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ObjectiveAccording to the precaution adoption process model, cervical screening nonparticipants represent a heterogeneous group including those who are unaware of, unengaged with, or undecided about screening, as well as intenders and decliners. We aimed to explore beliefs about cervical screening among these different types of nonparticipant.MethodsSemistructured interviews were carried out with women aged 26 to 65 years living in Britain (n = 29). Women were purposively sampled to represent different nonparticipant types. Interviews were transcribed verbatim, and data were analysed thematically using framework analysis.ResultsThe salience of some barriers to screening varied between different types of nonparticipant. Bad experiences were prominent in the discussions of women who had decided not to attend, while practical barriers were more prominent among intenders. There was also some overlap between nonparticipant types. For example, many of the undecided women described not wanting to go for screening, but with less certainty than decliners. Some intenders (particularly those who had not been screened before) described not really wanting to attend but feeling they ought to. Women's views on the invitation/reminder process also varied; intenders and maintainers appreciated written reminders and general practitioner (GP) prompts but decliners sometimes perceived these as “badgering.” Throughout the interviews, women described changing views on screening in the wider context of ageing and motherhood.ConclusionsThe salience of screening barriers varies by nonparticipant type, offering possibilities for tailored interventions. However, the fluidity of women's stage of screening adoption might have implications for this approach to intervention design.

Many everyday actions are implicit gambles because imprecisions in our visuomotor systems place probabilities on our success or failure. Choosing optimal action strategies involves weighting the costs and gains of potential outcomes by their corresponding probabilities, and requires stable representations of one's own imprecisions. How this ability is acquired during development in childhood when visuomotor skills change drastically is unknown. In a rewarded rapid reaching task, 6‐ to 11‐year‐old children followed ‘risk‐seeking’ strategies leading to overly high point‐loss. Adults' performance, in contrast, was close to optimal. Children's errors were not explained by distorted estimates of value or probability, but may reflect different action selection criteria or immature integration of value and probability information while planning movements. These findings provide a starting point for understanding children's risk‐taking in everyday visuomotor situations when suboptimal choices can be dangerous. Moreover, children's risky visuomotor decisions mirror those reported for non‐motor gambles, raising the possibility that common processes underlie development across decision‐making domains.

Objective Surgery is the mainstay of treatment for breast cancer. However, there is evidence that older women are not receiving this treatment. This study explores reasons why older women are not having surgery. Methods Twenty eight in‐depth interviews were conducted with women over 70 years old with operable breast cancer receiving primary endocrine therapy (PET) as their primary treatment. The interviews focused on their perceptions of why they were being treated with PET rather than surgery. Transcripts were analysed using the Framework method. Results Based on reasons for PET, patients were divided into three groups: ‘Patient Declined’, ‘Patient Considered’ or ‘Surgeon Decided’. The first group ‘Patient Declined’ absolutely ruled out surgery to treat their breast cancer. These patients were not interested in maximising their survival and rejected surgery citing their age or concerns about impact of treatment on their level of functioning. The second group ‘Patient Considered’ considered surgery but chose to have PET most specifying if PET failed then they could have the operation. Patients viewed this as offering them two options of treatment. The third group ‘Surgeon Decided’ was started by the surgeon on PET. These patients had comorbidities and in most cases the surgeon asserted that the comorbidities were incompatible with surgery. Conclusions Older women represent a diverse group and have multifaceted reasons for foregoing surgery. Discussions about breast cancer treatment should be patient centred and adapted to differing patient priorities. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.

International audience; The main goal of this study was to determine the reproducibility of the reading of wrist trauma case radiographs using three different media: laser film, a picture archiving and communication systems (PACS) workstation, and paper with an optimized layout. The study was conducted retrospectively in 200 consecutive patients consulting at the emergency department for wrist trauma and who underwent wrist X-ray investigation using a computed radiography system. There were 82 men and 118 women. The mean age was 48.3 years (16–95 years). Our institutional review board does not require patient approval or informed consent for retrospective review of case records. The readings were made by two independent readers who analyzed the 200 patient radiographs consecutively in one session for each type of media: paper, laser film, and on a PACS dual-screen workstation. The inter-reader agreements were substantial or almost perfect, with kappa values of 0.83 (0.76–0.90) for the PACS, 0.83 (0.76–0.90) for film, and 0.80 (0.72–0.87) for paper. The inter-technique agreement was almost perfect in all cases. There is a high interobserver agreement between PACS, laser film, and paper readings for wrist trauma cases. With a layout of one radiograph on each sheet, paper could replace laser films to communicate the results of wrist radiographs in trauma cases for outpatients.

Background Decisions concerning drug safety and efficacy are generally based on pivotal evidence provided by clinical trials. Unfortunately, finding the relevant clinical trials is difficult and their results are only available in text-based reports. Systematic reviews aim to provide a comprehensive overview of the evidence in a specific area, but may not provide the data required for decision making. Methods We review and analyze the existing information systems and standards for aggregate level clinical trials information from the perspective of systematic review and evidence-based decision making. Results The technology currently used has major shortcomings, which cause deficiencies in the transfer, traceability and availability of clinical trials information. Specifically, data available to decision makers is insufficiently structured, and consequently the decisions cannot be properly traced back to the underlying evidence. Regulatory submission, trial publication, trial registration, and systematic review produce unstructured datasets that are insufficient for supporting evidence-based decision making. Conclusions The current situation is a hindrance to policy decision makers as it prevents fully transparent decision making and the development of more advanced decision support systems. Addressing the identified deficiencies would enable more efficient, informed, and transparent evidence-based medical decision making.

Although there have been quite a number of theoretical and practical studies where axiomatic design (AD) principles have been used in the last few years, there is a lack of a comprehensive literature survey which evaluates and classifies these papers. This study provides a recognizable overview of literature on AD principles from the past 20 years and introduces a novel classification scheme covering 63 papers. Each article was classified into four main groups, namely the type of the axiom, the application area, the method, and the evaluation type. Findings of our paper indicate that most of the studies in the literature are application-based papers which use typically the independence axiom. While product design is put forward in the application area, the crisp approach is widely used as an evaluation type. A rise in the fuzzy evaluation based research studies using the information axiom for multi-attribute decision making problems has also been noticed. (C) 2010 Elsevier Ltd. All rights reserved.

There is increasing interest in the endoscopic treatment of Barrett’s esophagus. Endoscopic treatment has been utilized for many years, but in the past, no specific method has emerged as an appealing treatment option with appropriate safety, efficacy and ease of treatment for both patients and physicians. Recently there has been a growing literature related to the endoscopic ablation of Barrett’s esophagus using radiofrequency ablation (RFA) (Halo® system). In order to discuss when RFA is indicated for Barrett’s, one needs to know: (1) What is the ‘histology’ of the Barrett’s? Does the patient have intestinal metaplasia, low-grade dysplasia, high-grade dysplasia or intramucosal carcinoma? (2) What are the endoscopic options to be considered as opposed to RFA? What are the advantages and disadvantages of each? (3) What additional variables need to be examined?

Total order ranking methods are multicriteria decision making techniques used for the ranking of various alternatives on the basis of more than one criterion. The criteria, which are the standards by which the elements of the system are judged are not always in agreement, they can be conflicting, motivating the need to find an overall optimum that can deviate from the optima of one or more of the single criteria. Total order ranking methods are based on an aggregation of the criteria in a scalar function, i.e. an order or ranking index, which allow to sort elements according to its numerical value. Several evaluation methods which define a ranking parameter generating a total order ranking have been proposed in the literature. Four total order ranking methods are here described: Desirability functions, Utility functions, Dominance functions and Absolute Reference method. These methods have been compared to each other by applying them to a decision making problem in the paper industry. Various bleaching processes have been analysed and compared on the basis of multiple criteria, the aim being to find out best bleaching process among the ones proposed in the last years as alternative to chlorine bleaching process which is of high environmental impact due to the potential for chlorinated dioxin production.

Objectives: The purpose of this study was to describe the process used to decide which patients are admitted to the intensive care unit (ICU) at a hospital with special focus on access for neurosurgery patients, and evaluate it using “accountability for reasonableness”. Methods: Qualitative case study methodology was used. Data were collected from documents, interviews with key informants, and observations. The data were subjected to thematic analysis and evaluated using the four conditions of “accountability for reasonableness” (relevance, publicity, appeals, enforcement) to identify good practices and opportunities for improvement. Results: ICU admissions were based on the referring physician’s assessment of the medical need of the patient for an ICU bed. Non-medical criteria (for example, family wishes) also influenced admission decisions. Although there was an ICU bed allocation policy, patient need always superceded the bed allocation policy. ICU admission guidelines were not used. Admission decisions and reasons were disseminated to the ICU charge nurse, the bed coordinator, the ICU resident, the intensivist, and the requesting physician/surgeon by word of mouth and by written documentation in the patient’s chart, but not to the patient or family. Appeals occurred informally, through negotiations between clinicians. Enforcement of relevance, publicity, and appeals was felt to be either non-existent or deficient. Conclusions: Conducting a case study of priority setting decisions for patients requiring ICU beds, with a special focus on neurosurgical patients, and applying the ethical framework “accountability for reasonableness” can help critical care units improve the fairness of their priority setting.