Women's involvement in decision-making and association with reproductive health behaviors: findings from a cross-sectional survey in Niger.

BACKGROUND: Though women in Niger are largely responsible for the familial health and caretaking, prior research shows limited female autonomy in healthcare decisions. This study extends current understanding of women's participation in decision-making and its influence on reproductive health behaviors. METHODS: Cross-sectional survey with married women (15-49 years, N = 2,672) in Maradi and Zinder Niger assessed women's participation in household decision-making in health and non-health issues. Analyses examined [1] if participation in household decision-making was associated with modern contraceptive use, antenatal care (ANC) attendance, and skilled birth attendance at last delivery and [2] what individual, interpersonal, and community-level factors were associated with women's participation in decision-making. RESULTS: Only 16% of the respondents were involved-either autonomously or jointly with their spouse-in all three types of household decisions: (1) large purchase, (2) visiting family/parents, and (3) decisions about own healthcare. Involvement in decision making was significantly associated with increased odds of current modern contraceptive use [aOR:1.36 (95% CI: 1.06-1.75)] and four or more ANC visits during their recent pregnancy [aOR:1.34 (95% CI: 1.00-1.79)], when adjusting for socio-demographic characteristics. There was no significant association between involvement in decision-making and skilled birth attendance at recent delivery. Odds of involvement in decision-making was significantly associated with increasing age and household wealth status, listening to radio, and involvement in decision-making about their own marriage. CONCLUSION: Women's engagement in decision-making positively influences their reproductive health. Social and behavior change strategies to shift social norms and increase opportunities for women's involvement in household decision making are needed. For example, radio programs can be used to inform specific target groups on how women's decision-making can positively influence reproductive health while also providing specific actions to achieve change. Opportunities exist to enhance women's voice either before women enter marital partnerships or after (for instance, using health and social programming).

Implementing a shared decision-making intervention to support treatment decisions for patients following an anterior cruciate ligament rupture - a protocol for the POP-ACLR feasibility study.

BACKGROUND: Treatment for anterior cruciate ligament (ACL) rupture may follow a surgical or nonsurgical pathway. At present, there is uncertainty around treatment choice. Two shared decision-making tools have been codesigned to support patients to make a decision about treatment following an ACL rupture. The shared decision-making tools include a patient information leaflet and an option grid. We report the protocol for a mixed-methods feasibility study, with nested qualitative interviews, to understand feasibility, acceptability, indicators of effectiveness and implementation factors of these shared decision-making tools (combined to form one shared decision-making intervention). METHODS: A single-centre non-randomised feasibility study will be conducted with 20 patients. Patients diagnosed with an ACL rupture following magnetic resonance imaging will be identified from an orthopaedic clinic. The shared decision-making intervention will be delivered during a clinical consultation with a physiotherapist. The primary feasibility outcomes include the following: recruitment rate, fidelity, acceptability and follow-up questionnaire completion. The secondary outcome is the satisfaction with decision scale. The nested qualitative interview will explore experience of using the shared decision-making intervention to understand acceptability, implementation factors and areas for further refinement. DISCUSSION: This study will determine the feasibility of using a newly developed shared decision-making intervention designed to support patients to make a decision about treatment of their ACL rupture. The acceptability and indicators of effectiveness will also be explored. In the long term, the shared decision-making intervention may improve service and patient outcomes and ensure cost-effectiveness for the NHS; ensuring those most likely to benefit from surgical treatment proceed along this pathway. TRIAL REGISTRATION: Pending registration on ISRCTN.

Clinical Decision Making in Inflammatory Bowel Disease Mimics: Practice Management from Inflammatory Bowel Disease LIVE.

Background: Since 2009, inflammatory bowel disease (IBD) specialists have utilized "IBD LIVE," a weekly live video conference with a global audience, to discuss the multidisciplinary management of their most challenging cases. While most cases presented were confirmed IBD, a substantial number were diseases that mimic IBD. We have categorized all IBD LIVE cases and identified "IBD-mimics" with consequent clinical management implications. Methods: Cases have been recorded/archived since May 2018; we reviewed all 371 cases from May 2018-February 2023. IBD-mimics were analyzed/categorized according to their diagnostic and therapeutic workup. Results: Confirmed IBD cases made up 82.5% (306/371; 193 Crohn's disease, 107 ulcerative colitis, and 6 IBD-unclassified). Sixty-five (17.5%) cases were found to be mimics, most commonly medication-induced (n = 8) or vasculitis (n = 7). The evaluations that ultimately resulted in correct diagnosis included additional endoscopic biopsies (n = 13, 21%), surgical exploration/pathology (n = 10, 16.5%), biopsies from outside the GI tract (n = 10, 16.5%), genetic/laboratory testing (n = 8, 13%), extensive review of patient history (n = 8, 13%), imaging (n = 5, 8%), balloon enteroscopy (n = 5, 8%), and capsule endoscopy (n = 2, 3%). Twenty-five patients (25/65, 38%) were treated with biologics for presumed IBD, 5 of whom subsequently experienced adverse events requiring discontinuation of the biologic. Many patients were prescribed steroids, azathioprine, mercaptopurine, or methotrexate, and 3 were trialed on tofacitinib. Conclusions: The diverse presentation of IBD and IBD-mimics necessitates periodic consideration of the differential diagnosis, and reassessment of treatment in presumed IBD patients without appropriate clinical response. The substantial differences and often conflicting treatment approaches to IBD versus IBD-mimics directly impact the quality and cost of patient care.

Scandinavian perspectives on life support at the border of viability.

Advances in neonatal medicine have allowed us to rescue extremely preterm infants. However, both long-term vulnerability and the burden of treatment in the neonatal period increase with decreasing gestational age. This raises questions about the justification of life support when a baby is born at the border of viability, and has led to a so-called "grey zone", where many professionals are unsure whether provision of life support is in the child's best interest. Despite cultural, political and economic similarities, the Scandinavian countries differ in their approach to periviable infants, as seen in their respective national guidelines and practices. In Sweden, guidelines and practice are more rescue-focused at the lower end of the border of viability, Danish guidelines emphasizes the need to involve parental views in the decision-making process, whereas Norway appears to be somewhere in between. In this paper, I will give an overview of national consensus documents and practices in Norway, Sweden and Denmark, and reflect on the ethical justification for the different approaches.

When failure is not an option: a police firearms training concept for improving decision-making in shoot/don't shoot scenarios.

Sometimes, policing requires a quick and correct assessment of potentially hazardous situations. The training of tactical gaze control and visual attention, and its positive impact on efficient shoot/don't shoot decisions in police cadets' use of firearms has recently been demonstrated. On this basis, we designed an individual videobased police firearms training that was grounded on the Four-Component Instructional Design Model (4C/ID). We shifted toward an individual blended learning approach where we applied an intervention training focused on situational awareness, tactical gaze control, and visual attention. In a preregistered lab experiment, N = 45 senior police officers were randomly allocated to the intervention training or an active control training that resembled a traditional police firearms training. Both groups watched a self-produced educational video before proceeding to the practical training in our indoor firing range. In a pre- and post-test, they engaged in realistic shoot/don't shoot video scenarios. Both groups did very well regarding decision-making, the optimal muzzle position, and the tactical conduct to keep both eyes open before shooting. Although both groups performed on a comparable level in the pre-test's shoot scenarios, the intervention group significantly improved their response times and time until the first hit. Overall, we were able to provide an adapted, didactically based police firearms training that supplements current standards. We demonstrated that experts are still susceptible to innovative training concepts and therefore substantiate the recommendation to devote more attention to approaches that emphasize the importance of situational awareness, tactical gaze control, and visual attention in police firearms training.

The Insular Cortex: An Interface Between Sensation, Emotion and Cognition.

The insula is a complex brain region central to the orchestration of taste perception, interoception, emotion, and decision-making. Recent research has shed light on the intricate connections between the insula and other brain regions, revealing the crucial role of this area in integrating sensory, emotional, and cognitive information. The unique anatomical position and extensive connectivity allow the insula to serve as a critical hub in the functional network of the brain. We summarize its role in interoceptive and exteroceptive sensory processing, illustrating insular function as a bridge connecting internal and external experiences. Drawing on recent research, we delineate the insular involvement in emotional processes, highlighting its implications in psychiatric conditions, such as anxiety, depression, and addiction. We further discuss the insular contributions to cognition, focusing on its significant roles in time perception and decision-making. Collectively, the evidence underscores the insular function as a dynamic interface that synthesizes diverse inputs into coherent subjective experiences and decision-making processes. Through this review, we hope to highlight the importance of the insula as an interface between sensation, emotion, and cognition, and to inspire further research into this fascinating brain region.

Neural Signatures of Evidence Accumulation Encode Subjective Perceptual Confidence Independent of Performance.

Confidence is an adaptive computation when environmental feedback is absent, yet there is little consensus regarding how perceptual confidence is computed in the brain. Difficulty arises because confidence correlates with other factors, such as accuracy, response time (RT), or evidence quality. We investigated whether neural signatures of evidence accumulation during a perceptual choice predict subjective confidence independently of these factors. Using motion stimuli, a central-parietal positive-going electroencephalogram component (CPP) behaves as an accumulating decision variable that predicts evidence quality, RT, accuracy, and confidence (Experiment 1, N = 25 adults). When we psychophysically varied confidence while holding accuracy constant (Experiment 2, N = 25 adults), the CPP still predicted confidence. Statistically controlling for RT, accuracy, and evidence quality (Experiment 3, N = 24 adults), the CPP still explained unique variance in confidence. The results indicate that a predecision neural signature of evidence accumulation, the CPP, encodes subjective perceptual confidence in decision-making independent of task performance.

Improving sepsis classification performance with artificial intelligence algorithms: A comprehensive overview of healthcare applications.

PURPOSE: This study investigates the potential of machine learning (ML) algorithms in improving sepsis diagnosis and prediction, focusing on their relevance in healthcare decision-making. The primary objective is to contribute to healthcare decision-making by evaluating the performance of various supervised and unsupervised models. MATERIALS AND METHODS: Through an extensive literature review, optimal ML models used in sepsis research were identified. Diverse datasets from relevant sources were employed, and rigorous evaluation metrics, including accuracy, specificity, and sensitivity, were applied. Innovative techniques were introduced, such as a Stacked Blended Ensemble Model and Skopt Optimization with Blended Ensemble, incorporating Bayesian optimization for hyperparameter tuning. RESULTS: ML algorithms demonstrate efficacy in sepsis diagnosis, presenting an improved balance between specificity and sensitivity, critical for effective clinical decision-making. Classifier ensemble models show enhanced accuracy and efficiency, with novel optimization techniques contributing to improved adaptability. CONCLUSION: The study emphasizes the potential benefits of ML algorithms in sepsis management, advocating for ongoing research to optimize performance and ensure ethical utilization in healthcare decision-making. Ethical considerations, interpretability, and transparency are crucial factors in implementing these algorithms in clinical practice.

Precision healthcare: A deep dive into machine learning algorithms and feature selection strategies for accurate heart disease prediction.

This paper presents a comprehensive exploration of machine learning algorithms (MLAs) and feature selection techniques for accurate heart disease prediction (HDP) in modern healthcare. By focusing on diverse datasets encompassing various challenges, the research sheds light on optimal strategies for early detection. MLAs such as Decision Trees (DT), Random Forests (RF), Support Vector Machines (SVM), Gaussian Naive Bayes (NB), and others were studied, with precision and recall metrics emphasized for robust predictions. Our study addresses challenges in real-world data through data cleaning and one-hot encoding, enhancing the integrity of our predictive models. Feature extraction techniques-Recursive Feature Extraction (RFE), Principal Component Analysis (PCA), and univariate feature selection-play a crucial role in identifying relevant features and reducing data dimensionality. Our findings showcase the impact of these techniques on improving prediction accuracy. Optimized models for each dataset have been achieved through grid search hyperparameter tuning, with configurations meticulously outlined. Notably, a remarkable 99.12 % accuracy was achieved on the first Kaggle dataset, showcasing the potential for accurate HDP. Model robustness across diverse datasets was highlighted, with caution against overfitting. The study emphasizes the need for validation of unseen data and encourages ongoing research for generalizability. Serving as a practical guide, this research aids researchers and practitioners in HDP model development, influencing clinical decisions and healthcare resource allocation. By providing insights into effective algorithms and techniques, the paper contributes to reducing heart disease-related morbidity and mortality, supporting the healthcare community's ongoing efforts.

A breakthrough in macro-scale circularity and eco-efficiency assessment: A case study of OECD countries.

Countries' circularity performance and CO2 emissions should be addressed as a part of the UN net-zero Sustainable Development Goals (SDGs) 2030. Macro-scale circularity assessment is regarded as a helpful tool for tracking and adjusting nations' progress toward the sustainable Circular Economy (CE) and SDGs. However, practical frameworks are required to address the shortage of real-world circularity assessments at the macro level. The establishment of CE benchmarks is also essential to enhance circularity in less sustainable nations. Further, monitoring the extent to which nations' circularity activities are sustainable and in line with the SDGs is an area that lacks sufficient practical research. The current research aims to develop a macro-level framework and benchmarks for national sustainable circularity assessments. Methodologically, we develop a dynamic network data envelopment analysis (DN-DEA) framework for multi-period circularity and eco-efficiency assessment of OECD countries. To do so, we incorporate dual-role and bidirectional carryovers in our macro-scale framework. From a managerial perspective, we conduct a novel comparative analysis of the circularity and eco-efficiency of the nations to monitor macro-scale sustainable CE trends. Research results reveal a significant performance disparity in circularity, eco-efficiency, and benchmarking patterns. Accordingly, circularly efficient nations cannot necessarily be considered eco-friendly and sustainable. Although Germany (as a superior circular nation) can be regarded as a circularity benchmark, it cannot serve as an eco-efficiency benchmark for less eco-efficient nations. Hence, the new method allows decision-makers not only to identify the nations' circularity outcome but also to distinguish sustainable nations from less sustainable ones. This, on the one hand, provides policymakers with a multi-faceted sustainability analysis, beyond the previous unidimensional analysis. On the other, it proposes improvement benchmarks for planning and regulating nations' future circularity in line with real sustainability goals. The capabilities of our innovative approach are demonstrated in the case study.

Influential Factors Impacting Treatment Decision-making and Decision Regret in Patients with Localized or Locally Advanced Prostate Cancer: A Systematic Literature Review.

CONTEXT: Treatment decision-making (TDM) for patients with localized (LPC) or locally advanced (LAPC) prostate cancer is complex, and post-treatment decision regret (DR) is common. The factors driving TDM or predicting DR remain understudied. OBJECTIVE: Two systematic literature reviews were conducted to explore the factors associated with TDM and DR. EVIDENCE ACQUISITION: Three online databases, select congress proceedings, and gray literature were searched (September 2022). Publications on TDM and DR in LPC/LAPC were prioritized based on the following: 2012 onward, ≥100 patients, journal article, and quantitative data. The Preferred Reporting Items Reviews and Meta-analyses guidelines were followed. Influential factors were those with p < 0.05; for TDM, factors described as "a decision driver", "associated", "influential", or "significant" were also included. The key factors were determined by number of studies, consistency of evidence, and study quality. EVIDENCE SYNTHESIS: Seventy-five publications (68 studies) reported TDM. Patient participation in TDM was reported in 34 publications; overall, patients preferred an active/shared role. Of 39 influential TDM factors, age, ethnicity, external factors (physician recommendation most common), and treatment characteristics/toxicity were key. Forty-nine publications reported DR. The proportion of patients experiencing DR varied by treatment type: 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen-deprivation therapy), and 21-47% (combination therapy). Of 42 significant DR factors, treatment toxicity (sexual/urinary/bowel dysfunction), patient role in TDM, and treatment type were key. CONCLUSIONS: The key factors impacting TDM were physician recommendation, age, ethnicity, and treatment characteristics. Treatment toxicity and TDM approach were the key factors influencing DR. To help patients navigate factors influencing TDM and to limit DR, a shared, consensual TDM approach between patients, caregivers, and physicians is needed. PATIENT SUMMARY: We looked at factors influencing treatment decision-making (TDM) and decision regret (DR) in patients with localized or locally advanced prostate cancer. The key factors influencing TDM were doctor's recommendation, patient age/ethnicity, and treatment side effects. A shared, consensual TDM approach between patients and doctors was found to limit DR.

Structure-function relationship of oat flour fractions when blended with wheat flour: Instrumental and nutritional quality characterization of resulting breads.

The present work investigated the structure-function relationship of dry fractionated oat flour (DFOF) as a techno-functional ingredient using bread as a model system. Mechanically, DFOF fractions (F), that is, F1: <224 µm, F2: 250-280 µm, F3: 280-500 µm, F4: 500-600 µm, and whole oat flour (F5) were blended with white wheat flour at 10%, 30%, and 50% substitution levels for bread making. The blended flours, doughs, and bread samples were assessed for their techno-functional, nutritional, and structural characteristics. The results of Mixolab and the Rapid Visco Analyzer show that the 50% substituted F3 fraction exhibits the highest water absorption properties (69.53%), whereas the 50% F1 fraction exhibits the highest peak viscosity of the past slurry. Analysis of bread samples revealed a lower particle size of DFOF fractions and higher supplementation levels, increased ß-glucan levels (0.13-1.29 g/100 bread (db), reduced fermentable monosaccharides, that is, glucose (1.44-0.33 g/100 g), and fructose (1.06-0.28 g/100 g). The effect of particle size surpassed the substitution level effect on bread volume reduction. The lowest hardness value for F1 is 10%, and the highest value for F2 is 50%. The total number of cells in the bread slice decreased from the control to the F4 fraction (50%). Multi-criteria analysis indicated that DFOF fractions produced breads with similar structure and higher nutritional value developed from white wheat flour. PRACTICAL APPLICATION: The use of mechanically fractionated oat flours fractions in white wheat flour breads can improve the nutritional profile without affecting the physical properties of the bread product. Based on the oat flour fractions, bakers and food processing companies can tailor the bread formulations for high ß-glucan, high fiber, and low reduced sugar claims.

Data analytics in the football industry: a survey investigating operational frameworks and practices in professional clubs and national federations from around the world.

The use of data and analytics in professional football organisations has grown steadily over the last decade. Nevertheless, how and whether these advances in sports analytics address the needs of professional football remain unexplored. Practitioners from national federations qualified for the FIFA World Cup Qatar 2022™ and professional football clubs from an international community of practitioners took part in a survey exploring the characteristics of their data analytics infrastructure, their role, and their value for elaborating player monitoring and positional data. Respondents from 29 national federations and 32 professional clubs completed the survey, with response rates of 90.6% and 77.1%, respectively. Summary information highlighted the underemployment of staff with expertise in applied data analytics across organisations. Perceptions regarding analytical capabilities and data governance framework were heterogenous, particularly in the case of national federations. Only a third of national federation respondents (~30%) perceived information on positional data from international sports data analytics providers to be sufficiently clear. The general resourcing limitations, the overall lack of expertise in data analytics methods, and the absence of operational taxonomies for reference performance metrics pose constraints to meaningful knowledge translations from raw data in professional football organisations.

"This patient is not appropriate": Perspectives of physiotherapy students and clinical educators on exposing students to patients with complex needs during clinical practice placements.

BACKGROUND: Clinical practice placements play an important role in preparing students for challenging areas of clinical practice. Little is known about student learning needs for working with patients with complex needs during clinical practice placements, and clinical educator decision-making that underpins this exposure. PURPOSE: To explore the perspectives of physiotherapy students and clinical educators on exposing students to working with and learning from patients with complex needs during clinical practice placements across Queensland and New South Wales, Australia. METHODS: Six semi-structured focus groups with pre-registration physiotherapy students undertaking clinical practice placements (n = 19) and semi-structured one-on-one interviews with clinical educators (n = 20). Data were analyzed using reflexive thematic analysis. RESULTS: Four overarching themes were generated following analysis: 1) Complexity is challenging; 2) Tension between student exposure and patient care; 3) Variance in expectations; and 4) Readiness for complexity. CONCLUSION: Physiotherapy students and clinical educators recognize the challenges and importance of exposure to patients with complex needs. Student learning experiences are influenced by clinical educator decision-making, which is often unclear, leading to varying opportunities. This study highlights the need for enhanced support from clinical educators to prepare students for working with patients with complex needs.

Application of multi-criteria decision-making on low-impact development practice selection for the Kinyerezi River sub-catchments in Dar es Salaam, Tanzania.

The impermeable areas in catchments are proportional to peak flows that result in floods in river reaches where the flow-carrying capacity is inadequate. The high rate of urbanization witnessed in the Kinyerezi River catchment in Dar es Salaam city has been noted to contribute to floods and siltation in the Msimbazi River. The Low-Impact Development (LID) practices that includes bio-retention (BR) ponds, rain barrels (RBs), green roofs (GRs), etc. can be utilized to mitigate portion of the surface runoff. This study aims to propose suitable LID practices and their sizes for mitigating runoff floods in the Kinyerezi River catchment using the Multi-Criteria Decision-Making (MCDM) approach. The results indicated that the BR and RBs were ranked high in capturing the surface runoff while the sediment control fences were observed to be the best in reducing sediments flowing into the BR. The proposed BR ponds were greater than 800 m2 with 1.2 m depth while RB sizes for Kinyerezi and Kisungu secondary schools and Kinyerezi and Kifuru primary schools were 2,730; 2,748; 1,385; and 1,020 m3, respectively. The BR ponds and RBs are capable of promoting water-demanding economic activities such as horticulture, gardening, car washing while reducing the school expenses and runoff generation.

Iterative Development of an Interactive Website to Support Shared Decision-Making in Metastatic Breast Cancer.

Recent treatment advances have resulted in significantly increased survival times following metastatic breast cancer (MBC) diagnosis. Novel treatment approaches-and their related side effects-have changed the landscape of MBC treatment decision-making. We developed a prototype of an online educational tool to prepare patients with MBC for shared decision-making with their oncologists. We describe the five phases of tool development: (1) in-depth, semi-structured qualitative interviews and (2) feedback on storyboards of initial content with patients with MBC and oncology providers. This was followed by three phases of iterative feedback with patients in which they responded to (3) initial, non-navigable website content and (4) a beta version of the full website. In the final phase (5), patients newly diagnosed with MBC (N = 6) used the website prototype for 1 week and completed surveys assessing acceptability, feasibility, treatment knowledge, preparation for decision-making, and self-efficacy for decision-making. Participants in Phase 1 characterized a cyclical process of MBC treatment decision-making and identified key information needs. Website content and structure was iteratively developed in Phases 2-4. Most participants in Phase 5 (n = 4) accessed the website 2-5 times. All participants who accessed the website at least once (n = 5) felt they learned new information from the website prototype and would recommend it to others newly-diagnosed with MBC. After using the website prototype, participants reported high preparation and self-efficacy for decision-making. This multiphase, iterative process resulted in a prototype intervention designed to support decision-making for MBC patients.

Impact of lymph node dissection on cancer-specific survival in non-small cell lung cancer patients: a SEER database analysis.

Background: Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide, and lymph node dissection (LND) is a significant surgical procedure employed in its management. Although some studies suggest benefits of LND, the extent of its impact on survival, the optimal range of lymph nodes to be examined, and the specific patient groups that benefit most remain areas of active debate and investigation. Methods: A population-based analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed with NSCLC between 2004 and 2017, undergoing primary tumor resection, were included. Descriptive, univariate, and multivariate analyses assessed the effect of LND on survival, and a restricted cubic spline method determined the optimal range for lymph node examination. Results: This study of 37,323 NSCLC patients delved into the impact of LND on lung cancer-specific survival. Key findings revealed a median survival of 19.58 months, with 85% mortality. Baseline characteristics included a majority of White patients (81%), distant stage diagnoses (63%), and 64% with Grade IV tumors. LND emerged as a crucial predictor, influencing survival across age, gender, race, and tumor characteristics. Univariate analysis highlighted its significance, with higher T, N, and M categories, advanced stage, and poorer grade associating with elevated hazard ratios. Multivariate Cox proportional hazards (PH) analysis reinforced LND's impact, showcasing lower hazard ratios post-removal. Hazard ratios for biopsy/aspiration and removal of regional lymph nodes were 0.85 [95% confidence interval (CI): 0.81-0.89; P<0.001] and 0.43 (95% CI: 0.39-0.46; P<0.001), underscoring the protective effect. Visualizations and a U-shaped curve analysis identified an optimal range (24-32 nodes) for examination, emphasizing the nuanced benefits across NSCLC stages. Conclusions: The study findings suggest that LND plays a critical role in improving cancer-specific survival in NSCLC patients, particularly when tailored to the early stages of the disease. The optimal range of lymph nodes examined, between 24 and 32, offers crucial insights for personalized NSCLC treatment strategies and may enhance overall survival. These results underscore the need for refined surgical guidelines that incorporate the extent of LND, supporting the utility of a more personalized approach in NSCLC management.

Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients.

Purpose: The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods: We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results: The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion: The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.

An important paradigm shift within healthcare is the shift toward patient-centered care and away from disease-centered treatment. Patient-centered care is based on shared decision-making, respecting an individual patient's preferences, needs and values, and considering social context and best available research evidence to improve the quality of care. A multidisciplinary team (MDT) approach plays an important role in patient-centered care and MDTs are already adopted into daily oncology practices in many countries, especially in breast cancer care. Previous studies have shown that an effective MDT needs more patient-centered information but often that patient-centered information is notably absent from medical records. We investigated if and how patient-centered information such as psychosocial entries exists in patient records. For this purpose, we performed an exploratory pilot study in which the patient records of three patients with breast cancer, including two patients with advanced stage disease, were studied throughout their care pathway. We observed that the documentation of patient-centered information was fragmented and scattered across various medical records written by multidisciplinary professionals. Moreover, these pieces of scattered information were recorded from different perspectives and viewpoints. Our findings point to a significant role that healthcare informatics could play, as integrating the various healthcare professionals' electronic health record could likely produce multifaceted and more holistic patient-centered information which could be shared and used in shared decision-making and MDTs with a view to considering both patient and clinical perspectives, potentially improving the quality of care.

Demographic Determinants Influencing the Adoption of Genetic Testing for Cardiovascular Diseases in Japan　- Insights From a Large-Scale Online Survey.

Background: Genetic testing for cardiovascular diseases (CVD) is vital, but is underutilized in Japan due to limited insurance coverage, accessibility, and public disinterest. This study explores demographic factors influencing the decision to undergo CVD genetic testing. Methods and Results: We compared the CVD history and baseline demographics of Japanese adults who underwent genetic testing with those who did not, using an Internet survey. The regression model indicated that men, the young, married individuals, parents, and those with CVD, higher score for rationality, and lower quality of life were more inclined to undergo testing. Conclusions: Targeting strategies for CVD genetic testing could focus on these demographics.

Mobile-enhanced Family Integrated Care for preterm infants: A qualitative study of parents' views.

Objective: The Family Integrated Care (FICare) model improves outcomes for preterm infants and parents compared with family-centered care (FCC). FICare with mobile technology (mFICare) may improve uptake and impact. Research on FICare in the United States (US) is scarce and little is known about parents' experience. Methods: We conducted qualitative interviews with nine parents, exploring their NICU experiences, participation in and perceptions of the mFICare program. A directed content analysis approach was used, and common themes were derived from the data. Results: Overall, parents had positive NICU experiences and found mFICare helpful in meeting three common parenting priorities: actively caring for their infant, learning how to care for their infant, and learning about the clinical status of their infant. They described alignment and misalignment with mFICare components relative to their personal parenting priorities and offered suggestions for improvement. Nurses were noted to play key roles in providing or facilitating parent support and encouragement to participate in mFICare and parenting activities. Conclusion: The mFICare program showed potential for parental acceptance and participation in US NICUs. Innovation: The mFICare model is an innovation in neonatal care that can advance the consistent delivery of NICU family-centered care planning and caregiving.Clinical Trial Registration:NCT03418870 01/02/2018.