaysia. Patients' and health-care professionals' (HCPs) expectation of a PDA is unknown. We aimed to explore patients' and health-care professionals'(HCPs) views on the information needed in a patient decision aid (PDA) on insulin initiation developed for patients with type 2 diabetes mellitus (T2DM). We used a qualitative design and thematic approach. Three main primary health-care settings in Malaysia: public university-based primary care clinics, public health-care clinics and private general practices. We conducted focus groups and one-to-one interviews with a purposive sample of health professionals and patients with type 2 diabetes. We interviewed 18 patients and 13 HCPs. Patients viewed the content of the PDA as simple and clear. However, HCPs felt the PDA might be difficult for patients with low literacy to understand. HCPs thought the PDA was too lengthy. Nevertheless, patients would prefer more information. HCPs tended to focus on benefits of insulin, while patients wanted to know the impact of insulin on their quality of life and practical issues regarding insulin and its side-effects. Patients preferred numbers to weigh the risks and benefits of treatment options. HCPs' views that presenting numbers in a PDA would be too complex for patients to understand. It is important to consider including issues related to psycho-social impact of treatment to patients when developing a patient decision aid. © 2015 John Wiley & Sons Ltd.

Women's role in reproductive health decision making and vulnerability to STD and HIV/AIDS in Ekiti, Nigeria.

Science.gov (United States)

Orubuloye, I O; Oguntimehin, F; Sadiq, T

1997-01-01

An exploratory study of women's role in reproductive decision making in Ekiti shows that women in the state are increasingly taking active decisions on matters affecting their daily lives. More women than ever before believed that they could take decisions on family size, when to have a baby and choice of spacing period. The cultural barrier against short postpartum abstinence appeared to have diminished and sex during lactation was not considered a major cultural and religious taboo. Knowledge of contraception has become universal in recent years, and the majority of women take decisions on the method and timing of family planning. All women who used family planning considered their decision in this regard very important. The ability of women to take decisions on these issues may not only enhance their bargaining power but also reduce their vulnerability to STDs including AIDS from diseased or high-risk partners.

Comparative use of the computer-aided angiography and rapid prototyping technology versus conventional imaging in the management of the Tile C pelvic fractures.

Science.gov (United States)

Li, Baofeng; Chen, Bei; Zhang, Ying; Wang, Xinyu; Wang, Fei; Xia, Hong; Yin, Qingshui

2016-01-01

Computed tomography (CT) scan with three-dimensional (3D) reconstruction has been used to evaluate complex fractures in pre-operative planning. In this study, rapid prototyping of a life-size model based on 3D reconstructions including bone and vessel was applied to evaluate the feasibility and prospect of these new technologies in surgical therapy of Tile C pelvic fractures by observing intra- and perioperative outcomes. The authors conducted a retrospective study on a group of 157 consecutive patients with Tile C pelvic fractures. Seventy-six patients were treated with conventional pre-operative preparation (A group) and 81 patients were treated with the help of computer-aided angiography and rapid prototyping technology (B group). Assessment of the two groups considered the following perioperative parameters: length of surgical procedure, intra-operative complications, intra- and postoperative blood loss, postoperative pain, postoperative nausea and vomiting (PONV), length of stay, and type of discharge. The two groups were homogeneous when compared in relation to mean age, sex, body weight, injury severity score, associated injuries and pelvic fracture severity score. Group B was performed in less time (105 ± 19 minutes vs. 122 ± 23 minutes) and blood loss (31.0 ± 8.2 g/L vs. 36.2 ± 7.4 g/L) compared with group A. Patients in group B experienced less pain (2.5 ± 2.3 NRS score vs. 2.8 ± 2.0 NRS score), and PONV affected only 8 % versus 10 % of cases. Times to discharge were shorter (7.8 ± 2.0 days vs. 10.2 ± 3.1 days) in group B, and most of patients were discharged to home. In our study, patients of Tile C pelvic fractures treated with computer-aided angiography and rapid prototyping technology had a better perioperative outcome than patients treated with conventional pre-operative preparation. Further studies are necessary to investigate the advantages in terms of clinical results in the short and long run.

Implications of Decision Making Research for Decision Support and Displays

OpenAIRE

Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

1998-01-01

To appear in J. A. Cannon-Bowers & E. Salas (Eds.), Decision Making Under Stress: Implications for Training and Simulation. A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes, and cognitive analysis was conducted of the decision making problems faced by Navy ...

Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.

Science.gov (United States)

Berger, Bettina; Schwarz, Christiane; Heusser, Peter

2015-05-07

Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). A literature search was carried out in a variety of lay and medical databases. written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.

Involving women in personalised decision-making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid.

Science.gov (United States)

Schoorel, E N C; Vankan, E; Scheepers, H C J; Augustijn, B C C; Dirksen, C D; de Koning, M; van Kuijk, S M J; Kwee, A; Melman, S; Nijhuis, J G; Aardenburg, R; de Boer, K; Hasaart, T H M; Mol, B W J; Nieuwenhuijze, M; van Pampus, M G; van Roosmalen, J; Roumen, F J M E; de Vries, R; Wouters, M G A J; van der Weijden, T; Hermens, R P M G

2014-01-01

To develop a patient decision aid (PtDA) for mode of delivery after caesarean section that integrates personalised prediction of vaginal birth after caesarean (VBAC) with the elicitation of patient preferences and evidence-based information. A PtDA was developed and pilot tested using the International Patients Decision Aid Standards (IPDAS) criteria. Obstetric health care in the Netherlands. A multidisciplinary steering group, an expert panel, and 25 future users of the PtDA, i.e. women with a previous caesarean section. The development consisted of a construction phase (definition of scope and purpose, and selection of content, framework, and format) and a pilot testing phase by interview. The process was supervised by a multidisciplinary steering group. Usability, clarity, and relevance. The construction phase resulted in a booklet including unbiased balanced information on mode of birth after caesarean section, a preference elicitation exercise, and tailored risk information, including a prediction model for successful VBAC. During pilot testing, visualisation of risks and clarity formed the main basis for revisions. Pilot testing showed the availability of tailored structured information to be the main factor involving women in decision-making. The PtDA meets 39 out of 50 IPDAS criteria (78%): 23 out of 23 criteria for content (100%) and 16 out of 20 criteria for the development process (80%). Criteria for effectiveness (n = 7) were not evaluated. An evidence-based PtDA was developed, with the probability of successful VBAC and the availability of structured information as key items. It is likely that the PtDA enhances the quality of decision-making on mode of birth after caesarean section. © 2013 Royal College of Obstetricians and Gynaecologists.

The importance of decision-making aids in the energy area: from planning to the management of disorder and climate change

International Nuclear Information System (INIS)

Taverdet-Popiolek, N.

2011-01-01

The purpose of this article is to situate decision-making aids in the energy area in France and show how the tools have changed over time as a function of the changing economic and political context. The challenges faced, already important in the post-war era due to reconstruction, are now huge due to supply constraints and global warming. While it is the State's responsibility to address these issues, as the players in the energy area currently are mainly in the private sphere, we look at decisions taken both by the State and by companies. Schematically, we compare two major periods: that of post-war planning through the eighties, and that of risk management, which has been current practice since market deregulation. From the methodological standpoint, we show that decision-making aids borrow tools from varied disciplines ranging from economics through management to futurology and long range planning. (author)

Point-of-views representation for hypothetical reasoning: application to decision-aid

International Nuclear Information System (INIS)

Diaz, Antoine

1992-01-01

Most of the knowledge based Decision Support Systems must deal with two difficulties in problem solving representation: reasoning with incomplete knowledge and managing contradictory reasoning. We propose a method which answers the question of reasoning revision when a contradiction occurs, while preserving the functionalities of the De Kleer's ATMS System for simulating hypothetical reasoning. As a matter of fact, these functionalities are particularly suitable for decision aiding problems. In order to formalize the ATMS, we use a resolution method called Cat-resolution (Cayrol and Tayrac). This method allows the computation of ATMS functions relating to a set of propositional clauses by saturating this set. Owing to this choice, we can use the same principles as ATMS on the saturation trace. Each clause in the saturated set can be linked to the sets of initial clauses justifying its derivation by Cat-resolution. The reasoning inconsistency is now managed. First the user can identify the source of the inconsistency thanks to the empty clause explanation. Then he can try to restore the reasoning consistency by relaxing at least one of the initial clauses justifying the empty clause. The computation of 'partial' ATMS, representing a point of view in the decision-making problem, is more effective owing to the justifications of the derived clauses. (author) [fr

An exploration of decision aid effectiveness: the impact of promoting affective vs. deliberative processing on a health-related decision.

Science.gov (United States)

Davis, Esther L; McCaffery, Kirsten; Mullan, Barbara; Juraskova, Ilona

2015-12-01

Decision aids (DAs) are non-directive communication tools that help patients make value-consistent health-care decisions. However, most DAs have been developed without an explicit theoretical framework, resulting in a lack of understanding of how DAs achieve outcomes. To investigate the effect of promoting affective vs. deliberative processing on DA effectiveness based on dual-process theory. One hundred and forty-eight female university students participated in a randomized controlled experiment with three conditions: emotion-focused, information-focused and control. Preference-value consistency, knowledge, decisional conflict and satisfaction were compared across the conditions using planned contrast analyses. The intervention comprised two different DAs and instructional manipulations. The emotion-focused condition received a modified DA with affective content and instructions to induce an affective reaction. The information-focused and control conditions received the same DA without the affective content. The information-focused condition received additional instructions to induce deliberative processing. Controlling for the experiment-wise error rate at P processing may hinder value-consistent decision making, while deliberative processing may enhance decisional satisfaction. This investigation of the effect of affective and deliberative processes in DA-supported decision making has implications for the design and use of DAs. DA effectiveness may be enhanced by incorporating a simple instruction to focus on the details of the information. © 2014 John Wiley & Sons Ltd.

Analyzing the decision making process of certifying digital control systems of nuclear power plants

International Nuclear Information System (INIS)

Yih, Swu; Fan, Chin-Feng

2012-01-01

Highlights: ► We have performed basic research in analyzing certification process and developed a regulatory decision making model for nuclear digital control system certification. The model views certification as an evidence–confidence conversion process. ► We have applied this model to analyze previous nuclear digital I and C certification experiences and obtained valuable insights. ► Furthermore, a prototype of a computer-aided licensing support system based on the model has been developed to enhance regulatory review efficiency. - Abstract: Safety-critical computing systems need regulators’ approval before operation. Such a permit issue process is called “certification”. Digital instrumentation and Control (I and C) certification in the nuclear domain has always been problematic and lengthy. Thus, the certification efficiency has always been a crucial concern to the applicant whose business depends on the regulatory decision. However, to our knowledge, there is little basic research on this topic. This study presents a Regulatory Decision-Making Model aiming at analyzing the characteristics and efficiency influence factors in a generic certification process. This model is developed from a dynamic operational perspective by viewing the certification process as an evidence–confidence conversion process. The proposed model is then applied to previous nuclear digital I and C certification experiences to successfully explain why some cases were successful and some were troublesome. Lessons learned from these cases provide invaluable insights regarding to the regulatory review activity. Furthermore, to utilize the insights obtained from the model, a prototype of a computer-aided licensing support system has been developed to speed up review evidence preparation and manipulation; thus, regulatory review efficiency can be further improved.

Development and initial evaluation of a treatment decision dashboard.

Science.gov (United States)

Dolan, James G; Veazie, Peter J; Russ, Ann J

2013-04-21

For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5

A COMPUTERIZED OPERATOR SUPPORT SYSTEM PROTOTYPE

Energy Technology Data Exchange (ETDEWEB)

Thomas A. Ulrich; Roger Lew; Ronald L. Boring; Ken Thomas

2015-03-01

A computerized operator support system (COSS) is proposed for use in nuclear power plants to assist control room operators in addressing time-critical plant upsets. A COSS is a collection of technologies to assist operators in monitoring overall plant performance and making timely, informed decisions on appropriate control actions for the projected plant condition. A prototype COSS was developed in order to demonstrate the concept and provide a test bed for further research. The prototype is based on four underlying elements consisting of a digital alarm system, computer-based procedures, piping and instrumentation diagram system representations, and a recommender module for mitigation actions. The initial version of the prototype is now operational at the Idaho National Laboratory using the Human System Simulation Laboratory.

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai?i

OpenAIRE

Volandes, Angelo E.; Paasche-Orlow, Michael K.; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-01-01

Introduction: Advance care planning (ACP) seeks to promote care delivery that is concordant with patients’ informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Aim Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. Setting: The city o...

SOPHIA: Soft Orthotic Physiotherapy Hand Interactive Aid

Directory of Open Access Journals (Sweden)

Alistair C. McConnell

2017-06-01

Full Text Available This work describes the design, fabrication, and initial testing of a Soft Orthotic Physiotherapy Hand Interactive Aid (SOPHIA for stroke rehabilitation. SOPHIA consists of (1 a soft robotic exoskeleton, (2 a microcontroller-based control system driven by a brain–machine interface (BMI, and (3 a sensorized glove for passive rehabilitation. In contrast to other rehabilitation devices, SOPHIA is the first modular prototype of a rehabilitation system that is capable of three tasks: aiding extension based assistive rehabilitation, monitoring patient exercises, and guiding passive rehabilitation. Our results show that this prototype of the device is capable of helping healthy subjects to open their hand. Finger extension is triggered by a command from the BMI, while using a variety of sensors to ensure a safe motion. All data gathered from the device will be used to guide further improvements to the prototype, aiming at developing specifications for the next generation device, which could be used in future clinical trials.

Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

Directory of Open Access Journals (Sweden)

Dirk T Ubbink

2008-11-01

Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

Science.gov (United States)

Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

2017-12-01

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Barriers and Facilitators to Patient-Provider Communication When Discussing Breast Cancer Risk to Aid in the Development of Decision Support Tools.

Science.gov (United States)

Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita

2015-01-01

The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.

Exploring the requirements for a decision aid on familial breast cancer in the UK context: a qualitative study with patients referred to a cancer genetics service.

NARCIS (Netherlands)

Iredale, R.; Rapport, F.; Sivell, S.; Jones, W.; Edwards, A.; Gray, J.; Elwyn, G.

2008-01-01

RATIONALE: Patients concerned about a family history of breast cancer can face difficult decisions about screening, prophylactic surgery and genetic testing. Decision aids can facilitate patient decision making and currently include leaflets and computerized tools. These are largely aimed at the

Optimal Aide Security Information Search (OASIS)

National Research Council Canada - National Science Library

Kapadia, Chetna

2005-01-01

The purpose of the Optimal AIDE Security Information Search (OASIS) effort was to investigate and prototype a tool that can assist the network security analyst in collecting useful information to defend the networks they manage...

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

Science.gov (United States)

Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

2012-01-01

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Cultural and linguistic adaptation of a multimedia colorectal cancer screening decision aid for Spanish-speaking Latinos.

Science.gov (United States)

Ko, Linda K; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael

2014-01-01

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse, vulnerable populations, including Latinos. To address such disparities, health communication interventionists often face the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. The authors describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish-language version of an evidence-based (English language) multimedia colorectal cancer screening decision aid. The multistep process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. The authors integrated these findings in the creation of the new adapted intervention. They describe how they used this process to identify and integrate sociocultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish-language decision aid.

Towards the Significance of Decision Aid in Building Information Modeling (BIM Software Selection Process

Directory of Open Access Journals (Sweden)

Omar Mohd Faizal

2014-01-01

Full Text Available Building Information Modeling (BIM has been considered as a solution in construction industry to numerous problems such as delays, increased lead in times and increased costs. This is due to the concept and characteristic of BIM that will reshaped the way construction project teams work together to increase productivity and improve the final project outcomes (cost, time, quality, safety, functionality, maintainability, etc.. As a result, the construction industry has witnesses numerous of BIM software available in market. Each of this software has offers different function, features. Furthermore, the adoption of BIM required high investment on software, hardware and also training expenses. Thus, there is indentified that there is a need of decision aid for appropriated BIM software selection that fulfill the project needs. However, research indicates that there is limited study attempt to guide decision in BIM software selection problem. Thus, this paper highlight the importance of decision making and support for BIM software selection as it is vital to increase productivity, construction project throughout building lifecycle.

Cognitive Systems Engineering Tool Survey - A Subtask in Support of Commander's Decision Aids for Predictive Battle-Space Awareness (CDA4PBA)

National Research Council Canada - National Science Library

Sanders, Mary; Fitzhugh, Elisabeth

2005-01-01

...) DO 6, Commander's Decision Aids for Predictive Battle-Space Awareness, (CDA4PBA) is to identify system requirements necessary to capture the entire software and systems engineering process from concept...

A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation

DEFF Research Database (Denmark)

LaHaye, Stephen Andrew; Gibbens, Sabra Lynn; Ball, David Gerald Andrew

2012-01-01

The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime...

Decision making in the reactor control room

International Nuclear Information System (INIS)

Nelson, W.R.

1982-01-01

One of the most important roles of the nuclear reactor operator is that of decision maker. This paper discusses a simple model of the decision process used by the reactor operator. Resources that must be available so that he can perform the decision process are presented. Decision aids which have been investigated at EG and G Idaho, Inc., as part of the LOFT Augmented Operator Capability Program are briefly discussed. Some general concepts of computerized decision aiding are developed, and the promises and pitfalls of such decision aids are explored

Developing a Prototype ALHAT Human System Interface for Landing

Science.gov (United States)

Hirsh, Robert L.; Chua, Zarrin K.; Heino, Todd A.; Strahan, Al; Major, Laura; Duda, Kevin

2011-01-01

The goal of the Autonomous Landing and Hazard Avoidance Technology (ALHAT) project is to safely execute a precision landing anytime/anywhere on the moon. This means the system must operate in any lighting conditions, operate in the presence of any thruster generated regolith clouds, and operate without the help of redeployed navigational aids or prepared landing site at the landing site. In order to reach this ambitious goal, computer aided technologies such as ALHAT will be needed in order to permit these landings to be done safely. Although there will be advanced autonomous capabilities onboard future landers, humans will still be involved (either onboard as astronauts or remotely from mission control) in any mission to the moon or other planetary body. Because many time critical decisions must be made quickly and effectively during the landing sequence, the Descent and Landing displays need to be designed to be as effective as possible at presenting the pertinent information to the operator, and allow the operators decisions to be implemented as quickly as possible. The ALHAT project has established the Human System Interface (HSI) team to lead in the development of these displays and to study the best way to provide operators enhanced situational awareness during landing activities. These displays are prototypes that were developed based on multiple design and feedback sessions with the astronaut office at NASA/ Johnson Space Center. By working with the astronauts in a series of plan/build/evaluate cycles, the HSI team has obtained astronaut feedback from the very beginning of the design process. In addition to developing prototype displays, the HSI team has also worked to provide realistic lunar terrain (and shading) to simulate a "out the window" view that can be adjusted to various lighting conditions (based on a desired date/time) to allow the same terrain to be viewed under varying lighting terrain. This capability will be critical to determining the

A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter.

Science.gov (United States)

Gökce, Mehmet İlker; Esen, Barış; Sancı, Adem; Akpınar, Cağrı; Süer, Evren; Gülpınar, Ömer

2017-07-01

Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

"Provoking conversations": case studies of organizations where Option Grid™ decision aids have become 'normalized'.

Science.gov (United States)

Scalia, Peter; Elwyn, Glyn; Durand, Marie-Anne

2017-08-18

Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholders were conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. 'Coherent' motivations were guided by financial incentives at CapitalCare, and by a 'champion' physician at HealthPartners. Nurses worked 'collectively' at both settings and played an important role at sites where successful implementation occurred. Some physicians did not understand the perceived utility of Option Grid™, which led to varying degrees of implementation success across sites. The appraisal work (reflexive monitoring) identified benefits, particularly in terms of information provision. Physicians at both settings, however, were concerned with time pressures and the suitability of the tool for patients with low levels of health literacy. Although both practice settings illustrated the mechanisms of normalization postulated by the theory, the extent to which Option Grid™ was routinely embedded in clinic workflow varied between sites, and between clinicians. Implementation of new interventions will require attention to an identified rationale (coherence), and to the collective action, cognitive participation, and assessment of value by organizational members of the organization.

The development and use of decision aiding techniques for establishing intervention levels

International Nuclear Information System (INIS)

Kelly, G.N.; Sinnaeve, J.

1989-01-01

Following the Chernobyl accident there has been considerable international discussion on the principles underlying the choice of intervention levels and their practical application. While there is broad agreement on the underlying principles - that is to put potentially exposed individuals into a better position in the sense that lower overall risks are achieved at reasonable cost in financial and social terms - the determination of what constitutes the most appropriate type and level of intervention in any particular circumstances is more complex. Within the CEC Radiation Protection Research Programme techniques are being developed to aid well founded and more transparent decisions on the choice of intervention levels. The techniques are described and areas identified where they might usefully be applied

The Wind Atlas for South Africa (WASA): A tool to aid developers and decision makers

CSIR Research Space (South Africa)

Mabille, E

2015-10-01

Full Text Available ): A tool to aid developers and decision makers Eugene Mabille The WASA Project Team SANEDI South African National Energy Development Institute • executing agency – contracting the implementing partners • coordination and dissemination UCT... to produce wind atlas for generalised surface conditions (uniform terrain and roughness). Files compatible with WAsP software.  Used for the first WASA published in 2012.  KAMM/WAsP method, numerically very cheap, gives good results  underestimation...

When Prototyping Meets Storytelling. Practices and Malpractices in Innovating Software Firms

DEFF Research Database (Denmark)

Ciriello, Raffaele; Richter, Alexander; Schwabe, Gerhard

2017-01-01

Storytelling is an important but often underestimated practice in software engineering. Whereas existing research widely regards storytelling as creating a common understanding between developers and users, we argue that storytelling and prototyping are intertwined practices for innovators...... to persuade decision makers. Based on a two-year qualitative case study in two innovating software firms, we identify and dialectically examine practices of storytelling and prototyping. Our study implies that storytelling and prototyping should be integrated together into software engineering methods....

Effect of decision aid for breast cancer prevention on decisional conflict in women with a BRCA1 or BRCA2 mutation: a multisite, randomized, controlled trial.

Science.gov (United States)

Metcalfe, Kelly A; Dennis, Cindy-Lee; Poll, Aletta; Armel, Susan; Demsky, Rochelle; Carlsson, Lindsay; Nanda, Sonia; Kiss, Alexander; Narod, Steven A

2017-03-01

Women with a BRCA1 or BRCA2 mutation are at high risk for breast cancer and must make important decisions about breast cancer prevention and screening. In the current study, we report a multisite, randomized, controlled trial evaluating the effectiveness of a decision aid for breast cancer prevention in women with a BRCA mutation with no previous diagnosis of cancer. Within 1 month of receiving a positive BRCA result, women were randomized to receive either usual care (control group) or decision aid (intervention group). Participants were followed at 3, 6, and 12 months; were asked about preventive measures; and completed standardized questionnaires assessing decision making and psychosocial functioning. One hundred fifty women were randomized. Mean cancer-related distress scores were significantly lower in the intervention group compared with the control group at 6 months (P = 0.01) and at 12 months postrandomization (P = 0.05). Decisional conflict scores declined over time for both groups and at no time were there statistical differences between the two groups. The decision aid for breast cancer prevention in women with a BRCA1 or BRCA2 mutation is effective in significantly decreasing cancer-related distress within the year following receipt of positive genetic test results.Genet Med 19 3, 330-336.

A review of rapid prototyping techniques for tissue engineering purposes

NARCIS (Netherlands)

Peltola, Sanna M.; Melchels, Ferry P. W.; Grijpma, Dirk W.; Kellomaki, Minna

2008-01-01

Rapid prototyping (RP) is a common name for several techniques, which read in data from computer-aided design (CAD) drawings and manufacture automatically three-dimensional objects layer-by-layer according to the virtual design. The utilization of RP in tissue engineering enables the production of

Effect of decision making on ultrasonic examination performance

International Nuclear Information System (INIS)

Harris, D.H.

1992-05-01

A decision aid was developed to overcome examiner limitations in information processing and decision making during ultrasonic examinations. The aid provided a means of noting signal characteristics as they were observed during the examination, and of presenting them simultaneously for decision making. The aid also served as a way of providing detailed feedback on examination performance during training. The aid was incorporated into worksheets used for the conduct of practice examinations during ultrasonic examination training. To support the introduction and use of the decision aid, one hour of supplementary training was inserted in an existing 64-hour training course on ultrasonic detection of defects. This study represented a modest step in improving the performance of ultrasonic examinations in nuclear power plants. Findings indicated that aided decision making supported by limited training can significantly improve ultrasonic detection performance

Cultural and Linguistic Adaptation of a Multimedia Colorectal Cancer Screening Decision Aid for Spanish Speaking Latinos

Science.gov (United States)

Ko, Linda K.; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael

2014-01-01

As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid. PMID:24328496

New layer-based imaging and rapid prototyping techniques for computer-aided design and manufacture of custom dental restoration.

Science.gov (United States)

Lee, M-Y; Chang, C-C; Ku, Y C

2008-01-01

Fixed dental restoration by conventional methods greatly relies on the skill and experience of the dental technician. The quality and accuracy of the final product depends mostly on the technician's subjective judgment. In addition, the traditional manual operation involves many complex procedures, and is a time-consuming and labour-intensive job. Most importantly, no quantitative design and manufacturing information is preserved for future retrieval. In this paper, a new device for scanning the dental profile and reconstructing 3D digital information of a dental model based on a layer-based imaging technique, called abrasive computer tomography (ACT) was designed in-house and proposed for the design of custom dental restoration. The fixed partial dental restoration was then produced by rapid prototyping (RP) and computer numerical control (CNC) machining methods based on the ACT scanned digital information. A force feedback sculptor (FreeForm system, Sensible Technologies, Inc., Cambridge MA, USA), which comprises 3D Touch technology, was applied to modify the morphology and design of the fixed dental restoration. In addition, a comparison of conventional manual operation and digital manufacture using both RP and CNC machining technologies for fixed dental restoration production is presented. Finally, a digital custom fixed restoration manufacturing protocol integrating proposed layer-based dental profile scanning, computer-aided design, 3D force feedback feature modification and advanced fixed restoration manufacturing techniques is illustrated. The proposed method provides solid evidence that computer-aided design and manufacturing technologies may become a new avenue for custom-made fixed restoration design, analysis, and production in the 21st century.

Decision-Aiding and Optimization for Vertical Navigation of Long-Haul Aircraft

Science.gov (United States)

Patrick, Nicholas J. M.; Sheridan, Thomas B.

1996-01-01

different airspace design and air traffic management policies. A decision aid is proposed which would combine the pilot's notion of optimality with the GA-based optimization, provide the pilot with a number of alternative pareto-optimal trajectories, and allow him to consider unmodelled attributes and constraints in choosing among them. A solution to the problem of displaying alternatives in a multi-attribute decision space is also presented.

Review of decision aids for nuclear-plant operators

International Nuclear Information System (INIS)

Kisner, R.A.

1983-01-01

Responses to various computer-based operational aids varied widely in detail, thus forcing distillation of the salient features of many operational aids from information sources other than the initial questionnaire. These sources included technical and management presentations, technical papers and reports, personal discussions, taped responses, sales brochures, system specifications and schematics, and other documents. The data base is dynamic, not static, owing to the nature of current trends in operational aid development. The information contained in it is subject to review and revision by the developing organizations. More systems are pending review and entry into the data base; hence the list is incomplete

Impact of a web-based prostate cancer treatment decision aid on patient-reported decision process parameters: results from the Prostate Cancer Patient Centered Care trial.

Science.gov (United States)

Cuypers, Maarten; Lamers, Romy E D; Kil, Paul J M; van de Poll-Franse, Lonneke V; de Vries, Marieke

2018-05-12

To compare patients' evaluation of the treatment decision-making process in localized prostate cancer between counseling that included an online decision aid (DA) and standard counseling. Eighteen Dutch hospitals were randomized to DA counseling (n = 235) or the control group with standard counseling (n = 101) in a pragmatic, cluster randomized controlled trial. The DA was provided to patients at, or soon after diagnosis. Decisional conflict, involvement, knowledge, and satisfaction with information were assessed with a questionnaire after treatment decision-making. Anxiety and depression served as covariates. The levels of decision involvement and conflict were comparable between patients in both groups. Patients with a DA felt more knowledgeable but scored equally well on a knowledge test as patients without a DA. Small significant negative effects were found on satisfaction with information and preparation for decision-making. A preference for print over online and depression and anxiety symptoms was negatively associated with satisfaction and conflict scores in the DA group. The DA aimed to support shared decision-making, while outcomes for a majority of DA users were comparable to patients who received standard counseling. Patients, who are less comfortable with the online DA format or experience anxiety or depression symptoms, could require more guidance toward shared decision-making. To evaluate long-term DA effects, follow-up evaluation on treatment satisfaction and decisional regret will be done.

A multiattribute utility analysis of sites nominated for characterization for the first radioactive-waste repository: A decision-aiding methodology

Energy Technology Data Exchange (ETDEWEB)

none,

1986-05-01

In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report.

A multiattribute utility analysis of sites nominated for characterization for the first radioactive-waste repository: A decision-aiding methodology

International Nuclear Information System (INIS)

1986-05-01

In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report

Cell-free synthetic biology for in vitro prototype engineering.

Science.gov (United States)

Moore, Simon J; MacDonald, James T; Freemont, Paul S

2017-06-15

Cell-free transcription-translation is an expanding field in synthetic biology as a rapid prototyping platform for blueprinting the design of synthetic biological devices. Exemplar efforts include translation of prototype designs into medical test kits for on-site identification of viruses (Zika and Ebola), while gene circuit cascades can be tested, debugged and re-designed within rapid turnover times. Coupled with mathematical modelling, this discipline lends itself towards the precision engineering of new synthetic life. The next stages of cell-free look set to unlock new microbial hosts that remain slow to engineer and unsuited to rapid iterative design cycles. It is hoped that the development of such systems will provide new tools to aid the transition from cell-free prototype designs to functioning synthetic genetic circuits and engineered natural product pathways in living cells. © 2017 The Author(s).

The Mark III vertex chamber and prototype test results

International Nuclear Information System (INIS)

Grab, C.

1987-07-01

A vertex chamber has been constructed for use in the Mark III experiment. The chamber is positioned inside the current main drift chamber and will be used to trigger data collection, to aid in vertex reconstruction, and to improve the momentum resolution. This paper discusses the chamber's construction and performance and tests of the prototype

Preparing Parents to Make An Informed Choice About Antibiotic Use for Common Acute Respiratory Infections in Children: A Randomised Trial of Brief Decision Aids in a Hypothetical Scenario.

Science.gov (United States)

Coxeter, Peter D; Del Mar, Chris B; Hoffmann, Tammy C

2017-08-01

Childhood acute respiratory infections (ARIs) are one of the most common reasons for primary care consultations and for receiving an antibiotic. Public awareness of antibiotic benefit and harms for these conditions is low. To facilitate informed decision making, ideally in collaboration with their doctor, parents need clear communication about benefits and harms. Decision aids may be able to facilitate this process. The aim of this study was to evaluate the effectiveness of three decision aids about antibiotic use for common ARIs in children. Adult parents of children aged 1-16 years (n = 120) were recruited from community settings and then randomised using a computer-generated randomisation sequence to receive a decision aid (n = 60) or fact sheet (n = 60). Allocation was concealed and used sealed and opaque sequentially numbered envelopes. Participants self-completed questionnaires at baseline and immediately post-intervention. The primary outcome was informed choice (conceptual and numerical knowledge; attitudes towards, and intention to use, antibiotics for a future ARI). Secondary outcomes were decisional conflict, decisional self-efficacy, and material acceptability. After reading the information, significantly more intervention group participants made an informed choice [57%] compared with control group participants [29%] [difference 28, 95% confidence interval (CI) 11-45%, p decision aids prepared parents to make an informed choice about antibiotic use more than fact sheets, in a hypothetical situation. Their effect within a consultation needs to be evaluated. Clinical Trials Registration Number: ACTRN12615000843550.

Decisional equipoise is not decisional conflict: avoiding the false clarity bias in the evaluation of decision aids and Shared Decision Making processes

DEFF Research Database (Denmark)

Kaltoft, Mette Kjer; Salkeld, Glenn; Cunich, Michelle

2014-01-01

not include such ‘sureness’ criteria. Methods: In the fixed criteria arm of an Australian trial of decision aids relating to PSA testing for prostate cancer 727 respondents supplied their importance weights for 5 criteria (loss of lifetime, needless biopsy, and bowel, urinary and sexual problems). Combining...... these criteria weights with the best available evidence on the performance of the two options (have or not have a PSA test) on each criterion, produced a personalised expected value score for each option on a 0 to 1 scale. The Absolute Difference (AD) between the two option scores for each individual...... was calculated and those whose AD was .01 or less were defined as being in effective equipoise. These ADs were then correlated with respondent’s scores on the self-weighted and self-rated instrument, MyDecisionQuality, which contains 8 items (Options, Effects, Importance, Chances, Trust, Support, Control...

To notify or not to notify : Decision aid for policy makers on whether to make an infectious disease mandatorily notifiable

NARCIS (Netherlands)

Bijkerk, Paul; Fanoy, E. B.; Kardamanidis, K.; van der Plas, S. M.; te Wierik, M. J.; Kretzschmar, M. E.; Haringhuizen, G. B.; van Vliet, H. J.; van der Sande, M. A.

2015-01-01

Mandatory notification can be a useful tool to support infectious disease prevention and control. Guidelines are needed to help policymakers decide whether mandatory notification of an infectious disease is appropriate. We developed a decision aid, based on a range of criteria previously used in the

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions

Directory of Open Access Journals (Sweden)

Kadir Masood

2007-01-01

Full Text Available Abstract Background Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. Methods A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Results HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Conclusion Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions.

Science.gov (United States)

Husain, Sara; Kadir, Masood; Fatmi, Zafar

2007-01-23

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real

Evaluating the content and development of decision aid tools for the management of menopause: A scoping review.

Science.gov (United States)

Siyam, Tasneem; Sultani, Humirah; Ross, Sue; Chatterley, Trish; Yuksel, Nese

2017-12-01

Decision-making during menopause (especially surgical menopause) can be complex given the variability in risk-benefit perceptions of menopausal treatments. Decision aid tools (DATs) help women participate in decision-making about options. Our objective is to identify and evaluate the content and development of DATs for managing menopause, with a special focus on surgical menopause. We systematically searched electronic databases, including MEDLINE and EMBASE, from inception to March 2017 for relevant records. The principal inclusion criterion was that papers reported studies on DATs for managing menopause. Search terms were derived from two concepts: menopause and DATs. Data extracted were presented in written evidence tables and narrative summaries. Our search yielded 18,801 records. Of these, 26 records met our inclusion criteria, which gave rise to 12 DATs from peer-reviewed literature and 6 from grey literature. Seventeen DATs were focused on natural menopause and two targeted surgical menopause, both identified from grey literature. More than half were published before the Women's Health Initiative (WHI) publication and 70% before the release of the International Patient Decision Aid Standards (IPDAS). Very few studies reported the full development of the DAT involved, and less than half of DATs were informed by a needs assessment to identify the decisional needs of their target population. Most DATs focused on hormone therapy as a treatment option and did not provide a comprehensive overview of other options. None of the DATs reported the steps involved in finding, appraising and summarizing scientific content of the tool. This review highlights several limitations in the content and development of DATs for managing menopause. No peer-reviewed DATs were identified for surgical menopause. A need for a complete, evidence-based DAT in the context of surgical menopause is identified. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient and family communication during consultation visits: The effects of a decision aid for treatment decision-making for localized prostate cancer.

Science.gov (United States)

Song, Lixin; Tyler, Christina; Clayton, Margaret F; Rodgiriguez-Rassi, Eleanor; Hill, Latorya; Bai, Jinbing; Pruthi, Raj; Bailey, Donald E

2017-02-01

To analyze the effects of a decision aid on improving patients' and family members' information giving and question asking during consultations for prostate cancer treatment decision-making. This study is a secondary analysis of archived audio-recorded real-time consultation visits with participants from a randomized clinical trial. Participants were randomly assigned into three groups: TD-intervention targeted patient-only; TS-intervention targeted patients and family members; and control-a handout on staying healthy during treatment. We conducted content analysis using a researcher-developed communication coding system. Using SAS 9.3, we conducted Chi-square/Fisher's exact test to examine whether information giving and question asking among patients and family members varied by groups when discussing different content/topics. Compared with those in the TS and control groups, significantly higher percentages of participants in the TD group demonstrated information giving in discussing topics about diagnosis, treatment options, risks and benefits, and preferences; and engaged in question asking when discussing diagnosis, watchful waiting/active surveillance, risks and benefits, and preferences for treatment impacts. Information support and communication skills training for patients were effective in improving communication during treatment decision-making consultations. Providing information about prostate cancer and communication skills training empower patients and their family members. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A digitalising board for the prototype array of LHAASO WCDA

International Nuclear Information System (INIS)

Hao Xinjun; Liu Shubin; Zhao Lei; An Qi

2011-01-01

In this paper, a digitalising board for readout of PMT signals in the prototype array of WCDA (water Cerenkov detector array) for LHAASO (Large high altitude air shower observatory)is designed. The prototype array is composed of 9 PMTs, including the pulse time and charge measurement from the PMTs, and clock generation and trigger decision. In the digitalising board, FPGA reconfiguration and data readout via VME bus are implemented. Test results show that the performances meet well with the requirements of readout electronics. It has been installed in Yangbajing and tests with the prototype array and DAQ is ongoing. (authors)

Rapid prototyping for biomedical engineering: current capabilities and challenges.

Science.gov (United States)

Lantada, Andrés Díaz; Morgado, Pilar Lafont

2012-01-01

A new set of manufacturing technologies has emerged in the past decades to address market requirements in a customized way and to provide support for research tasks that require prototypes. These new techniques and technologies are usually referred to as rapid prototyping and manufacturing technologies, and they allow prototypes to be produced in a wide range of materials with remarkable precision in a couple of hours. Although they have been rapidly incorporated into product development methodologies, they are still under development, and their applications in bioengineering are continuously evolving. Rapid prototyping and manufacturing technologies can be of assistance in every stage of the development process of novel biodevices, to address various problems that can arise in the devices' interactions with biological systems and the fact that the design decisions must be tested carefully. This review focuses on the main fields of application for rapid prototyping in biomedical engineering and health sciences, as well as on the most remarkable challenges and research trends.

Generalizing Prototype Theory: A Formal Quantum Framework

Directory of Open Access Journals (Sweden)

Diederik eAerts

2016-03-01

Full Text Available Theories of natural language and concepts have been unable to model the flexibility, creativity, context-dependence, and emergence, exhibited by words, concepts and their combinations. The mathematical formalism of quantum theory has instead been successful in capturing these phenomena such as graded membership, situational meaning, composition of categories, and also more complex decision making situations, which cannot be modeled in traditional probabilistic approaches. We show how a formal quantum approach to concepts and their combinations can provide a powerful extension of prototype theory. We explain how prototypes can interfere in conceptual combinations as a consequence of their contextual interactions, and provide an illustration of this using an intuitive wave-like diagram. This quantum-conceptual approach gives new life to original prototype theory, without however making it a privileged concept theory, as we explain at the end of our paper.

Generalizing Prototype Theory: A Formal Quantum Framework

Science.gov (United States)

Aerts, Diederik; Broekaert, Jan; Gabora, Liane; Sozzo, Sandro

2016-01-01

Theories of natural language and concepts have been unable to model the flexibility, creativity, context-dependence, and emergence, exhibited by words, concepts and their combinations. The mathematical formalism of quantum theory has instead been successful in capturing these phenomena such as graded membership, situational meaning, composition of categories, and also more complex decision making situations, which cannot be modeled in traditional probabilistic approaches. We show how a formal quantum approach to concepts and their combinations can provide a powerful extension of prototype theory. We explain how prototypes can interfere in conceptual combinations as a consequence of their contextual interactions, and provide an illustration of this using an intuitive wave-like diagram. This quantum-conceptual approach gives new life to original prototype theory, without however making it a privileged concept theory, as we explain at the end of our paper. PMID:27065436

Multi-criteria decision aid approach for the selection of the best compromise management scheme for ELVs: the case of Cyprus.

Science.gov (United States)

Mergias, I; Moustakas, K; Papadopoulos, A; Loizidou, M

2007-08-25

Each alternative scheme for treating a vehicle at its end of life has its own consequences from a social, environmental, economic and technical point of view. Furthermore, the criteria used to determine these consequences are often contradictory and not equally important. In the presence of multiple conflicting criteria, an optimal alternative scheme never exists. A multiple-criteria decision aid (MCDA) method to aid the Decision Maker (DM) in selecting the best compromise scheme for the management of End-of-Life Vehicles (ELVs) is presented in this paper. The constitution of a set of alternatives schemes, the selection of a list of relevant criteria to evaluate these alternative schemes and the choice of an appropriate management system are also analyzed in this framework. The proposed procedure relies on the PROMETHEE method which belongs to the well-known family of multiple criteria outranking methods. For this purpose, level, linear and Gaussian functions are used as preference functions.

S4HARA: System for HIV/AIDS resource allocation.

Science.gov (United States)

Lasry, Arielle; Carter, Michael W; Zaric, Gregory S

2008-03-26

HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA) that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation. S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa. The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease. Condom uptake at the clinic should be increased by changing the condom distribution policy from a pull system to a push

Assessing the acceptability and usability of an interactive serious game in aiding treatment decisions for patients with localized prostate cancer.

Science.gov (United States)

Reichlin, Lindsey; Mani, Nithya; McArthur, Kara; Harris, Amy M; Rajan, Nithin; Dacso, Clifford C

2011-01-12

Men diagnosed with localized prostate cancer face a potentially life-altering treatment decision that can be overwhelming. Enhancing patient knowledge through education can significantly reduce feelings of uncertainty while simultaneously increasing confidence in decision making. Serious games have been shown in other populations to increase health knowledge and assist with the health decision-making process. We developed an interactive serious game, Time After Time, which translates evidence-based treatment outcome data into an accessible and understandable format that men can utilize in their prostate cancer treatment decision-making process. The game specifically aims to raise men's awareness and understanding of the impact of health-related quality of life issues associated with the major treatment options and to enrich their conversations with their health care providers. This study determined the acceptability and usability of the alpha version of Time After Time, an interactive decision aid for men diagnosed with localized prostate cancer, in order to inform future iterations of the serious game. The study employed a mixed methods approach to assess the acceptability and usability of the Time After Time serious game using qualitative focus groups and a quantitative Likert scale survey. A total of 13 men who had already completed treatment for localized prostate cancer completed the survey and participated in focus group meetings. The majority of the study participants rated Time After Time as an appropriate decision tool for localized prostate cancer and verified that it meets its goals of increasing focus on side effects and generating questions for the patient's health care team. However, participants also expressed concerns about game usability and the diversity of information covered regarding treatment options and potential treatment outcomes. Serious games are a promising approach to health education and decision support for older men. Participants

Computer-Aided Facilities Management Systems (CAFM).

Science.gov (United States)

Cyros, Kreon L.

Computer-aided facilities management (CAFM) refers to a collection of software used with increasing frequency by facilities managers. The six major CAFM components are discussed with respect to their usefulness and popularity in facilities management applications: (1) computer-aided design; (2) computer-aided engineering; (3) decision support…

A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney

Directory of Open Access Journals (Sweden)

Rachel E. Patzer

2016-05-01

Discussion: Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.

Randomized controlled trial of a patient decision-making aid for orthodontics.

Science.gov (United States)

Parker, Kate; Cunningham, Susan J; Petrie, Aviva; Ryan, Fiona S

2017-08-01

Patient decision-making aids (PDAs) are instruments that facilitate shared decision making and enable patients to reach informed, individual decisions regarding health care. The objective of this study was to assess the efficacy of a PDA compared with traditional information provision for adolescent patients considering fixed appliance orthodontic treatment. Before treatment, orthodontic patients were randomly allocated into 2 groups: the intervention group received the PDA and standard information regarding fixed appliances, and the control group received the standard information only. Decisional conflict was measured using the Decisional Conflict Scale, and the levels of decisional conflict were compared between the 2 groups. Seventy-two patients were recruited and randomized in a ratio of 1:1 to the PDA and control groups. Seventy-one patients completed the trial (control group, 36; PDA group, 35); this satisfied the sample size calculation. The median total Decisional Conflict Scale score in the PDA group was lower than in the control group (15.63 and 19.53, respectively). However, this difference was not statistically significant (difference between groups, 3.90; 95% confidence interval of the difference, -4.30 to 12.11). Sex, ethnicity, age, and the time point at which patients were recruited did not have significant effects on Decisional Conflict Scale scores. No harm was observed or reported for any participant in the study. The results of this study showed that the provision of a PDA to adolescents before they consented for fixed appliances did not significantly reduce decisional conflict. There may be a benefit in providing a PDA for some patients, but it is not yet possible to say how these patients could be identified. This trial was registered with the Harrow National Research Ethics Committee (reference 12/LO/0279). The protocol was not published before trial commencement. Copyright © 2017. Published by Elsevier Inc.

Experience in a Climate Microworld: Influence of Surface and Structure Learning, Problem Difficulty, and Decision Aids in Reducing Stock-Flow Misconceptions

Directory of Open Access Journals (Sweden)

Medha Kumar

2018-03-01

Full Text Available Research shows that people’s wait-and-see preferences for actions against climate change are a result of several factors, including cognitive misconceptions. The use of simulation tools could help reduce these misconceptions concerning Earth’s climate. However, it is still unclear whether the learning in these tools is of the problem’s surface features (dimensions of emissions and absorptions and cover-story used or of the problem’s structural features (how emissions and absorptions cause a change in CO2 concentration under different CO2 concentration scenarios. Also, little is known on how problem’s difficulty in these tools (the shape of CO2 concentration trajectory, as well as the use of these tools as a decision aid influences performance. The primary objective of this paper was to investigate how learning about Earth’s climate via simulation tools is influenced by problem’s surface and structural features, problem’s difficulty, and decision aids. In experiment 1, we tested the influence of problem’s surface and structural features in a simulation called Dynamic Climate Change Simulator (DCCS on subsequent performance in a paper-and-pencil Climate Stabilization (CS task (N = 100 across four between-subject conditions. In experiment 2, we tested the effects of problem’s difficulty in DCCS on subsequent performance in the CS task (N = 90 across three between-subject conditions. In experiment 3, we tested the influence of DCCS as a decision aid on subsequent performance in the CS task (N = 60 across two between-subject conditions. Results revealed a significant reduction in people’s misconceptions in the CS task after performing in DCCS compared to when performing in CS task in the absence of DCCS. The decrease in misconceptions in the CS task was similar for both problems’ surface and structural features, showing both structure and surface learning in DCCS. However, the proportion of misconceptions was similar across

The International Decision Support Initiative Reference Case for Economic Evaluation: An Aid to Thought.

Science.gov (United States)

Wilkinson, Thomas; Sculpher, Mark J; Claxton, Karl; Revill, Paul; Briggs, Andrew; Cairns, John A; Teerawattananon, Yot; Asfaw, Elias; Lopert, Ruth; Culyer, Anthony J; Walker, Damian G

2016-12-01

Policymakers in high-, low-, and middle-income countries alike face challenging choices about resource allocation in health. Economic evaluation can be useful in providing decision makers with the best evidence of the anticipated benefits of new investments, as well as their expected opportunity costs-the benefits forgone of the options not chosen. To guide the decisions of health systems effectively, it is important that the methods of economic evaluation are founded on clear principles, are applied systematically, and are appropriate to the decision problems they seek to inform. The Bill and Melinda Gates Foundation, a major funder of economic evaluations of health technologies in low- and middle-income countries (LMICs), commissioned a "reference case" through the International Decision Support Initiative (iDSI) to guide future evaluations, and improve both the consistency and usefulness to decision makers. The iDSI Reference Case draws on previous insights from the World Health Organization, the US Panel on Cost-Effectiveness in Health Care, and the UK National Institute for Health and Care Excellence. Comprising 11 key principles, each accompanied by methodological specifications and reporting standards, the iDSI Reference Case also serves as a means of identifying priorities for methods research, and can be used as a framework for capacity building and technical assistance in LMICs. The iDSI Reference Case is an aid to thought, not a substitute for it, and should not be followed slavishly without regard to context, culture, or history. This article presents the iDSI Reference Case and discusses the rationale, approach, components, and application in LMICs. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Application of computer-aided three-dimensional skull model with rapid prototyping technique in repair of zygomatico-orbito-maxillary complex fracture.

Science.gov (United States)

Li, Wei Zhong; Zhang, Mei Chao; Li, Shao Ping; Zhang, Lei Tao; Huang, Yu

2009-06-01

With the advent of CAD/CAM and rapid prototyping (RP), a technical revolution in oral and maxillofacial trauma was promoted to benefit treatment, repair of maxillofacial fractures and reconstruction of maxillofacial defects. For a patient with zygomatico-facial collapse deformity resulting from a zygomatico-orbito-maxillary complex (ZOMC) fracture, CT scan data were processed by using Mimics 10.0 for three-dimensional (3D) reconstruction. The reduction design was aided by 3D virtual imaging and the 3D skull model was reproduced using the RP technique. In line with the design by Mimics, presurgery was performed on the 3D skull model and the semi-coronal incision was taken for reduction of ZOMC fracture, based on the outcome from the presurgery. Postoperative CT and images revealed significantly modified zygomatic collapse and zygomatic arch rise and well-modified facial symmetry. The CAD/CAM and RP technique is a relatively useful tool that can assist surgeons with reconstruction of the maxillofacial skeleton, especially in repairs of ZOMC fracture.

Development of a decision aid for the treatment of benign prostatic hyperplasia : A four stage method using a Delphi consensus study

NARCIS (Netherlands)

Lamers, Romy E D; Cuypers, Maarten; Garvelink, Mirjam M.; Bosch, J. L H Ruud; Kil, Paul J M

2016-01-01

Objective: To develop a web-based decision aid (DA) for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH). Methods: From February-September 2014 we performed a four-stage development method: 1: Two-round Delphi consensus method among urologists, 2:

The NIAID Division of AIDS enterprise information system: integrated decision support for global clinical research programs

Science.gov (United States)

Gupta, Nitin; Varghese, Suresh; Virkar, Hemant

2011-01-01

The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs. PMID:21816958

Computer-aided detection as a decision assistant in chest radiography

Science.gov (United States)

Samulski, Maurice R. M.; Snoeren, Peter R.; Platel, Bram; van Ginneken, Bram; Hogeweg, Laurens; Schaefer-Prokop, Cornelia; Karssemeijer, Nico

2011-03-01

Background. Contrary to what may be expected, finding abnormalities in complex images like pulmonary nodules in chest radiographs is not dominated by time-consuming search strategies but by an almost immediate global interpretation. This was already known in the nineteen-seventies from experiments with briefly flashed chest radiographs. Later on, experiments with eye-trackers showed that abnormalities attracted the attention quite fast but often without further reader actions. Prolonging one's search seldom leads to newly found abnormalities and may even increase the chance of errors. The problem of reading chest radiographs is therefore not dominated by finding the abnormalities, but by interpreting them. Hypothesis. This suggests that readers could benefit from computer-aided detection (CAD) systems not so much by their ability to prompt potential abnormalities, but more from their ability to 'interpret' the potential abnormalities. In this paper, this hypothesis was investigated by an observer experiment. Experiment. In one condition, the traditional CAD condition, the most suspicious CAD locations were shown to the subjects, without telling them the levels of suspiciousness according to CAD. In the other condition, interactive CAD condition, levels of suspiciousness were given, but only when readers requested them at specified locations. These two conditions focus on decreasing search errors and decision errors, respectively. Results of reading without CAD were also recorded. Six subjects, all non-radiologists, read 223 chest radiographs in both conditions. CAD results were obtained from the OnGuard 5.0 system developed by Riverain Medical (Miamisburg, Ohio). Results. The observer data were analyzed by Location Response Operating Characteristic analysis (LROC). It was found that: 1) With the aid of CAD, the performance is significantly better than without CAD; 2) The performance with interactive CAD is significantly better than with traditional CAD at low false

NALDA (Naval Aviation Logistics Data Analysis) CAI (computer aided instruction)

Energy Technology Data Exchange (ETDEWEB)

Handler, B.H. (Oak Ridge K-25 Site, TN (USA)); France, P.A.; Frey, S.C.; Gaubas, N.F.; Hyland, K.J.; Lindsey, A.M.; Manley, D.O. (Oak Ridge Associated Universities, Inc., TN (USA)); Hunnum, W.H. (North Carolina Univ., Chapel Hill, NC (USA)); Smith, D.L. (Memphis State Univ., TN (USA))

1990-07-01

Data Systems Engineering Organization (DSEO) personnel developed a prototype computer aided instruction CAI system for the Naval Aviation Logistics Data Analysis (NALDA) system. The objective of this project was to provide a CAI prototype that could be used as an enhancement to existing NALDA training. The CAI prototype project was performed in phases. The task undertaken in Phase I was to analyze the problem and the alternative solutions and to develop a set of recommendations on how best to proceed. The findings from Phase I are documented in Recommended CAI Approach for the NALDA System (Duncan et al., 1987). In Phase II, a structured design and specifications were developed, and a prototype CAI system was created. A report, NALDA CAI Prototype: Phase II Final Report, was written to record the findings and results of Phase II. NALDA CAI: Recommendations for an Advanced Instructional Model, is comprised of related papers encompassing research on computer aided instruction CAI, newly developing training technologies, instructional systems development, and an Advanced Instructional Model. These topics were selected because of their relevancy to the CAI needs of NALDA. These papers provide general background information on various aspects of CAI and give a broad overview of new technologies and their impact on the future design and development of training programs. The paper within have been index separately elsewhere.

Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers

Directory of Open Access Journals (Sweden)

Tromp Noor

2012-12-01

Full Text Available Abstract Background In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization’s Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. Methods We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country’s health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. Results Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and. Conclusions This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

S4HARA: System for HIV/AIDS resource allocation

Directory of Open Access Journals (Sweden)

Carter Michael W

2008-03-01

Full Text Available Abstract Background HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation. Methods S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa. Results The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease. Conclusion Condom uptake at the clinic should be increased by

[The adaptation and validation to Spanish of the questionnaire Aid to Capacity Evaluation (ACE), for the assessment of the ability of patients in medical decision-making].

Science.gov (United States)

Moraleda Barba, Sandra; Ballesta Rodríguez, M Isabel; Delgado Quero, Antonio Luis; Lietor Villajos, Norberto; Moreno Corredor, Andrés; Delgado Rodríguez, Miguel

2015-03-01

To adapt and validate the Spanish version of the Aid to Capacity Evaluation scale, designed to assess the capacity of the adult in medical decision-making, both in diagnosis and treatment processes. Observational study of prospective validation. Primary and hospital care of the basic health area of Jaen. One hundred twenty-nine patients. Questionnaire which included sociodemographic variables, concerning the decision (scope, type of decision, the need for written informed consent), assessment of the capacity to the Aid to Capacity Evaluation scale and other related comorbidity (hearing loss, alcoholism, cognitive level variables with the Mini-Mental State Examination and depression by Goldberg or Yesavage test). The tool is considered viable. The conclusions of the expert panel were favorable. The result of the criteria' validity, comparing the results with the assessment of the experts (forensic and psychiatrist) was very satisfying (P<.001). The intra-observer reliability was low (kappa=0,135). Interobserver reliability remained high (kappa=0.74). The internal consistency was awarded an alpha of Cronbach's 0,645 for the reduced model of 6 items. The Aid to Capacity Evaluation scale was adapted to Spanish, demonstrating adequate internal consistency and construct validity. Its use in clinical practice could contribute to the identification of patients unable to make a particular medical decision and/or to give an informed consent. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

A decision aiding and action management tool to control the energy demand - from conception to development; Un outil d`aide a la decision et de gestion des actions pour la maitrise de la demande d`energie - de la conception au developpement

Energy Technology Data Exchange (ETDEWEB)

Kaehler, J W.M.

1993-07-06

This work presents a synthesis of three points: the environment, energy and man. The consideration of these aspects allows us to confront the unequal distribution of energy resources, the constraints and political influences which determine the exploitation of these energy resources, and the concentration of the consumption of energy by one fifth of the world`s population and the perspective of future growth of energy use by the remaining four-fifths. It is understanding of the importance and the benefits of reducing energy requirements, combined with the environmental perspectives, that forms the core of the Integrated Resource Planning of Least is proposed. This framework will utilize the knowledge of the engineer for developing a system to aid with decision making and the management of information, and particularly with the notions henceforth referred to as `Demand-Site Management` as applied to the electrical grid. The model of such a Management Information System which demonstrates these theoretical advances is called SIADEME (Systeme Interactif d`Aide a la Decision et de Gestion des Actions de Maitrise de la Demande d`energie). This includes some examples for the management of electricity demand for both the lighting and refrigeration cases in large (> 2500 m{sup 2}) supermarkets for the French environmental and energy management agency (Ademe). (author) 216 refs.

Contingency Contractor Optimization Phase 3 Sustainment Platform Requirements - Contingency Contractor Optimization Tool - Prototype

Energy Technology Data Exchange (ETDEWEB)

Durfee, Justin David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Frazier, Christopher Rawls [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Bandlow, Alisa [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Gearhart, Jared Lee [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Katherine A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2016-06-01

Sandia National Laboratories (Sandia) is in Phase 3 Sustainment of development of a prototype tool, currently referred to as the Contingency Contractor Optimization Tool - Prototype (CCOTP), under the direction of OSD Program Support. CCOT-P is intended to help provide senior Department of Defense (DoD) leaders with comprehensive insight into the global availability, readiness and capabilities of the Total Force Mix. The CCOT-P will allow senior decision makers to quickly and accurately assess the impacts, risks and mitigating strategies for proposed changes to force/capabilities assignments, apportionments and allocations options, focusing specifically on contingency contractor planning. During Phase 2 of the program, conducted during fiscal year 2012, Sandia developed an electronic storyboard prototype of the Contingency Contractor Optimization Tool that can be used for communication with senior decision makers and other Operational Contract Support (OCS) stakeholders. Phase 3 used feedback from demonstrations of the electronic storyboard prototype to develop an engineering prototype for planners to evaluate. Sandia worked with the DoD and Joint Chiefs of Staff strategic planning community to get feedback and input to ensure that the engineering prototype was developed to closely align with future planning needs. The intended deployment environment was also a key consideration as this prototype was developed. Initial release of the engineering prototype was done on servers at Sandia in the middle of Phase 3. In 2013, the tool was installed on a production pilot server managed by the OUSD(AT&L) eBusiness Center. The purpose of this document is to specify the CCOT-P engineering prototype platform requirements as of May 2016. Sandia developed the CCOT-P engineering prototype using common technologies to minimize the likelihood of deployment issues. CCOT-P engineering prototype was architected and designed to be as independent as possible of the major deployment

Brachial Plexus Blocker Prototype

Directory of Open Access Journals (Sweden)

Stéphanie Coelho Monteiro

2017-08-01

Full Text Available Although the area of surgical simulation has been the subject of study in recent years, it is still necessary to develop artificial experimental models with a perspective to dismiss the use of biological models. Since this makes the simulators more real, transferring the environment of the health professional to a physical or virtual reality, an anesthetic prototype has been developed, where the motor response is replicated when the brachial plexus is subjected to a proximal nervous stimulus. Using action-research techniques, with this simulator it was possible to validate that the human nerve response can be replicated, which will aid the training of health professionals, reducing possible risks in a surgical environment.

Autotransplantation of immature third molars using a computer-aided rapid prototyping model: a report of 4 cases.

Science.gov (United States)

Jang, Ji-Hyun; Lee, Seung-Jong; Kim, Euiseong

2013-11-01

Autotransplantation of immature teeth can be an option for premature tooth loss in young patients as an alternative to immediately replacing teeth with fixed or implant-supported prostheses. The present case series reports 4 successful autotransplantation cases using computer-aided rapid prototyping (CARP) models with immature third molars. The compromised upper and lower molars (n = 4) of patients aged 15-21 years old were transplanted with third molars using CARP models. Postoperatively, the pulp vitality and the development of the roots were examined clinically and radiographically. The patient follow-up period was 2-7.5 years after surgery. The long-term follow-up showed that all of the transplants were asymptomatic and functional. Radiographic examination indicated that the apices developed continuously and the root length and thickness increased. The final follow-up examination revealed that all of the transplants kept the vitality, and the apices were fully developed with normal periodontal ligaments and trabecular bony patterns. Based on long-term follow-up observations, our 4 cases of autotransplantation of immature teeth using CARP models resulted in favorable prognoses. The CARP model assisted in minimizing the extraoral time and the possible Hertwig epithelial root sheath injury of the transplanted tooth. Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Expanding the Reach of Participatory Risk Management: Testing an Online Decision-Aiding Framework for Informing Internally Consistent Choices.

Science.gov (United States)

Bessette, Douglas L; Campbell-Arvai, Victoria; Arvai, Joseph

2016-05-01

This article presents research aimed at developing and testing an online, multistakeholder decision-aiding framework for informing multiattribute risk management choices associated with energy development and climate change. The framework was designed to provide necessary background information and facilitate internally consistent choices, or choices that are in line with users' prioritized objectives. In order to test different components of the decision-aiding framework, a six-part, 2 × 2 × 2 factorial experiment was conducted, yielding eight treatment scenarios. The three factors included: (1) whether or not users could construct their own alternatives; (2) the level of detail regarding the composition of alternatives users would evaluate; and (3) the way in which a final choice between users' own constructed (or highest-ranked) portfolio and an internally consistent portfolio was presented. Participants' self-reports revealed the framework was easy to use and providing an opportunity to develop one's own risk-management alternatives (Factor 1) led to the highest knowledge gains. Empirical measures showed the internal consistency of users' decisions across all treatments to be lower than expected and confirmed that providing information about alternatives' composition (Factor 2) resulted in the least internally consistent choices. At the same time, those users who did not develop their own alternatives and were not shown detailed information about the composition of alternatives believed their choices to be the most internally consistent. These results raise concerns about how the amount of information provided and the ability to construct alternatives may inversely affect users' real and perceived internal consistency. © 2015 Society for Risk Analysis.

The Cat and the Pigeons: Some General Comments on (TP) Tax Rulings and State Aid After the Starbucks and Fiat Decisions

NARCIS (Netherlands)

Wattel, P.J.; Richelle, I.; Schön, W.; Traversa, E.

2016-01-01

The Commission State aid decisions on individual tax rulings have created legal uncertainty, which may have been one of their goals. This article comments on their political and policy merits and effects, it wonders whether EU law requires member States to have—and apply in a certain manner—specific

An Optimization Model for the Allocation of University Based Merit Aid

Science.gov (United States)

Sugrue, Paul K.

2010-01-01

The allocation of merit-based financial aid during the college admissions process presents postsecondary institutions with complex and financially expensive decisions. This article describes the application of linear programming as a decision tool in merit based financial aid decisions at a medium size private university. The objective defined for…

An Integrated Decision-Making Model for Categorizing Weather Products and Decision Aids

Science.gov (United States)

Elgin, Peter D.; Thomas, Rickey P.

2004-01-01

The National Airspace System s capacity will experience considerable growth in the next few decades. Weather adversely affects safe air travel. The FAA and NASA are working to develop new technologies that display weather information to support situation awareness and optimize pilot decision-making in avoiding hazardous weather. Understanding situation awareness and naturalistic decision-making is an important step in achieving this goal. Information representation and situation time stress greatly influence attentional resource allocation and working memory capacity, potentially obstructing accurate situation awareness assessments. Three naturalistic decision-making theories were integrated to provide an understanding of the levels of decision making incorporated in three operational situations and two conditions. The task characteristics associated with each phase of flight govern the level of situation awareness attained and the decision making processes utilized. Weather product s attributes and situation task characteristics combine to classify weather products according to the decision-making processes best supported. In addition, a graphical interface is described that affords intuitive selection of the appropriate weather product relative to the pilot s current flight situation.

Controlled braking scheme for a wheeled walking aid

OpenAIRE

Coyle, Eugene; O'Dwyer, Aidan; Young, Eileen; Sullivan, Kevin; Toner, A.

2006-01-01

A wheeled walking aid with an embedded controlled braking system is described. The frame of the prototype is based on combining features of standard available wheeled walking aids. A braking scheme has been designed using hydraulic disc brakes to facilitate accurate and sensitive controlled stopping of the walker by the user, and if called upon, by automatic action. Braking force is modulated via a linear actuating stepping motor. A microcontroller is used for control of both stepper movement...

Prototype Hanford Surface Barrier: Design basis document

International Nuclear Information System (INIS)

Myers, D.R.; Duranceau, D.A.

1994-11-01

The Hanford Site Surface Barrier Development Program (BDP) was organized in 1985 to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site and other arid sites. This document provides the basis of the prototype barrier. Engineers and scientists have momentarily frozen evolving barrier designs and incorporated the latest findings from BDP tasks. The design and construction of the prototype barrier has required that all of the various components of the barrier be brought together into an integrated system. This integration is particularly important because some of the components of the protective barreir have been developed independently of other barreir components. This document serves as the baseline by which future modifications or other barrier designs can be compared. Also, this document contains the minutes of meeting convened during the definitive design process in which critical decisions affecting the prototype barrier's design were made and the construction drawings

Mechanical Prototyping and Manufacturing Internship

Science.gov (United States)

Grenfell, Peter

2016-01-01

The internship was located at the Johnson Space Center (JSC) Innovation Design Center (IDC), which is a facility where the JSC workforce can meet and conduct hands-on innovative design, fabrication, evaluation, and testing of ideas and concepts relevant to NASA's mission. The tasks of the internship included mechanical prototyping design and manufacturing projects in service of research and development as well as assisting the users of the IDC in completing their manufacturing projects. The first project was to manufacture hatch mechanisms for a team in the Systems Engineering and Project Advancement Program (SETMAP) hexacopter competition. These mechanisms were intended to improve the performance of the servomotors and offer an access point that would also seal to prevent cross-contamination. I also assisted other teams as they were constructing and modifying their hexacopters. The success of this competition demonstrated a proof of concept for aerial reconnaissance and sample return to be potentially used in future NASA missions. I also worked with Dr. Kumar Krishen to prototype an improved thermos and a novel, portable solar array. Computer-aided design (CAD) software was used to model the parts for both of these projects. Then, 3D printing as well as conventional techniques were used to produce the parts. These prototypes were then subjected to trials to determine the success of the designs. The solar array is intended to work in a cluster that is easy to set up and take down and doesn't require powered servomechanisms. It could be used terrestrially in areas not serviced by power grids. Both projects improve planetary exploration capabilities to future astronauts. Other projects included manufacturing custom rail brackets for EG-2, assisting engineers working on underwater instrument and tool cases for the NEEMO project, and helping to create mock-up parts for Space Center Houston. The use of the IDC enabled efficient completion of these projects at

The development of the CoRE-Values framework as an aid to ethical decision-making.

Science.gov (United States)

Manson, Helen M

2012-01-01

Ethical analysis frameworks can help to identify the ethical dimensions to clinical care and provide a method for justifying clinical decisions. Published frameworks, however, have some limitations to easy, practical use. The aim was to identify a comprehensive yet easy-to-use framework that clarifies ethical decision-making, suitable for use by medical learners and clinical educators. A literature search identified published frameworks that define the components of ethical clinical decision-making. On this basis, a new framework, the 'CoRE-Values Compass and Grid' was constructed. This was formally evaluated during a medical school interprofessional teaching session. For 88% of 228 medical and nursing students, the new framework was easy to understand; 85% reported it as easy to use. The framework improved awareness of the ethical dimensions to a clinical scenario for 97% of students and the ability to systematically identify ethical aspects for 83%. Students and instructors reported that the framework helped to link ethics theory with clinical practice. The framework was described as a useful educational tool by 85% of students and 95% of instructors. The 'CoRE-Values Compass and Grid' is a new framework, shown to aid the systematic identification and consideration of ethical aspects to clinical cases.

Monitoring and aid to diagnosis of French PWRs

International Nuclear Information System (INIS)

Jousellin, A.; Trenty, A.; Benas, J.C.; Renault, Y.; Busquet, J.L.; Mouhamed, B.

1996-01-01

In order to improvise safety and availability in its nuclear power plants, EDF has designed a new generation of monitoring systems integrated into a workstation for monitoring and aid to diagnosis (PSAD). These systems perform on-line monitoring of the main power plant components and PSAD stations provide homogeneous aid to diagnosis which enable plant personnel to pinpoint the mechanical behavior of plant equipments. The objective of PSAD is to provide them with high-efficiency and user-friendly tools which can considerably free them from routine tasks. The first version of the prototype is working on a French plant at Tricastin. This version includes the software host structure and two monitoring functions: the reactor coolant pumps and the turbo-generator monitoring functions. Internal Structures Monitoring (ISM) and Loose Parts Detection function (LPD) are under development and should be integrated into PSAD prototype in 1996. (authors)

Accident Diagnosis and Prognosis Aide (ADPA)

International Nuclear Information System (INIS)

Gunter, A.D.; Touchton, R.A.

1987-01-01

This presentation provides a demonstration of a prototypical expert system developed by Technology Applications, Inc. (TAI) under a contract with the Department of Energy as a part of their Small Business Innovation Research Program. The Accident Diagnosis and Prognosis Aide (ADPA) Demonstration Prototype is a working scale model of a real-time expert system which: Diagnoses an accident situation (as well as a number of underlying failures, events, and conditions deduced along the way). Calculates the change in the likelihood of core damage as a function of the events and failures diagnosed. Dynamically generates a recovery procedure tailored to the specific plant state at hand

Airline Operations Aid

Science.gov (United States)

1993-01-01

C Language Integrated Production System (CLIPS), a NASA-developed expert systems program, is used by American Airlines for three purposes: as a rapid prototyping tool; to develop production prototypes; and to develop production application. An example of the latter is CLIPS' use in "Hub S1AAshing," a knowledge based system that recommends contingency plans when severe schedule reductions must be made. Hub S1AAshing has replaced a manual, labor intensive process. It saves time and allows Operations Control Coordinators to handle more difficult situations. Because the system assimilates much of the information necessary to facilitate educated decision making, it minimizes negative impact in situations where it is impossible to operate all flights.

Microprocessor-based, on-line decision aid for resolving conflicting nuclear reactor instrumentation

International Nuclear Information System (INIS)

Alesso, H.P.

1981-01-01

We describe one design for a microprocessor-based, on-line decision aid for identifying and resolving false, conflicting, or misleading instrument indications resulting from certain systems interactions for a pressurized water reactor. The system processes sensor signals from groups of instruments that track together under nominal transient and certain accident conditions, and alarms when they do not track together. We examine multiple-casualty systems interaction and formulate a trial grouping of variables that track together under specified conditions. A two-of-three type redundancy check of key variables provides alarm and indication of conflicting information when one signal suddenly tracks in opposition due to multiple casualty, instrument failure, and/or locally abnormal conditions. Since a vote count of two of three variables in conflict as inconclusive evidence, the system is not designed to provide tripping or corrective action, but improves the operator/instrument interface by providing additional and partially digested information

On the suitability of fast and frugal heuristics for designing values clarification methods in patient decision aids: a critical analysis.

Science.gov (United States)

Pieterse, Arwen H; de Vries, Marieke

2013-09-01

Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference-sensitive health-care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that deliberation is advantageous. Research suggests that simple, fast and frugal heuristic decision strategies sometimes result in better judgments and decisions. Durand et al. have developed two fast and frugal heuristic-based VCMs. To critically analyse the suitability of the 'take the best' (TTB) and 'tallying' fast and frugal heuristics in the context of patient decision making. Analysis of the structural similarities between the environments in which the TTB and tallying heuristics have been proven successful and the context of patient decision making and of the potential of these heuristic decision processes to support patient decision making. The specific nature of patient preference-sensitive decision making does not seem to resemble environments in which the TTB and tallying heuristics have proven successful. Encouraging patients to consider less rather than more relevant information potentially even deteriorates their values clarification process. Values clarification methods promoting the use of more intuitive decision strategies may sometimes be more effective. Nevertheless, we strongly recommend further theoretical thinking about the expected value of such heuristics and of other more intuitive decision strategies in this context, as well as empirical assessments of the mechanisms by which inducing such decision strategies may impact the quality and outcome of values clarification. © 2011 John Wiley & Sons Ltd.

Decision support in vaccination policies.

Science.gov (United States)

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

Making fair decisions about financing care for persons with AIDS.

Science.gov (United States)

Roper, W L; Winkenwerder, W

1988-01-01

An estimated 40 percent of the nation's 55,000 persons with acquired immunodeficiency syndrome (AIDS) have received care under the Medicaid Program, which is administered by the Health Care Financing Administration (HCFA) and funded jointly by the Federal Government and the States. In fiscal year 1988, Medicaid will spend between $700 and $750 million for AIDS care and treatment. Medicaid spending on AIDS is likely to reach $2.4 billion by fiscal year 1992, an estimate that does not include costs of treatment with zidovudine (AZT). Four policy principles are proposed for meeting this new cost burden in a way that is fair, responsive, efficient, and in harmony with our current joint public-private system of health care financing. The four guidelines are to (a) treat AIDS as any other serious disease, without the creation of a disease-specific entitlement program; (b) bring AIDS treatment financing into the mainstream of the health care financing system, making it a shared responsibility and promoting initiatives such as high-risk insurance pools: (c) give States the flexibility to meet local needs, including Medicaid home care and community-based care services waivers; (d) encourage health care professionals to meet their obligation to care for AIDS patients. PMID:3131823

Architectures of prototypes and architectural prototyping

DEFF Research Database (Denmark)

Hansen, Klaus Marius; Christensen, Michael; Sandvad, Elmer

1998-01-01

together as a team, but developed a prototype that more than fulfilled the expectations of the shipping company. The prototype should: - complete the first major phase within 10 weeks, - be highly vertical illustrating future work practice, - continuously live up to new requirements from prototyping......This paper reports from experience obtained through development of a prototype of a global customer service system in a project involving a large shipping company and a university research group. The research group had no previous knowledge of the complex business of shipping and had never worked...... sessions with users, - evolve over a long period of time to contain more functionality - allow for 6-7 developers working intensively in parallel. Explicit focus on the software architecture and letting the architecture evolve with the prototype played a major role in resolving these conflicting...

Evidence-based surgery: Dissemination, communication, decision aids

NARCIS (Netherlands)

Knops, A.M.

2013-01-01

Surgeons are expected to make treatment decisions that are based on the best available evidence. Moreover, they are called to recognise that important decisions should also be shared with patients. While dissemination of evidence-based surgery and communication of evidence to patients have been

Collaborative Prototyping

DEFF Research Database (Denmark)

Bogers, Marcel; Horst, Willem

2014-01-01

of the prototyping process, the actual prototype was used as a tool for communication or development, thus serving as a platform for the cross-fertilization of knowledge. In this way, collaborative prototyping leads to a better balance between functionality and usability; it translates usability problems into design......This paper presents an inductive study that shows how collaborative prototyping across functional, hierarchical, and organizational boundaries can improve the overall prototyping process. Our combined action research and case study approach provides new insights into how collaborative prototyping...... can provide a platform for prototype-driven problem solving in early new product development (NPD). Our findings have important implications for how to facilitate multistakeholder collaboration in prototyping and problem solving, and more generally for how to organize collaborative and open innovation...

Exploring a clinically friendly web-based approach to clinical decision support linked to the electronic health record: design philosophy, prototype implementation, and framework for assessment.

Science.gov (United States)

Miller, Perry; Phipps, Michael; Chatterjee, Sharmila; Rajeevan, Nallakkandi; Levin, Forrest; Frawley, Sandra; Tokuno, Hajime

2014-07-01

Computer-based clinical decision support (CDS) is an important component of the electronic health record (EHR). As an increasing amount of CDS is implemented, it will be important that this be accomplished in a fashion that assists in clinical decision making without imposing unacceptable demands and burdens upon the provider's practice. The objective of our study was to explore an approach that allows CDS to be clinician-friendly from a variety of perspectives, to build a prototype implementation that illustrates features of the approach, and to gain experience with a pilot framework for assessment. The paper first discusses the project's design philosophy and goals. It then describes a prototype implementation (Neuropath/CDS) that explores the approach in the domain of neuropathic pain and in the context of the US Veterans Administration EHR. Finally, the paper discusses a framework for assessing the approach, illustrated by a pilot assessment of Neuropath/CDS. The paper describes the operation and technical design of Neuropath/CDS, as well as the results of the pilot assessment, which emphasize the four areas of focus, scope, content, and presentation. The work to date has allowed us to explore various design and implementation issues relating to the approach illustrated in Neuropath/CDS, as well as the development and pilot application of a framework for assessment.

Preliminary experimental results from a linear reciprocating magnetic refrigerator prototype

International Nuclear Information System (INIS)

Tagliafico, Luca Antonio; Scarpa, Federico; Valsuani, Federico; Tagliafico, Giulio

2013-01-01

A linear reciprocating magnetic refrigerator prototype was designed and built with the aid of an industrial partner. The refrigerator is based on the Active Magnetic Regenerative cycle, and exploits two regenerators working in parallel. The active material is Gadolinium in plates, 0.8 mm thick, for a total mass of 0.36 kg. The device is described and results about magnetic field and temperature span measurements are presented. The designed permanent magnet structure, based on an improved cross-type arrangement, generates a maximum magnetic field intensity of 1.55 T in air, over a gap of (13 × 50 × 100) mm 3 . The maximum temperature span achieved is 5.0 K, in a free run condition. -- Highlights: ► We give preliminary results from a linear reciprocating magnetic refrigerator prototype. ► The design is intended to process visualization and investigation. ► The prototype behavior gives us various suggestions to improve its general performance

Hearing aid adjustment

DEFF Research Database (Denmark)

Heinemann, Trine; Matthews, Ben; Raudaskoski, Pirkko Liisa

2012-01-01

to the interaction during hearing aid fitting. This report of a Danish pilot study describes two such problems. The first problem arises from the requirement that the audiologist needs to ‘translate’ the patient’s subjective hearing description for making technological decisions. The second problem is the way...... in which the hearing aid user’s implicit and often unrealistic expectations are handled. This kind of research has potential application for developing a model of best practices....

Rethink! prototyping transdisciplinary concepts of prototyping

CERN Document Server

Nagy, Emilia; Stark, Rainer

2016-01-01

In this book, the authors describe the findings derived from interaction and cooperation between scientific actors employing diverse practices. They reflect on distinct prototyping concepts and examine the transformation of development culture in their fusion to hybrid approaches and solutions. The products of tomorrow are going to be multifunctional, interactive systems – and already are to some degree today. Collaboration across multiple disciplines is the only way to grasp their complexity in design concepts. This underscores the importance of reconsidering the prototyping process for the development of these systems, particularly in transdisciplinary research teams. “Rethinking Prototyping – new hybrid concepts for prototyping” was a transdisciplinary project that took up this challenge. The aim of this programmatic rethinking was to come up with a general concept of prototyping by combining innovative prototyping concepts, which had been researched and developed in three sub-projects: “Hybrid P...

Open source GIS for HIV/AIDS management

Directory of Open Access Journals (Sweden)

Ricketts Adam

2008-10-01

Full Text Available Abstract Background Reliable access to basic services can improve a community's resilience to HIV/AIDS. Accordingly, work is being done to upgrade the physical infrastructure in affected areas, often employing a strategy of decentralised service provision. Spatial characteristics are one of the major determinants in implementing services, even in the smaller municipal areas, and good quality spatial information is needed to inform decision making processes. However, limited funds, technical infrastructure and human resource capacity result in little or no access to spatial information for crucial infrastructure development decisions at local level. This research investigated whether it would be possible to develop a GIS for basic infrastructure planning and management at local level. Given the resource constraints of the local government context, particularly in small municipalities, it was decided that open source software should be used for the prototype system. Results The design and development of a prototype system illustrated that it is possible to develop an open source GIS system that can be used within the context of local information management. Usability tests show a high degree of usability for the system, which is important considering the heavy workload and high staff turnover that characterises local government in South Africa. Local infrastructure management stakeholders interviewed in a case study of a South African municipality see the potential for the use of GIS as a communication tool and are generally positive about the use of GIS for these purposes. They note security issues that may arise through the sharing of information, lack of skills and resource constraints as the major barriers to adoption. Conclusion The case study shows that spatial information is an identified need at local level. Open source GIS software can be used to develop a system to provide local-level stakeholders with spatial information. However, the

Decision support system for containment and release management

Energy Technology Data Exchange (ETDEWEB)

Oosterhuis, B [Twente Univ., Enschede (Netherlands). Computer Science Dept.

1995-09-01

The Containment and Release Management project was carried out within the Reinforced Concerted Action Programme for Accident Management Support and partly financed by the European Union. In this report a prototype of an accident management support system is presented. The support system integrates several concepts from accident management research, like safety objective trees, severe accident phenomena, calculation models and an emergency response data system. These concepts are provided by the prototype in such a way that the decision making process of accident management is supported. The prototype application is demonstrated by process data taken from a severe accident scenario for a pressurized water reactor (PWR) that was simulated with the thermohydraulic computer program MAAP. The prototype was derived from a decision support framework based on a decision theory. For established and innovative concepts from accident management research it is pointed out in which way these concepts can support accident management and how these concepts can be integrated. This approach is generic in two ways; it applies to both pressurized and boiling water reactors and it applies to both in vessel management and containment and release management. The prototype application was developed in Multimedia Toolbox 3.0 and requires at least a 386 PC with 4 MB memory, 6 MB free disk space and MS Windows 3.1. (orig.).

Decision support system for containment and release management

International Nuclear Information System (INIS)

Oosterhuis, B.

1995-09-01

The Containment and Release Management project was carried out within the Reinforced Concerted Action Programme for Accident Management Support and partly financed by the European Union. In this report a prototype of an accident management support system is presented. The support system integrates several concepts from accident management research, like safety objective trees, severe accident phenomena, calculation models and an emergency response data system. These concepts are provided by the prototype in such a way that the decision making process of accident management is supported. The prototype application is demonstrated by process data taken from a severe accident scenario for a pressurized water reactor (PWR) that was simulated with the thermohydraulic computer program MAAP. The prototype was derived from a decision support framework based on a decision theory. For established and innovative concepts from accident management research it is pointed out in which way these concepts can support accident management and how these concepts can be integrated. This approach is generic in two ways; it applies to both pressurized and boiling water reactors and it applies to both in vessel management and containment and release management. The prototype application was developed in Multimedia Toolbox 3.0 and requires at least a 386 PC with 4 MB memory, 6 MB free disk space and MS Windows 3.1. (orig.)

System for selecting relevant information for decision support.

Science.gov (United States)

Kalina, Jan; Seidl, Libor; Zvára, Karel; Grünfeldová, Hana; Slovák, Dalibor; Zvárová, Jana

2013-01-01

We implemented a prototype of a decision support system called SIR which has a form of a web-based classification service for diagnostic decision support. The system has the ability to select the most relevant variables and to learn a classification rule, which is guaranteed to be suitable also for high-dimensional measurements. The classification system can be useful for clinicians in primary care to support their decision-making tasks with relevant information extracted from any available clinical study. The implemented prototype was tested on a sample of patients in a cardiological study and performs an information extraction from a high-dimensional set containing both clinical and gene expression data.

Using a group decision support system to make investment prioritisation decisions

OpenAIRE

Read, Martin; Gear, Tony; Minkes, Leonard; Irving, Ann

2013-01-01

This paper is concerned with how decision making groups involved in making investment prioritisation decisions involving funding of technology and science projects may be supported by a group decision support system (GDSS). While interested in decision outcomes, the primary focus of this paper is the role of a group support system as an aid to developing shared understanding within a group. The paper develops the conceptual framework of decision-making, communication and group support, and de...

Design of the decision aiding system for the control of the research nuclear reactor

International Nuclear Information System (INIS)

Adda, F.; Allek, M.; Larbes, C.

2003-01-01

Intelligent and decision aiding systems as support to operators are becoming increasingly a necessity in nuclear installations and in nuclear reactors in particular, specially after the Tree Mile Island. Development of new technologies based on linguistic approaches such as fuzzy logic has given rise to much interest during the last years. Fuzzy logic controller (FLC) has many advantage compared to conventional controllers using classical techniques. The aim of the present work is to use a fuzzy logic controller in parallel to actual semi-automatic controller in order to supervise in real time the operation of the research nuclear reactor. The principal of this controller is based on rules which are established previous from experiment using the semi-automatic controller and from the knowledge of the operators. (authors)

Evaluating Adaptation of a Cancer Clinical Trial Decision Aid for Rural Cancer Patients: A Mixed-Methods Approach.

Science.gov (United States)

Pathak, Swati; George, Nerissa; Monti, Denise; Robinson, Kathy; Politi, Mary C

2018-06-03

Rural-residing cancer patients often do not participate in clinical trials. Many patients misunderstand cancer clinical trials and their rights as participant. The purpose of this study is to modify a previously developed cancer clinical trials decision aid (DA), incorporating the unique needs of rural populations, and test its impact on knowledge and decision outcomes. The study was conducted in two phases. Phase I recruited 15 rural-residing cancer survivors in a qualitative usability study. Participants navigated the original DA and provided feedback regarding usability and implementation in rural settings. Phase II recruited 31 newly diagnosed rural-residing cancer patients. Patients completed a survey before and after using the revised DA, R-CHOICES. Primary outcomes included decisional conflict, decision self-efficacy, knowledge, communication self-efficacy, and attitudes towards and willingness to consider joining a trial. In phase I, the DA was viewed positively by rural-residing cancer survivors. Participants provided important feedback about factors rural-residing patients consider when thinking about trial participation. In phase II, after using R-CHOICES, participants had higher certainty about their choice (mean post-test = 3.10 vs. pre-test = 2.67; P = 0.025) and higher trial knowledge (mean percentage correct at post-test = 73.58 vs. pre-test = 57.77; P decision self-efficacy, communication self-efficacy, and attitudes towards or willingness to join trials. The R-CHOICES improved rural-residing patients' knowledge of cancer clinical trials and reduced conflict about making a trial decision. More research is needed on ways to further support decisions about trial participation among this population.

A group-based spatial decision support system for wind farm site selection in Northwest Ohio

International Nuclear Information System (INIS)

Gorsevski, Pece V.; Cathcart, Steven C.; Mirzaei, Golrokh; Jamali, Mohsin M.; Ye, Xinyue; Gomezdelcampo, Enrique

2013-01-01

The purpose of this paper is to demonstrate the benefits of applying a spatial decision support system (SDSS) framework for evaluating the suitability for wind farm siting in Northwest Ohio. The multiple criteria evaluation (MCE) prototype system is intended for regional planning but also for promoting group decision making that could involve participants with different interests in the development of decision alternatives. The framework integrates environmental and economic criteria and builds a hierarchy for wind farm siting using weighted linear combination (WLC) techniques and GIS functionality. The SDSS allows the multiple participants to interact and develop an understanding of the spatial data for assigning importance values to each factor. The WLC technique is used to combine the assigned values with map layers, which are standardized using fuzzy set theory, to produce individual suitability maps. The maps created by personal preferences from the participants are aggregated for producing a group solution using the Borda method. Sensitivity analysis is performed on the group solution to examine how small changes in the factor weights affect the calculated suitability scores. The results from the sensitivity analysis are intended to aid understanding of compromised solutions through changes in the input data from the participant's perspective. - Highlights: ► We present a prototype tool that we developed for wind farm site selection. ► Multiple participants rank the factors for promoting group-based decision making. ► The factors are aggregated by WLC technique to generate maps from participants. ► Group-based solution uses Borda method to aggregate the maps from participants. ► Sensitivity analysis is performed on the group solution to examine solution affects

Relatively Inexpensive Rapid Prototyping of Small Parts

Science.gov (United States)

Swan, Scott A.

2003-01-01

Parts with complex three-dimensional shapes and with dimensions up to 8 by 8 by 10 in. (20.3 by 20.3 by 25.4 cm) can be made as unitary pieces of a room-temperature-curing polymer, with relatively little investment in time and money, by a process now in use at Johnson Space Center. The process is one of a growing number of processes and techniques that are known collectively as the art of rapid prototyping. The main advantages of this process over other rapid-prototyping processes are greater speed and lower cost: There is no need to make paper drawings and take them to a shop for fabrication, and thus no need for the attendant paperwork and organizational delays. Instead, molds for desired parts are made automatically on a machine that is guided by data from a computer-aided design (CAD) system and can reside in an engineering office.

Helping decision makers frame, analyze, and implement decisions

Science.gov (United States)

Runge, Michael C.; McDonald-Madden, Eve

2018-01-01

All decisions have the same recognizable elements. Context, objectives, alternatives, consequences, and deliberation. Decision makers and analysts familiar with these elements can quickly see the underlying structure of a decision.There are only a small number of classes of decisions. These classes differ in the cognitive and scientific challenge they present to the decision maker; the ability to recognize the class of decision leads a decision maker to tools to aid in the analysis.Sometimes we need more information, sometimes we don’t. The role of science in a decision-making process is to provide the predictions that link the alternative actions to the desired outcomes. Investing in more science is only valuable if it helps to choose a better action.Implementation. The successful integration of decision analysis into environmental decisions requires careful attention to the decision, the people, and the institutions involved.

Validity of prototype diagnosis for mood and anxiety disorders.

Science.gov (United States)

DeFife, Jared A; Peart, Joanne; Bradley, Bekh; Ressler, Kerry; Drill, Rebecca; Westen, Drew

2013-02-01

CONTEXT With growing recognition that most forms of psychopathology are best represented as dimensions or spectra, a central question becomes how to implement dimensional diagnosis in a way that is empirically sound and clinically useful. Prototype matching, which involves comparing a patient's clinical presentation with a prototypical description of the disorder, is an approach to diagnosis that has gained increasing attention with forthcoming revisions to both the DSM and the International Classification of Diseases. OBJECTIVE To examine prototype diagnosis for mood and anxiety disorders. DESIGN, SETTING, AND PATIENTS In the first study, we examined clinicians' DSM-IV and prototype diagnoses with their ratings of the patients' adaptive functioning and patients' self-reported symptoms. In the second study, independent interviewers made prototype diagnoses following either a systematic clinical interview or a structured diagnostic interview. A third interviewer provided independent ratings of global adaptive functioning. Patients were recruited as outpatients (study 1; N = 84) and from primary care clinics (study 2; N = 143). MAIN OUTCOME MEASURES Patients' self-reported mood, anxiety, and externalizing symptoms along with independent clinical ratings of adaptive functioning. RESULTS Clinicians' prototype diagnoses showed small to moderate correlations with patient-reported psychopathology and performed as well as or better than DSM-IV diagnoses. Prototype diagnoses from independent interviewers correlated on average r = .50 and showed substantial incremental validity over DSM-IV diagnoses in predicting adaptive functioning. CONCLUSIONS Prototype matching is a viable alternative for psychiatric diagnosis. As in research on personality disorders, mood and anxiety disorder prototypes outperformed DSM-IV decision rules in predicting psychopathology and global functioning. Prototype matching has multiple advantages, including ease of use in clinical practice, reduced

A Computuerized Operator Support System Prototype

Energy Technology Data Exchange (ETDEWEB)

Thomas, Ken [Idaho National Lab. (INL), Idaho Falls, ID (United States); Boring, Ronald [Idaho National Lab. (INL), Idaho Falls, ID (United States); Lew, Roger [Idaho National Lab. (INL), Idaho Falls, ID (United States); Ulrich, Tom [Idaho National Lab. (INL), Idaho Falls, ID (United States); Villim, Richard [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2013-11-01

A report was published by the Idaho National Laboratory in September of 2012, entitled Design to Achieve Fault Tolerance and Resilience, which described the benefits of automating operator actions for transients. The report identified situations in which providing additional automation in lieu of operator actions would be advantageous. It recognized that managing certain plant upsets is sometimes limited by the operator’s ability to quickly diagnose the fault and to take the needed actions in the time available. Undoubtedly, technology is underutilized in the nuclear power industry for operator assistance during plant faults and operating transients. In contrast, other industry sectors have amply demonstrated that various forms of operator advisory systems can enhance operator performance while maintaining the role and responsibility of the operator as the independent and ultimate decision-maker. A computerized operator support system (COSS) is proposed for use in nuclear power plants to assist control room operators in addressing time-critical plant upsets. A COSS is a collection of technologies to assist operators in monitoring overall plant performance and making timely, informed decisions on appropriate control actions for the projected plant condition. The COSS does not supplant the role of the operator, but rather provides rapid assessments, computations, and recommendations to reduce workload and augment operator judgment and decision-making during fast-moving, complex events. This project proposes a general model for a control room COSS that addresses a sequence of general tasks required to manage any plant upset: detection, validation, diagnosis, recommendation, monitoring, and recovery. The model serves as a framework for assembling a set of technologies that can be interrelated to assist with each of these tasks. A prototype COSS has been developed in order to demonstrate the concept and provide a test bed for further research. The prototype is based

A Computuerized Operator Support System Prototype

Energy Technology Data Exchange (ETDEWEB)

Thomas, Ken [Idaho National Lab. (INL), Idaho Falls, ID (United States); Boring, Ronald [Idaho National Lab. (INL), Idaho Falls, ID (United States); Lew, Roger [Idaho National Lab. (INL), Idaho Falls, ID (United States); Ulrich, Tom [Idaho National Lab. (INL), Idaho Falls, ID (United States); Villim, Richard [Idaho National Lab. (INL), Idaho Falls, ID (United States)

2013-08-01

A report was published by the Idaho National Laboratory in September of 2012, entitled Design to Achieve Fault Tolerance and Resilience, which described the benefits of automating operator actions for transients. The report identified situations in which providing additional automation in lieu of operator actions would be advantageous. It recognized that managing certain plant upsets is sometimes limited by the operator’s ability to quickly diagnose the fault and to take the needed actions in the time available. Undoubtedly, technology is underutilized in the nuclear power industry for operator assistance during plant faults and operating transients. In contrast, other industry sectors have amply demonstrated that various forms of operator advisory systems can enhance operator performance while maintaining the role and responsibility of the operator as the independent and ultimate decision-maker. A computerized operator support system (COSS) is proposed for use in nuclear power plants to assist control room operators in addressing time-critical plant upsets. A COSS is a collection of technologies to assist operators in monitoring overall plant performance and making timely, informed decisions on appropriate control actions for the projected plant condition. The COSS does not supplant the role of the operator, but rather provides rapid assessments, computations, and recommendations to reduce workload and augment operator judgment and decision-making during fast-moving, complex events. This project proposes a general model for a control room COSS that addresses a sequence of general tasks required to manage any plant upset: detection, validation, diagnosis, recommendation, monitoring, and recovery. The model serves as a framework for assembling a set of technologies that can be interrelated to assist with each of these tasks. A prototype COSS has been developed in order to demonstrate the concept and provide a test bed for further research. The prototype is based

Intersubjective decision-making for computer-aided forging technology design

Science.gov (United States)

Kanyukov, S. I.; Konovalov, A. V.; Muizemnek, O. Yu.

2017-12-01

We propose a concept of intersubjective decision-making for problems of open-die forging technology design. The intersubjective decisions are chosen from a set of feasible decisions using the fundamentals of the decision-making theory in fuzzy environment according to the Bellman-Zadeh scheme. We consider the formalization of subjective goals and the choice of membership functions for the decisions depending on subjective goals. We study the arrangement of these functions into an intersubjective membership function. The function is constructed for a resulting decision, which is chosen from a set of feasible decisions. The choice of the final intersubjective decision is discussed. All the issues are exemplified by a specific technological problem. The considered concept of solving technological problems under conditions of fuzzy goals allows one to choose the most efficient decisions from a set of feasible ones. These decisions correspond to the stated goals. The concept allows one to reduce human participation in automated design. This concept can be used to develop algorithms and design programs for forging numerous types of forged parts.

Assisted supervision of a computer aided tele-operation system

Energy Technology Data Exchange (ETDEWEB)

Le Bars, H; Gravez, P; Fournier, R

1994-12-31

This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs.

Assisted supervision of a computer aided tele-operation system

International Nuclear Information System (INIS)

Le Bars, H.; Gravez, P.; Fournier, R.

1994-01-01

This paper talks about Computer Aided Tele-operation (CAT) in dismantling and maintenance of nuclear plants. The current research orientations at CEA, basic concepts of the supervision assistance system and the realisation of a prototype are presented. (TEC). 3 refs., 4 figs

Views of general practice staff about the use of a patient-oriented treatment decision aid in shared decision making for patients with type 2 diabetes: A mixed-methods study.

Science.gov (United States)

Wildeboer, Anita; du Pon, Esther; Schuling, Jan; Haaijer-Ruskamp, Flora M; Denig, Petra

2018-02-01

Decision aids can be used to support shared decision making (SDM). A patient-oriented treatment decision aid (DA) was developed for type 2 diabetes but its use by general practice staff appeared to be limited. To explore views of practice staff towards SDM and the DA. A mixed-methods study within the Dutch PORTDA-diab trial. Included were 17 practices with staff members who were responsible for routine diabetes care and had worked with the DA, and 209 of their patients. Interviews were conducted focusing on applicability, usefulness and feasibility of the DA. Interviews were tape-recorded, transcribed verbatim and subjected to content analysis for identifying and classifying views. Patient-reported data about the use of the DA were collected. Associations between specific views and use of the DA were tested using Pearson point-biserial correlation. The majority of practice staff expressed positive views towards SDM, which was associated with making more use of the DA. Most of the staff expressed that the DA stimulated a two-way conversation. By using the DA, several became aware of their paternalistic approach. Some staff experienced a conflict with the content of the DA, which was associated with making less use of the DA. The DA was considered useful by practice staff to support SDM. A positive view towards SDM was a facilitator, whereas experiencing a conflict with the content of the DA was a barrier for making use of the DA. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation.

Science.gov (United States)

Wong, Charlene A; Kulhari, Sajal; McGeoch, Ellen J; Jones, Arthur T; Weiner, Janet; Polsky, Daniel; Baker, Tom

2018-05-29

The design of the Affordable Care Act's (ACA) health insurance marketplaces influences complex health plan choices. To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison. In November-December 2016, we examined the public and private online health insurance exchanges. We navigated each site for "real-shopping" (personal information required) and "window-shopping" (no required personal information). Public (n = 13; 12 state-based marketplaces and HealthCare.gov ) and private (n = 23) online health insurance exchanges. Features included consumer decision aids (e.g., total cost estimators, provider lookups) and plan display (e.g., order of plans). We examined private health insurance exchanges for notable features (i.e., those not found on public exchanges) and compared the total cost estimates on public versus private exchanges for a standardized consumer. Nearly all studied consumer decision aids saw increased deployment in the public marketplaces in OEP4 compared to OEP3. Over half of the public exchanges (n = 7 of 13) had total cost estimators (versus 5 of 14 in OEP3) in window-shopping and integrated provider lookups (window-shopping: 7; real-shopping: 8). The most common default plan orders were by premium or total cost estimate. Notable features on private health insurance exchanges were unique data presentation (e.g., infographics) and further personalized shopping (e.g., recommended plan flags). Health plan total cost estimates varied substantially between the public and private exchanges (average difference $1526). The ACA's public health insurance exchanges offered more tools in OEP4 to help consumers select a plan. While private health insurance exchanges presented notable features, the total cost estimates for a standardized consumer varied widely on public

The use of decision analytic techniques in energy policy decisions

International Nuclear Information System (INIS)

Haemaelaeinen, R.P.; Seppaelaeinen, T.O.

1986-08-01

The report reviews decision analytic techniques and their applications to energy policy decision making. Decision analysis consists in techniques for structuring the essential elements of a decision problem and mathematical methods for ranking the alternatives from a set of simple judgments. Because modeling subjective judgments is characteristic of decision analysis, the models can incorporate qualitative factors and values, which escape traditional energy modeling. Decision analysis has been applied to choices among energy supply alternatives, siting energy facilities, selecting nuclear waste repositories, selecting research and development projects, risk analysis and prioritizing alternative energy futures. Many applications are done in universities and research institutions, but during the 70's the use of decision analysis has spread both to the public and the private sector. The settings where decision analysis has been applied range from aiding a single decision maker to clarifying opposing points of view. Decision analytic methods have also been linked with energy models. The most valuable result of decision analysis is the clarification of the problem at hand. Political decisions cannot be made solely on the basis of models, but models can be used to gain insight of the decision situation. Models inevitably simplify reality, so they must be regarded only as aids to judgment. So far there has been only one decision analysis of energy policy issues in Finland with actual political decision makers as participants. The experiences of this project and numerous foreign applications do however suggest that the decision analytic approach is useful in energy policy questions. The report presents a number of Finnish energy policy decisions where decision analysis might prove useful. However, the applicability of the methods depends crucially on the actual circumstances at hand

DSSHerbicide: Herbicide field trials in winter wheat. How to come to a decision

Directory of Open Access Journals (Sweden)

Sefzat, David

2014-02-01

Full Text Available Herbicide decision support systems can calculate efficient, economically optimized herbicide mixtures with reduced dosages, if field specific weed data are given. Thus, they can be a sensible tool for integrated weed control. However, advises of decision support systems have to be tested before introducing them into practical farming. In Mecklenburg-Vorpommern two herbicide field trials were installed with four different prototypes of decision support systems. An untreated plot and three expert advices, private advisors, official advisory service and a farmer decision, were included as additional test variables. Herbicide efficacies in autumn, weed dry matter after spring applications, herbicide costs and wheat yield were measured to evaluate the decision support system prototypes. In one field trial with low weed density before treatments efficacies were at least 85%. In two prototypes efficacies were lower than in the expert plots. No significant differences between decision variables were found regarding weed dry matter after spraying in spring. On this site, herbicide costs were higher when expert advises were used compared to decision support system advises. No significant differences were detected in yield. Even yield in “untreated” was not significantly different. The second field trial carried higher weed densities. Here herbicide efficacies were lower in all treatments. Poa annua and Matricaria recutita were significantly affected by the treatments resulting from the decision tools. However, these differences did not result in statistically different weed dry matter or wheat yield. Three of the prototypes advised solutions with very low herbicide costs in autumn, but high costs in spring. As a result, total weed costs in these plots were higher than in the plots advised by experts. It is concluded from the field trials, that different prototypes of decision support systems are giving sensible herbicide advice. In fields with low

Development of a new first-aid biochemical detector

Science.gov (United States)

Hu, Jingfei; Liao, Haiyang; Su, Shilin; Ding, Hao; Liu, Suquan

2016-10-01

The traditional biochemical detector exhibits poor adaptability, inconvenient carrying and slow detection, which can't meet the needs of first-aid under field condition like natural or man-made disasters etc. Therefore a scheme of first-aid biochemical detector based on MOMES Micro Spectrometer, UV LED and Photodiode was proposed. An optical detection structure combined continuous spectrum sweep with fixed wavelength measurement was designed, which adopted mobile detection optical path consisting of Micro Spectrometer and Halogen Lamp to detect Chloride (Cl-), Creatinine (Cre), Glucose (Glu), Hemoglobin (Hb). The UV LED and Photodiode were designed to detect Potassium (K-), Carbon dioxide (CO2), Sodium (Na+). According to the field diagnosis and treatment requirements, we designed the embedded control hardware circuit and software system, the prototype of first-aid biochemical detector was developed and the clinical trials were conducted. Experimental results show that the sample's absorbance repeatability is less than 2%, the max coefficient of variation (CV) in the batch repeatability test of all 7 biochemical parameters in blood samples is 4.68%, less than the clinical requirements 10%, the correlation coefficient (R2) in the clinical contrast test with AU5800 is almost greater than 0.97. To sum up, the prototype meets the requirements of clinical application.

Collaborative Platforms Aid Emergency Decision Making

Science.gov (United States)

2013-01-01

Terra. Aqua. Cloudsat. Landsat. NASA runs and partners in many missions dedicated to monitoring the Earth, and the tools used in these missions continuously return data on everything from shifts in temperature to cloud formation to pollution levels over highways. The data are of great scientific value, but they also provide information that can play a critical role in decision making during times of crisis. Real-time developments in weather, wind, ocean currents, and numerous other conditions can have a significant impact on the way disasters, both natural and human-caused, unfold. "NASA has long recognized the need to make its data from real-time sources compatible and accessible for the purposes of decision making," says Michael Goodman, who was Disasters Program manager at NASA Headquarters from 2009-2012. "There are practical applications of NASA Earth science data, and we d like to accelerate the use of those applications." One of the main obstacles standing in the way of eminently practical data is the fact that the data from different missions are collected, formatted, and stored in different ways. Combining data sets in a way that makes them useful for decision makers has proven to be a difficult task. And while the need for a collaborative platform is widely recognized, very few have successfully made it work. Dave Jones, founder and CEO of StormCenter Communications Inc., which consults with decision makers to prepare for emergencies, says that "when I talk to public authorities, they say, If I had a nickel for every time someone told me they had a common operating platform, I d be rich. But one thing we ve seen over the years is that no one has been able to give end users the ability to ingest NASA data sets and merge them with their own."

Analytic Procedures For Designing and Evaluating Decision Aids.

Science.gov (United States)

1980-04-01

the taxonomy of decision charateristics . Chapter 5 applies the taxonomies to the information processing functions needed for AAW decisions, and...rationality emphasizes the extent to which organizations and other social institutions consist of individuals who pursue individual objectives by means of...adaptive rationality is always wrong or naive; most of us know persons that seem to be naturally good decision-makers. There is no logic that guarantees

Rational Suicide and AIDS: Considerations for the Psychotherapist.

Science.gov (United States)

Werth, James L., Jr.

1992-01-01

Reviews literature on suicide and terminal illnesses. Examines suicide rate for persons with Acquired Immune Deficiency Syndrome (AIDS). Explores physical and psychosocial factors that may contribute to decision by person with AIDS to commit suicide. Applies Siegel's criteria for rational suicide to case of person with AIDS. Examines role of…

Clinical evaluation of a computer-aided diagnosis (CAD) prototype for the detection of pulmonary embolism.

Science.gov (United States)

Buhmann, Sonja; Herzog, Peter; Liang, Jin; Wolf, Mathias; Salganicoff, Marcos; Kirchhoff, Chlodwig; Reiser, Maximilian; Becker, Christoph H

2007-06-01

To evaluate the performance of a prototype computer-aided diagnosis (CAD) tool using artificial intelligence techniques for the detection of pulmonary embolism (PE) and the possible benefit for general radiologists. Forty multidetector row computed tomography datasets (16/64- channel scanner) using 100 kVp, 100 mAs effective/slice, and 1-mm axial reformats in a low-frequency reconstruction kernel were evaluated. A total of 80 mL iodinated contrast material was injected at a flow rate of 5 mL/seconds. Primarily, six general radiologists marked any PE using a commercially available lung evaluation software with simultaneous, automatic processing by CAD in the background. An expert panel consisting of two chest radiologists analyzed all PE marks from the readers and CAD, also searching for additional finding primarily missed by both, forming the ground truth. The ground truth consisted of 212 emboli. Of these, 65 (31%) were centrally and 147 (69%) were peripherally located. The readers detected 157/212 emboli (74%) leading to a sensitivity of 97% (63/65) for central and 70% (103/147) for peripheral emboli with 9 false-positive findings. CAD detected 168/212 emboli (79%), reaching a sensitivity of 74% for central (48/65) and 82%(120/147) for peripheral emboli. A total of 154 CAD candidates were considered as false positives, yielding an average of 3.85 false positives/case. The CAD software showed a sensitivity comparable to that of the general radiologists, but with more false positives. CAD detection of findings incremental to the radiologists suggests benefit when used as a second reader. Future versions of CAD have the potential to further increase clinical benefit by improving sensitivity and reducing false marks.

Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience

Directory of Open Access Journals (Sweden)

Giguere Anik

2012-08-01

Full Text Available Abstract Background This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together. Methods Seven researchers (including four practicing family physicians selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb’s seven themes (valuable, usable, credible, useful, desirable, accessible, and findable, and included new themes suggested by the data. Prototypes were modified in light of our findings. Results Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users’ first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes’ purpose and a flow chart representing the shared decision

Fuzzy prototype classifier based on items and its application in recommender system

Directory of Open Access Journals (Sweden)

Mei Cai

2017-01-01

Full Text Available Currently, recommender systems (RS are incorporating implicit information from social circle of the Internet. The implicit social information in human mind is not easy to reflect in appropriate decision making techniques. This paper consists of 2 contributions. First, we develop an item-based prototype classifier (IPC in which a prototype represents a social circlers preferences as a pattern classification technique. We assume the social circle which distinguishes with others by the items their members like. The prototype structure of the classifier is defined by two2-dimensional matrices. We use information gain and OWA aggregator to construct a feature space. The item-based classifier assigns a new item to some prototypes with different prototypicalities. We reform a typical data setmIris data set in UCI Machine Learning Repository to verify our fuzzy prototype classifier. The second proposition of this paper is to give the application of IPC in recommender system to solve new item cold-start problems. We modify the dataset of MovieLens to perform experimental demonstrations of the proposed ideas.

Patient specific ankle-foot orthoses using rapid prototyping.

Science.gov (United States)

Mavroidis, Constantinos; Ranky, Richard G; Sivak, Mark L; Patritti, Benjamin L; DiPisa, Joseph; Caddle, Alyssa; Gilhooly, Kara; Govoni, Lauren; Sivak, Seth; Lancia, Michael; Drillio, Robert; Bonato, Paolo

2011-01-12

Prefabricated orthotic devices are currently designed to fit a range of patients and therefore they do not provide individualized comfort and function. Custom-fit orthoses are superior to prefabricated orthotic devices from both of the above-mentioned standpoints. However, creating a custom-fit orthosis is a laborious and time-intensive manual process performed by skilled orthotists. Besides, adjustments made to both prefabricated and custom-fit orthoses are carried out in a qualitative manner. So both comfort and function can potentially suffer considerably. A computerized technique for fabricating patient-specific orthotic devices has the potential to provide excellent comfort and allow for changes in the standard design to meet the specific needs of each patient. In this paper, 3D laser scanning is combined with rapid prototyping to create patient-specific orthoses. A novel process was engineered to utilize patient-specific surface data of the patient anatomy as a digital input, manipulate the surface data to an optimal form using Computer Aided Design (CAD) software, and then download the digital output from the CAD software to a rapid prototyping machine for fabrication. Two AFOs were rapidly prototyped to demonstrate the proposed process. Gait analysis data of a subject wearing the AFOs indicated that the rapid prototyped AFOs performed comparably to the prefabricated polypropylene design. The rapidly prototyped orthoses fabricated in this study provided good fit of the subject's anatomy compared to a prefabricated AFO while delivering comparable function (i.e. mechanical effect on the biomechanics of gait). The rapid fabrication capability is of interest because it has potential for decreasing fabrication time and cost especially when a replacement of the orthosis is required.

Developing and user-testing Decision boxes to facilitate shared decision making in primary care - a study protocol

Directory of Open Access Journals (Sweden)

Rousseau François

2011-03-01

Full Text Available Abstract Background Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users. Methods/Design We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable, and will include new themes suggested by the data (inductive analysis. Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings. Discussion This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It

Characteristics of products generated by selective sintering and stereolithography rapid prototyping processes

Science.gov (United States)

Cariapa, Vikram

1993-01-01

The trend in the modern global economy towards free market policies has motivated companies to use rapid prototyping technologies to not only reduce product development cycle time but also to maintain their competitive edge. A rapid prototyping technology is one which combines computer aided design with computer controlled tracking of focussed high energy source (eg. lasers, heat) on modern ceramic powders, metallic powders, plastics or photosensitive liquid resins in order to produce prototypes or models. At present, except for the process of shape melting, most rapid prototyping processes generate products that are only dimensionally similar to those of the desired end product. There is an urgent need, therefore, to enhance the understanding of the characteristics of these processes in order to realize their potential for production. Currently, the commercial market is dominated by four rapid prototyping processes, namely selective laser sintering, stereolithography, fused deposition modelling and laminated object manufacturing. This phase of the research has focussed on the selective laser sintering and stereolithography rapid prototyping processes. A theoretical model for these processes is under development. Different rapid prototyping sites supplied test specimens (based on ASTM 638-84, Type I) that have been measured and tested to provide a data base on surface finish, dimensional variation and ultimate tensile strength. Further plans call for developing and verifying the theoretical models by carefully designed experiments. This will be a joint effort between NASA and other prototyping centers to generate a larger database, thus encouraging more widespread usage by product designers.

Software for rapid prototyping in the pharmaceutical and biotechnology industries.

Science.gov (United States)

Kappler, Michael A

2008-05-01

The automation of drug discovery methods continues to develop, especially techniques that process information, represent workflow and facilitate decision-making. The magnitude of data and the plethora of questions in pharmaceutical and biotechnology research give rise to the need for rapid prototyping software. This review describes the advantages and disadvantages of three solutions: Competitive Workflow, Taverna and Pipeline Pilot. Each of these systems processes large amounts of data, integrates diverse systems and assists novice programmers and human experts in critical decision-making steps.

Patient-Centered Robot-Aided Passive Neurorehabilitation Exercise Based on Safety-Motion Decision-Making Mechanism

Directory of Open Access Journals (Sweden)

Lizheng Pan

2017-01-01

Full Text Available Safety is one of the crucial issues for robot-aided neurorehabilitation exercise. When it comes to the passive rehabilitation training for stroke patients, the existing control strategies are usually just based on position control to carry out the training, and the patient is out of the controller. However, to some extent, the patient should be taken as a “cooperator” of the training activity, and the movement speed and range of the training movement should be dynamically regulated according to the internal or external state of the subject, just as what the therapist does in clinical therapy. This research presents a novel motion control strategy for patient-centered robot-aided passive neurorehabilitation exercise from the point of the safety. The safety-motion decision-making mechanism is developed to online observe and assess the physical state of training impaired-limb and motion performances and regulate the training parameters (motion speed and training rage, ensuring the safety of the supplied rehabilitation exercise. Meanwhile, position-based impedance control is employed to realize the trajectory tracking motion with interactive compliance. Functional experiments and clinical experiments are investigated with a healthy adult and four recruited stroke patients, respectively. The two types of experimental results demonstrate that the suggested control strategy not only serves with safety-motion training but also presents rehabilitation efficacy.

"Aid to Thought"--Just Simulate It!

Science.gov (United States)

Kinczkowski, Linda; Cardon, Phillip; Speelman, Pamela

2015-01-01

This paper provides examples of Aid-to-Thought uses in urban decision making, classroom laboratory planning, and in a ship antiaircraft defense system. Aid-to-Thought modeling and simulations are tools students can use effectively in a STEM classroom while meeting Standards for Technological Literacy Benchmarks O and R. These projects prepare…

Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy.

Science.gov (United States)

Ager, B; Jansen, J; Porter, D; Phillips, K A; Glassey, R; Butow, P

2018-05-22

Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Implications of Modern Decision Science for Military Decision-Support Systems

Science.gov (United States)

2005-01-01

Stock of Naturalistic Decision Making," Journal of Behavioral Decision Making, Vol. 14, No. 5, 2001, pp. 331-352. Llinas, James, Ann Bisantz, Colin Drury ...on aided adversarial decisionmaking (Llinas, Bisantz, Drury , Song, and Jian, 1998). Cohen argues for a situation-specific trust model: The problem of...and P. Fishwick, eds., 2000, pp. 1739-1746. Camerer, Colin F., "Individual Decision Making," in John H. Kagel and Alvin E. Roth, eds., Handbook of

Induction of Ordinal Decision Trees

NARCIS (Netherlands)

J.C. Bioch (Cor); V. Popova (Viara)

2003-01-01

textabstractThis paper focuses on the problem of monotone decision trees from the point of view of the multicriteria decision aid methodology (MCDA). By taking into account the preferences of the decision maker, an attempt is made to bring closer similar research within machine learning and MCDA.

Prototype development of user specific climate services

Science.gov (United States)

Jacob, Daniela

2017-04-01

Systematic consultations in the last years with representatives from sectors particularly affected by climate change have helped the Climate Service Center Germany (GERICS) to identify the most pressing needs of stakeholders from public and private sectors. Besides the development of innovative climate service products and methods, areas are also identified, for which intensive research activities have to be initiated. An example is the demand of decision makers for high-resolution climate change information needed at regional to local levels for their activities towards climate change adaptation. For questions concerning adaptation to climate change, no standard solutions can be provided. Different from mitigation measures, adaptation measures must be framed in accordance with the specific circumstances prevailing in the local situation. Here, individual solutions, which satisfy the individual requirements and needs, are necessary. They have to be developed in close co-operation with the customers and users. For example, the implications of climate change on strategic and operative decisions, e.g. in enterprises and urban planning, are becoming increasingly important. Therefore, high-quality consultancy for businesses and public administration is needed, in order to support decision makers in identifying associated risks and opportunities. For the development of prototype products, GERICS has framed a general methodological approach, including the idea generation, the iterative development, and the prototype testing in co-development with the user. High process transparency and high product quality are prerequisite for the success of a product. The co-development process ensures the best possible communication of user tailored climate change information for different target groups.

Text summarization as a decision support aid

Directory of Open Access Journals (Sweden)

Workman T

2012-05-01

Full Text Available Abstract Background PubMed data potentially can provide decision support information, but PubMed was not exclusively designed to be a point-of-care tool. Natural language processing applications that summarize PubMed citations hold promise for extracting decision support information. The objective of this study was to evaluate the efficiency of a text summarization application called Semantic MEDLINE, enhanced with a novel dynamic summarization method, in identifying decision support data. Methods We downloaded PubMed citations addressing the prevention and drug treatment of four disease topics. We then processed the citations with Semantic MEDLINE, enhanced with the dynamic summarization method. We also processed the citations with a conventional summarization method, as well as with a baseline procedure. We evaluated the results using clinician-vetted reference standards built from recommendations in a commercial decision support product, DynaMed. Results For the drug treatment data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.848 and 0.377, while conventional summarization produced 0.583 average recall and 0.712 average precision, and the baseline method yielded average recall and precision values of 0.252 and 0.277. For the prevention data, Semantic MEDLINE enhanced with dynamic summarization achieved average recall and precision scores of 0.655 and 0.329. The baseline technique resulted in recall and precision scores of 0.269 and 0.247. No conventional Semantic MEDLINE method accommodating summarization for prevention exists. Conclusion Semantic MEDLINE with dynamic summarization outperformed conventional summarization in terms of recall, and outperformed the baseline method in both recall and precision. This new approach to text summarization demonstrates potential in identifying decision support data for multiple needs.

Autonomous motivation is associated with hearing aid adoption.

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Ridgway, Jason; Hickson, Louise; Lind, Christopher

2015-07-01

To use the self-determination theory of motivation to investigate whether different forms of motivation were associated with adults' decisions whether or not to adopt hearing aids. A quantitative approach was used in this cohort study. Participants completed the treatment self-regulation questionnaire (TSRQ), which measured autonomous and controlled motivation for hearing aid adoption. Sociodemographic data and audiometric information were also obtained. Participants were 253 adults who had sought information about their hearing but had not consulted with a hearing professional. Participants were categorized as hearing aid adopters if they had been fitted with hearing aids 4-6 months after completing the TSRQ, and as non-adopters if they had not. Multivariate logistic regression was used to examine associations between autonomous and controlled motivation, sociodemographic and audiometric variables, and hearing aid adoption (n = 160). Three factors were significantly associated with increased hearing aid adoption when the influence of other variables was accounted for: autonomous motivation, perceived hearing difficulty, and poorer hearing. Controlled motivation was not found to influence hearing aid adoption. These empirical findings that link autonomous motivation to decisions of hearing help-seekers have implications for the ways practitioners may evaluate motivation and could inform discussions with clients about hearing aid adoption.

What factors influence health professionals to use decision aids for Down syndrome prenatal screening?

Science.gov (United States)

Lépine, Johanie; Leiva Portocarrero, Maria Esther; Delanoë, Agathe; Robitaille, Hubert; Lévesque, Isabelle; Rousseau, François; Wilson, Brenda J; Giguère, Anik M C; Légaré, France

2016-09-05

Health professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up. We planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews. Out of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues' approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a

Architectural prototyping

DEFF Research Database (Denmark)

Bardram, Jakob Eyvind; Christensen, Henrik Bærbak; Hansen, Klaus Marius

2004-01-01

A major part of software architecture design is learning how specific architectural designs balance the concerns of stakeholders. We explore the notion of "architectural prototypes", correspondingly architectural prototyping, as a means of using executable prototypes to investigate stakeholders...

User involvement in the design and evaluation of a smart mobility aid.

Science.gov (United States)

Lacey, G; MacNamara, S

2000-01-01

This paper describes the design and evaluation of an innovative smart mobility aid for the frail visually impaired. The Personal Adaptive Mobility AID (PAM-AID) was developed to address the difficulties in personal mobility of the frail and elderly visually impaired. The paper provides an overview of the PAM-AID research at Trinity College and describes the evolutionary nature of the design process. Because there were no existing systems to guide its development, a series of prototypes was constructed and they were regularly evaluated in the field. This approach views potential users as vital contributing members of the design team and led to rapid and hopefully useful improvements in the design.

A randomised controlled trial evaluating the utility of a patient Decision Aid to improve clinical trial (RAVES 08.03) related decision-making.

Science.gov (United States)

Sundaresan, Puma; Ager, Brittany; Turner, Sandra; Costa, Dan; Kneebone, Andrew; Pearse, Maria; Woo, Henry; Tesson, Stephanie; Juraskova, Ilona; Butow, Phyllis

2017-10-01

Randomised controlled trials (RCTs) are considered the 'gold-standard' for evaluating medical treatments. However, patients and clinicians report difficulties with informed consent and recruitment. We evaluated the utility of a Decision Aid (DA) in reducing RCT-related decisional conflict, and improving RCT knowledge and recruitment. Potential participants for a radiotherapy RCT were invited to participate in the current study. Participants were randomised to receive the RCT's participant information sheet with or without a DA. Questionnaires were administered at baseline, one and six months. The primary outcome measure was decisional conflict. Secondary outcome measures included knowledge regarding and recruitment to the RCT. 129 men were randomised to the DA (63) and control (66) arms. Decisional conflict was significantly lower over 6-months (p=0.048) in the DA arm. Knowledge regarding the RCT was significantly higher at 6months (p=0.033) in the DA arm. 20.6% of the DA arm (13 of 63) and 9% of the control arm (6 of 66) entered the RCT. This study demonstrates the utility of a DA in reducing decisional conflict and improving trial knowledge in men with cancer who are making decisions regarding RCT participation. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

Patient specific ankle-foot orthoses using rapid prototyping

Directory of Open Access Journals (Sweden)

Sivak Seth

2011-01-01

Full Text Available Abstract Background Prefabricated orthotic devices are currently designed to fit a range of patients and therefore they do not provide individualized comfort and function. Custom-fit orthoses are superior to prefabricated orthotic devices from both of the above-mentioned standpoints. However, creating a custom-fit orthosis is a laborious and time-intensive manual process performed by skilled orthotists. Besides, adjustments made to both prefabricated and custom-fit orthoses are carried out in a qualitative manner. So both comfort and function can potentially suffer considerably. A computerized technique for fabricating patient-specific orthotic devices has the potential to provide excellent comfort and allow for changes in the standard design to meet the specific needs of each patient. Methods In this paper, 3D laser scanning is combined with rapid prototyping to create patient-specific orthoses. A novel process was engineered to utilize patient-specific surface data of the patient anatomy as a digital input, manipulate the surface data to an optimal form using Computer Aided Design (CAD software, and then download the digital output from the CAD software to a rapid prototyping machine for fabrication. Results Two AFOs were rapidly prototyped to demonstrate the proposed process. Gait analysis data of a subject wearing the AFOs indicated that the rapid prototyped AFOs performed comparably to the prefabricated polypropylene design. Conclusions The rapidly prototyped orthoses fabricated in this study provided good fit of the subject's anatomy compared to a prefabricated AFO while delivering comparable function (i.e. mechanical effect on the biomechanics of gait. The rapid fabrication capability is of interest because it has potential for decreasing fabrication time and cost especially when a replacement of the orthosis is required.

Multi-Stakeholder Decision Aid for Improved Prioritization of the Public Health Impact of Climate Sensitive Infectious Diseases

Directory of Open Access Journals (Sweden)

Valerie Hongoh

2016-04-01

Full Text Available The effects of climate change on infectious diseases are an important global health concern and necessitate decisions for allocation of resources. Economic tools have been used previously; however, how prioritization results might differ when done using broader considerations identified by local stakeholders has yet to be assessed. A multicriteria decision analysis (MCDA approach was used to assess multi-stakeholder expressed concerns around disease prioritization via focus groups held in Quebec and Burkina Faso. Stakeholders weighted criteria and comparisons were made across study sites. A pilot disease prioritization was done to examine effects on disease rankings. A majority of identified criteria were common to both sites. The effect of context specific criteria and weights resulted in similar yet distinct prioritizations of diseases. The presence of consistent criteria between sites suggests that common concerns exist for prioritization; however, context-specific adjustments reveal much regarding resource availability, capacity and concerns that should be considered as this impacts disease ranking. Participatory decision aid approaches facilitate rich knowledge exchange and problem structuring. Furthermore, given multiple actors in low- and middle-income countries settings, multi-actor collaborations across non-governmental organizations, local government and community are important. Formal mechanisms such as MCDA provide means to foster consensus, shared awareness and collaboration.

Multi-Stakeholder Decision Aid for Improved Prioritization of the Public Health Impact of Climate Sensitive Infectious Diseases.

Science.gov (United States)

Hongoh, Valerie; Michel, Pascal; Gosselin, Pierre; Samoura, Karim; Ravel, André; Campagna, Céline; Cissé, Hassane Djibrilla; Waaub, Jean-Philippe

2016-04-12

The effects of climate change on infectious diseases are an important global health concern and necessitate decisions for allocation of resources. Economic tools have been used previously; however, how prioritization results might differ when done using broader considerations identified by local stakeholders has yet to be assessed. A multicriteria decision analysis (MCDA) approach was used to assess multi-stakeholder expressed concerns around disease prioritization via focus groups held in Quebec and Burkina Faso. Stakeholders weighted criteria and comparisons were made across study sites. A pilot disease prioritization was done to examine effects on disease rankings. A majority of identified criteria were common to both sites. The effect of context specific criteria and weights resulted in similar yet distinct prioritizations of diseases. The presence of consistent criteria between sites suggests that common concerns exist for prioritization; however, context-specific adjustments reveal much regarding resource availability, capacity and concerns that should be considered as this impacts disease ranking. Participatory decision aid approaches facilitate rich knowledge exchange and problem structuring. Furthermore, given multiple actors in low- and middle-income countries settings, multi-actor collaborations across non-governmental organizations, local government and community are important. Formal mechanisms such as MCDA provide means to foster consensus, shared awareness and collaboration.

A decision support system prototype including human factors based on the TOGA meta-theory approach

International Nuclear Information System (INIS)

Cappelli, M.; Memmi, F.; Gadomski, A. M.; Sepielli, M.

2012-01-01

The human contribution to the risk of operation of complex technological systems is often not negligible and sometimes tends to become significant, as shown by many reports on incidents and accidents occurred in the past inside Nuclear Power Plants (NPPs). An error of a human operator of a NPP can derive by both omission and commission. For instance, complex commission errors can also lead to significant catastrophic technological accidents, as for the case of the Three Mile Island accident. Typically, the problem is analyzed by focusing on the single event chain that has provoked the incident or accident. What is needed is a general framework able to include as many parameters as possible, i.e. both technological and human factors. Such a general model could allow to envisage an omission or commission error before it can happen or, alternatively, suggest preferred actions to do in order to take countermeasures to neutralize the effect of the error before it becomes critical. In this paper, a preliminary Decision Support System (DSS) based on the so-called (-) TOGA meta-theory approach is presented. The application of such a theory to the management of nuclear power plants has been presented in the previous ICAPP 2011. Here, a human factor simulator prototype is proposed in order to include the effect of human errors in the decision path. The DSS has been developed using a TRIGA research reactor as reference plant, and implemented using the LabVIEW programming environment and the Finite State Machine (FSM) model The proposed DSS shows how to apply the Universal Reasoning Paradigm (URP) and the Universal Management Paradigm (UMP) to a real plant context. The DSS receives inputs from instrumentation data and gives as output a suggested decision. It is obtained as the result of an internal elaborating process based on a performance function. The latter, describes the degree of satisfaction and efficiency, which are dependent on the level of responsibility related to

Virtual Reality based User Interface for Conceptual Design and Rapid Prototyping

OpenAIRE

Jadhav, Saurabh Subhash

2017-01-01

Computer Aided Design and Engineering (CAD/ CAE) tools currently available in the market have dramatically improved since their inception. In product development, CAD/ CAE has enabled the user to design, test, analyze and optimize the product virtually even before the first prototype is built. Use of direct modeling for product conceptualization allows the designer to create concept design iterations freely, quickly, flexibly and fast optimization. While modeling geometric databases have been...

Visual Aids for Improving Patient Decision Making in Severe Symptomatic Carotid Stenosis.

Science.gov (United States)

Fridman, Sebastian; Saposnik, Gustavo; Sposato, Luciano A

2017-12-01

Because of the large amount of information to process and the limited time of a clinical consult, choosing between carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS) can be confusing for patients with severe symptomatic internal carotid stenosis (ICA). We aim to develop a visual aid tool to help clinicians and patients in the decision-making process of selecting between CEA and CAS. Based on pooled analysis from randomized controlled trials including patients with symptomatic and severe ICA (SSICA), we generated visual plots comparing CEA with CAS for 3 prespecified postprocedural time points: (1) any stroke or death at 4 months, and (2) any stroke or death in the first 30 days and ipsilateral stroke thereafter at 5 years and (3) at 10 years. A total of 4574 participants (2393 assigned to CAS, and 2361 to CEA) were included in the analyses. For every 100 patients with SSICA, 6 would develop any stroke or death in the CEA group compared with 9 undergoing CAS at 4 months (hazard ratio [HR] 1.53; 95%CI 1.20-1.95). At 5 years, 7 patients in the CEA group would develop any periprocedural stroke or death and ipsilateral stroke thereafter versus 12 undergoing CAS (HR 1.72; 95%CI 1.24-2.39), compared with 10 patients in the CEA and 13 in the CAS groups at 10 years (HR 1.17; 95%CI 0.82-1.66). Visual aids presented in this study could potentially help patients with severe symptomatic internal carotid stenosis to better weigh the risks and benefits of CEA versus CAS as a function of time, allowing for the prioritization of personal preferences, and should be prospectively assessed. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Development of transportation asset management decision support tools : final report.

Science.gov (United States)

2017-08-09

This study developed a web-based prototype decision support platform to demonstrate the benefits of transportation asset management in monitoring asset performance, supporting asset funding decisions, planning budget tradeoffs, and optimizing resourc...

Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

Science.gov (United States)

Elwyn, G; Edwards, A; Hood, K; Robling, M; Atwell, C; Russell, I; Wensing, M; Grol, R

2004-08-01

A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients. The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations. A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. Half the consultations were randomly selected for audio-taping, of which 352 patients attended and were audio-taped successfully. After baseline, participating doctors were randomized to receive training in (i) SDM skills or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were allocated randomly to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations were audio-taped from each phase. Raters (independent, trained and blinded to study phase) assessed the audio-tapes using a validated scale to assess levels of patient involvement (OPTION: observing patient involvement), and to analyse the nature of risk information discussed. Clinicians completed questionnaires after each consultation, assessing perceived clinician-patient agreement and level of patient involvement in decisions. Multilevel modelling was carried out with the OPTION score as the dependent variable, and

Exploring Audiologists' Language and Hearing Aid Uptake in Initial Rehabilitation Appointments.

Science.gov (United States)

Sciacca, Anna; Meyer, Carly; Ekberg, Katie; Barr, Caitlin; Hickson, Louise