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2.
BMC Med Inform Decis Mak ; 22(1): 124, 2022 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-35524307

RESUMEN

BACKGROUND: An emergency response to a medical situation is generally considered to be a risk decision-making problem. When an emergency event occurs, it makes sense to take into account more than one decision maker's opinions and psychological behaviors. The existing research tends to ignore these multidimensional aspects. To fill this literature gap, we propose a multi-attribute model. METHODS: The model is based on cumulative prospect theory (CPT), considering multiple experts' psychological factors. By not assuming full rationality, we extend existing models to allow multiple experts' risk preferences to be incorporated into the decision-making process in the case of an emergency. Then, traditional CPT is extended by allowing for multiple attributes. In addition, rather than using crisp data, interval values are adopted to tackle the usual uncertainties in reality. RESULTS: The multi-attribute CPT based model proposed can deal with the selection of potential emergency alternatives. The model incorporates interval values to allow more uncertainty and the comparative studies show that the optimal solution changes under different scenarios. CONCLUSIONS: Our illustrative example and comparative study show that considering multiple experts and multiple attributes is more reasonable, especially in complicated situations under an emergency. In addition, decision-makers' risk preferences highly affect the selection outcomes, highlighting their importance in the medical decision-making process. Our proposed model can be applied to similar fields with appropriate modifications.


Asunto(s)
Toma de Decisiones Clínicas , Toma de Decisiones , Humanos , Incertidumbre
3.
BMC Cancer ; 22(1): 515, 2022 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-35525917

RESUMEN

BACKGROUND: Monitoring proteinuria is important for the management of patients with cancer treated with anti-vascular endothelial growth factor (VEGF) or anti-VEGF receptor (VEGFR) inhibitors (VEGF/Ri). Here we investigated the difference between the urine protein/creatinine ratio (UPCR) and a qualitative value test (QV) on the decision making of treatment continuation and the usefulness of UPCR testing in patients with gastrointestinal cancer treated with anti-VEGF/Ri. METHODS: From January 2017 to December 2018, a survey was conducted based on the medical records of patients with gastrointestinal cancer with a QV of ≥2+ during the use of anti-VEGF/Ri at seven Japanese institutions participating in the Onco-nephrology Consortium. The primary endpoint was the ratio of the worst UPCR < 2.0 (low UPCR) in cases with a QV2+ at the point of the first proteinuria onset. The secondary endpoints were a comparison of low UPCR and worst UPCR ≥2.0 (high UPCR), the concordance rate between UPCR and QV in the Common Terminology Criteria for Adverse Events (CTCAE) grading, and the differences in the decision making for anti-VEGF/Ri continuation. RESULTS: Among the 71 patients enrolled, the proportion of low UPCR in onset QV2+ (n = 53) was 66% (n = 35). In a comparison between low (n = 36) and high UPCR cases (n = 24), body weight (P = 0.036), onset QV status (P = 0.0134), and worst QV status (P < 0.0001) were significantly associated with UPCR levels. The concordance rate for CTCAE Grade 2 of both the QV and UPCR was 83%. Regarding the judgment of anti-VEGF/Ri continuation, treatment was continued in 42.4% of cases when the QV became 3+, whereas only 25% continued treatment when the UPCR value became high. CONCLUSION: Urine dipstick test results may overestimate proteinuria, and the UPCR result tended to be more critical than the QV when deciding the treatment policy. TRIAL REGISTRATION: This study is a multiple institutional retrospectively registered observational trial. CLINICAL TRIAL NUMBER: University Hospital Medical Information Network (UMIN) Clinical Trials Registry (protocol ID UMIN000042545 ).


Asunto(s)
Proteinuria , Factor A de Crecimiento Endotelial Vascular , Inhibidores de la Angiogénesis , Creatinina , Toma de Decisiones , Femenino , Humanos , Pruebas de Función Renal , Masculino , Proteinuria/orina
4.
Rom J Ophthalmol ; 66(1): 55-60, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35531452

RESUMEN

Objective. To evaluate the utility of intraoperative OCT and its influence on the surgeon's decision during vitreoretinal surgery. Methods. This was a pilot, prospective case series conducted at a tertiary care ophthalmology department in Lahore, Pakistan. Sixteen patients undergoing vitreoretinal surgeries were included using the Leica Enfocus microscope integrated intraoperative optical coherence tomography (IOCT). We also investigated the changes in surgical decision making based on the findings revealed by IOCT using a questionnaire. Results. 16 patients with a mean age of 40.6 ± 19.0 (range: 11-66) years, were included in the study; one case of acute postoperative endophthalmitis could not be imaged. The surgeon had to modify surgical decisions in four (26.7%) cases. IOCT clearly delineated various tissue planes for efficient and safe surgical dissection in pathologies such as posterior vitreous detachment, vitreomacular traction and epiretinal membranes. Furthermore, it also helped identifying perfluorocarbon-retina interface. Conclusions. The intraoperative OCT modality is a feasible and useful intraoperative imaging technique for various kinds of vitreoretinal disorders. The decision making of the surgeon was modified in a quarter of the cases after the use of this newer modality.


Asunto(s)
Membrana Epirretinal , Oftalmología , Cirugía Vitreorretiniana , Adulto , Toma de Decisiones , Humanos , Persona de Mediana Edad , Tomografía de Coherencia Óptica/métodos , Cirugía Vitreorretiniana/métodos , Adulto Joven
5.
Am J Health Promot ; 36(5): 755-760, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35531998
6.
Inquiry ; 59: 469580221094469, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35506691

RESUMEN

Health insurance coverage options are complicated and often leave Medicare beneficiaries, families, advocates, and brokers confused. Medicare should make small changes to its existing "Compare Coverage Options" tool that would enhance the public's understanding of the trade-offs between Medicare Advantage and supplemental Medigap with Fee-for-Service Medicare. For cost considerations, Medicare should include a projection of annual out-of-pocket (OOP) spending, whether an OOP cap applies and whether the ability to alter OOP for additional clinical benefit is offered. For access considerations, Medicare should provide access to information to educate the public on coverage and costs associated with dental, vision, and hearing benefits, network adequacy, prior authorization, and supplemental benefits. These changes will enhance transparency and decision making.


Asunto(s)
Medicare Part C , Acceso a la Información , Anciano , Toma de Decisiones , Gastos en Salud , Humanos , Seguro Adicional , Estados Unidos
7.
PLoS One ; 17(5): e0268158, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35522688

RESUMEN

In the problem of multiple attributes group decision making (MAGDM), the probabilistic linguistic term sets (PLTSs) is an useful tool which can be more flexible and accurate to express the evaluation information of decision makers (DMs). However, due to the lack of time or knowledge, DMs tend to provide the evaluation information by incomplete PLTSs (InPLTSs) which contain missing information. The process to estimate the missing information of InPLTSs is essential, which is called the normalization of InPLTSs. By analyzing the previous methods, the existing defect is that the original uncertainty information of InPLTS can be hardly retained after normalizing. Moreover, the literature that considers the normalization method from perspective of entropy change is absent. Thus, to overcome the shortcoming and fill the research blank, we propose two optimization models based on minimum entropy change of InPLTSs, which can remain the original uncertainty information of InPLTSs to the greatest extent. Inspired by entropy measure of PLTSs, the novel concepts related to entropy measure of InPLTS are developed. In addition, based on the novel normalization method, a decision model is constructed to solve the MAGDM problem. To verify the feasibility and superiority of the proposed method and model, a case about the selection of five-star scenic spots is given and we conduct to have comparative analysis with other methods.


Asunto(s)
Toma de Decisiones , Lógica Difusa , Entropía , Lingüística/métodos , Incertidumbre
8.
Cogn Sci ; 46(5): e13143, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35523123

RESUMEN

When facing many options, we narrow down our focus to very few of them. Although behaviors like this can be a sign of heuristics, they can actually be optimal under limited cognitive resources. Here, we study the problem of how to optimally allocate limited sampling time to multiple options, modeled as accumulators of noisy evidence, to determine the most profitable one. We show that the effective sampling capacity of an agent increases with both available time and the discriminability of the options, and optimal policies undergo a sharp transition as a function of it. For small capacity, it is best to allocate time evenly to exactly five options and to ignore all the others, regardless of the prior distribution of rewards. For large capacities, the optimal number of sampled accumulators grows sublinearly, closely following a power law as a function of capacity for a wide variety of priors. We find that allocating equal times to the sampled accumulators is better than using uneven time allocations. Our work highlights that multialternative decisions are endowed with breadth-depth tradeoffs, demonstrates how their optimal solutions depend on the amount of limited resources and the variability of the environment, and shows that narrowing down to a handful of options is always optimal for small capacities.


Asunto(s)
Heurística , Recompensa , Toma de Decisiones , Humanos
10.
J Paediatr Child Health ; 58(5): 750-751, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35499936
11.
Med Educ Online ; 27(1): 2070940, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35506997

RESUMEN

PURPOSE: Caring for critically ill patients requires non-technical skills such as teamwork, communication, and task management. The Behaviorally Anchored Rating Scale (BARS) is a brief tool used to assess non-technical skills. The investigators determined inter- and intra-rater reliability of the BARS when used to assess medical students in simulated scenarios. METHOD: The investigators created simulation scenarios for medical students during their pediatric clerkship. Content experts reviewed video recordings of the simulations and assigned BARS scores for four performance components (Situational Awareness, Decision-Making, Communication, and Teamwork) for the leader and for the team as a whole. Krippendorff's alpha with ordinal difference was calculated to measure inter- and intra-rater reliability. RESULTS: Thirty medical students had recordings available for review. Inter- and intra-rater reliability for performance components were, respectively, Individual Situational Awareness (0.488, 0.638), Individual Decision-Making (0.529, 0.691), Individual Communication (0.347, 0.473), Individual Teamwork (0.414, 0.466), Team Situational Awareness (0.450, 0.593), Team Decision Making (0.423, 0.703), Team Communication (0.256, 0.517), and Team Teamwork (0.415, 0.490). CONCLUSIONS: The BARS demonstrated limited reliability when assessing medical students during their pediatric clerkship. Given the unique needs of this population, a modified or new objective scoring system for assessing non-technical skills may be needed for medical students.


Asunto(s)
Estudiantes de Medicina , Niño , Competencia Clínica , Toma de Decisiones , Humanos , Grupo de Atención al Paciente , Reproducibilidad de los Resultados
12.
Elife ; 112022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35535494

RESUMEN

Given the ubiquity of potentially adverse behavioural bias owing to myopic trial-and-error learning, it seems paradoxical that improvements in decision-making performance through conformist social learning, a process widely considered to be bias amplification, still prevail in animal collective behaviour. Here we show, through model analyses and large-scale interactive behavioural experiments with 585 human subjects, that conformist influence can indeed promote favourable risk taking in repeated experience-based decision making, even though many individuals are systematically biased towards adverse risk aversion. Although strong positive feedback conferred by copying the majority's behaviour could result in unfavourable informational cascades, our differential equation model of collective behavioural dynamics identified a key role for increasing exploration by negative feedback arising when a weak minority influence undermines the inherent behavioural bias. This 'collective behavioural rescue', emerging through coordination of positive and negative feedback, highlights a benefit of collective learning in a broader range of environmental conditions than previously assumed and resolves the ostensible paradox of adaptive collective behavioural flexibility under conformist influences.


When it comes to making decisions, like choosing a restaurant or political candidate, most of us rely on limited information that is not accurate enough to find the best option. Considering others' decisions and opinions can help us make smarter choices, a phenomenon called "collective intelligence". Collective intelligence relies on individuals making unbiased decisions. If individuals are biased toward making poor choices over better ones, copying the group's behavior may exaggerate biases. Humans are persistently biased. To avoid repeated failure, humans tend to avoid risky behavior. Instead, they often choose safer alternatives even when there might be a greater long-term benefit to risk-taking. This may hamper collective intelligence. Toyokawa and Gaissmaier show that learning from others helps humans make better decisions even when most people are biased toward risk aversion. The experiments first used computer modeling to assess the effect of individual bias on collective intelligence. Then, Toyokawa and Gaissmaier conducted an online investigation in which 185 people performed a task that involved choosing a safer or risker alternative, and 400 people completed the same task in groups of 2 to 8. The online experiment showed that participating in a group changed the learning dynamics to make information sampling less biased over time. This mitigated people's tendency to be risk-averse when risk-taking is beneficial. The model and experiments help explain why humans have evolved to learn through social interactions. Social learning and the tendency of humans to conform to the group's behavior mitigates individual risk aversion. Studies of the effect of bias on individual decision-making in other circumstances are needed. For example, would the same finding hold in the context of social media, which allows individuals to share unprecedented amounts of sometimes incorrect information?


Asunto(s)
Aprendizaje Social , Animales , Conducta Animal , Toma de Decisiones , Humanos , Aprendizaje
13.
BMJ Open ; 12(5): e059307, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501088

RESUMEN

OBJECTIVES: Women's autonomy is valued in a range of healthcare settings, from seeking and receiving care to deciding between treatment options. This study aimed to assess the level of decision-making autonomy women have and associated factors when it comes to using maternal healthcare services. DESIGN: A community-based cross-sectional study was conducted. SETTING: The study was conducted in Mettu Rural District, Iluababor Zone, Southwest Ethiopia. METHODS: Data were collected using a pretested interviewer-administered questionnaire from 541 women selected by a multistage sampling technique. The collected data were entered into EpiData V.3.1 and exported to SPSS V.22 for analysis. Bivariable and multivariable binary logistic regression were used to identify factors associated with women's decision-making autonomy on maternal health service use. Variables with a p value less than 0.05 at 95% CI were declared significant, and the strength of the association was measured by an adjusted OR (AOR). PRIMARY OUTCOME: Level of women's decision-making autonomy on maternal health service use. RESULTS: It was found that 60.5% of women were autonomous in maternal health service use (95% CI 56.2% to 64.7%). The older age group (AOR=4.27, 95% CI 1.6 to 11.4, p=0.034), higher educational level (AOR=3.8, 95% CI 2.2 to 6.7, p=0.042), small family size (AOR=2.5, 95% CI 1.5 to 4.1, p=0.01) and proximity to health facilities (AOR=5.3, 95% CI 2.5 to 11.3, p=0.004) were all associated factors with healthcare decision-making autonomy. CONCLUSION: Two-fifths of women have diminished autonomy in decision making on healthcare service use. Age, level of education, family size and accessibility of health services were found to influence women's autonomy. Special attention should be given to education and access to health services to improve women's autonomy.


Asunto(s)
Servicios de Salud Materna , Anciano , Servicios de Salud Comunitaria , Estudios Transversales , Toma de Decisiones , Etiopía , Femenino , Humanos , Masculino , Autonomía Personal , Embarazo
14.
Aust J Gen Pract ; 51(5): 321-326, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35491455

RESUMEN

BACKGROUND: Patients with cancer live with considerable uncertainty. This uncertainty can be related to the process of diagnosis, treatment, remission or palliative care, and therefore it can be experienced repeatedly or continuously throughout a patient's life. For patients with low literacy or low numeracy, it can be difficult to access, understand and interpret risk, so shared decision making may be difficult. OBJECTIVE: The aim of this article is to address the challenges of managing anxiety and uncertainty for patients with cancer in the general practice setting. DISCUSSION: The diagnosis of cancer is a life-changing event, and it can herald a long journey of anxiety, uncertainty and change. General practitioners (GPs) can assist patients to navigate complex health systems and find a sense of autonomy and agency in an otherwise marginalising life experience. For patients with low literacy and numeracy, GPs have a critical role in enabling shared decision making and ensuring consent is fully informed.


Asunto(s)
Toma de Decisiones , Neoplasias , Humanos , Neoplasias/terapia , Cuidados Paliativos , Gestión de Riesgos , Incertidumbre
15.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud | ID: lis-48736

RESUMEN

Em 22 de março de 2022, foi publicada a PORTARIA GAB/SAPS Nº 13 que institui a Câmara Técnica Assessora para contribuir com atividades técnico-científicas na promoção, proteção e apoio ao aleitamento materno no âmbito do SUS.


Asunto(s)
Lactancia Materna , Promoción de la Salud , Sistema Único de Salud , Toma de Decisiones
16.
Comput Intell Neurosci ; 2022: 9903364, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35371199

RESUMEN

The informatization of cities has been further promoted, and the construction of smart cities supported by technological innovation has been upgraded. The financial industry and data are closely related. Whether the financial industry can make good use of new information technology is the key to its successful transformation. The development of smart cities has a significant effect on the development of people's livelihood, the process of urbanization, the use of technology, the solution of urban problems, and the improvement of economic levels. This also provides a good choice for the development of cities in each country. For better development, it needs technical support. Therefore, it is very important to improve the technical level. This research mainly discusses the risk assessment and regulation algorithms of financial technology platforms in smart cities. This study divides the risk decision channels into two paths based on the smart city theory, considers the internal risk factors and external risk factors of the robo-advisory service platform from the three perspectives of platform characteristics, corporate characteristics, and investor characteristics and exploring the construction of a robo-advisory service platform risk prediction model based on the machine learning perspective. The design and implementation of a personalized financial investment prototype system, a Python-based web development framework Django, and a variety of toolkits have realized a B/S architecture robo-advisor. Among them, the function of buying and selling ETF and the trend recording function after buying are realized by simulating the transaction data collected by the data collection module. The study found that the key potential characteristics that constitute platform risks are mainly the listing year of the background company, the age of the platform, the investment threshold, and the search index. To a certain extent, this provides data support for investors and regulatory authorities to evaluate platform capabilities and platform selection. Investors should comprehensively consider platform qualifications when making platform decisions and pay attention to information such as the age of listing of companies with platform background, platform age, and investment thresholds. Only when the quality of people is improved, the quality of the population of this city improves, so that the development of the city has a broad room for growth. The accuracy of the similar formula calculation method in the big data proposed in this study reached 88%. This research provides new ideas for perfecting the black box regulatory system of robo-advisory algorithms.


Asunto(s)
Algoritmos , Toma de Decisiones , Ciudades , Humanos , Medición de Riesgo , Tecnología
20.
Lancet Public Health ; 7(4): e378-e390, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35366410

RESUMEN

Clinicians, patients, policy makers, funders, programme managers, regulators, and science communities invest considerable amounts of time and energy in influencing or making decisions at various levels, using systematic reviews, health technology assessments, guideline recommendations, coverage decisions, selection of essential medicines and diagnostics, quality assurance and improvement schemes, and policy and evidence briefs. The criteria and methods that these actors use in their work differ (eg, the role economic analysis has in decision making), but these methods frequently overlap and exist together. Under the aegis of WHO, we have brought together representatives of different areas to reconcile how the evidence that influences decisions is used across multiple health system decision levels. We describe the overlap and differences in decision-making criteria between different actors in the health sector to provide bridging opportunities through a unifying broad framework that we call theory of everything. Although decision-making activities respond to system needs, processes are often poorly coordinated, both globally and on a country level. A decision made in isolation from other decisions on the same topic could cause misleading, unnecessary, or conflicted inputs to the health system and, therefore, confusion and resource waste.


Asunto(s)
Ecosistema , Evaluación de la Tecnología Biomédica , Personal Administrativo , Toma de Decisiones , Humanos
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