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Data envelopment analysis (DEA) is a broadly used non-parametric technique for performance evaluation and data analytics. While conventional single-stage DEA models overlook the internal interactions of decision making units (DMUs), network DEA opens this black box to investigate the internal structure of DMUs. Practically, many network DEA models involve shared performance measures that are not easily divisible among individual components of a network. Based upon a two-stage network DEA model, the current study treats such performance measures as inseparable links, implying that no proportions are optimized and allocated to the two stages of the network. The shared and unsplittable links in the proposed two-stage DEA model manifest integrality while both ends of the link are maximized or minimized simultaneously, and this setting has not been modeled in any existing DEA studies. The shared and unsplittable links in our model can be considered intermediate measures, but they are different from the two existing types of dual-role intermediate measures, which are traditional intermediate measures and feedback measures. Our performance link is a new type of intermediate measure that is minimized or maximized in both stages of the network. The resulting network DEA model is highly non-linear. To address the non-linearity, a parametric linear model is adopted. The proposed approach is construed in four variants, and then illustrated using a set of 100 banks in the United States. [ABSTRACT FROM AUTHOR]

Objectives: To determine preference patterns for topical anesthesia in patients undergoing endoscopy pre‐coronavirus (2019 coronavirus disease [COVID‐19]) pandemic and analyze outcomes based on preference, using a decision aid format. Methods: A decision aid was developed with expert and patient input. New patients presenting to subspecialty clinics over a 2‐month pre‐COVID‐19 period completed a pre‐procedure survey about their priorities, then were asked to choose between topical oxymetazoline/lidocaine spray or none. A post‐procedure outcome survey followed. Results: Of 151 patients, 90.1% patients elected to have topical anesthesia. Top patient priorities were "I want the scope to be easy for the doctor" and "I want to be as comfortable as possible." Patients who strongly wanted to avoid medication (P =.002) and bad taste (P =.003) were more likely to select no spray, whereas those who wanted to avoid pain received anesthetic (P =.011). According to the post‐procedure assessment, 95.4% of patients were satisfied or strongly satisfied their choice, and this did not correlate with anesthetic vs none. Conclusions: Patient preferences are easily elicited and correlate with treatment choices. Most patients chose to have topical anesthetic and were willing to tolerate side effects; however, both patients with and without topical anesthetic were satisfied with their choices. This decision aid can be used to optimize shared decision making in the otolaryngology clinic. Given the aerosolizing potential of both spray and no spray conditions, this insight may be consequential when devising office protocols for post‐COVID‐19 practice. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Introduction: Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective: To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods: Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results: Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients' expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion: Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information. [ABSTRACT FROM AUTHOR]

Objective: EDs have the potential ability to predict patient wait times and to display this to patients and other stakeholders. Little is known about whether consumers and stakeholders would want this information and how wait time predictions might be used. The aim of the present study was to gain perspectives from consumers and health services personnel regarding the concept of emergency wait time visibility. Methods: We conducted a qualitative interview and focus group study in 2019. Participants included emergency medicine patients, families, paramedics, well community members, and hospital/paramedic administrators from multiple EDs and organisations in Victoria, Australia. Transcripts were coded and themes presented. Results: One focus group and 103 semi‐structured interviews were conducted in 2019 including 32 patients, 22 carers/advocates and 21 paramedics in the ED; 20 health service administrators (paramedic and hospital) and 15 community members. Consumers and paramedics face physical and psychological difficulties when wait times are not visible. Consumers believe about a 2‐h wait is tolerable, beyond this most begin to consider alternative strategies for seeking care. Consumers want to see triage to doctor times; paramedics want door‐to‐off stretcher times (for all possible transport destinations); with 47 of 50 consumers and 30 of 31 paramedics potentially using this information. About 28 of 50 consumers would use times to inform facility or provider choice, another 19 of 50 want information once in the waiting room. During prolonged waits, 51 of 52 consumers would continue to seek care. Conclusions: Consumers and paramedics want wait time information visibility. They would use the information in a variety of ways, both pre‐hospital and while waiting for care. [ABSTRACT FROM AUTHOR]

Aging adults depend on complex treatment plans to manage chronic conditions, yet little is known about their ability to perform the sophisticated behaviors required of technologically engaged patients. This qualitative descriptive study describes engagement with the plan of care. Forty chronically ill adults participated in this study, which involved an observation of the clinical encounter and an interview. Data were collected and analyzed simultaneously in keeping with principles of qualitative research. Multiple techniques were used to test conclusions and findings were constructed as thematic sentences, including the following: I act in ways that support my health, I manage my health-related information, I make visits with my doctor part of my routine, I participate in treatment planning. Older adults work to achieve self-management to the best of their ability, shunning the use of health information technology (HIT) and demonstrating a preference for provider-created treatment plans. [ABSTRACT FROM AUTHOR]

Background: Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim: To understand patients' and clinicians' experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design: Longitudinal qualitative study. Setting: Five general practices in south‐west England. Method: Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results: Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients' understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion: For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution: A patient group contributed to the design of this study. [ABSTRACT FROM AUTHOR]

REFERENCES 1 Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Keywords: Cysts; Decision-making; Ethanol; Patient-Reported Outcome Measures; Radiology; Shared; Thyroid nodule EN Cysts Decision-making Ethanol Patient-Reported Outcome Measures Radiology Shared Thyroid nodule 645 649 5 04/06/21 20210501 NES 210501 Key Points The majority of thyroid cysts are benign and asymptomatic but some continue to enlarge, causing local compressive symptoms or cosmetic concerns. Ethanol ablation of benign thyroid cysts and predominantly cystic thyroid nodules: factors that predict outcome. Introducing an ethanol ablation service for recurrent symptomatic thyroid cysts within the NHS - a prospective study of twenty-six patients. [Extracted from the article]

Purpose: The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process, which will maximize symptom control and quality of life, while minimizing adverse events and burden of disease., Methods: An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements., Results: This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including non-invasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB., Conclusion: Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.

Abstract Introduction: Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective: To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods: Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results: Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion: Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.

Background: Major gaps exist in the routine initiation and dose up-titration of guideline-directed medical therapies (GDMT) for patients with heart failure with reduced ejection fraction. Without novel approaches to improve prescribing, the cumulative benefits of heart failure with reduced ejection fraction treatment will be largely unrealized. Direct-to-consumer marketing and shared decision making reflect a culture where patients are increasingly involved in treatment choices, creating opportunities for prescribing interventions that engage patients.Methods: The EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) trial randomized patients with heart failure with reduced ejection fraction from a diverse health system to usual care versus patient activation tools-a 3-minute video and 1-page checklist-delivered electronically 1 week before, 3 days before, and 24 hours before a cardiology clinic visit. The tools encouraged patients to work collaboratively with their clinicians to "make one positive change" in heart failure with reduced ejection fraction prescribing. The primary endpoint was the percentage of patients with GDMT medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days after, compared with usual care during the same period.Results: EPIC-HF enrolled 306 patients, 290 of whom attended a clinic visit during the study period: 145 were sent the patient activation tools and 145 were controls. The median age of patients was 65 years; 29% were female, 11% were Black, 7% were Hispanic, and the median ejection fraction was 32%. Preclinic data revealed significant GDMT opportunities, with no patients on target doses of β-blocker, sacubitril/valsartan, and mineralocorticoid receptor antagonists. From immediately preceding the cardiology clinic visit to 30 days after, 49.0% in the intervention and 29.7% in the control experienced an initiation or intensification of their GDMT (P=0.001). The majority of these changes were made at the clinician encounter itself and involved dose uptitrations. There were no deaths and no significant differences in hospitalization or emergency department visits at 30 days between groups.Conclusions: A patient activation tool delivered electronically before a cardiology clinic visit improved clinician intensification of GDMT. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334188. [ABSTRACT FROM AUTHOR]

Background: Shared decision making (SDM) is considered important to realise personalised cancer care. Increased GP involvement after a diagnosis is advocated to improve SDM. Aim: To explore whether patients with cancer are in need of GP involvement in cancer care in general and in SDM, and whether GP involvement occurs. Design & setting: An online national survey was distributed by the Dutch Federation of Cancer Patient Organisations (NFK) in May 2019. Method: The survey was sent to (former) patients with cancer. Topics included GP involvement in cancer care in general and in SDM. Descriptive statistics and quotes were used. Results: Among 4763 (former) patients with cancer, 59% (n = 2804) expressed a need for GP involvement in cancer care. Of these patients, 79% (n = 2193) experienced GP involvement. Regarding GP involvement in SDM, 82% of patients (n = 3724) expressed that the GP should 'listen to patients' worries and considerations', 69% (n = 3130) to 'check patients' understanding of information', 66% (n = 3006) to 'discuss patients' priorities in life and the consequences of treatment options for these priorities', and 67% (n = 3045) to 'create awareness of the patient's role in the decision making'. This happened in 47%, 17%, 15% and 10% of these patients, respectively. Conclusion: The majority of (former) patients with cancer expressed a need for active GP involvement in cancer care. GP support in the fundamental SDM steps is presently insufficient. Therefore, GPs should be made aware of these needs and enabled to support their patients with cancer in SDM. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether established prognosis tools used in the general population of critically ill patients will accurately predict tracheotomy-related outcomes and survival outcomes in critically ill patients undergoing tracheotomy. Methods: Retrospective chart review of 94 consecutive critically ill patients undergoing isolated tracheotomy. Results: Logistic Organ Dysfunction System (LODS) and sepsis-related organ failure assessment (SOFA) scores, 2 validated measures of acuity in critically ill patients, were calculated for all patients. The only tracheotomy-related outcome of significance was the finding that patients with an LODS score ≤6 were more likely to become ventilator independent (P <.015). Higher LODS or SOFA scores were associated with in-house death (LODS, P =.001, SOFA, P =.008) and death within 90 days (LODS, P =.009, SOFA, P =.031), while death within 180 days was associated only with a higher LODS score (LODS, P =.018). When controlling for age, there was an association between both LODS (P =.015) and SOFA (P =.019) scores and death within 90 days of tracheotomy. Conclusions: The survival outcome for critically ill patients undergoing tracheotomy seems accurately predicted based on scoring systems designed for use in the general population of critically ill patients. Logistic Organ Dysfunction System may also be useful to predict the likelihood of the tracheotomy-related outcome of ventilator independence. This suggests that LODS scores may be helpful to palliative care clinicians as part of a shared decision-making aid in critically ill, ventilated patients for whom tracheotomy is being considered. [ABSTRACT FROM AUTHOR]

Objectives: Physician and patient/parent communication is of utmost importance in consultations to improve the shared decision‐making (SDM) processes. This study investigated SDM‐related outcomes through turn analysis and an assessment of patient‐centred dialogue. Design: Multi‐centre prospective cohort study analysing audio‐ and video‐recorded patient/parent‐physician interactions. Setting: Two tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah. Participants: Paediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy. Main outcome measures: Medical dialogue measures (turn analysis, patient‐centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM‐Q‐9). Results: Turn density was significantly higher for physicians than patients/parents (P <.001), as were total statements (P <.001), and total time talking (P <.001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P =.003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient‐centredness score was 0.2 (range 0‐0.56). Significant negative correlations between patient‐centredness score and physician turn density (r = −.390, P =.002), physician mean turn time (r = −.406, P =.001), total physician statements (r = −.426, P =.001) and total physician speaking time (r = −.313, P =.016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient‐centredness scores. Conclusions: Surgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient‐centredness nor turn analysis correlated with perceptions of SDM from the parents' perspective. [ABSTRACT FROM AUTHOR]

My discussion of Dr. Goldstein's paper "Trust and Suspicion or Sameness of Difference? Reframing Hermeneutics with the Invisible Other" centers on a key clinical question: what, if any, are the limits to therapeutic understanding and interpretation? In distinction to Goldstein, and in returning to Ricœur and Freud, I caution against unduly limiting the interpretive range of what can be shared between a patient and their analyst. [ABSTRACT FROM AUTHOR]

Introduction: Discordance (misalignment) regarding treatment satisfaction may exist in real-life clinical practice between patients and their physicians. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in rheumatoid arthritis (RA). Method: A point-in-time, multinational survey of patients and physicians was conducted in Latin America from December 2014 to October 2015. Physician- and patient-reported satisfaction levels with current RA treatment, alignment levels in satisfaction perception, and factors associated with satisfaction misalignment were assessed through bivariate and logistic regression analyses. Results: Participating physicians (N = 114) completed 555 patient record forms (PRFs); 372 patients completed self-complete questionnaires (PSC). A total of 346 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 270/346 (78.0%) PRFs; patients reported such satisfaction in 286/346 (82.7%) PSCs. Physician-patient alignment was observed in 78.6% of pairs. Compared with aligned patients, misaligned patients were younger, more likely to have moderate or severe disease (physician subjectively defined), deteriorating or unstable disease (physician subjectively defined), been exposed to a greater number of advanced therapy lines (biologic or Janus kinase inhibitor), greater current pain, a current acute episode, poorer health, and greater disability and impairment. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were more likely to experience greater activity impairment. Conclusions: High treatment satisfaction and alignment were observed among RA patients and their physicians in Latin America. Misaligned patients were more likely to report more severe disease and were less likely to be in remission. Addressing misalignment may lead to improved RA disease control. Key Points • High treatment satisfaction was observed among RA patients and their treating physicians in Latin America. • One-fifth of physician-patient pairs were misaligned in treatment satisfaction. • Patients misaligned with their physicians reported higher disease activity, lower quality of life, and greater disability than those who were aligned with their physicians. • Understanding and addressing misalignment in treatment satisfaction may improve outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Background: Shared governance is examined through a framework for developing independent decision making in professional nursing practice and improving patient care outcomes. Aims: This study is designed to obtain a baseline measurement of the degree of shared governance in a selected children's hospital in Saudi Arabia. Methods: The study was guided by the Donabedian model. The Professional Nursing Governance Index was used. A total of 400 questionnaires were distributed to nurses working at the hospital, with a response rate of 77% (n = 307). Descriptive and inferential statistics were used for analysis. Results: The results corresponded with those from nurses and managers in most subscales of the Index of Professional Nursing Governance (information, goals, resources, participation and practice). However, nurses working in the operating theatre and surgical unit have a perceived higher level of shared governance than those in critical care units and medical wards. Conclusions: The results could encourage shareholders and leaders in the nursing field to develop the perception of shared governance by adopting a shared governance model, which in turn might improve the quality of nursing care. [ABSTRACT FROM AUTHOR]

Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally.

Objective: To explore general practitioners (GPs’) experiences from consultations when a patient’s request is denied, and outcomes of such incidents. Design and participants: We conducted a qualitative study with semi-structured individual interviews with six GPs in Norway. We asked them to tell about experiences from specific encounters where they had refused a patient’s request. The texts were analysed with Systematic Text Condensation, a method for thematic cross-case analysis. Main outcome measures: Accounts of experiences from consultations when GPs refused their patients’ requests. Results: Subjects of dispute included clinical topics like investigation and treatment, certification regarding welfare benefits and medico-legal issues, and administrative matters. The arguments took different paths, sometimes settled by reaching common ground but more often as unresolved disagreement with anger or irritation from the patient, sometimes with open hostility and violence. The aftermath and outcomes of these disputes lead to strong emotional impact where the doctors reflected upon the incidents and sometimes regretted their handling of the consultation. Some long-standing and close patient–doctor relationships were injured or came to an end. Conclusions: The price for denying a patient’s request may be high, and GPs find themselves uncomfortable in such encounters. Skills pertaining to this particular challenge could be improved though education and training, drawing attention to negotiation of potential conflicts. Also, the notion that doctors have a professional commitment to his or her own autonomy and to society should be restored, through increased emphasis on core professional ethics in medical education at all levels.

Study Objectives: We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM., Methods: Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans., Results: Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively., Conclusions: Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes., Citation: Kinney AR, Brenner LA, Nance M, et al. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med . 2024;20(5):801-812., (© 2024 American Academy of Sleep Medicine.)

This pilot and acceptability study sought to report provider acceptability and developmental concerns expressed by caregivers of children with prenatal opioid exposure using the Shared Decision-Making Tool (SDMT), an instrument created by study authors. Data were collected from five health care and early intervention providers and 83 caregivers from a medical clinic and early intervention service center. Descriptive statistics were used to identify frequency, mean level, and prioritization of developmental concerns using the SDMT, and to summarize provider acceptability about integrating the SDMT into their workflow. Communication was the most frequently cited concern in four consecutive age categories, followed by Inattention/impulsivity and Problem behavior. All providers "strongly agreed" or "agreed" with all statements on the provider feedback survey, except two instances. Results of this study support the SDMT as a potential tool to help engage caregivers and providers of children with prenatal opioid exposure in the shared decision-making process by standardizing communication related to areas of developmental concern and caregivers' priority needs. Findings from this pilot study will inform modifications to the SDMT and administration instructions before our next study, which will examine psychometric properties and caregiver acceptability of the scale., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: National guidelines recommend lung cancer screening (LCS) using low-dose computed tomography (LDCT) for high-risk patients, including survivors of other tobacco-related cancers like head and neck cancer (HNC). This qualitative study investigated clinicians' practices and attitudes toward LCS with LDCT with patients who have survived HNC, in the context of mandated requirements for shared decision making (SDM) using decision aids. Methods: Thematic analysis of transcribed semi-structured clinician interviews and focus group. Results: Clinicians recognized LCS' utility for some HNC survivors with smoking histories. However, they identified many challenges to SDM in diverse clinic settings, including time, workflow, uncertainty about guidelines and reimbursement, decision aids, competing patient priorities, unclear evidence, potentially heightened patient receptivity and stress, and the complexity of discussions. They also identified challenges to LCS implementation. Conclusions: While clinicians feel that LDCT LCS may benefit some HNC survivors, there are barriers both to implementing LCS SDM for these patients in primary care as currently recommended and to integrating it into cancer clinics. Challenges for SDM across settings include a lack of decision aids tailored to patients with cancer histories. Given recommendations to broaden LCS eligibility criteria, more research may be required before refinement of current guidelines. [ABSTRACT FROM AUTHOR]

Background: Given uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients. Aim: To explore how GPs discuss deprescribing of statins with their older patients. Design & setting: A qualitative study was undertaken using face-to- face, semi-structured interviews with Danish GPs from the regions of Southern Demark and Zealand. Method: The GP participants belonged to group practices and were identified from personal networks and snowballing. The interviews lasted approximately 30 minutes and were conducted in English. They were analysed using systematic text condensation. Results: A total of 11 GPs were interviewed and three themes were identified. (1) Reason for initiating a discussion: statin deprescribing mainly came up when GPs reviewed medication lists. There were differences between GPs regarding when or if they brought up deprescribing. (2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people. There were differences in how and if GPs discussed patient preferences. GPs viewed uncertainty and life expectancy as difficult to discuss. (3) Depth of discussion: the perceived level of patient engagement, and clinical context, could influence the extent of discussion. Conclusion: GPs identified a range of topics that could be discussed with patients surrounding statin deprescribing. The depth and content of discussions varied according to the situation, and between GPs. Challenges may exist in communicating around certain topics, such as uncertainty and life expectancy. Further understanding of how to best communicate around challenging topics, and development of structured frameworks, may help facilitate statin deprescribing discussions. Identifying what patients think is important to discuss would provide necessary insight to promote quality discussions and shared understanding of the decision. [ABSTRACT FROM AUTHOR]

Complex decision-making when dealing with situations such as feeding in the context of dementia, palliative care, and severe dysphagia is a complex clinical area for speech language pathologists (SLPs). The objective of this study was to provide an exploratory overview of complex feeding decisions, in order to highlight areas for improvement in clinical practice. A retrospective clinical chart audit of 82 participants was conducted within two hospital settings between 2012 and 2017 using an explorative approach. Complex feeding decisions were documented as "risk feeding" in 59.8% of instances and were most commonly made by the patient/family in consultation with the medical team (23.2%). Many of the complex feeding decisions were made without a multidisciplinary case conference (82.9%), without appropriate discussions with families regarding feeding decisions/options/alternatives (63.4%), and without relevant patient and family education (59.8%). Feeding decisions are ethically and clinically complex and therefore require a interdisciplinary and person-centred approach to discussion and education, as well as clear unbiased documentation. [ABSTRACT FROM AUTHOR]

This research proposed an innovative Internet of Things (IoT) networking and service architecture based on the essence of "sharing and reciprocity" - a Shared LoRa Network with the Shared LoRa Gateways as the infrastructure. To prove the feasibility of this idea, this research designed and implemented not only the Shared LoRa Gateway but also a total solution for tracking pets. The total solution consists of the LoRa End Node, the Shared LoRa Gateway, the Shared LoRa App, and the back-end Shared LoRa Service. This research primarily utilized the following technologies to implement the system prototype: Long Range (LoRa), Global Positioning System (GPS), Bluetooth Low Energy (BLE), USB On-The-Go (OTG), Arduino UNO microcontroller board, mobile app programming, and RESTful Application Programming Interface (API) design. The system prototype experimental results confirmed that the gateway design and the system design are both feasible, and the prototype implementation properly worked. [ABSTRACT FROM AUTHOR]

Genomic selection is an efficient approach to get shorter breeding cycles in recurrent selection programs and greater genetic gains with selection of superior individuals. Despite advances in genotyping techniques, genetic studies for polyploid species have been limited to a rough approximation of studies in diploid species. The major challenge is to distinguish the different types of heterozygotes present in polyploid populations. In this work, we evaluated different genomic prediction models applied to a recurrent selection population of 530 genotypes of Panicum maximum, an autotetraploid forage grass. We also investigated the effect of the allele dosage in the prediction, i.e., considering tetraploid (GS-TD) or diploid (GS-DD) allele dosage. A longitudinal linear mixed model was fitted for each one of the six phenotypic traits, considering different covariance matrices for genetic and residual effects. A total of 41,424 genotypingby-sequencing markers were obtained using 96-plex and Pst1 restriction enzyme, and quantitative genotype calling was performed. Six predictive models were generalized to tetraploid species and predictive ability was estimated by a replicated fivefold cross-validation process. GS-TD and GS-DD models were performed considering 1,223 informative markers. Overall, GS-TD data yielded higher predictive abilities than with GS-DD data. However, different predictive models had similar predictive ability performance. In this work, we provide bioinformatic and modeling guidelines to consider tetraploid dosage and observed that genomic selection may lead to additional gains in recurrent selection program of P. maximum. [ABSTRACT FROM AUTHOR]

Intermediate wheatgrass (Thinopyrum intermedium, IWG) is a perennial grain crop with high biomass and grain yield, long seeds, and resistance to pests and diseases. It also reduces soil erosion, nitrate and mineral leaching into underground water tables, and sequesters carbon in its roots. The domestication timeline of IWG as a grain crop spans only 3 decades, hence it lags annual grain crops in yield and seed characteristics. One approach to improve its agronomic traits is by using molecular markers to uncover marker-trait associations. In this study, we performed association mapping on IWG breeding germplasm from the third recurrent selection cycle at the University of Minnesota. The IWG population was phenotyped in St Paul, MN in 2017 and 2018, and in Crookston, MN in 2018 for grain yield, seed length, width and weight, spike length and weight, and number of spikelets per spike. Strong positive correlations were observed among most trait pairs, with correlations as high as 0.76. Genotyping using high throughput sequencing identified 8,899 high-quality genome-wide SNPs which were combined with phenotypic data in association mapping to discover regions associated with the yield component traits. We detected 154 genetic loci associated with these traits of which 19 were shared between at least two traits. Prediction of breeding values using significant loci as fixed effects in genomic selection model improved predictive abilities by up to 14%. Genetic mapping of agronomic traits followed by using genomic selection to predict breeding values can assist breeders in selecting superior genotypes to accelerate IWG domestication. [ABSTRACT FROM AUTHOR]

Urgency of the research. Collective activity as a specific research area has long been a subject of intensive socio-philosophical reflection. The shift in the role of social integration, a dynamic metamorphosis of the societal relations paradigm, an emergence of novel forms of cooperative endeavors coupled with new modes of globalized social partnership motivates to approach this quickly growing field relying on a variety of innovative research techniques and methodological tools. Target setting. Collective intentional attitudes are crosscutting in our lives. Such cooperative teleological undertakings form the core of specialized studies' interest in exploring their critical relevance for the foundation and functioning of social reality. The author, thus, tasks himself with providing a scrupulous overview of the variegated modes of joint activity which allow us to view our personality through the prism of social group impact, shape and evaluate the scope of our praxeological interconnectedness, fulfill our civic duties and responsibilities while performing numerous sustainability-driven social roles and functions. Actual scientific researches and issues analysis. Critical reflection pertaining to the general foundations of the issues at hand is presented in the works of the following Ukrainian researchers: V. Andrushenko, Y. Boyko, M. Boychenko, L. Gubernskiy, A. Yermolenko, A. Yermolaev, V. Lisoviy, M. Mikhalchenko, V. Navrotskiy, M. Nadolniy, V. Nikolaev, N. Petruk, O. Polishuk and others. The research objective. The aim of this work is to shed light on the previously understudied within Ukrainian social philosophy phenomenon of “collective intentionality” by analyzing major stances in the current sociophilosophical debate pertaining to the ontological status of collective activity, individual and shared praxeological dimension of intentional manifestations, various of cooperative acts, states and modalities. The statement of basic materials. The article examines the dominant paradigm and current research state of the theoretical and practical dimension of cooperative behavior based on the notion of “collective intentionality” scrutinized within the framework of analytic social philosophy. Accordingly, the goal was to elaborate foundational normative, socio-ontological and psychological aspects of the debate around the underlying nature of the mechanisms of content, modality, and subjects of shared praxeological undertakings, outline major points of agreement, controversy and contention in positions and arguments of the principal sides and their proponents. Conclusions. The paper's findings can be interpreted to support a non-distributive we-mode conjecture which requires a thorough mereological account of cooperation to complement an overly individualistic I-mode account of shared collaborative undertakings prevalent in Anglo-Saxon social science. Thus, if assessed through the lens of the individual self-interest mode almost half of the standard experiment participants choose to cooperate by employing wereasoning approaches, thereby proving that a team of people can intend to act in rational ways achieving Pareto-optimal outcomes. A further critical deficiency of such models is their atomistically hermetic methodology which in spite of producing immediate logical gains nonetheless completely disregards a host of crucial real-life cumulative factors of cooperation, viz. cultural embeddedness, communal trust and reciprocity that build up and are shaped over time. [ABSTRACT FROM AUTHOR]

In the last two decades, muscle synergies analysis has been commonly used to assess the neurophysiological mechanisms underlying human motor control. Several synergy models and algorithms have been employed for processing the electromyographic (EMG) signal, and it has been shown that the coordination of motor control is characterized by the presence of phasic (movement-related) and tonic (anti-gravity and related to co-contraction) EMG components. Neural substrates indicate that phasic and tonic components have non-homogeneous origin; however, it is still unclear if these components are generated by the same set of synergies or by distinct synergies. This study aims at testing whether phasic and tonic components are generated by distinct phasic and tonic synergies or by the same set of synergies with phasic and tonic activation coefficients. The study also aims at characterizing the differences between the phasic and the tonic synergies. Using a comprehensive mapping of upper-limb point-to-point movements, synergies were extracted from phasic and tonic EMG signal separately, estimating the tonic components with a linear ramp model. The goodness of reconstruction (R2) as a function of the number of synergies was compared, and sets of synergies extracted from each dataset at three R2 threshold levels (0.80, 0.85, 0.90) were retained for further analysis. Then, shared, phasic-specific, and tonic-specific synergies were extracted from the two datasets concatenated. The dimensionality of the synergies shared between the phasic and the tonic datasets was estimated with a bootstrap procedure based on the evaluation of the distribution of principal angles between the subspaces spanned by phasic and tonic synergies due to noise. We found only few shared synergies, indicating that phasic and tonic synergies have in general different structures. To compare consistent differences in synergy composition, shared, phasic-specific, and tonic-specific synergies were clustered separately. Phasic-specific clusters were more numerous than tonic-specific ones, suggesting that they were more differentiated among subjects. The structure of phasic clusters and the higher sparseness indicated that phasic synergies capture specific muscle activation patterns related to the movement while tonic synergies show co-contraction of multiple muscles for joint stabilization and holding postures. These results suggest that in many scenarios phasic and tonic synergies should be extracted separately, especially when performing muscle synergy analysis in patients with abnormal tonic activity and for tuning devices with gravity support. • EMG signal is composed of phasic (movement related) and tonic (postural) components. • Phasic and tonic muscle synergies are extracted from EMG of upper limb movements. • Phasic and tonic EMG components are generated by specific synergies. • Phasic and tonic-specific synergies have different structures and sparseness. • The results suggest that phasic and tonic synergies should be extracted separately. [ABSTRACT FROM AUTHOR]

Born in Cologne, Germany, in 1929, Amitai Etzioni is one of the best known intellectuals in public life in the United States. A sociologist, he taught at Columbia University and in the Harvard Business School and worked in the White House for Jimmy Carter before inspiring Tony Blair in his “Third Way” project to deal with the market economy. He founded the first trend in “socio-economics” in the United State, then the North American communitarian movement. He is the author of 24 books, including classics on the theory of organizations, international relations and political science. His most recent work deals with the frontiers of privacy and the definition of “commons.” The interview reflects on his life then goes on to a discussion about his concept of “community,” living together and “privacy” and the role of intellectuals in a global world.

Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.

To examine which medical home care components (i.e., personal doctor or nurse, usual source of sick care, family centered care, difficulty getting referrals, effective care coordination, and shared decision-making), are associated with the likelihood of current educational service use, after controlling for sociodemographic and clinical factors, in children and youth on the autism spectrum. Cross-sectional study using pooled data from the 2016 through 2019 National Survey of Children's Health (NSCH). The NSCH is fielded yearly to households in the U.S. and District of Columbia. Caregivers of children and youth on the autism spectrum, ages 1-17 years (n=1,922). reported on their child or youth's current educational service use. N/A. Current educational service use under an individualized family service plan (IFSP) or an individualized education program (IEP). After controlling for sociodemographic and clinical factors, caregiver-reported difficulty getting referrals (aOR= 2.93, 95% CI [1.33, 6.41], p =.007) and not receiving shared decision-making (aOR= 2.93, 95% CI [1.10, 3.44], p =.016) was associated with higher likelihood of current educational service use in children and youth on the autism spectrum. Sociodemographic factors significantly associated with lower likelihood of current educational service use were older children (aOR= 0.91, 95% CI [0.85, 0.97], p =.003). Children and youth on the autism spectrum with moderate/severe autism had higher likelihood of current educational service use (aOR= 1.80, 95% CI [1.10, 2.95], p =.019). Caregivers reporting greater difficulty with referrals or who lacked shared decision-making with medical providers were more likely to report their children and youth on the autism spectrum had current educational service use under an IFSP or an IEP. Although counter-intuitive, these findings warrant exploration to examine caregiver strategies for navigating educational services considering limited medical home care. The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

1 Although transcatheter mitral valve procedures are increasingly being performed, transcatheter aortic valve procedures are now approved for use in low-risk patients. Decision making, shared, guidelines, heart valve prosthesis implantation, transcatheter aortic valve replacement, surgical aortic valve replacement 5 In summary, transcatheter valve therapies remain an exciting and dynamic field that offers patients a less invasive treatment option. [Extracted from the article]

Background: Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains., Objective: To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice., Methods: We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses., Results: The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001)., Conclusions: This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice., (© The Author(s) 2024. Published by Oxford University Press.)

Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient "high risk," warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%-80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach., Competing Interests: Declaration of competing interest None of the authors reported any conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)