Bridging Gaps in Shared Decision-Making for Anxiety Disorders: A Commentary on Villena et al.

This commentary reflects on the recent study by Villena et al., which addresses the need for enhanced shared decision-making (SDM) for individuals with anxiety disorders. As a psychiatrist with expertise in anxiety management, I commend the study's emphasis on patient involvement and its alignment with real-world clinical challenges. The findings, particularly regarding patients' preferences for psychological interventions and the current trend towards pharmacological treatments, highlight the need to better align treatment approaches with evidence-based guidelines. Additionally, the study underscores the importance of psychoeducation and active coping strategies like exposure techniques. These insights offer valuable contributions towards improving patient-centred care and SDM in anxiety disorder treatment.

An adapted taxonomy and framework for monitoring road safety strategies: a case study of Morocco.

Traditional approaches to monitoring road safety have primarily focused on measuring outcomes such as the number of fatalities and injuries. While effective in capturing overall trends, this macroscopic approach often overlooks the underlying causes of unsafe conditions. Recognizing these limitations, many countries now embrace a safe system-based approach, which emphasizes a holistic view of road safety, considering various elements and their interactions. In response to this shift, this study introduces a five-step framework designed to provide comprehensive coverage and tailored assistance in selecting and utilizing appropriate Road Safety Indicators (RSIs) for more effective performance monitoring. The framework integrates a novel RSIs taxonomy aligned with critical elements of the safe system. It also incorporates an MCDA-based approach to account for decision-makers' preferences when selecting suitable RSIs. A case study demonstrates the practical application of the proposed steps, including the identification, classification, selection, and development of descriptive sheets for each selected RSI, as well as the continuous updating of the RSIs set. The findings offered valuable insights into the commonly used indicators in international road safety reports, while also revealing the limitations of currents metrics and data in fully capturing critical elements and hierarchical level within the road safety management system.

Age Differences in Consulting Others During Decision Making.

OBJECTIVES: Many choices are made in the context of one's social network, but age differences in consulting others during decision-making remain underexplored. This pre-registered study examined age differences in the composition of decision-related social networks and associated social preferences and motivations. Based on prior findings regarding age differences in information-seeking and socioemotional preferences, we predicted that with advanced age people would consult fewer and more emotionally close social partners, consult them less frequently, rate consultations as more helpful, and prioritize social goals during decision-making. METHODS: An adult lifespan sample (N = 485; Mage = 51.08; SDage = 19.63, rangeage = 18-96 years) considered hypothetical choices and reported how many and what types of people they would consult and how often they would consult them. They also identified their most important decision consultants and evaluated interactions with those individuals. RESULTS: As predicted, age was associated with consulting fewer people less frequently and this was not explained by having a smaller range of potential consultants in one's network. Contrary to predictions, the proportion of close social partners in decision networks and the perceived helpfulness of consultants did not vary significantly by age. Moreover, older adults were less likely than younger adults to prioritize relationship quality over decision quality. Controlling for potential covariates did not diminish the observed age effects. DISCUSSION: These findings align with the prior literature on age-related decrements in pre-decisional information seeking but suggest that age-related preferences for close social partners and socioemotional goals do not extend to decision-related consultations.

Establishing Triage Competencies and Verification Processes: A Survey Study.

INTRODUCTION: Although the ED triage function is a critical means of ensuring patient safety, core competencies for ED triage are not well defined in the literature. The purpose of the study was to identify and validate emergency triage nursing competencies and to develop a competency verification process. METHODS: A sample of 1181 emergency nurses evenly divided between roles with oversight of triage training and competency assessment (manager-level and staff nurses performing triage) completed an online survey evaluating competency elements that comprised the following in terms of frequency and importance, training modalities, and evaluation methods: expert assessment, clinical judgment, management of medical resources, communication, and timely decisions. RESULTS: Both manager-level and triage nurses agreed on the importance of the identified competencies. Gaps in training and evaluation were reported by both staff nurses and manager-level nurses. Triage nurses reported less training offered and less competency evaluation compared with manager-level nurses. Triage nurses reported performing all competencies more frequently and at higher level of competency than manager-level nurses reporting on triage nurse performance. DISCUSSION: This study provides both a standard set of triage competencies and a method by which to evaluate them. Managers and educators might consider this standard to establish initial triage role competency and periodic competency assessment per institutional guidelines. The gap in perceived education and evaluation suggests that standard education and evaluation processes be adopted across emergency departments.

"I Do Not Believe We Should Disclose Everything to an Older Patient": Challenges and Ethical Concerns in Clinical Decision-Making in Old-Age Care in Ethiopia.

Clinical decision-making in old-age care is a complex and ethically sensitive process. Despite its importance, research addressing the challenges of clinical decision-making in old-age care within this cultural context is limited. This study aimed to explore the challenges and ethical concerns in clinical decision-making in old-age care in Ethiopia. This qualitative study employed an inductive approach with data collected via semi-structured interviews with 20 older patients and 26 health professionals recruited from healthcare facilities in Ethiopia. Data were analysed using reflexive thematic analysis. Our analysis identified three key themes. First, participants highlighted perceptions that older patients' religious beliefs interfere with the clinical decisions both older patients and health professionals make. Second, older patients often receive limited information from health professionals about their diagnosis and treatment. Third, families of older patients appear to strongly influence clinical decisions made by older patients or health professionals. This research enhances the understanding of clinical decision-making in old-age care within Ethiopia, a context where such research is scarce. As a result, this study contributes towards advancing the deliberation of ethical dilemmas that health professionals who work with older patients in Ethiopia might face. A key implication of the study is that there is a need for more ethics and cultural competence training for health professionals working with older patients in Ethiopia.

A review of national climate policies via existing databases.

Various databases have been developed to track national climate policy efforts. These datasets facilitate comparisons across countries regarding policy activity, instrument choice, and policy effectiveness. This article evaluates these datasets to see whether they converge in their observations about climate policy development. Our findings reveal that all datasets agree at the aggregate level in that they show that ever-more climate policies are being adopted. However, they diverge significantly when scrutinizing more nuanced elements like policy instrument types and their stringency. The main contributions of our review are to highlight what research endeavors are already possible with existing datasets and to identify the gaps that still remain. We also provide concrete suggestions on how to enhance the existing datasets, making them more useful for social science research on climate policy. The article provides the most comprehensive and up-to-date source for scholars and practitioners interested in the comparative analysis of governmental climate policy efforts.

Evidence for interacting but decoupled controls of decisions and movements in non-human primates.

Many recent studies indicate that control of decisions and actions is integrated during interactive behavior. Among these, several carried out in humans and monkeys conclude that there is a co-regulation of choices and movements. Another perspective, based on human data only, proposes a decoupled control of decision duration and movement speed, allowing for instance to trade decision duration for movement duration when time pressure increases. Crucially, it is not currently known whether this ability to flexibly dissociate decision duration from movement speed is specific to humans, whether it can vary depending on the context in which a task is performed, and whether it is stable over time. These are important questions to address, especially to rely on monkey electrophysiology to infer the neural mechanisms of decision-action coordination in humans. To do so, we trained two macaque monkeys in a perceptual decision-making task and analyzed data collected over multiple behavioral sessions. Our findings reveal a strong and complex relationship between decision duration and movement vigor. Decision duration and action duration can co-vary but also "compensate" each other. Such integrated but decoupled control of decisions and actions aligns with recent studies in humans, validating the monkey model in electrophysiology as a means of inferring neural mechanisms in humans. Crucially, we demonstrate for the first time that this control can evolve with experience, in an adapted manner. Together, the present findings contribute to deepening our understanding of the integrated control of decisions and actions during interactive behavior.

Predictors of mastectomy in breast cancer patients with complete remission of primary tumor after neoadjuvant therapy: A retrospective study.

INTRODUCTION: Neoadjuvant therapy (NAT) should increase the rate of breast-conserving surgery (BCS) in non-metastatic breast cancer (BC) patients, especially in those achieving tumor shrinkage. Still, the conversion from a pre-planned mastectomy to BCS in patients responding to NAT is not a widespread standard. We aimed to identify factors influencing surgical choices in this setting. MATERIALS AND METHODS: We retrospectively collected data of BC patients with complete remission of primitive tumor (ypT0) after NAT, treated with BCS or mastectomy in two Italian breast units. Predictors of mastectomy were explored using logistic regression. Distant recurrence and event-free survival were assessed in the BCS and mastectomy cohort. RESULTS: 243 patients were included, 147 (60.5 %) treated with BCS and 96 (39.5 %) treated with mastectomy. In the mastectomy group, there were more centrally-located, multiple and larger tumors. At univariate regression analysis, central location, baseline tumor extension on ultrasound (US) and magnetic resonance imaging (MRI), multiple foci and clinical stage were significantly associated with the chance of receiving mastectomy. At multivariate analysis, only baseline focality on US and extension on MRI retained significance as predictors of mastectomy. Distant recurrence and event-free survival were significantly longer in patients undergoing BCS. CONCLUSION: Baseline tumor extension and focality were the main predictors of mastectomy in patients with ypT0 after NAT. However, BCS did not negatively affect survival outcomes in our cohort. An effort should be made to avoid potentially unnecessary mastectomy in this population, aiming at minimizing surgery-associated toxicities and improving patients' quality of life.

Teamwork in Clinical Medicine.

Clinical teams are at the heart of healthcare value. Teamwork requires an appreciation of the unique geniuses of each team member as well as an understanding of team dynamics and larger organizational challenges. Effective teams leverage each member's unique talents within a culture of shared humility, service, and dedication. While interpersonal communication is paramount, organizations which promote a culture of psychological safety to allow productive and necessary conflict are most effective at the fostering shared commitment that allows real accountability and result-oriented, responsive systems. Healthy teams can serve to energize clinicians to provide outstanding service and high value care.

Do stress hormones influence choice? A systematic review of pharmacological interventions on the HPA axis and/or SAM system.

The hypothalamus-pituitary-adrenal axis (HPA axis) and the sympathetic-adrenal-medullary system (SAM system), two neuroendocrine systems associated with the stress response, have often been implicated to modulate decision-making in various domains. This systematic review summarizes the scientific evidence on the effects of pharmacological HPA axis and SAM system modulation on decision-making. We found 6375 references, of which 17 studies fulfilled our inclusion criteria. We quantified the risk of bias in our results with respect to missing outcome data, measurements, and selection of the reported results. The included studies administered hydrocortisone, fludrocortisone (HPA axis stimulants), yohimbine, reboxetine (SAM system stimulants), and/or propranolol (SAM system inhibitor). Integrating the evidence, we found that SAM system stimulation had no impact on risk aversion, loss aversion or intertemporal choice, while SAM system inhibition showed a tentative reduction in sensitivity to losses. HPA axis stimulation had no effect on loss aversion or reward anticipation but likely a time-dependent effect on decision under risk. Lastly, combined stimulation of both systems exhibited inconsistent results that could be explained by dose differences (loss aversion) and sex differences (risk aversion). Future research should address time-, dose-, and sex-dependencies of pharmacological effects on decision-making.

Strengthening nutrition policy and service delivery: Lessons learned from a six-country assessment of Alive and Thrive's technical assistance.

Alive & Thrive (A&T) provides strategic technical assistance (TA) to develop effective policies; improve maternal, infant, and young child nutrition (MIYCN) programme design and implementation and enhance system capacity to sustain quality MIYCN service delivery at scale. A qualitative assessment was conducted using document review and stakeholder interviews (n = 79) to describe a selection of A&T's TA in six countries and systematically assess the contextual and TA process-related factors that influenced the results achieved and document the lessons learned about MIYCN TA design and implementation. To facilitate the selection of different types of TA, we classified TA into two levels of stakeholder engagement and intensity. Under the Technical Advisor TA category, we assessed A&T's support to strengthen national policy formulation, monitoring, and implementation of the International Code of Marketing of Breast-milk Substitutes. For Capacity Development TA, we assessed A&T support to scale-up maternal nutrition services and to increase strategic use of data. Factors important for TA provision included identifying and engaging with the right people, using evidence to support advocacy and decision-making, using multiple ways to strengthen capacity, developing packages of tools to support programme scale-up, and reinforcing feedback mechanisms to improve service provision and data quality. Challenges included shifts in the political context, poorly functioning health systems, and limited resources to replicate or sustain the progress made. Continued investment in evidence-based and practical TA that strengthens the institutionalization of nutrition across all stakeholders-including government, medical associations, civil society and development partners-is essential. Future TA must support governments to strengthen system capacity for nutrition, including financial and human resource gaps that hamper full scale-up.

Erratum: Assessing the credibility of a drug's effects: identification and judgment of uncertainty by the Dutch Medicines Evaluation Board.

[This corrects the article DOI: 10.3389/fmed.2024.1409259.].

Emerging perspectives for the study of the neural basis of motor behaviour.

The 33rd Annual Meeting of the Society for the Neural Control of Movement (NCM) brought together over 500 experts to discuss recent advancements in motor control. This article highlights key topics from the conference, including the foundational mechanisms of motor control, the ongoing debate over the context-dependency of feedforward and feedback processes, and the interplay between motor and cognitive functions in learning, memory, and decision-making. It also presents innovative methods for studying movement in complex, real-world environments.

Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making.

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.

La toma de decisiones por parte de familias y profesionales acerca de cómo apoyar el desarrollo de los niños es un aspecto integral de las visitas a casa. Este estudio investigó la decisión de hacer visitas a casa en el programa de Estados Unidos para familias que viven en pobreza, "De un comienzo temprano" (Early Head Start), a través de las siguientes preguntas: ¿Qué tipo de decisiones toman las visitadoras a casa y las familias acerca del desarrollo de los niños durante las visitas a casa del programa "De un comienzo temprano?" ¿Cómo y hasta qué punto las visitadoras a casa y las familias participan durante la toma de estas decisiones? Se implementó un diseño convergente mixto de métodos de investigación para investigar la participación por medio de conteos frecuentes y análisis de las transcritas conversaciones de la visita a casa. Las visitadoras a casa que participaron fueron cuatro mujeres, tres blancas y una de raza negra. Doce familias participaron (12 mamás, 2 papás). Los progenitores se identificaron como blancos (n = 8), negros (n = 3) y multirraciales (n = 3, negros y blancos). Uno de los progenitores era hablante bilingüe de árabe e inglés. Se identificó un total de 66 decisiones acerca del desarrollo de los niños, de las cuales 49 fueron iniciadas por las visitadoras a casa y 17 por las familias. Aunque las familias hablaron más y asumieron un papel activo cuando hablaban primero sobre las decisiones (v.g., cuando abrían la conversación), las visitadoras a casa predominantemente controlaron la toma de decisiones. La participación cuantitativa y cualitativa difirió sólo al principio de las decisiones iniciadas por las familias y las visitadoras a casa gradualmente asumieron mayor control.

Decision regret analysis in early URSL vs medical expulsive therapy 1 for ureteric calculi ≤ 1cm.

BACKGROUND: The study assesses the decisional regret following Shared Decision-making (SDM) in patients selecting either early ureteroscopic lithotripsy (URSL) or medical expulsive therapy (MET) for ureteric stones ≤ 1 cm, with the aim to evaluate their decisional Conflict, satisfaction, and regret regarding their opted treatment choices. METHODS: Adults aged more than 18 years with one stone up to 1 cm in either ureter were included. After SDM, the patients were allocated into their opted group viz. URSL or MET. Patients in each group were reassessed at "treatment completion". Cambridge Ureteric Stone PROM (CUSP) questionnaire for HRQoL, Decision Regret Scale and the OPTION scale (SDM) were filled at treatment completion. FINDINGS: 111 patients opted for MET, while 396 patients opted for early URSL. Mean stone size was larger in URSL group (7.16 ± 1.63 mm vs. 5.50 ± 1.89; p < 0.001). Decisional conflict was higher in patients opting for URSL (77.3% vs. 57.7%; p < 0.001). Stone-free rate at four weeks was higher in URSL group (87.1%vs68.5%, p < 0.001). Decisional regret was higher in patients opting for MET (33.24 ± 30.89 vs. 17.26 ± 12.92; p = 0.002). Anxiety, was higher in patients opting for MET (6.94 ± 1.89 vs. 5.85 ± 1.54; p < 0.001). Urinary symptoms and interference in patients' travel plans and work-related activities were more in URSL group (6.21 ± 1.57 vs. 5.59 ± 1.46; p < 0.001 and 6.56 ± 1.59 vs. 6.05 ± 1.72; p < 0.001 respectively). INTERPRETATION: After SDM, decisional regret is higher in patients opting for MET mainly due protracted treatment duration with increased pain and anxiety during the treatment course and the need for additional procedure for attaining stone clearance and the. Despite higher decisional conflict, a larger proportion of patients opt for early URSL with the aim of avoiding anxiety and achieving early stone clearance.

Routine health data use for decision making and its associated factors among primary healthcare managers in dodoma region.

BACKGROUND: Data demand and use culture have a tremendous impact on the proper allocation of scarce resources and evidence-based decision making. However, primary healthcare managers in the majority of Sub-Saharan African countries continue to struggle with using routine health data for decision-making. PURPOSE/OBJECTIVE: This study aimed to assess routine health data use for decision making among primary healthcare managers in Dodoma region. METHODS: Cross-sectional study design involved 188 primary healthcare managers from Dodoma City Council, Kondoa Town Council and Bahi District Council was conducted. A self-administered questionnaire adapted from the Performance of Routine Information System Management (PRISM) tools was used to collect the data. Data was analysed by using the Statistical Package for Social Science (SPSS) program. Principal Component Analysis was used to find the level of routine health data use, binary logistic regression analysis was used to determine factors associated with routine health data use for decision making among primary healthcare managers. The study was conducted from May to June, 2022. RESULTS: The level of adequate routine health data use for decision making among healthcare managers was 63.30%. Factors associated with adequate routine health data use for decision making among healthcare managers were; respondents characteristics: years of working experience (OR = 1.955, 95% CI= [0.892,4.287]), district surveyed (OR = 4.760, 95%CI= [1.412,16.049]), level of health facility (OR = 3.867, 95%CI= [1.354,7.122]) and male gender (OR = 1.901, 95%CI= [1.027,3.521]). Individual factors: comparing data with strategic objectives (OR = 2.986, 95%CI= [1.233-7.229]), decision based on health needs (OR = 7.330, 95%CI= [1.968-27.295]) and decision based on detection of outbreak (OR = 3.769, 95%CI= [1.091-13.019]). Technical factors: ability to check data accuracy (OR = 3.120, 95%CI= [1.682-5.789]), ability to explain findings and its implication (OR = 2.443, 95%CI= [1.278-4.670]) and ability to use information to identity gaps and targets (OR = 2.621, 95%CI= [1.381-4.974]). Organizational factors: organizational support (OR = 3.530, CI= [1.397-8.919]), analyse data regularly (OR = 2.026, 95%CI= [1.075-3.820]) and displays information on key performance indicators (OR = 3.464, 95%CI= [1.525-7.870]). CONCLUSION AND RECOMMENDATION: The level of routine health data use for decision making among primary healthcare managers was found to be modest. The level of data demand and use culture may increase more quickly if capacity building is strengthened and issues that de-motivate primary health care managers from using data are addressed.

Clinical decision-making during childbirth in health facilities from the perspectives of labouring women, relatives, and health care providers: A scoping review.

PROBLEM: For health care providers to ensure appropriate decision-making in clinical settings during childbirth, facilitators and barriers must be identified. BACKGROUND: Women who experience a sense of control by participating in the decision-making process, are more likely to have a positive birth experience. However, decision-making may involve hierarchies of close observation and control. AIM: The aim of the scoping review was to map and summarise existing literature on the process of clinical decision-making during childbirth from the perspective of labouring women, relatives and health care providers. METHODS: We carried out a scoping review in line with Joanna Briggs Institute scoping review methodology. The search identified studies in Scandinavian or English languages from 2010 - Jan 2023 comprising evidence at different levels of the pyramid, resulting in 18.227 hits. Following the PRISMA checklist, the final inclusion comprised 62 papers. FINDINGS: Four main categories summarized the importance of the following factors: 1) Woman-caregiver relationship, with sub-categories The importance of communication and Midwifery care, 2) Consent and legal issues, 3) Organization, with sub-categories Medicalization, Working atmosphere, and Complexity, and 4) Decision-making tools and models, with sub-categories Shared decision-making, and Other tools and models for decision-making. CONCLUSION: Balancing intuition and expertise of caregivers with evidence-based practices, is crucial to ensure women's participation in decision-making. Furthermore, a trusting relationship between the mother, partner, and health care provider is of utmost importance. Shared decision-making, which appeared to be the primary model for clinical decision-making regardless context, requires reflective practice and is a communication strategy.

Assessing the Burden of Atopic Dermatitis in Portugal through Patient-Centered Experiences.

INTRODUCTION: Adult patients and caregivers of children with atopic dermatitis experience high physical, mental, and financial burden in Portugal. We outline the experience of atopic dermatitis management and how the current medical care model impacts patient-centered concerns such as financial burden, quality of life, disease burden, and treatment satisfaction. METHODS: We conducted a survey of 419 Portuguese adults and caregivers of children to capture the experience of managing atopic dermatitis in Portugal. RESULTS: Respondents reported average satisfaction with treatment, with a mean satisfaction rating of 3.15/5.00 (SD = 0.77). Adults reported slightly better control of atopic dermatitis symptoms (mean = 56.6) than pediatric patients (mean = 55.9, caregiver reported). Nearly 34% of adults and 39% of caregivers of children and adolescents indicated that their healthcare providers asked about their priorities at the last medical visit. Additionally, only 40% of adult patients and 32% of caregivers reported that patient training was offered to them. Respondents seeing dermatologists reported higher satisfaction than those seeing other healthcare providers (p = 0.01) but there were no differences in long-term control of symptoms by provider type (p = 0.85) when controlling for severity. Portuguese adult patients scored 0.86/1.00 on the EQ-5D (where 0 = death and 1 = perfect health). Financial concern was high as nearly 80% of patients and caregivers reported using savings, borrowing money, and/or reducing spending to cover atopic dermatitis-related costs. CONCLUSION: Portuguese patients with atopic dermatitis and caregivers experience financial burden, lower health-related quality of life, higher disease burden, and treatment satisfaction issues with their current medical care. These factors often deteriorate as the disease's severity increases. Providers, researchers and policymakers should focus on better addressing patient-centered concerns for individuals suffering from atopic dermatitis to improve care and health outcomes.