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We aimed to investigate differences in patients' anxiety and satisfaction between patients undergoing paper-based patient decision aid (PDA) for shared decision-making (SDM) and those receiving computer-based PDA. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to use of paper-based or computer-based PDA. In addition, Pearson correlation analysis was applied to assess the relationships among variables. In total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). Near half of the patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all the patients based on use of paper-based or computer-based PDA, the reduction of anxiety level was greater in the patients who underwent paper-based PDA when compared with that of those who underwent computer-based PDA. However, there was no significant difference in satisfaction between the two groups. Paper-based PDA was as effective as computer-based PDA. Further studies comparing different types of PDA are warranted to fill the knowledge gaps in the literature., (© 2023. The Author(s).)

Objectives: Producing living guidelines requires making important decisions about methods for evidence identification, appraisal, and integration to allow the living mode to function. Clarifying what these decisions are and the trade-offs between options is necessary. This article provides living guideline developers with a framework to enable them to choose the most suitable model for their living guideline topic, question, or context., Study Design and Setting: We developed this guidance through an iterative process informed by interviews, feedback, and a consensus process with an international group of living guideline developers., Results: Several key decisions need to be made both before commencing and throughout the continual process of living guideline development and maintenance. These include deciding what approach is taken to the systematic review process; decisions about methods to be applied for the evidence appraisal process, including the use of unpublished data; and selection of "triggers" to incorporate new studies into living guideline recommendations. In each case, there are multiple options and trade-offs., Conclusion: We identify trade-offs and important decisions to be considered throughout the living guideline development process. The most appropriate, and most sustainable, mode of development and updating will be dependent on the choices made in each of these areas., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To describe and discuss clinical strategies for nurses working in partnership with substitute decision-makers for people living with advanced dementia., Background: By providing person-centred care to patients living with advanced dementia, nurses are positioned to work in partnership with substitute decision-makers who make healthcare decisions related to advanced care. Because the experience of being substitute decision-makers is complex and stressful, nurses need skillsets for working in partnership with substitute decision-makers., Design: In this discursive paper, an innovative framework for working in partnership with substitute decision-makers is proposed., Method: Evidence-based findings from a systematic review provided five domain foci for the partnership framework. In each domain, two clinical strategies were discursively proposed. Clinical strategies were hypothesised from research findings and insights from the authors' nursing experiences. Then, topical literature was searched, and findings were used to support the discursively argued strategies., Discussion: To deal with complexities and reduce stress for substitute decision-makers, an innovative Nurse-Substitute Decision-Maker Partnership Framework for use in the context of advanced dementia is proposed and discussed. The partnership framework consists of five domains: Building trust, Exploring emotions, Translating quality of life, Encouraging proactivity and Negotiating families. Within these domains, ten strategies to support the practices of clinical nurses to work in partnership with substitute decision-makers are discussed., Relevance to Clinical Practice: In the framework, the ten clinical nursing strategies are designed to provide targeted care to substitute decision-makers in areas that are known to cause complexity and stress to them. The Nurse-Substitute Decision-Maker Partnership Framework has been designed to improve nurse-substitute decision-maker partnerships and reduce the stress experienced by substitute decision-makers as they work through the complexities associated with advanced dementia., (© 2020 John Wiley & Sons Ltd.)

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective., (© 2021 American Society for Parenteral and Enteral Nutrition.)

The two most popular decision-making processes are tossing a coin and playing rock, paper, scissors. In the activity described in this article, students find the theoretical probabilities of winning a coin toss and a round of the rock, paper, scissors game. They next devise strategies to win and test them out. Students then compare the theoretical probabilities they found with the experimental probabilities. The mathematical topics covered in this activity include calculating basic probability; understanding that for independent events A and B, P(A and B) = P(A) × P(B); recognizing a geometric series and applying the appropriate formula to find what it converges to; and understanding the meaning of descriptive statistics. Students were able to prove that although theoretically both games are fair in that they both give each of the two players a 50 percent chance of winning, several strategies can be employed to make each game unfair.

Aim: To discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model., Method: The position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature., Results: We identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge., Conclusion: The PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Predicting and modeling human behavior and finding trends within human decision-making processes is a major problem of social science. Rock Paper Scissors (RPS) is the fundamental strategic question in many game theory problems and real-world competitions. Finding the right approach to beat a particular human opponent is challenging. Here we use an AI (artificial intelligence) algorithm based on Markov Models of one fixed memory length (abbreviated as "single AI") to compete against humans in an iterated RPS game. We model and predict human competition behavior by combining many Markov Models with different fixed memory lengths (abbreviated as "multi-AI"), and develop an architecture of multi-AI with changeable parameters to adapt to different competition strategies. We introduce a parameter called "focus length" (a positive number such as 5 or 10) to control the speed and sensitivity for our multi-AI to adapt to the opponent's strategy change. The focus length is the number of previous rounds that the multi-AI should look at when determining which Single-AI has the best performance and should choose to play for the next game. We experimented with 52 different people, each playing 300 rounds continuously against one specific multi-AI model, and demonstrated that our strategy could win against more than 95% of human opponents.

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.

The importance of shared decision making (SDM) for informed consent has been emphasised in the updated regulatory guidelines. Errors of completion, legibility and omission have been associated with paper-based consent forms. We introduced a digital consent process and compared it against a paper-based process for quality and patient reported involvement in shared decision making. 223 patients were included in this multi-site, single centre study. Patient consent documentation was by either a paper consent form or the Concentric digital consent platform. Consent forms were assessed for errors of legibility, completion and accuracy of content. Core risks for 20 orthopaedic operations were pre-defined by a Delphi round of experts and forms analysed for omission of these risks. SDM was determined via the 'collaboRATE Top Score', a validated measure for gold-standard SDM. 72% (n = 78/109) of paper consent forms contained ≥1 error compared to 0% (n = 0/114) of digital forms (P < 0.0001). Core risks were unintentionally omitted in 63% (n = 68/109) of paper-forms compared to less than 2% (n = 2/114) of digital consent forms (P < 0.0001). 72% (n = 82/114) of patients giving consent digitally reported gold-standard SDM compared to 28% (n = 31/109) with paper consent (P < 0.001). Implementation of a digital consent process has been shown to reduce both error rate and the omission of core risks on consent forms whilst increasing the quality of SDM. This novel finding suggests that using digital consent can improve both the quality of informed consent and the patient experience of SDM. • The paper consent process is associated with errors and omissions of core risks. • A digital consent process improved error rate and omission rate of core risks. • Patients reported a higher level of shared decision making with a digital process. • Documentation of consent can be reliably standardised with an electronic record. [ABSTRACT FROM AUTHOR]

It is essential to establish a multi-dimensional postgraduate quality evaluation system for student assessment and training. This study aimed to explore the construction of the multiindex and hierarchical comprehensive evaluation system for postgraduate training in science and engineering based on the Context, Input, Process, Product (CIPP) model using Analytic Hierarchy Process. It involved 756 postgraduates in physics and engineering who were randomly selected via the Internet. Data were collected from the questionnaire about postgraduates' basic information. After collection, Factor Analysis was used to verify the rationality of the design of second-level and third-level indicators, and adjust the corresponding weights. On this basis, Cluster Analysis was used to classify the training quality of the postgraduates based on their scores on academic ability, basic quality, and social ability indicators. The results revealed that the index system includes 4 first-level indicators,12 second-level indicators and 36 third-level indicators, and different weights being assigned to the indicators according to their influence on the training quality of postgraduates in science and engineering. This study also provides some reference for the quality of science and engineering postgraduate training in Chinese universities by proposing relevant measures, which could be interesting also for international audience.

Objective: To develop an ethical framework for collaboration in international academic partnerships in family medicine., Composition of the Committee: A subgroup of the Besrour Centre of the College of Family Physicians of Canada including family medicine and bioethics experts began to collaborate in 2014 to undertake the development of an ethical framework and tools for the establishment of ethically sound international academic partnerships., Methods: Following 2 consultative workshops and a wider consultation process with the Besrour Centre global community, the authors developed an ethical framework and tools for approval by the Besrour Centre leadership in November 2017., Report: Partnerships are essential to family practice and to the field of international development. The flawed nature of many North-South research partnerships underlines the importance of and need for delineating core principles for ethically sound partnerships, of which 10 have been identified in this process: accountability, cost and efficiencies, excellence, equity, humility, justice, leadership, reciprocity, respect for self-determination, and transparency. Based on these principles, a decision-making framework was created to translate these values into actions and to promote a cohesive and transparent structure for discussions. Fostering fairness, transparency, and consistency in decision making reduces the potential for inequity in a partnership, leading to lasting relationships that endure beyond the scope of a partnership agreement., (Copyright© the College of Family Physicians of Canada.)

Numerous socio-legal factors make the process of surrogate decision-making for people living in dementia very complicated in Japan. In this discussion paper, we argue that the lack of early consultation between patients, surrogate decision-makers and healthcare providers and the overreliance of patients and their families on doctors to assume the decision-making role lead to healthcare practices that may not align with the patient's wishes. Further, we argue that lack of laws on surrogate decision-making, changing family structure and the liabilities associated with the care of people living with dementia contribute to the complexity of the decision-making process in Japan. Finally, given the rapidly changing social and healthcare norms in Japan, we call for greater involvement of nurses and care workers in the decision-making process to ensure patient-centric treatment and care are adopted., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects is favourable. Determining certainty of net benefit requires considering certainty of effect estimates, the expected importance of outcomes and variability in importance, and the interaction of these concepts. Certainty of net harm is the certainty that the net effect is unfavourable. Guideline panels using or testing this approach might limit strong recommendations to actions with a high certainty of net benefit or against actions with a moderate or high certainty of net harm. Recommendations may differ in direction or strength from that suggested by the certainty of net benefit or harm when influenced by cost, equity, acceptability or feasibility., Competing Interests: Competing interests: All authors are members of the GRADE Working Group and conduct scholarly activity or professional services related to the concepts in this article. BSA and PO are employed by EBSCO Information Services and IK is employed by Duodecim Medical Publications Ltd., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Challenge: Injuries, especially traumatic brain injury, or specific illnesses and their respective sequelae can result in the demise of the patients afflicted despite all efforts of modern intensive care medicine. If in principle organ donation is an option after a patient's death, intensive therapeutic measures are regularly required in order to maintain the homeostasis of the organs. These measures, however, cannot benefit the patient afflicted anymore-which in turn might lead to an ethical conflict between dignified palliative care for him/her and expanded intensive treatment to facilitate organ donation for others, especially if the patient has opted for the limitation of life-sustaining therapies in an advance directive., Method: The Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) have convened several meetings and a telephone conference and have arrived at a decision-making aid as to the extent of treatment for potential organ donors. This instrument focusses first on the assessment of five individual dimensions regarding organ donation, namely the certitude of a complete and irreversible loss of all brain function, the patient's wishes as to organ donation, his or her wishes as to limiting life-sustaining therapies, the intensity of expanded intensive treatment for organ protection and the odds of its successful attainment. Then, the combination of the individual assessments, as graphically shown in a {Netzdiagramm}, will allow for a judgement as to whether a continuation or possibly an expansion of intensive care measures is ethically justified, questionable or even inappropriate., Result: The aid described can help mitigate ethical conflicts as to the extent of intensive care treatment for moribund patients, when organ donation is a medically sound option. NOTE: Gerald Neitzke und Annette Rogge contributed equally to this paper and should be considered co-first authors.

Established in 1950, the Association for University and College Counseling Center Directors (AUCCCD) is an international organization comprising universities and colleges (https://www.aucccd.org). AUCCCD members are the higher education leaders for student mental health. Our members represent a wide range of professional disciplines, public and private institutions, and a range of institutional student enrollment sizes. This white paper: (a) provides a historical background on counseling and mental health services on college campuses; (b) argues that, based on current research, there is no single organizational structure that is optimal; (c) makes recommendations about factors to consider when making decisions about the counseling center that are based on specific campus needs and resources rather than a preferred organizational structure; and (d) advocates for a collaborative care model regardless of organizational structure.

This paper provides an introduction to issues surrounding the participation rights of young people in research and the implications of their growing involvement in research as well as providing a discourse on the ethical implications related to consent. The unique contribution of this paper is that it considers children's rights in respect to the increasing opportunities for young people to take part in evaluation research. The aim of this paper, therefore, is to acknowledge the growing involvement for young people in research and the implications of ensuring that their rights of participation are respected. Secondly, we will consider the children's rights legislation and our obligations as researchers to implement this. Finally, we will explore consent as an issue in its own right as well as the practicalities of accessing participants. This paper will postulate that any research about young people should involve and prioritize at all stages of the research process; including participation in decision-making. We conclude by identifying five key principles, which we believe can help to facilitate the fulfilment of post-primary pupils' ability to consent to participate in trials and evaluative research.

The studies reported here examined differences in user behaviour when presented with a low-fidelity paper prototype compared to fully operational product, and evaluated the effectiveness of different types of enhanced labelling of controls. In the first study with a paper prototype, 30 users of high-pressure washers were asked to choose the settings of the temperature control for different cleaning objects, comparing standard with information-enriched control labelling. In the second study, 34 users operated a real high-pressure washer with different forms of control labelling. The results of both studies provided evidence for some benefits of an information-enriched control labelling over traditional temperature-centred controls labelling. Furthermore, a comparative analysis of the data of the two studies suggested that low-fidelity paper prototypes may have to be used with caution. Therefore, designers need to be aware that the behavioural effects induced by different design modifications may be overestimated when using paper prototypes. The implications of the findings are discussed within the framework of an enlarged concept of fidelity.

There are millions of children attending English as a Medium of Instruction (EMI) government schools for their basic education. The vast majority of these are in countries across the Global South. In these contexts, EMI policy decisions are rarely based on educational arguments while global learning discussions exist with limited engagement with the challenges of EMI. This is despite a significant evidence base that highlights the widespread impact that EMI has both on educational quality and inequalities. A recent British Council position paper suggests that EMI research tends to be descriptive, perceptions-based and lacking in theoretical underpinning. This paper responds to this critique by bringing together critical theories of social and epistemic justice to develop a series of questions that could be used to interrogate the multiple ways that EMI impacts children's basic education in the Global South.

Objective: Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making., Method: Ethical and professional issues were reviewed and considered., Conclusions: The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.

Background: Advance care planning (ACP) aids can help prepare patients, family members, and physicians for in-the-moment medical decision-making. We wished to describe the content and approach of paper-based ACP aids in order to characterize existing aids and inform the development of a new ACP aid., Methods: Paper-based ACP aids were identified through an environmental scan and screened for eligibility. ACP conceptual frameworks and data were gathered via stakeholder engagement and used to inform the coding framework that two investigators used to independently code each aid. A directed content analysis was conducted on these eligible aids. Aids were categorized through a deliberative process with an investigator abstracting general information for each aid., Results: Fifteen aids met the eligibility criteria. They ranged in length from 6 to 78 pages with the average aid written at an eighth-grade reading level. The content analysis revealed that many aids encouraged choosing a surrogate decision maker and informed users about legal medical documents. Fewer than half of the aids facilitated patient clarification of values regarding quality of life issues. The authors identified and termed the following three categories of aids: informative; semi-action oriented; and action-oriented. It was often unclear whether patients contributed to the development or testing of the ACP aids reviewed., Conclusions: Most existing paper-based ACP aids address legal matters such as completing an advance directive. Only a minority elicited patient values and it was unclear whether any were developed in partnership with patients. Future development of ACP aids should account for patient preferences with a goal of supporting in-the-moment medical decision-making.

This design case details the design process of a multiple-choice assessment of socio-scientific systems thinking. This assessment is situated within a larger project that aims to understand the ways students use multiple scientific models to understand complex socio-scientific issues. In addition to the research component, this project entails developing curriculum and assessment resources that support science teaching and learning. We begin this paper by framing the needs that motivated the design of this assessment and introducing the design team. We then present a narrative outlining the design process, focusing on key challenges that arose and the ways these challenges influenced our final design. We conclude this paper with a discussion of the compromises that had to be made in the process of designing this instrument.

Decision prediction based on neurophysiological signals is of great application value in many real‐life situations, especially in human–AI collaboration or counteraction. Single‐trial analysis of electroencephalogram (EEG) signals is a very valuable step in the development of an online decision‐prediction system. However, previous EEG‐based decision‐prediction methods focused mainly on averaged EEG signals of all decision‐making trials to predict an individual's general decision tendency (e.g., risk seeking or aversion) over a period rather than on a specific decision response in a single trial. In the present study, we used a rock–paper–scissors game, which is a common multichoice decision‐making task, to explore how to predict participants' single‐trial choice with EEG signals. Forty participants, comprising 20 females and 20 males, played the game with a computer player for 330 trials. Considering that the decision‐making process of this game involves multiple brain regions and neural networks, we proposed a new algorithm named common spatial pattern‐attractor metagene (CSP‐AM) to extract CSP features from different frequency bands of EEG signals that occurred during decision making. The results showed that a multilayer perceptron classifier achieved an accuracy significantly exceeding the chance level among 88.57% (31 of 35) of participants, verifying the classification ability of CSP features in multichoice decision‐making prediction. We believe that the CSP‐AM algorithm could be used in the development of proactive AI systems. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to identify and describe critical appraisal tools designed for assessing the quality of evidence (QoE) and/or strength of recommendations (SoRs) related to health care-related tests and diagnostic strategies (HCTDSs)., Study Design and Setting: We conducted a systematic review to identify tools applied in guidelines, methodological articles, and systematic reviews to assess HCTDS., Results: We screened 5,534 titles and abstracts, 1,004 full-text articles, and abstracted data from 330 references. We identified 29 tools and 14 modifications of existing tools for assessing QoE and SoR. Twenty-three out of 29 tools acknowledge the importance of assessing the QoE and SoR separately, but in 8, the SoR is based solely on QoE. When making decisions about the use of tests, patient values and preferences and impact on resource utilization were considered in 6 and 8 tools, respectively. There is also confusion about the terminology that describes the various factors that influence the QoE and SoR., Conclusion: Although at least one approach includes all relevant criteria for assessing QoE and determining SoR, more detailed guidance about how to operationalize these assessments and make related judgments will be beneficial. There is a need for a better description of the framework for using evidence to make decisions and develop recommendations about HCTDS., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objectives: The objective of the study was to identify the critical factors that determine recommendations and other decisions about healthcare-related tests and diagnostic strategies (HCTDS)., Methods: We used a qualitative descriptive approach and conducted semi-structured in-depth interviews with 24 international experts (informants) in evidence and decisions about HCTDS., Results: Although test accuracy (TA) was the factor most commonly considered by organizations when developing recommendations about HCTDS, informants agreed that TA is necessary but rarely, if ever, sufficient and may be misleading when solely considered. The informants identified factors that are important for developing recommendations about HCTDS. Informants largely agreed that laying out the potential care pathways based on the test result is an essential early step but is rarely done in developing recommendations about HCTDS. Most informants also agreed that decision analysis could be useful for organizing the clinical, cost, and preference data relevant to the use of tests in the absence of direct evidence. However, they noted that using models is limited by the lack of resources and expertise required., Conclusion: Developing guidelines about HCTDS requires consideration of factors beyond TA, but implementing this may be challenging. Further development and testing of "frameworks" that can guide this process is a priority for decision makers., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Pragmatic trials may deliver real-world evidence on the added value of new medications compared with usual care and inform decision making earlier in development. This fifth paper in a series on pragmatic trials in the Journal discusses usual care as a comparator and the allocation of treatment strategies. The allocation and implementation of treatment strategies should resemble clinical practice as closely as possible. Randomization at the level of the site, as opposed to at the individual level, may be preferred. Data analysis according to the intention-to-treat principle is recommended, and crossover between treatment arms and strong treatment preferences may be accounted for in the study design in specific situations. Although usual care is the comparator of choice, this may differ substantially between centers and countries complicating comparator choice. Using clinical guidelines to define usual care can be helpful in standardizing comparator treatments; however, this may decrease the applicability of the results to real-life settings. Conversely, using multiple usual-care treatment arms will increase the complexity of the study. The specific objectives of the trial and design choices should be discussed with all stakeholders to realize the full potential of the pragmatic trial., (Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: There is a shift toward making health care patient centered, whereby patients are part of medical decision-making and take responsibility for managing their health. Patient-reported outcomes (PROs) capture the patient voice and can be used to engage patients in medical decision-making., Objective: The objective of this paper is to present important factors from patients', clinicians', researchers', and decision-makers' perspectives that influence successful adoption of PROs in clinical practice. Factors recommended in this paper were informed by a patient partner., Discussion: Based on themes arising from the Montreal Accord proceedings, we describe factors that influence the adoption of PROs and how PROs can have a positive effect by enhancing communication and providing opportunities to engage patients, carers, and clinicians in care. Consideration of patient factors (e.g., health literacy), family support and networks (e.g., peer-support networks), technology (e.g., e-health), and health care system factors (e.g., resources to implement PROs) is necessary to ensure PROs are successfully adopted. PRO evaluation plans most likely to succeed over the long term are those incorporating PROs identified by patients as necessary for self-management and that coincide with providers' needs for collaboratively developing treatment plans with patients and families., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Academic journals rely crucially upon the willingness of academics to review papers and for them to provide high-quality review reports. The purpose of this Editorial is to assist reviewers for Tourism and Hospitality in providing review reports that will be helpful to the journal editors in making decisions about whether to accept, reject or require revisions to papers that are submitted to the journal. It provides reviewers with a 'peep behind the curtain' of what can sometimes seem a rather opaque paper review process, with the aim of clarifying the purpose and format of the review process, and thereby to gain a greater appreciation of what it required of them. Several tips for writing high-quality review reports are also presented. [ABSTRACT FROM AUTHOR]

An editorial is presented on the release of a white paper by the International Federation of Dental Hygienists (IFDH), summarizing findings from 5 global surveys on oral health conducted between 2019 and 2023. Topics discussed include toothpaste and electric toothbrush recommendations, oral-systemic links, sustainable dentistry, and oral hygiene instruction practices, revealing gaps between evidence-based knowledge and clinical decision making among dental hygienists.

In the care of adolescents, health care providers often face situations raising ethical concerns or dilemmas, such as refusal of a treatment or hospitalization, or request of confidentiality while engaging in risky behaviors or facing unplanned pregnancy. This position paper provides concrete avenues as how to assess the adolescent's capacity for autonomous decision making, e.g. the patient's competence in a specific situation, and how to elicit informed choice or consent. To do so, professionals need to be sensitized and trained as how to assess the cognitive and socio-psychological development of the young patient. Another challenge for the health professionals is to balance the needs to support patient's autonomy while offering secure guidance and protection if needed. To optimize such a process, they establish a climate of trust and empathy that will allow the patient to participate freely in the decision. In addition, especially when the decisions have potentially important consequences on the health and life, the professionals include, with the adolescent's permission, parents, caregivers or other significant adults, as well as they may request the opinion of other members of the health care team or expert colleagues such as ethicists.

Purpose: The aim of this paper, using the intuitionistic fuzzy (IF)–set based Preference Ranking Organization Method for Enrichment Evaluation (PROMETHEE) method, is to create multicriteria decision-making (MCDM) mechanism that evaluates the papers according to the offset print quality, separately for each of the CMYK colors. Thanks to the mechanism, the most suitable and the most unsuitable paper for printing is determined. Design/methodology/approach: With the IF PROMETHEE method, respectively, deviations are calculated by linear criteria type; the overall IF preference relation matrix is obtained. Finally, the positive and negative outranking flows are calculated; by obtaining net outranking flows, all papers are ranked from best to worst for printability. Findings: Based on the results of the MCDM algorithm; the best offset printing quality is Matte Coated 115 gr. for cyan, magenta and black and Glossy Coated 115 gr. for yellow. The worst offset printing quality for all papers is 70 gr. III. low grade paper. According to the findings, when all colors are examined, the best paper for offset printing quality is coated papers; the worst paper is III. low grade papers. Originality/value: The creation of mechanism that evaluates all criteria together leads to the most accurate result. Cases of hesitation are also addressed using an IF-based algorithm; all criteria were assigned individual importance levels, and a single result was obtained by activating all of the criteria simultaneously. Therefore reasons, this is paper that will bring innovation and shed light on studies in this field. [ABSTRACT FROM AUTHOR]

People often make inefficient decisions for themselves and the community (e.g. they underuse medical screenings or vaccines and they do not vote) also because of their individual characteristics, such as their level of avoidance or anxiety. In recent years, governments have successfully applied strategies, called "nudges", to help people maximizing their decisions in several fields; however, the role of individual characteristics has been poorly explored. The present study investigated whether one kind of nudge, the default option (automatic enrolment in a specific plan), can modulate the influence of such individual differences, promoting favourable decisions in different field, such as the medical and civic ones. One hundred and eighty-three participants completed the Trait Anxiety Inventory, the General Decision-Making Styles Inventory and scenarios about health and civic decisions. Participants have hypothetically been enrolled by default or not enrolled in specific plans and had to decide whether adhere or not to the plan proposed. Result showed that the default option drives anxious and avoidant individuals, who usually refuse to make a choice due to their overestimation of negative events' occurrence, to undergo medical screenings and vaccine and to vote more. Nudge confirmed its effectiveness in favouring better decisions among people according to their individual differences., (© 2023. The Author(s), under exclusive licence to Marta Olivetti Belardinelli.)

Introduction Triage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area., Objective: The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates., Method: Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire., Results: The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups., Conclusion: This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A "just-in-time" educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI. Cuttance G , Dansie K , Rayner T . Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3-13.

Enterprise imaging governance is an emerging need in health enterprises today. This white paper highlights the decision-making body, framework, and process for optimal enterprise imaging governance inclusive of five areas of focus: program governance, technology governance, information governance, clinical governance, and financial governance. It outlines relevant parallels and differences when forming or optimizing imaging governance as compared with other established broad horizontal governance groups, such as for the electronic health record. It is intended for CMIOs and health informatics leaders looking to grow and govern a program to optimally capture, store, index, distribute, view, exchange, and analyze the images of their enterprise.

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions. A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes., (Copyright © 2015. Published by Elsevier Ltd.)

Through historically oriented critical discourse analysis this article considers how the messages regarding the purpose of higher education, as presented in prospectuses of four case study institutions, have been impacted by massification and marketisation in England between 1977 and 2018. The prospectuses of four higher education institutions of different status were analysed to trace how discourses relating to the value of an undergraduate degree could be identified in the prospectuses. The findings suggest that while the prospectuses presented multiple rationales as to why students should undertake degrees, there was a significant increase in focus on graduate transitions to employment and a parallel hollowing-out of information relating to course content. The study found that over the period the vocabularies drawn on to present the value of a degree have become homogenised, yet the rationales given for undertaking tertiary study became more numerous and complex, making diversity of institutional offers difficult for prospective students to differentiate.

Reviews have long been recognized as among the most important forms of scientific communication. The rapid growth of the primary literature has further increased the need for reviews to distill and interpret the literature. This review on Reviews and Reviewing: Approaches to Research Synthesis encompasses the evolution of the review literature, taxonomy of review literature, uses and users of reviews, the process of preparing reviews, assessment of review quality and impact, the impact of information technology on the preparation of reviews, and research opportunities for information science related to reviews and reviewing. In addition to providing a synthesis of prior research, this review seeks to identify gaps in the published research and to suggest possible future research directions. [ABSTRACT FROM AUTHOR]

Aim Design Method Conclusion Impact on Nursing Practice No Patient or Public Contribution Patients' death or adverse events appear to be associated with poor healthcare decision‐making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem‐related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision‐making (PRDM) to support a new nursing theoretical frame.Discursive paper.This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.Nursing recognizes the patient–nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.There was no patient or public involvement in the design or writing of this discursive article. [ABSTRACT FROM AUTHOR]

The objective of this paper is to show the added value of using tools such as eyetracking, galvanic skin response, facial coding and others in the field of market research and user experience research. We will present 3 case studies in which these tools have been used successfully. We will give an overview of the background, the objectives, methods and results and how the neuro-tools provided additional insights into consumer behaviour, which would otherwise not have been possible. In this paper we will specifically show cases from packaging design, advertising research and user experience research thus only covering a small part of possible application areas. [ABSTRACT FROM AUTHOR]

Rock, Paper, Scissors (RPS) represents a unique gaming space in which the predictions of human rational decision-making can be compared with actual performance. Playing a computerized opponent adopting a mixed-strategy equilibrium, participants revealed a non-significant tendency to over-select Rock. Further violations of rational decision-making were observed using an inter-trial analysis where participants were more likely to switch their item selection at trial n + 1 following a loss or draw at trial n, revealing the strategic vulnerability of individuals following the experience of negative rather than positive outcome. Unique switch strategies related to each of these trial n outcomes were also identified: after losing participants were more likely to 'downgrade' their item (e.g., Rock followed by Scissors) but after drawing participants were more likely to 'upgrade' their item (e.g., Rock followed by Paper). Further repetition analysis revealed that participants were more likely to continue their specific cyclic item change strategy into trial n + 2. The data reveal the strategic vulnerability of individuals following the experience of negative rather than positive outcome, the tensions between behavioural and cognitive influences on decision making, and underline the dangers of increased behavioural predictability in other recursive, non-cooperative environments such as economics and politics.

Aim: A discussion which aims to explore the diversity of decision-making during teenage and young adult cancer treatment. The discussion will be related to the concepts of autonomy, dependence and decision-making in this age group., Background: The experience of cancer involves a significant series of treatment decisions. However, other non-treatment decisions also have to be made which can relate to any aspect of everyday life. These decisions occur against the backdrop of young people's disease experience., Design: Discussion paper., Data Sources: A literature search for the period 1990-2013 was undertaken. This included searching the following databases: Cumulative Index for Nursing and Allied Health Literature (CINAHL), SCOPUS, Medline, DARE, Applied Social Sciences Index and Abstracts (ASSIA), (Psych Info) and The Cochrane Library., Implications for Nursing: There is a lack of evidence into the experience of everyday decisions made by young people during cancer treatment. This may affect them in the form of unmet needs that nurses, or other professionals, fail to appreciate., Conclusion: Further exploration of how teenagers and young adults experience the range and process of decision-making during cancer treatment could be useful in helping to provide effective supportive care for this age group., (© 2015 John Wiley & Sons Ltd.)

Aims: To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks., Background: Scope of practice in professional nursing and midwifery is an evolving process which needs to be responsive to clinical, service, societal, demographic and fiscal changes. Codes and frameworks offer a system of rules and principles by which the nursing and midwifery professions are expected to regulate members and demonstrate responsibility to society., Design: Discussion paper., Data Sources: Twelve scope of practice and associated decision-making frameworks (January 2000-March 2014)., Implications for Nursing: Two main approaches to the regulation of the scope of practice and associated decision-making frameworks exist internationally. The first approach is policy and regulation driven and behaviour oriented. The second approach is based on notions of autonomous decision-making, professionalism and accountability. The two approaches are not mutually exclusive, but have similar elements with a different emphasis. Both approaches lack explicit recognition of the aesthetic aspects of care and patient choice, which is a fundamental principle of evidence-based practice., Conclusion: Nursing organizations, regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction., (© 2015 John Wiley & Sons Ltd.)

Many researchers in the construction field have explored the utilization of augmented reality (AR) and its impact on the industry. Previous studies have shown potential uses for AR in the construction industry. However, a comprehensive critical review exploring the ways in which AR supports synchronized communication is still missing. This paper aims to fill this gap by examining trends identified in the literature and by analyzing both beneficial and challenging attributes. This work was performed by collecting numerous journal and conference papers, using keywords including "augmented reality", "construction", and "synchronous communication". The papers were then categorized based on the reported attributes that were indicated to be challenges or benefits. Throughout the analysis, several benefits were consistently reported, including training, visualization, instantly sharing information, decision making, and intuitive interaction. Similarly, several challenges were consistently reported, such as difficulty in manipulation, unfriendly interface, device discomfort, and sun brightness. Regarding other attributes, such as field of view, cost, safety hazards, and hands-free mode, researchers provided divergent reports regarding whether they were beneficial or detrimental to AR communication. These findings provide valuable guidance for future researchers and practitioners, enabling them to leverage AR for synchronized communication in ways that consistently offer value. [ABSTRACT FROM AUTHOR]

Background and Context: Continuous improvement and networked improvement science have emerged as prominent approaches to improving schools. Although continuous improvement approaches have generated promising results in education, how these efforts come to be enacted remains a crucial question that can generate insight into how these approaches can be improved. Purpose and Objective: Our study is focused on understanding how improvement is performed by focusing on the process of generating a shared aim statement in a teacher-preparation improvement network. We seek to understand how practitioners within a network (a) engage a central tension (between language acquisition and multilingualism), (b) negotiate this tension, and (c) reach a settlement that results in a shared aim. Setting: This study takes place in a teacher-preparation improvement network as part of the California Teacher Education Research and Improvement Network (CTERIN). The focus of the network centered on improving the preparation of candidates to build on multilingual students' strengths. Participants: The improvement network that is the focus of our research consists of 49 teacher educators across eight teacher preparation programs as well as three facilitators who were part of CTERIN, including the two authors of this study. Research Design: Our analysis examines the interactions among teacher educators and improvement facilitators to unveil the practices that they engaged in to produce a shared aim. Data for this study include audio and video recordings of three 90-minute videoconference meetings, audio-video of a two-day in-person convening, and improvement artifacts such as fishbone and driver diagrams. Findings: Our study highlights the range of practices that practitioners engaged in and how those evolved as they negotiated and settled a tension between language acquisition and multilingualism. As the process of generating an aim unfolded, teacher educators engaged in the practices of aspirationalizing, dualizing, recentering, rerouting, clarifying, tuning, and converting. Conclusions and Recommendations: We argue that these practices make visible that the process of generating an aim statement is a complex and complicated process that requires negotiation and a recognition that some perspectives are foregrounded and others are backgrounded. Understanding this process has implications for how improvement facilitators engage practitioners in the process of doing improvement and generates theory of improvement implementation by highlighting how disparate teams, individuals, and organizations reaching sharedness requires negotiating, foregrounding, and backgrounding.

Rationale, Aims and Objectives: Despite extensive evidence on the value of patient decision support interventions (DESIs), there is no consensus on optimal DESI formats. Assessing clinicians' perceptions about DESI formats can help facilitate their adoption. The aim of this study was to assess clinicians' perceptions of DESIs formats and potential use in practice., Methods: Semi-structured qualitative interviews were conducted with doctors from diverse practice areas (internal medicine, OB/GYN, surgery, medical oncology, emergency medicine) and elicited perceptions toward patient DESIs formats (digital vs. paper) and timing of administration. Questions also elicited beliefs underlying attitudes, perceived social norms and self-efficacy for using DESIs and the feasibility of doing so. Data analysis was conducted using a thematic analysis approach., Results: Participants identified strengths of both more comprehensive digital and shorter paper-based tools and thought they could complement each other. Participants consistently expressed the advantages of using DESIs outside the consultation to supplement clinical discussions about cancer decisions given the amount of information to discuss during these emotion-laden conversations. Participants felt that patients with older age and lower socio-economic status were more likely to use a paper-based compared with a digital DESI. Participants also noted challenges related to reliable resources such as computers and Internet in the practice setting, which would be necessary for implementing the digital DESIs on site., Conclusions: Clinicians' perceptions and opinions about value of DESIs can vary widely across doctor, patient and clinic characteristics. A one-size-fits-all approach to implementation might not be feasible, suggesting that flexible approaches to providing decision support for patients are needed to drive broader adoption., (© 2014 John Wiley & Sons, Ltd.)