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BACKGROUND: Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDSTs feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDSTs effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS: The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION: If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION: ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.

BACKGROUND: Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (RA PRO dashboard). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. CONCLUSIONS: The study provides valuable insights into clinicians perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

BACKGROUND: The intricate balance between the advantages and risks of low-dose computed tomography (LDCT) impedes the utilization of lung cancer screening (LCS). Guiding shared decision-making (SDM) for well-informed choices regarding LCS is pivotal. There has been a notable increase in research related to SDM. However, these studies possess limitations. For example, they may ignore the identification of decision support and needs from the perspective of health care providers and high-risk groups. Additionally, these studies have not adequately addressed the complete SDM process, including pre-decisional needs, the decision-making process, and post-decision experiences. Furthermore, the East-West divide of SDM has been largely ignored. This study aimed to explore the decisional needs and support for shared decision-making for LCS among health care providers and high-risk groups in China. METHODS: Informed by the Ottawa Decision-Support Framework, we conducted qualitative, face-to-face in-depth interviews to explore shared decision-making among 30 lung cancer high-risk individuals and 9 health care providers. Content analysis was used for data analysis. RESULTS: We identified 4 decisional needs that impair shared decision-making: (1) LCS knowledge deficit; (2) inadequate supportive resources; (3) shared decision-making conceptual bias; and (4) delicate doctor-patient bonds. We identified 3 decision supports: (1) providing information throughout the LCS process; (2) providing shared decision-making decision coaching; and (3) providing decision tools. CONCLUSIONS: This study offers valuable insights into the decisional needs and support required to undergo LCS among high-risk individuals and perspectives from health care providers. Future studies should aim to design interventions that enhance the quality of shared decision-making by offering LCS information, decision tools for LCS, and decision coaching for shared decision-making (e.g., through community nurses). Simultaneously, it is crucial to assess individuals needs for effective deliberation to prevent conflicts and regrets after arriving at a decision.

PURPOSE: Little is known about the shared decision-making (SDM) needs, barriers, and facilitators of patients with newly diagnosed advanced cancer in the hospital. Understanding this may improve SDM and cancer care quality in this vulnerable population. METHODS: A single-site, mixed-methods study of hospitalized patients with newly diagnosed advanced cancer, caregivers, and oncologists was conducted. After discharge, patient ± caregiver semi-structured interviews exploring SDM needs, barriers, and facilitators regarding their most important upcoming cancer-related decision were conducted. Oncologists were surveyed about patient knowledge and SDM needs using closed- and open-ended questions, respectively. Thematic analysis was performed for qualitative data with a focus on themes unique to or amplified by hospitalization. Descriptive statistics and the Chi-squared test were performed for quantitative data. RESULTS: Patients and caregivers reported high SDM needs surrounding treatment and prognostic information, leading to decisional conflict. Eight themes emerged: anticipated cancer treatment decisions, variable control preferences in decision-making, high cancer-related information needs and uncertainty, barriers and facilitators to information gathering during and post hospitalization, and decision-making facilitators. Among 32 oncologists, most (56%) reported patients were poorly informed about treatment and prognosis. Oncologists reported variable expectations about patient knowledge after hospitalization, facilitators to patient decision-making, and patient uncertainty while awaiting an outpatient oncologist appointment. CONCLUSION: Patients newly diagnosed with advanced cancer in the hospital have high SDM needs and experience decisional conflict. This may be due to barriers unique to or exacerbated by hospitalization. Further research is needed to develop strategies to address these barriers and enhance the facilitators identified in this study.

Background: The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level. Methods: The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation. Discussion: The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts. Trial registration: ClinicalTrials.gov NCT06171737. Registered on December 15, 2023. [ABSTRACT FROM AUTHOR]

This study highlights the importance of customizing preventive strategies for psychological distress in healthcare workers by considering their personal experiences and values. It emphasizes improving organizational support and clarifying misconceptions about prevention responsibilities. Such tailored interventions could increase health care workers' engagement in protecting their health and enhance the effectiveness of these strategies. Background: The objectives of this study are to explore healthcare workers' (HCWs') mental models regarding psychological distress and to compare these with that of experts. Methods: Semistructured interviews were conducted (n = 28 HCWs, n = 13 experts). The topic list encompassed risk perception, early stress symptoms, causes, consequences, and preventive measures of psychological distress. Interviews were transcribed verbatim and thematically analyzed using MAXQDA (VERBI Software, Berlin). Results: Similarities were found in risk perception, symptoms, causes, and consequences. Differences arose in HCWs' reliance on personal experiences and values versus experts' scientific perspective. Preventive measures also showed discrepancies. Variation within HCWs was found on all aspects of their mental model. Conclusion: For effective preventive interventions regarding psychological distress, experts should consider HCWs' personal values and experiences, acknowledging the variation in their mental models. This approach may enhance HCWs' engagement in preventive behaviors. [ABSTRACT FROM AUTHOR]

Shared decision making (SDM) between health care professionals and patients is essential to help patients make well informed choices about lung cancer screening (LCS). Patients who participate in SDM have greater LCS knowledge, reduced decisional conflict, and improved adherence to annual screening compared with patients who do not participate in SDM. SDM tools are acceptable to patients and clinicians. The importance of SDM in LCS is emphasized in recommendations from professional organizations and highlighted as a priority in the 2022 President's Cancer Panel Report. The updated 2022 national coverage determination from the Centers for Medicare & Medicaid Services reaffirms the value of SDM in offering LCS to eligible beneficiaries. The Shared Decision‐Making Task Group of the American Cancer Society National Lung Cancer Roundtable undertook a group consensus process to identify priorities for research and implementation related to SDM for LCS and then evaluated current knowledge in these areas. Priority areas included: (1) developing feasible, adaptable SDM training programs for health care professionals; (2) understanding the impact of alternative health system LCS models on SDM practice and outcomes; (3) developing and evaluating new patient decision aids for use with diverse populations and in varied settings; (4) offering conceptual clarity about what constitutes a high‐quality decision and developing appropriate quality measures; and (5) studying the use of prediction‐augmented screening to support SDM in practice. Gaps in current research in all areas were observed. The authors conclude with a research and implementation agenda to advance the quality and implementation of SDM for persons who might benefit from LCS. Patients who participate in shared decision making about lung cancer screening have greater knowledge, lower decisional conflict, and better adherence to screening compared with patients who do not participate. The American Cancer Society Shared Decision‐Making Task Group identified five priority areas for research and to improve the implementation of lung cancer screening in the United States. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Objectives Methods Results Conclusion Recent studies have demonstrated that early rhythm control for first‐line treatment of atrial fibrillation (AF) improved cardiovascular outcomes. However, there is limited data regarding the long‐term outcome of patients who failed antiarrhythmic drugs and who refuse radiofrequency catheter ablation (RFCA).Patients with AF who were refractory to antiarrhythmic drugs and had refused further rhythm control attempts via RFCA were retrospectively identified and propensity‐score (PS) matched with those who had been treated with RFCA. The primary outcome of interest was all‐cause mortality or ischemic stroke.A total of 169 patients who refused rhythm control with RFCA and PS matched 169 patients who had been treated with RFCA were included for analysis. During a mean follow‐up of 4.3 (2.3;6.9) years, maintenance of sinus rhythm was more achieved in RFCA group (7 [4.1%] in Refuse group vs. 133 [78.7%] in RFCA group, p < 0.001). The incidence of ischemic stroke was significantly higher in patients who refused RFCA compared with patients who underwent RFCA (2.96 per 100 person‐years in the Refused group vs. 0.74 per 100 person‐years in the RFCA group, log‐rank p < 0.001), but all‐cause mortality was not significantly different (log‐rank p = 0.8). Refusal of attempted rhythm control via RFCA was an independent risk factor for ischemic stroke on multivariate Cox analysis (hazard ratio [HR] 3.2; 95% confidence interval [CI] 1.2–8.53, p = 0.02).In patients with antiarrhythmic drug‐refractory AF, the risk of stroke was significantly higher in patients who refused rhythm control via RFCA compared with that of those treated with RFCA. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to evaluate the use of a free online continuing education (CE) course that sought to address barriers of capability by training dental team members in the specific recommendations of the American Dental Association (ADA)-endorsed adult guideline for the pharmacologic management of acute dental pain, shared decision-making, and the adoption of the guideline into practice. Methods: In 2022 and 2023, dentists completed an online, asynchronous CE course on the guideline-concordant pharmacologic management of acute dental pain. They completed 11-item knowledge tests before and after completing the course. Total scores on the pre- and post-tests were compared using a t-test. Results: The mean score increased from 7.68 (SD = 1.08) on the pretest to 8.79 (SD = 1.35) on the post-test (t(4468) = -27.34, p <.01), indicating that dentists gained knowledge from the CE course. Conclusions: We found that the CE course increased knowledge with respect to the guideline recommendations and shared decision-making but not epidemiology or incorporating a guideline into practice. Future studies should evaluate whether the CE course increased guideline-concordant prescribing. [ABSTRACT FROM AUTHOR]

Purpose: This research was conducted to explore the mediating effect of perceived social support and health literacy on the relationship between decisional dilemmas and participation in shared decision-making among Chinese parents of premature infants. Design and Methods: This cross-sectional study recruited 225 Chinese parents of premature infants in a neonatal ward of a Chinese hospital through convenience sampling. Data were collected from August 2022 to February 2023 using 5 self-administered instruments. Structural equation modeling and multiple mediation tests were applied to explore the interplay among perceived social support, health literacy, decisional dilemmas, and participation in shared decision-making. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Decisional dilemmas were found to negatively impact participation in shared decision-making. Perceived social support and health literacy were identified as partial mediators in this relationship, collectively accounting for a mediation effect of −0.413, which represents 50.0% of the total effect. Conclusion: The findings elucidate a multifaceted model of factors influencing participation in shared decision-making among Chinese parents of premature infants. Prompt recognition of these variables can enable nursing professionals to incorporate tailored management strategies within patient-centered care frameworks, thereby enhancing decisional outcomes. [ABSTRACT FROM AUTHOR]

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 Noninvasive 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 FROM AUTHOR]

Previous work presented a reference model for shared autonomous vehicles in urban areas supported by a systematic literature review and topic modeling. The proposed reference model was then evaluated with two real-world demonstrations: the service provided by Waymo in Phoenix and another offered by Baidu in Beijing. In this paper, we present another evaluation based on a survey conducted with a group of potential stakeholders belonging to the mobility industry who were asked about their agreement with each of the concepts in the reference model. The resulting artifact is stronger and more reliable because it reflects the feedback of mobility experts. [ABSTRACT FROM AUTHOR]

Abstract Background The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level. Methods The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation. Discussion The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts. Trial registration ClinicalTrials.gov NCT06171737. Registered on December 15, 2023.

Abstract Background The purpose of the present study was to evaluate the use of a free online continuing education (CE) course that sought to address barriers of capability by training dental team members in the specific recommendations of the American Dental Association (ADA)-endorsed adult guideline for the pharmacologic management of acute dental pain, shared decision-making, and the adoption of the guideline into practice. Methods In 2022 and 2023, dentists completed an online, asynchronous CE course on the guideline-concordant pharmacologic management of acute dental pain. They completed 11-item knowledge tests before and after completing the course. Total scores on the pre- and post-tests were compared using a t-test. Results The mean score increased from 7.68 (SD = 1.08) on the pretest to 8.79 (SD = 1.35) on the post-test (t (4468) = -27.34, p

ObjectiveWe conducted a cluster-randomized, shared decision-making (SDM) trial offering lifestyle change, metformin, or both options, to adults at risk for diabetes in a primary care network (n = 20 practices).Research design and methodsWe used propensity score matching to identify control patients and used electronic health record data to compare weight loss at 24 and 36 months of follow-up and diabetes incidence at 36 months of follow-up.ResultsIn adjusted post hoc analyses, SDM participants (n = 489) maintained modestly greater 24-month weight loss of -3.1 lb and 36-month weight loss of -2.7 lb versus controls (n = 1,430, both comparisons P < 0.001). SDM participants who chose both lifestyle change and metformin sustained weight loss at 36 months of -4.1 lb (P < 0.001 vs. controls). We found no differences in incident diabetes (15% of SDM participants, 14% of control participants; P = 0.64).ConclusionsThis is one of the first studies to demonstrate weight loss maintenance up to 36 months after diabetes prevention SDM.

BackgroundLung cancer screening (LCS) is recommended for individuals at high risk due to age and smoking history after a shared decision-making conversation. However, little is known about best strategies for incorporating shared decision-making, especially in a busy primary care setting.ObjectiveTo develop a novel tool, Lung Cancer Assessment of Risk and Education (LungCARE) to guide LCS decisions among eligible primary care patients.DesignPilot cluster randomized controlled trial of LungCARE versus usual care.ParticipantsPatients of providers in a university primary care clinic, who met criteria for LCS.InterventionProviders were randomized to LungCARE intervention or control. LungCARE participants completed a computer tablet-based video assessment of lung cancer educational needs in the waiting room prior to a primary care visit. Patient and provider both received a summary handout of patient concerns and responses.Main measuresAll eligible patients completed baseline interviews by telephone. One week after the index visit, participants completed a follow-up telephone survey that assessed patient-physician discussion of LCS, referral to and scheduling of LCS, as well as LCS knowledge and acceptability of LungCARE. Two months after index visit, we reviewed patients' electronic health records (EHRs) for evidence of a shared decision-making conversation and referral to and receipt of LCS.Key resultsA total of 66 participants completed baseline and follow-up visits (34: LungCARE; 32: usual care). Mean age was 65.9 (± 6.0). Based on EHR review, compared to usual care, LungCARE participants were more likely to have discussed LCS with their physicians (56% vs 25%; p = 0.04) and to be referred to LCS (44% vs 13%; p

Carlos De las Cuevas,1 Omaira Benadero2 1Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, La Laguna, Canary Islands, Spain; 2School of Medicine of the University of La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, SpainCorrespondence: Carlos De las Cuevas, Department of Internal Medicine, Dermatology and Psychiatry, School of Medicine, University of La Laguna, Campus de Ofra s/. 38071, San Cristobal de La Laguna, Canary Islands, Spain, Email ccuevas@ull.edu.esObjective: This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population.Methods: A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient’s Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings.Results: Significant correlations were found between patients’ control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes.Conclusion: The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients’ control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.Plain Language Summary: In today’s fast-paced world, understanding how we can better cater to the needs of psychiatric patients is more important than ever. This study, conducted in Tenerife, Spain, with 151 participants, shines a light on the intricate relationship between a patient’s psychological mindset and their involvement in psychiatric care. Researchers explored how patients’ beliefs about health control, their resistance or openness to psychiatric advice, and their preferences in treatment decisions intertwine to affect their approach to psychiatric treatment.The core findings reveal a fascinating tapestry of patient attitudes and behaviors. For example, patients who prefer a joint approach with their psychiatrists toward managing their treatment tend to have a more positive outlook on medication and a deeper trust in their doctors. This suggests that when patients feel they are part of the decision-making process, they are more likely to follow through with treatment plans, leading to better outcomes.What does this mean in everyday terms? Essentially, the study highlights the power of listening and integrating patients’ viewpoints into their care plans. When patients see their insights and preferences reflected in their treatment, their engagement and adherence to medication improve. This not only fosters a more supportive environment for healing but also paves the way for more personalized, effective psychiatric care.In essence, this research is a call to action for healthcare providers to delve deeper into understanding each patient’s unique psychological makeup. By doing so, they can tailor treatments that resonate more closely with the patient’s own beliefs and preferences, ultimately leading to a more positive healthcare experience for everyone involved.Keywords: patient-centered care, community mental health centers, internal-external control, health belief model, decision making, shared

Abstract Background The recombination landscape and subsequent natural selection have vast consequences forevolution and speciation. However, most of the crossover and recombination hotspots are yet to be discovered. We previously reported the relevance of C and G trinucleotide two-repeat units (CG-TTUs) in crossovers and recombination. Methods On a genome-wide scale, here we mapped all combinations of A and T trinucleotide two-repeat units (AT-TTUs) in human, consisting of AATAAT, ATAATA, ATTATT, TTATTA, TATTAT, and TAATAA. We also compared a number of the colonies formed by the AT-TTUs (distance between consecutive AT-TTUs 96%) resided in approximately 1.4 million colonies, spread throughout the human genome. In comparison to the CG-TTU colonies, the AT-TTU colonies were significantly more abundant and larger in size. Pure units and overlapping units of the pure units were readily detectable in the same colonies, signifying that the units were the sites of unequal crossover. We discovered dynamic sharedness of several of the colonies across the primate species studied, which mainly reached maximum complexity and size in human. Conclusions We report novel crossover and recombination hotspots of the finest molecular resolution, massively spread and shared across the genomes of human and several other primates. With respect to crossovers and recombination, these genomes are far more dynamic than previously envisioned.

In the seemingly new world of work after the pandemic, managers are confronted with new difficulties in managing their teams. This research aims to answer the important research question on adaptive leadership dynamics: how do leaders steer in change? Drawing on the constantly evolving nature of flexible working environments. This paper seeks to establish the various approaches used by leaders in the current work environment. The purpose of this investigation is to provide critical recommendations to the organizational decision-makers on how to manage their employees in this post-COVID-19 world. Both quantitative and qualitative data collection methods will be employed to interview leaders in various sectors regarding the following: (1) identifying and contacting leaders who have effectively navigated the team’s post-pandemic; (2) identifying firsthand experiences and understanding of leadership strategies. The study used interviews, of which 70% were semi-structured, and the number of participants was 10. The analysis presented in this study revealed the type of leadership and their coping mechanisms, the factors that led to the activation of the coping mechanisms, and that post-pandemic, a leader’s style can be altered not only for business gain but also as a positive change for the leader themselves. The change that leaders had to undergo in post-pandemic working arrangements was diverse, and changing has never been unfamiliar to changing the leadership style. Despite the fact that our studies provide significant information regarding the main area of leadership in the management climate, there are certain aspects that deserve certain considerations. The coordination of this research is based only on middle managers, which restrains the viewpoint of our study with cross-industry background. However, there is one major limitation of the study because the study was conducted at the end of the pandemic, and therefore it may not be equally relevant as any other period of time. Therefore, the leadership phenomenon can be explored from the leader’s perspective alone, and this might result in ignoring crucial follower or any other stakeholder information. In this research, there was no other interview conducted to compare with the interview completed in this research to validate the respondent answers. In view of these, it would be appropriate to take a closer look at the leadership processes from different angles in order to gain a better appreciation of the phenomenon. [ABSTRACT FROM AUTHOR]

Background: Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. Aim: To identify barriers and facilitators for applying SDM in cystitis management in general practice. Design & setting: Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Method: Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Results: Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. Conclusion: SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management. [ABSTRACT FROM AUTHOR]

Introduction: Older adults with cancer facing competing treatments must prioritize between various outcomes. This study assessed health outcome prioritization among older adults with cancer starting chemotherapy. Methods: Secondary analysis of a randomized trial addressing vulnerabilities in older adults with cancer. Patients completed three validated outcome prioritization tools: 1) Health Outcomes Tool: prioritizes outcomes (survival, independence, symptoms) using a visual analog scale; 2) Now vs. Later Tool: rates the importance of quality of life at three times—today versus 1 or 5 years in the future; and 3) Attitude Scale: rates agreement with outcome‐related statements. The authors measured the proportion of patients prioritizing various outcomes and evaluated their characteristics. Results: A total of 219 patients (median [range] age 71 [65–88], 68% with metastatic disease) were included. On the Health Outcomes Tool, 60.7% prioritized survival over other outcomes. Having localized disease was associated with choosing survival as top priority. On the Now vs. Later Tool, 50% gave equal importance to current versus future quality of life. On the Attitude Scale, 53.4% disagreed with the statement "the most important thing to me is living as long as I can, no matter what my quality of life is"; and 82.2% agreed with the statement "it is more important to me to maintain my thinking ability than to live as long as possible". Conclusion: Although survival was the top priority for most participants, some older individuals with cancer prioritize other outcomes, such as cognition and function. Clinicians should elicit patient‐defined priorities and include them in decision‐making. In this secondary analysis of 219 older participants (median age 71 years) from a randomized trial addressing vulnerabilities in older adults with cancer, 61% prioritized survival over other outcomes such as maintaining their independence or being free from symptoms. Clinicians should elicit patient‐defined priorities and include them in decision‐making when discussing treatment. [ABSTRACT FROM AUTHOR]

Background: The recombination landscape and subsequent natural selection have vast consequences forevolution and speciation. However, most of the crossover and recombination hotspots are yet to be discovered. We previously reported the relevance of C and G trinucleotide two-repeat units (CG-TTUs) in crossovers and recombination. Methods: On a genome-wide scale, here we mapped all combinations of A and T trinucleotide two-repeat units (AT-TTUs) in human, consisting of AATAAT, ATAATA, ATTATT, TTATTA, TATTAT, and TAATAA. We also compared a number of the colonies formed by the AT-TTUs (distance between consecutive AT-TTUs < 500 bp) in several other primates and mouse. Results: We found that the majority of the AT-TTUs (> 96%) resided in approximately 1.4 million colonies, spread throughout the human genome. In comparison to the CG-TTU colonies, the AT-TTU colonies were significantly more abundant and larger in size. Pure units and overlapping units of the pure units were readily detectable in the same colonies, signifying that the units were the sites of unequal crossover. We discovered dynamic sharedness of several of the colonies across the primate species studied, which mainly reached maximum complexity and size in human. Conclusions: We report novel crossover and recombination hotspots of the finest molecular resolution, massively spread and shared across the genomes of human and several other primates. With respect to crossovers and recombination, these genomes are far more dynamic than previously envisioned. [ABSTRACT FROM AUTHOR]

The increasing volume of personal motorized vehicles (PMVs) in cities has become a serious issue leading to congestion, noise, air pollution and high land consumption. To ensure the sustainability of urban transportation, it is imperative to transition the current transportation paradigm toward a more sustainable state. Transitions within socio-technical systems often arise from niche innovation. Therefore, this paper pursues the technical optimization of such a niche innovation by applying a technical sustainability perspective on an innovative mobility and logistics concept within a case study. This case study is based on a centrally managed connected, automated, shared and electric (CASE) vehicle fleet which might replace PMV use in urban city centers of the future. The key technical system components of the envisioned mobility and logistics concept are analyzed and optimized with regard to economic, ecological and social sustainability dimensions to maximize the overall sustainability of the ecosystem. Specifically, this paper identifies key challenges and proposes possible solutions across the vehicle components as well as the orchestration of the vehicles' operations within the envisioned mobility and logistics concept. Thereby, the case study gives an example of how different engineering disciplines can contribute to different sustainability dimensions, highlighting the interdependences. Finally, the discussion concludes that the early integration of sustainability considerations in the technical optimization efforts of innovative transportation systems can provide an important building block for the transition of the current transportation paradigm to a more sustainable state. [ABSTRACT FROM AUTHOR]

IntroductionDue to the rapid aging of the global population, new approaches are required to improve the quality of life of older people and to reduce healthcare system expenditures. One of the approaches that can be used is value-based healthcare. This article describes a value-based solution for older people who have suffered a myocardial infarction.MethodsThis solution combines the work of healthcare professionals and informal caregivers and the use of modern and user-friendly technologies to support the achievement of patients’ values. Patients older than 65 years who have suffered a myocardial infarction will be divided into control and intervention groups within a pre-post-controlled design research study. Members of the intervention group will be provided with a personalized plan developed by healthcare professionals and based on the results from the baseline questionnaire.DiscussionTwo ValueCare digital solution components will be developed: a mobile application for the participants and a web platform for the professionals, researchers, and informal caregivers. Together with smartwatches, which will track important health aspects, and applications, this approach would enable older people to improve their health through correct lifestyle choices and their professional and informal caregivers to track their progress. With the use of the described technology and the multidisciplinary approach, the unmet needs and values of participants could be achieved. Using this approach, it could be possible to reduce overall healthcare expenses through the active involvement of both older people and their informal caregivers through a shared decision-making process with healthcare professionals.Clinical trial registrationThe ISRCTN registry number is 25089186. The date of trial registration is 16/11/2021.

Objective: The objective of this review was to find literature related to the concepts of patient engagement and co-creation in healthcare services and identify models and/or frameworks that combined these concepts. Methods: We developed the eligibility criteria using the Population-Concept-Context framework applicable to studies with population of patients exploring the concepts of engagement and co-creation in the context of healthcare services. The search was conducted in PubMed, CINAHL, Cochrane, APA PsycINFO, and Ovid MEDLINE. We searched for articles in English with no search limitations on publication dates. Reviewers screened abstracts and full texts to identify articles for data extraction. We developed, piloted, and implemented a data extraction tool to extract key information needed to answer the research questions. Results: Our search yielded 3632 references. Fifty-five studies were included in this review with 26 studies in patient engagement and 29 studies in co-creation. Many identified studies explored the field of healthcare services research. We identified the common principles of patient engagement and co-creation along with the existing models and frameworks that were either applied to guide these studies or proposed through these studies. Conclusion: Though there were several models describing different components and phases of patient engagement and co-creation concepts, there was a lack of unified, domain-agnostic models that described characteristics of these combined concepts. This review suggested the need for an innovative conceptual model that would bring together the concepts of co-creation and the principles of patient engagement applicable to various activities in healthcare such as research, implementation, and evaluation.

The effects of AVs on cities remain uncertain but will ultimately be shaped by the predominant service model—either private ownership or shared usage. People’s decisions about which one to use are based in part on individual perceptions and preferences. To date, there have been only a handful of studies on AV preferences from the Global South, yet these countries may benefit greatly from AVs, but they also present a unique set of challenges for implementation. This study therefore fills some important research gaps about understanding preferences across different AV service models (i.e., privately owned AVs vs. shared AVs) and ride types (i.e., solo vs. pooled rides). From our stated preference research in Bangkok, Thailand our respondents show somewhat low interest in AVs overall, but we also found that men, people with higher incomes, and those who currently travel by private vehicles and those who use public transport all show more interest in privately-owned AVs over shared AVs (SAVs). However, being a public transport user increases interest in pooled SAVs, and income was not a significant effect on interest in SAVs. Our study revealed that people interested in SAVs would also be interested in pooled ride SAVs, and vice versa. These results can help inform policy and regulatory areas that need to be addressed for sustainable, accessible and inclusive AV implementation in Thailand. We also discuss the broader implications for future research about AV preferences in the Global South.

Background The Centers for Medicare and Medicaid Services (CMS) recently updated its split/shared policy but delayed enforcing sole time-based billing methodology in 2023 after industry pushback. However, the new time-based requirement is set for 2024. Yet, there is no published literature addressing perceived organizational impacts associated with new split/shared rules. Methods A cross-sectional survey study was administered via electronic email Listserv (n = 108) over a two-and-a-half-week period in 2023. The survey was conducted to examine the potential organizational impact of complying with the new Medicare split/shared visit policy. The collected survey data were analyzed using descriptive statistics. Results Despite the small sample size, this novel research study seems to suggest that there is a range of perceived issues associated with the new split/shared rules, including a perceived decrease in physician compensation due to changes in work relative value unit (wRVU) attribution and potential conflict between physicians and advanced practice providers (APPs) as they compete for wRVU credit for inpatient services. Additionally, respondents felt that the new regulatory change would lead to layoffs and/or hiring freezes of inpatient APP positions, thereby impacting team-based care dynamics. Further work is needed to better understand the impact of the new split/shared rules on coding practices, revenue, efficiency, provider, and patient satisfaction. Conclusion The findings reported in this study shed new light on the perceived impacts of the new split/shared visit rules on healthcare institutions. Although the updated rules are designed to provide greater transparency and better align reimbursement with services performed, concerns persist around the potential impact on day-to-day workflows, physician compensation, net revenue, and potential economic impact on the traditional team-based care model.

BackgroundUnderstanding how prenatal care influences planned postpartum contraception can help guide shared decision-making. This study looks to examine the association of the quality of prenatal care with planned postpartum contraception.MethodsThis is a retrospective cohort study conducted in a single tertiary, academic urban institution in the southwest United States. The institutional review board (IRB) for human research at Valleywise Health Medical Center approved this study. Using a validated measure of prenatal care, the Kessner index, prenatal care was classified as adequate, intermediate, or inadequate. The World Health Organization (WHO) protocol for contraceptive effectiveness was used to classify contraceptives as very effective, effective, and less effective. The planned contraceptive choice was determined at the time of hospital discharge after delivery by discharge summary. Chi-squared testing and logistic regression were used to measure associations between the adequacy of prenatal care and contraceptive planning.ResultsThis study included 450 deliveries, 404 (90%) patients with adequate prenatal care, and 46 (10%) patients without adequate (intermediate or inadequate) prenatal care. There was not a statistically significant difference in planning for very effective or effective methods of contraception at hospital discharge between adequate (74%) and non-adequate (61%) prenatal care groups (p = 0.06). There was no association between the adequacy of prenatal care and the effectiveness of contraceptive planning after controlling for age and parity (aOR = 1.7, 95% CI 0.89-3.22).ConclusionsMany women chose very effective and effective methods of postpartum contraception; however, there was no statistically significant association between the quality of prenatal care and planned contraception at hospital discharge.

Background: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient–practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. Methods: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. Results: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. Conclusion: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective. [ABSTRACT FROM AUTHOR]

Introduction: Contraceptive illiteracy leads to non-adherence, discontinuation, and dissatisfaction with the method. Person-centered contraceptive counseling is based on quality care on a communicative basis that promotes shared decision-making, leading to a choice adapted to the woman's needs, lifestyle, and health condition. We intend to build and validate an instrument that serves as a guide for quality contraceptive counseling, facilitating decision-making about contraceptive methods. Methods: We used the Delphi method in a total of two rounds. The content was validated through a panel of eighteen experts with experience in teaching, research in contraceptive counseling, and obstetric nursing. To assess the consensus and stability of the responses, two questionnaires were administered and the Content Validity Index and Content Validity Ratio were calculated. Results: The initial version of the guide, consisting of six indicators and thirty-five items, was submitted to the panel of experts to obtain consensus and stability from respondents (first round). The results showed a response rate of 66.0%; thirty-four indicators reached consensus and one did not reach consensus. Suggestions for modifying the indicator were received by the experts and incorporated in the next round. In the second round, the response rate increased to 78.0%. Two indicators were resubmitted, of which one was accepted. This resulted in the final version of the instrument, with six points and thirty-five items. Discussion: The guide proved to be a valid tool for nurse–midwives to provide quality contraceptive advice to women, allowing them to make autonomous and informed choices regarding their sexual and reproductive health. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CH ildbirth O ptions, I nformation and person- C entered E xplanation (CHOICEs). Study Design and Methods: Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? Results: Four major themes were identified: provider told me what to do ; communication about interventions during labor and birth ; preferences overlooked ; multiple team members. Under the theme of provider told me what to do , there was one sub-theme of induction of labor. Clinical Implications: Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members. Interventions during labor and birth are at an all-time high in the United States and women are not always fully informed participants in various aspects of their care. In this study, women who had given birth were interviewed as part of a process to improve and add to the CHildbirth Options, Information and person-Centered Explanation (CHOICEs) measure. Based on the findings, the measure will be updated and tested further. [ABSTRACT FROM AUTHOR]

BackgroundGestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Metformin and lifestyle change through a Diabetes Prevention Program (DPP) are equally effective in preventing diabetes in patients with a GDM history, so women can choose a strategy based on their preferences. This study aims to test whether shared decision making (SDM) can help women with a history of GDM increase adoption of evidence-based strategies and lose weight to lower their risk of incident diabetes in real-world settings.MethodsThis pragmatic randomized controlled trial (RCT) will test the effectiveness of SDM for diabetes prevention among 310 overweight/obese women with a history of GDM and prediabetes from two large health care systems (n = 155 from UCLA Health and n = 155 from Intermountain Healthcare). The primary outcome is the proportion of participants who lose ≥5% body weight at 12 months. Secondary outcomes include uptake of DPP and/or metformin and other patient-reported outcomes such as patient activation and health-related quality of life. Rates of GDM in a subsequent pregnancy will be an exploratory outcome. A descriptive analysis of costs related to SDM implementation will also be conducted.ConclusionThis is the first RCT to examine the effectiveness of SDM on weight loss, lifestyle change and/or metformin use, and other patient-reported outcomes in participants with a GDM history at risk of developing diabetes.Trial registrationClinicalTrials.gov, NCT03766256. Registered on 6 December 2018.

BackgroundLiveborn infants with non-mosaic trisomy 22 are rarely described in the medical literature. Reported lifespan of these patients ranges from minutes to 3 years, with the absence of cardiac anomalies associated with longer-term survival. The landscape for offering cardiac surgery to patients with rare autosomal trisomies is currently evolving, as has been demonstrated recently in trisomies 13 and 18. However, limited available data on patients with rare autosomal trisomies provides a significant challenge in perinatal counseling, especially when there are options for surgical intervention.Case presentationIn this case report, we describe an infant born at term with prenatally diagnosed apparently non-mosaic trisomy 22 and multiple cardiac anomalies, including a double outlet right ventricle, hypoplastic aortic valve and severe aortic arch hypoplasia, who underwent cardiac surgery. The decisions made by her family lending to her progress and survival to this day were made with a focus on the shared decision making model and support in the prenatal and perinatal period. We also review the published data on survival and quality of life after cardiac surgery in infants with rare trisomies.ConclusionsThis patient is the only known case of apparently non-mosaic trisomy 22 in the literature who has undergone cardiac surgery with significant survival benefit. This case highlights the impact of using a shared decision making model when there is prognostic uncertainty.

BackgroundFinancial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling.MethodsUtilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations.ResultsOf the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P = .7).ConclusionsIn this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making.

Objectives: To identify, describe and synthesise the views and experiences of adults living with asthma regarding shared decision‐making (SDM) in the existing qualitative literature Methods: We conducted a comprehensive search of 10 databases (list databases) from inception until September 2023. Screening was performed according to inclusion criteria. Tools from the Joanna Briggs lnstitute were utilised for the purposes of data extraction and synthesis in this study. The data extraction process in this study employed the Capability, Opportunity and Motivation Model of Behaviour (COM‐B model) as a framework, and a pragmatic meta‐aggregative approach was employed to synthesise the collected results. Results: Nineteen studies were included in the metasynthesis. Three synthesised themes were identified: the capability of people living with asthma, the opportunities of people living with asthma in SDM, and the motivation of the people living with asthma in SDM. Conclusions: We have identified specific factors influencing people living with asthma engaging in SDM. The findings of this study can serve as a basis for the implementation of SDM in people living with asthma and provide insights for the development of their SDM training programs. The ConQual score for the synthesised findings was rated as low. To enhance confidence, future studies should address dependability and credibility factors. Practice Implications: This review contemplates the implementation of SDM from the perspective of people living with asthma, with the aim of providing patient‐centred services for them. The results of this review can benefit the implementation of SDM and facilitate information sharing. It offers guidance for SDM skills training among adults living with asthma, fosters a better doctor–patient relationship and facilitates consensus in treatment decisions, thereby enabling personalised and tailored medical care. Patient or Public Contribution: Three nursing graduate students participated in the data extraction and integration process, with two students having extensive clinical experience that provided valuable insights for the integration. [ABSTRACT FROM AUTHOR]

This editorial is an introduction to the issue of Footprint 34, 'Narrating Shared Futures'. The issue is dedicated to a transdisciplinary encounter between literature and cultural heritage, namely, here we seek to understand how literature can help us unpack complex meanings of places of heritage, and use that knowledge to imagine, design and produce shared and inclusive futures. We elaborate on three notions that appear in the title of the issue - 'narrating', 'shared' and 'futures' - and then we explain how each of the articles featured in this volume contributes to the proposed framing. We conclude with a brief discussion of ways in which the past, present and future are constantly being made in-the-now through both literary and design techniques. [ABSTRACT FROM AUTHOR]

Major abdominopelvic surgery is an important risk factor for postoperative venous thromboembolism (VTE). VTE is the leading cause of 30-day postoperative mortality in patients with cancer undergoing major abdominopelvic surgery. Randomized controlled trials have shown that extended duration thromboprophylaxis using a low molecular weight heparin or a direct oral anticoagulant significantly decreases the risk of overall VTE (symptomatic events and asymptomatic deep vein thrombosis). Hence, several clinical practice guidelines suggest the use of extended duration thromboprophylaxis for all high-risk patients undergoing major abdominopelvic surgery. Despite these recommendations by clinical practice guidelines, adoption of extended duration thromboprophylaxis in clinical practice remains low and clinical equipoise seems to persist. In this narrative review, we aim is to highlight and summarize the reasons that may explain discrepancy between clinical guideline recommendations and current practice regarding extended duration thromboprophylaxis in this patient population. We also aim to review different personalized approaches based on patients' individualized risk of VTE that may foster shared decision making and improve patient outcomes by reducing decisional conflict, increasing patient knowledge, and increasing risk perception accuracy. • Abdominopelvic surgery is a risk factor for postoperative venous thromboembolism (VTE). • Extended duration thromboprophylaxis decreases the risk of asymptomatic and symptomatic VTE. • Guidelines suggests the use of extended duration thromboprophylaxis in this patient population. • However, adoption is low in clinical practice and equipoise seems to persist. • Many factors are contributing to the discrepancy between guidelines recommendations and clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Alexander Keenan,1 Hoa H Le,1 Kavita Gandhi,2 Lola Adedokun,3 Eddie Jones,4 Mia Unsworth,4 James Pike,5 Emily Trenholm4 1Scientific Affairs, Janssen Pharmaceuticals Inc., Titusville, NJ, USA; 2Research and Development, Janssen Pharmaceuticals Inc., Titusville, NJ, USA; 3Research and Development, Janssen-Cilag Ltd, High Wycombe, UK; 4Central Nervous System, Adelphi Real World, Bollington, Cheshire, UK; 5Statistics & Data Analytics, Adelphi Real World, Bollington, Cheshire, UKCorrespondence: Mia Unsworth, Adelphi Real World, Adelphi Mill, Grimshaw Lane, Macclesfield, Bollington, Cheshire, SK10 5JB, United Kingdom, Tel +441625578677, Email mia.unsworth@adelphigroup.comIntroduction: Multiple sclerosis (MS) is a neurodegenerative disease characterized by progressive deterioration of cognitive and physical functioning, reducing activities of daily living and quality of life (QoL). Several treatments are available that modify the course of the disease and reduce the frequency of relapses. Although effective, all treatment options are accompanied by adverse events, and this study aimed to assess the extent to which patients were involved in the choice of treatment.Methods: Data were drawn from the Adelphi Multiple Sclerosis Disease Specific Program (DSP)™, a cross-sectional survey of healthcare practitioners (HCP) and their patients with MS in real-world clinical settings in Europe and the United States (US) between December 2020 and July 2021. HCPs reported patient demographics, clinical characteristics, current and previous treatment, and treatment outcomes. Patients voluntarily completed questionnaires reporting the physical and psychological impact of their MS and its treatment. Regression analysis with inverse probability of treatment weighting was used to compare treatment outcomes in patients actively involved in their current treatment choice with those who were not.Results: Of a total of 692 patients, median age 40 years and 64% female, mostly diagnosed with relapsing-remitting MS, those who were involved in shared decision-making tended to choose oral therapies such as dimethyl fumarate more often than HCPs. MS had greater impact on physical and psychological functioning in patients whose HCP made treatment decisions solely. Patients involved in decision-making reported greater satisfaction with their treatment and a better QoL.Discussion: Because no single optimal therapy exists for patients with MS, treatments should be individualized with consideration of patients’ preferences. Our study shows that shared decision-making is under-utilized in the management of MS and supports the benefits of patient involvement.Conclusion: Patients who have an active role in treatment decision-making show improved wellbeing and QoL, and overall treatment satisfaction.Plain Language Summary: Multiple sclerosis (MS) is a disease that affects the brain, causing symptoms such as blurred vision and problems with movements, thoughts, and feelings. MS is a lifelong condition that becomes worse over time and limits the activities that people can do. There are many treatments that can help to reduce relapses (when symptoms become worse), but all have their benefits and drawbacks. It is often the physician who decides which treatment to use, but we wanted to know if patients would feel better if they were involved in the decision.Using our standardized and validated questionnaires, we surveyed physicians and nurses who treat patients with MS in Europe and the United States of America between December 2020 and July 2021, to assess how they felt about the treatment they chose and its effect on the patient. We also asked the patients themselves how they felt about their illness and treatment, whether they were given the chance to choose which treatment to take, and how their treatment affected their symptoms and overall quality of life.The information provided by both the physicians and their patients was used to compare how patients responded when they were involved in the treatment decisions. We found that patients who were involved in choosing their treatment were more satisfied with their treatment and responded better than those whose physicians decided alone. Therefore, it is important for physicians treating patients with MS to consider their patients’ preferences when deciding which treatment is best for them.Keywords: multiple sclerosis, patient preference, decision-making, shared, multinational, survey

Previous work presented a reference model for shared autonomous vehicles in urban areas supported by a systematic literature review and topic modeling. The proposed reference model was then evaluated with two real-world demonstrations: the service provided by Waymo in Phoenix and another offered by Baidu in Beijing. In this paper, we present another evaluation based on a survey conducted with a group of potential stakeholders belonging to the mobility industry who were asked about their agreement with each of the concepts in the reference model. The resulting artifact is stronger and more reliable because it reflects the feedback of mobility experts.

OBJECTIVE: Engaging youth and caregivers as active collaborators in the treatment planning process is a patient-centered approach with the potential to facilitate the personalization of established evidence-based treatments. This study is the first randomized clinical trial to evaluate shared decision-making (SDM) to plan youth psychotherapy. METHOD: Forty youth (7-15 years; 33% ethnic minority) were randomly assigned to psychosocial treatment planned using SDM (n = 20) or planned primarily by the clinician (n = 20). In the SDM condition, clinicians guided youth and caregivers through a collaborative treatment planning process that relies on research findings to inform three primary decisions: (a) treatment target problem(s), (b) treatment participants, and (c) treatment techniques. Assessments occurred at baseline, following treatment planning, midtreatment, and post-treatment. RESULTS: Youth and caregivers in the SDM condition reported significantly greater involvement in the treatment planning process compared to their counterparts in the clinician-guided condition (U = 123.00, p = .037; U = 84.50, p = .014, respectively) and SDM caregivers reported significantly lower decisional conflict (U = 72.00, p = .004) and decisional regret (U = 73.50, p = .020). Supporting the feasibility of successful SDM implementation, there were no significant differences between conditions on treatment length, satisfaction with decisions, or engagement. There were no significant diagnostic or symptom differences between conditions. CONCLUSIONS: Planning psychosocial treatments in collaboration with youth and caregivers is a promising way to support youth and caregiver autonomy and plan evidence-based treatments that are responsive to patient preferences, culture, and values. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

OBJECTIVE: To examine pain treatment preferences before and after participation in an N-of-1 trial. STUDY DESIGN AND SETTING: In this observational study nested within a randomized trial, we examined chronic pain patients preferences before and after treatment in relation to N-of-1 trial results; assessed the influence of different schemes for defining comparative superiority on potential conclusions; and generated classification trees illustrating the relationship between pre-treatment preferences, N-of-1 trial results, and post-treatment preferences. RESULTS: Treatment preferences differed pre- and post-trial for 40% of participants. The proportion of patients whose N-of-1 trials demonstrated superiority of one treatment regimen over the other varied depending on how superiority was defined and ranged from 24% (using criteria that required statistically significant differences between regimens) to 62% (when relying only on differences in point estimates). Regardless of criteria for declaring treatment superiority, nearly three-fourths of patients with equivocal N-of-1 trial results nevertheless expressed definite preferences post-trial. CONCLUSION: A large segment of patients undergoing N-of-1 trials for chronic pain altered their treatment preferences. However, the direction of preference change did not necessarily correspond to the N-of-1 results. More research is needed to understand how patients use N-of-1 trial results, why preferences are sticky even in the face of personalized data, and how patients and clinicians might be educated to use N-of-1 trial results more informatively.

Abstract Most cancers occur in older people and the burden in this age group is increasing. Over the past two decades the evidence on how best to treat this population has increased rapidly. However, implementation of new best practices has been slow and needs involvement of policymakers. This perspective paper explains why older people with cancer have different needs than the wider population. An overview is given of the recommended approach for older people with cancer and its benefits on clinical outcomes and cost-effectiveness. In older patients, the geriatric assessment (GA) is the gold standard to measure level of fitness and to determine treatment tolerability. The GA, with multiple domains of physical health, functional status, psychological health and socio-environmental factors, prevents initiation of inappropriate oncologic treatment and recommends geriatric interventions to optimize the patient’s general health and thus resilience for receiving treatments. Multiple studies have proven its benefits such as reduced toxicity, better quality of life, better patient-centred communication and lower healthcare use. Although GA might require investment of time and resources, this is relatively small compared to the improved outcomes, possible cost-savings and compared to the large cost of oncologic treatments as a whole.

Abstract Objectives To identify, describe and synthesise the views and experiences of adults living with asthma regarding shared decision‐making (SDM) in the existing qualitative literature Methods We conducted a comprehensive search of 10 databases (list databases) from inception until September 2023. Screening was performed according to inclusion criteria. Tools from the Joanna Briggs lnstitute were utilised for the purposes of data extraction and synthesis in this study. The data extraction process in this study employed the Capability, Opportunity and Motivation Model of Behaviour (COM‐B model) as a framework, and a pragmatic meta‐aggregative approach was employed to synthesise the collected results. Results Nineteen studies were included in the metasynthesis. Three synthesised themes were identified: the capability of people living with asthma, the opportunities of people living with asthma in SDM, and the motivation of the people living with asthma in SDM. Conclusions We have identified specific factors influencing people living with asthma engaging in SDM. The findings of this study can serve as a basis for the implementation of SDM in people living with asthma and provide insights for the development of their SDM training programs. The ConQual score for the synthesised findings was rated as low. To enhance confidence, future studies should address dependability and credibility factors. Practice Implications This review contemplates the implementation of SDM from the perspective of people living with asthma, with the aim of providing patient‐centred services for them. The results of this review can benefit the implementation of SDM and facilitate information sharing. It offers guidance for SDM skills training among adults living with asthma, fosters a better doctor–patient relationship and facilitates consensus in treatment decisions, thereby enabling personalised and tailored medical care. Patient or Public Contribution Three nursing graduate students participated in the data extraction and integration process, with two students having extensive clinical experience that provided valuable insights for the integration.

Introduction We aimed to develop a decision aid to support shared-decision making between physicians and women with average breast cancer risk when deciding whether to participate in breast cancer screening. Methods We included women at average risk of breast cancer and physicians involved in supporting the decision of breast cancer screening from an Academic Hospital in Buenos Aires, Argentina. We followed the International Patient Decision Aid Standards to develop our decision aid. Guided by a steering group and a multidisciplinary consultancy group including a patient advocate, we reviewed the evidence about breast cancer screening and previous decision aids, explored the patients' information needs on this topic from the patients' and physicians' perspective using semi-structured interviews, and we alpha-tested the prototype to determine its usability, comprehensibility and applicability. Results We developed the first prototype of a web-based decision aid to use during the clinical encounter with women aged 40 to 69 with average breast cancer risk. After a meeting with our consultancy group, we developed a second prototype that underwent alpha-testing. Physicians and patients agreed that the tool was clear, useful and applicable during a clinical encounter. We refined our final prototype according to their feedback. Conclusion We developed the first decision aid in our region and language on this topic, developed with end-users' input and informed by the best available evidence. We expect this decision aid to help women and physicians make shared decisions during the clinical encounter when talking about breast cancer screening.