Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a quali...Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.展开更多
Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used ...Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.展开更多
Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dys...Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dyspepsia and nausea.Typically,diag-nosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy.Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor(PPI)class being the preferred and most effective.Complete symptom resolution is not always achieved and long-term PPI therapy can put patients at risk for serious side effects and needless expense.The brain-gut connection and hypervigilance plays an important role in symptom resolution and treatment success,especially in the case of non-PPI responders.Hypervigilance is a combination of increased esophageal sensory sensitivity in combination with exaggerated threat perception surrounding esophageal symptoms.Hypervigilance requires a different approach to GERD managements,where continued PPI therapy and surgery are usually not recommended.Rather,helping physicians and patients understand the brain-gut connection can guide and improve care.Education and reassurance should be the main pillars or treatment.However,it is important not to suggest the symptoms are due to anxiety alone,this often leads to patient dissatisfaction.Patient dissatisfaction with treatment reveals the need for a more patient-centered approach to GERD management and better communication between patients and providers.Shared decision making(SDM)with the incorporation of patient-reported outcomes(PRO)promotes patient adherence and satisfaction.SDM is a joint discussion between clinician and patient in which a mutually shared solution is explored for GERD symptoms.For SDM to work the physician needs to capture patients'perceptions which may not be obtained in the standard interview.This can be done through the use of PROs which promote a dialogue with patients about their symptoms and treatment priorities in the context of the SDM patient encounter.SDM could potentially help in the management of patient expectations for GERD treatment,ultimately positively impacting their health-related quality of life.展开更多
Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variable...Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.展开更多
Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated...Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14;p < 0.001) and patients’ age (b = 0.12;p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.展开更多
Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM...Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM in residential aged care (RAC) and potential barriers and enablers to implement SDM utilising a theoretical framework of implementation. A review of the literature on SDM in RAC from 2005 to 2016 was undertaken, using MEDLINE (Ovid), CINAHL, PsychINFO and Scopus. The articles were synthesised by utilising an implementation theory framework to better understand what may facilitate or hinder the introduction of SDM. Eighteen studies were identified and analysed to determine barriers and enablers to SDM in RAC from the perspectives of staff, residents and relatives. A workplace culture of person-centred care and judicious use of research evidence are enablers of SDM. There is a potential need for additional resources, such as education for staff and families to enable implementation of SDM. Implementation of any health care intervention, including SDM, relies on many complex factors but these are predominantly related to capacity. Determining current uptake and readiness of RAC organisations, residents and their families to adopt SDM is an essential starting point.展开更多
Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude...Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude individuals(vs.non-solitude)would prefer feeling-based strategy in decision-making,resulting in a higher intention of choosing the affectively superior option over the cognitively superior option(Study 1).Self-focus plays the underlying mechanism in the solitude effect(Study 2).Moreover,we also examine two boundary conditions:motivation(Study 3)and temporal orientation(Study 4),which indicates that involuntary motivation and future orientation can mitigate the solitude effect on affective processing.These findings provide insights into consumers’judgments of product attributes and selection of decision-making strategies according to their situations.展开更多
We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese coll...We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese college students(female=964;mean age=19.53 years,SD=1.33 years)completed an online questionnaire.Path analysis indicated that social support was positively associated with higher levels of career adaptability.Both proactive personality and career decision-making self-efficacy served as parallel mediators,strengthening the relationship between social support and career adaptability.The complete chain mediation analysis revealed that social support influences career adaptability primarily through proactive personality,which in turn enhances career decision-making self-efficacy,further contributing to increased career adaptability.These findings extend career capital theory by demonstrating that social and psychological resources jointly facilitate career adaptability.展开更多
This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy ess...This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy essential axiomatic properties or produce unintuitive outcomes.To address these limitations,we propose a new three-dimensional divergence-based DM that ensures mathematical consistency,enhances the discrimination of information,and adheres to the axiomatic framework of distance theory.Building on this foundation,we construct a multi-criteria decision-making(MCDM)model that utilizes the proposed DM to evaluate and rank alternatives effectively.The applicability and robustness of the model are validated through a practical case study,demonstrating that it leads to more rational,consistent,and reliable decision outcomes compared to existing approaches.展开更多
In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point res...In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point results are established in the framework of metric spaces.Based on the presented work,some examples reflecting decision-making problems related to real life are also solved.The suggested method’s flexibility and efficacy compared to conventional techniques are demonstrated in decision-making situations involving uncertainty,such as choosing the best options in multi-criteria settings.We noted that the presented work combines and generalizes two major concepts,the idea of soft sets and hesitant fuzzy set-valued mapping from the existing literature.展开更多
Aiming at the triangular fuzzy(TF)multi-attribute decision making(MADM)problem with a preference for the distribution density of attribute(DDA),a decision making method with TF number two-dimensional density(TFTD)oper...Aiming at the triangular fuzzy(TF)multi-attribute decision making(MADM)problem with a preference for the distribution density of attribute(DDA),a decision making method with TF number two-dimensional density(TFTD)operator is proposed based on the density operator theory for the decision maker(DM).Firstly,a simple TF vector clustering method is proposed,which considers the feature of TF number and the geometric distance of vectors.Secondly,the least deviation sum of squares method is used in the program model to obtain the density weight vector.Then,two TFTD operators are defined,and the MADM method based on the TFTD operator is proposed.Finally,a numerical example is given to illustrate the superiority of this method,which can not only solve the TF MADM problem with a preference for the DDA but also help the DM make an overall comparison.展开更多
The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may ...The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.展开更多
With the development of big data and social computing,large-scale group decisionmaking(LGDM)is nowmerging with social networks.Using social network analysis(SNA),this study proposes an LGDM consensus model that consid...With the development of big data and social computing,large-scale group decisionmaking(LGDM)is nowmerging with social networks.Using social network analysis(SNA),this study proposes an LGDM consensus model that considers the trust relationship among decisionmakers(DMs).In the process of consensusmeasurement:the social network is constructed according to the social relationship among DMs,and the Louvain method is introduced to classify social networks to form subgroups.In this study,the weights of each decision maker and each subgroup are computed by comprehensive network weights and trust weights.In the process of consensus improvement:A feedback mechanism with four identification and two direction rules is designed to guide the consensus of the improvement process.Based on the trust relationship among DMs,the preferences are modified,and the corresponding social network is updated to accelerate the consensus.Compared with the previous research,the proposedmodel not only allows the subgroups to be reconstructed and updated during the adjustment process,but also improves the accuracy of the adjustment by the feedbackmechanism.Finally,an example analysis is conducted to verify the effectiveness and flexibility of the proposed method.Moreover,compared with previous studies,the superiority of the proposed method in solving the LGDM problem is highlighted.展开更多
For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making...For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.展开更多
Mangroves are woody plant communities that appear in tropical and subtropical regions,mainly in intertidal zones along the coastlines.Despite their considerable benefits to humans and the surrounding environment,their...Mangroves are woody plant communities that appear in tropical and subtropical regions,mainly in intertidal zones along the coastlines.Despite their considerable benefits to humans and the surrounding environment,their existence is threatened by anthropogenic activities and natural drivers.Accordingly,it is vital to conduct efficient efforts to increase mangrove plantations by identifying suitable locations.These efforts are required to support conservation and plantation practices and lower the mortality rate of seedlings.Therefore,identifying ecologically potential areas for plantation practices is mandatory to ensure a higher success rate.This study aimed to identify suitable locations for mangrove plantations along the southern coastal frontiers of Hormozgan,Iran.To this end,we applied a hybrid Fuzzy-DEMATEL-ANP(FDANP)model as a Multi-Criteria Decision Making(MCDM)approach to determine the relative importance of different criteria,combined with geospatial and remote sensing data.In this regard,ten relevant sources of environmental criteria,including meteorological,topographical,and geomorphological,were used in the modeling.The statistical evaluation demonstrated the high potential of the developed approach for suitable location identification.Based on the final results,6.10%and 20.80%of the study area were classified as very-high suitable and very-low suitable areas.The obtained values can elucidate the path for decision-makers and managers for better conservation and plantation planning.Moreover,the utility of charge-free remote sensing data allows cost-effective implementation of such an approach for other regions by interested researchers and governing organizations.展开更多
In the USA,risk-based decision making has not been a common approach to tunnel safety in the past,but this is changing,as concepts such as“equivalency”in the NFPA 502 framework gain acceptance in the USA and elsewhe...In the USA,risk-based decision making has not been a common approach to tunnel safety in the past,but this is changing,as concepts such as“equivalency”in the NFPA 502 framework gain acceptance in the USA and elsewhere.In other regions,in particular in Europe,risk assessment techniques have been used for nearly two decades in many jurisdictions as an additional tool to complement the application of prescriptive guidelines and support decisions related to tunnel safety.After some initial difficulties these methods are meanwhile a well-established element of tunnel safety management.There are several tools available which have been practically applied and further developed over years,such as the Austrian tunnel risk model TuRisMo,or the PIARC owned DG-QRAM model.Whereas TuRisMo is a holistic,system-based model,which is best suited to quantify and assess fire risk and associated mitigation measures,DG-QRAM focusses on the risks related to the transport of hazardous materials.Depending on the objectives and the scope of the investigation and the regulatory environment,tunnel risk assessment tools are in use for different purposes,mainly to demonstrate a sufficient level of safety and to decide on and select(additional)risk mitigation measures.The international experience substantiates that the general approach is flexible and that the methods and tools are mature and can be applied for different problems in different environments.First case studies like the risk study on conditions and permissibility of the transport of hazardous materials through the Eisenhower-Johnson-Memorial Tunnel in Colorado demonstrate the applicability of a risk-based concept for decision making in the US-American environment.展开更多
Real estate has been a dominant industry in many countries. One problem for real estate companies is determining the most valuable area before starting a new project. Previous studies on this issue mainly focused on m...Real estate has been a dominant industry in many countries. One problem for real estate companies is determining the most valuable area before starting a new project. Previous studies on this issue mainly focused on market needs and economic prospects, ignoring the impact of natural disasters. We observe that natural disasters are important for real estate area selection because they will introduce considerable losses to real estate enterprises. Following this observation, we first develop a self-defined new indicator named Average Loss Ratio to predict the losses caused by natural disasters in an area. Then, we adopt the existing ARIMA model to predict the Average Loss Ratio of an area. After that, we propose to integrate the TOPSIS model and the Grey Prediction Model to rank the recommendation levels for candidate areas, thereby assisting real estate companies in their decision-making process. We conduct experiments on real datasets to validate our proposal, and the results suggest the effectiveness of the proposed method.展开更多
Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients...Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.展开更多
The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to addres...The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to address the following important enquiries:1)the engineering applications addressed by the different material choosing and ranking methods;2)the predominantly used decision making tools addressing the optimal material selection for the engineering applications;3)merits and demerits of decision making tools used;4)the dominantly used criteria or objectives considered while selecting a suitable alternative material;5)overview of DEA on material selection field.The authors have surveyed literatures from different regions of the globe and considered literatures since 1988.The present review not only stresses the importance of material selection in the early design stage of the product development but also aids the design and material engineers to apply different decision making tools systematically.展开更多
A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based o...A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based on the semantics of terms on the domain. Then, the hedges can be represented after the upper and loose upper approximations of a linguistic term are derived. Accordingly, some compact formulae can be derived for the semantics of linguistic expressions with hedges. Parameters in these formulae are objectively determined according to the semantics of original terms. The proposed model presents a more natural way to express the decision information under uncertainties and its semantics is clear. The proposed model is clarified by solving the problem of evaluation and selection of sustainable innovative energy technologies. Computational results demonstrate that the model can deal with various uncertainties of the problem. Finally, the model is compared with existing techniques and extended to the case when the semantics of terms are represented by trapezoidal fuzzy numbers.展开更多
基金financed by the Flinders University College of Business,Government and Law Large Project Grant(Grant number:100031.21).
文摘Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.
文摘Since the first publication describing the identification of prostate-specific antigen （PSA） in the 1960s, much progress has been made. The PSA test changed from being initially a monitoring tool to being also used as a diagnostic tool. Over time, the test has been heavily debated due to its lack of sensitivity and specificity. However, up to now the PSA test is still the only biomarker for the detection and monitoring of prostate cancer. PSA-based screening for prostate cancer is associated with a high proportion of unnecessary testing and overdiagnosis with subsequent overtreatment. In the early years of screening for prostate cancer, high rates of uptake were very important. However, over time the opinion on PSA-based screening has shifted towards the notion of informed choice. Nowadays, it is thought to be unethical to screen men without them being aware of the pros and cons of PSA testing, as well as the fact that an informed choice is related to better patient outcomes. Now, as the results of three major screening studies have been presented and the downsides of screening are becoming better understood, informed choice is becoming more relevant.
文摘Gastroesophageal reflux disease(GERD)is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough,asthma,hoarseness,dyspepsia and nausea.Typically,diag-nosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy.Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor(PPI)class being the preferred and most effective.Complete symptom resolution is not always achieved and long-term PPI therapy can put patients at risk for serious side effects and needless expense.The brain-gut connection and hypervigilance plays an important role in symptom resolution and treatment success,especially in the case of non-PPI responders.Hypervigilance is a combination of increased esophageal sensory sensitivity in combination with exaggerated threat perception surrounding esophageal symptoms.Hypervigilance requires a different approach to GERD managements,where continued PPI therapy and surgery are usually not recommended.Rather,helping physicians and patients understand the brain-gut connection can guide and improve care.Education and reassurance should be the main pillars or treatment.However,it is important not to suggest the symptoms are due to anxiety alone,this often leads to patient dissatisfaction.Patient dissatisfaction with treatment reveals the need for a more patient-centered approach to GERD management and better communication between patients and providers.Shared decision making(SDM)with the incorporation of patient-reported outcomes(PRO)promotes patient adherence and satisfaction.SDM is a joint discussion between clinician and patient in which a mutually shared solution is explored for GERD symptoms.For SDM to work the physician needs to capture patients'perceptions which may not be obtained in the standard interview.This can be done through the use of PROs which promote a dialogue with patients about their symptoms and treatment priorities in the context of the SDM patient encounter.SDM could potentially help in the management of patient expectations for GERD treatment,ultimately positively impacting their health-related quality of life.
基金The Instituto de Salud Carlos III, FEDER Union Europea (Grant No. PI10/00955).
文摘Objective: To assess preferences for participation in shared decision making in a representative sample of psychiatric outpatients with affective disorders and to understand how clinical and socio-demographic variables influence patients’ preferences for participation. Method: A cross-sectional survey of 172 consecutive psychiatric outpatients with affective disorders attending at Community Mental Health Care setting was carried out. Patients expressed preferences on each of 3 aspects of decision making (seeking information, discussing options, making the final decision). The “CGI Severity and Improvement Scales” and the “Beck Depression Inventory” scale were used for severity assessment. Additionally the “Drug Attitude Inventory”, the “Beliefs about Medicine Questionnaire” and the “Leeds Attitude toward Concordance Scale” were applied to all participants. Effects of variables considered on preferences were assessed using proportional odds regression models. Results: We registered a high response rate of 85%. Nearly all patients (91%) preferred to leave final decisions to their treating psychiatrists and 87% preferred to rely on psychiatrists for medical knowledge rather than seeking their own information. In contrast, 81% of patients preferred to be offered options and to be asked their opinion by their doctors. Gender, age, educational level, number of psychotropics used and belief about psychiatric medication overuse were significant predictors in decision making dimensions considered. Conclusion: Shared decision making approach of patients with affective disorder must take into consideration a more doctor-directed approach preferred by the patients in which the desire to be offered options is not automatically linked with the willingness of taking decisions or getting more knowledge.
文摘Background: Shared Decision Making (SDM) is primarily intended to enhance patient autonomy. To date, the relationship between patients’ perceived levels of involvement and autonomy support has never been investigated in the field of physical therapy. Based on the recently reported extremely low level of observed SDM in physical therapy, similarly poor patient perceptions are expected. Objective: The main objectives of this study were to examine patients’ perceptions of SDM and autonomy support in physical therapy and to explore the relationship between both. Design: Patient survey after real consultations in physical therapy. Methods: Patients completed the Dyadic Observing Patient Involvement (Dyadic OPTION) instrument and the Health Care Climate Questionnaire (HCCQ) to examine patients’ perceived levels of SDM and autonomy support, respectively. Multilevel analyses were applied to determine the relationship between both perceptions. Results: Two hundred and twenty-nine patients, who were recruited by 13 physical therapists, agreed to participate. The median Dyadic OPTION score was 72.9 out of a total possible score of 100. The median HCCQ score was 94.3 out of a total possible score of 100. Patients’ experienced level of SDM (b = 0.14;p < 0.001) and patients’ age (b = 0.12;p = 0.001) contributed to patients’ perceived autonomy support. None of the physical therapist characteristics were related to patients’ perceived autonomy support. Limitations: Only 13 out of 125 therapists who were personally contacted agreed to participate. Conclusion: Using patients’ perceptions, we found that a relationship between SDM and autonomy support existed. In contrast to observational studies, our study also demonstrated that the participating physical therapists individually tailored patient support by adapting their implementation of SDM to each patient.
文摘Very little is known about shared decision making (SDM) in residential aged care, despite world-wide policy and imperatives that encourage resident choice and autonomy. This paper provides a framework synthesis of SDM in residential aged care (RAC) and potential barriers and enablers to implement SDM utilising a theoretical framework of implementation. A review of the literature on SDM in RAC from 2005 to 2016 was undertaken, using MEDLINE (Ovid), CINAHL, PsychINFO and Scopus. The articles were synthesised by utilising an implementation theory framework to better understand what may facilitate or hinder the introduction of SDM. Eighteen studies were identified and analysed to determine barriers and enablers to SDM in RAC from the perspectives of staff, residents and relatives. A workplace culture of person-centred care and judicious use of research evidence are enablers of SDM. There is a potential need for additional resources, such as education for staff and families to enable implementation of SDM. Implementation of any health care intervention, including SDM, relies on many complex factors but these are predominantly related to capacity. Determining current uptake and readiness of RAC organisations, residents and their families to adopt SDM is an essential starting point.
文摘Across four studies,we explore the impact of solitude on consumers’reliance on feelings versus reasons in decision making,along with the underlying mechanism and boundary conditions.The results indicate that solitude individuals(vs.non-solitude)would prefer feeling-based strategy in decision-making,resulting in a higher intention of choosing the affectively superior option over the cognitively superior option(Study 1).Self-focus plays the underlying mechanism in the solitude effect(Study 2).Moreover,we also examine two boundary conditions:motivation(Study 3)and temporal orientation(Study 4),which indicates that involuntary motivation and future orientation can mitigate the solitude effect on affective processing.These findings provide insights into consumers’judgments of product attributes and selection of decision-making strategies according to their situations.
基金supported by“Planning Subject for the 14th Five Year Plan of National Education Sciences of China(DBA210296)”.
文摘We examined the relationship between social support and career adaptability,as well as the mediating roles of proactive personality and career decision-making self-efficacy in this process.A total of 1354 Chinese college students(female=964;mean age=19.53 years,SD=1.33 years)completed an online questionnaire.Path analysis indicated that social support was positively associated with higher levels of career adaptability.Both proactive personality and career decision-making self-efficacy served as parallel mediators,strengthening the relationship between social support and career adaptability.The complete chain mediation analysis revealed that social support influences career adaptability primarily through proactive personality,which in turn enhances career decision-making self-efficacy,further contributing to increased career adaptability.These findings extend career capital theory by demonstrating that social and psychological resources jointly facilitate career adaptability.
文摘This study introduces a novel distance measure(DM)for(p,q,r)-spherical fuzzy sets((p,q,to improve decision-making in complex and uncertain environments.Many existing distance measures eitherr)-SFSs)fail to satisfy essential axiomatic properties or produce unintuitive outcomes.To address these limitations,we propose a new three-dimensional divergence-based DM that ensures mathematical consistency,enhances the discrimination of information,and adheres to the axiomatic framework of distance theory.Building on this foundation,we construct a multi-criteria decision-making(MCDM)model that utilizes the proposed DM to evaluate and rank alternatives effectively.The applicability and robustness of the model are validated through a practical case study,demonstrating that it leads to more rational,consistent,and reliable decision outcomes compared to existing approaches.
基金funded by National Science,Research and Innovation Fund(NSRF)King Mongkut's University of Technology North Bangkok with Contract No.KMUTNB-FF-68-B-46.
文摘In this manuscript,the notion of a hesitant fuzzy soft fixed point is introduced.Using this notion and the concept of Suzuki-type(μ,ν)-weak contraction for hesitant fuzzy soft set valued-mapping,some fixed point results are established in the framework of metric spaces.Based on the presented work,some examples reflecting decision-making problems related to real life are also solved.The suggested method’s flexibility and efficacy compared to conventional techniques are demonstrated in decision-making situations involving uncertainty,such as choosing the best options in multi-criteria settings.We noted that the presented work combines and generalizes two major concepts,the idea of soft sets and hesitant fuzzy set-valued mapping from the existing literature.
基金supported by the Natural Science Foundation of Hunan Province(2023JJ50047,2023JJ40306)the Research Foundation of Education Bureau of Hunan Province(23A0494,20B260)the Key R&D Projects of Hunan Province(2019SK2331)。
文摘Aiming at the triangular fuzzy(TF)multi-attribute decision making(MADM)problem with a preference for the distribution density of attribute(DDA),a decision making method with TF number two-dimensional density(TFTD)operator is proposed based on the density operator theory for the decision maker(DM).Firstly,a simple TF vector clustering method is proposed,which considers the feature of TF number and the geometric distance of vectors.Secondly,the least deviation sum of squares method is used in the program model to obtain the density weight vector.Then,two TFTD operators are defined,and the MADM method based on the TFTD operator is proposed.Finally,a numerical example is given to illustrate the superiority of this method,which can not only solve the TF MADM problem with a preference for the DDA but also help the DM make an overall comparison.
基金Supported by Peking Union Medical College,No.2019zlgc0503.
文摘The rapid progress of research into inflammatory bowel disease(IBD)has resulted in increasingly more treatment options.Different options have different advantages and disadvantages,and the preferences of patients may also differ.If patients can be invited to the formulation of medical decision-making,their compliance and satisfaction would be improved,thus possibly achieving better therapeutic results.The present review aims to summarize the current literature on shared decision-making(SDM)in the management of IBD,with the goal of promoting the application of SDM.
基金The work was supported by Humanities and Social Sciences Fund of the Ministry of Education(No.22YJA630119)the National Natural Science Foundation of China(No.71971051)Natural Science Foundation of Hebei Province(No.G2021501004).
文摘With the development of big data and social computing,large-scale group decisionmaking(LGDM)is nowmerging with social networks.Using social network analysis(SNA),this study proposes an LGDM consensus model that considers the trust relationship among decisionmakers(DMs).In the process of consensusmeasurement:the social network is constructed according to the social relationship among DMs,and the Louvain method is introduced to classify social networks to form subgroups.In this study,the weights of each decision maker and each subgroup are computed by comprehensive network weights and trust weights.In the process of consensus improvement:A feedback mechanism with four identification and two direction rules is designed to guide the consensus of the improvement process.Based on the trust relationship among DMs,the preferences are modified,and the corresponding social network is updated to accelerate the consensus.Compared with the previous research,the proposedmodel not only allows the subgroups to be reconstructed and updated during the adjustment process,but also improves the accuracy of the adjustment by the feedbackmechanism.Finally,an example analysis is conducted to verify the effectiveness and flexibility of the proposed method.Moreover,compared with previous studies,the superiority of the proposed method in solving the LGDM problem is highlighted.
文摘For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.
基金funded by Erasmus+ICM programme for a 3-month and 5-month stay at Lund University,Lund,Sweden,and thank the European Union.
文摘Mangroves are woody plant communities that appear in tropical and subtropical regions,mainly in intertidal zones along the coastlines.Despite their considerable benefits to humans and the surrounding environment,their existence is threatened by anthropogenic activities and natural drivers.Accordingly,it is vital to conduct efficient efforts to increase mangrove plantations by identifying suitable locations.These efforts are required to support conservation and plantation practices and lower the mortality rate of seedlings.Therefore,identifying ecologically potential areas for plantation practices is mandatory to ensure a higher success rate.This study aimed to identify suitable locations for mangrove plantations along the southern coastal frontiers of Hormozgan,Iran.To this end,we applied a hybrid Fuzzy-DEMATEL-ANP(FDANP)model as a Multi-Criteria Decision Making(MCDM)approach to determine the relative importance of different criteria,combined with geospatial and remote sensing data.In this regard,ten relevant sources of environmental criteria,including meteorological,topographical,and geomorphological,were used in the modeling.The statistical evaluation demonstrated the high potential of the developed approach for suitable location identification.Based on the final results,6.10%and 20.80%of the study area were classified as very-high suitable and very-low suitable areas.The obtained values can elucidate the path for decision-makers and managers for better conservation and plantation planning.Moreover,the utility of charge-free remote sensing data allows cost-effective implementation of such an approach for other regions by interested researchers and governing organizations.
文摘In the USA,risk-based decision making has not been a common approach to tunnel safety in the past,but this is changing,as concepts such as“equivalency”in the NFPA 502 framework gain acceptance in the USA and elsewhere.In other regions,in particular in Europe,risk assessment techniques have been used for nearly two decades in many jurisdictions as an additional tool to complement the application of prescriptive guidelines and support decisions related to tunnel safety.After some initial difficulties these methods are meanwhile a well-established element of tunnel safety management.There are several tools available which have been practically applied and further developed over years,such as the Austrian tunnel risk model TuRisMo,or the PIARC owned DG-QRAM model.Whereas TuRisMo is a holistic,system-based model,which is best suited to quantify and assess fire risk and associated mitigation measures,DG-QRAM focusses on the risks related to the transport of hazardous materials.Depending on the objectives and the scope of the investigation and the regulatory environment,tunnel risk assessment tools are in use for different purposes,mainly to demonstrate a sufficient level of safety and to decide on and select(additional)risk mitigation measures.The international experience substantiates that the general approach is flexible and that the methods and tools are mature and can be applied for different problems in different environments.First case studies like the risk study on conditions and permissibility of the transport of hazardous materials through the Eisenhower-Johnson-Memorial Tunnel in Colorado demonstrate the applicability of a risk-based concept for decision making in the US-American environment.
文摘Real estate has been a dominant industry in many countries. One problem for real estate companies is determining the most valuable area before starting a new project. Previous studies on this issue mainly focused on market needs and economic prospects, ignoring the impact of natural disasters. We observe that natural disasters are important for real estate area selection because they will introduce considerable losses to real estate enterprises. Following this observation, we first develop a self-defined new indicator named Average Loss Ratio to predict the losses caused by natural disasters in an area. Then, we adopt the existing ARIMA model to predict the Average Loss Ratio of an area. After that, we propose to integrate the TOPSIS model and the Grey Prediction Model to rank the recommendation levels for candidate areas, thereby assisting real estate companies in their decision-making process. We conduct experiments on real datasets to validate our proposal, and the results suggest the effectiveness of the proposed method.
文摘Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.
基金the financial support received from MHRD, India during the course of research work.
文摘The present work reviews different decision making tools(material comparing and choosing tools)used for selecting the best material considering different parameters.In this review work,the authors have tried to address the following important enquiries:1)the engineering applications addressed by the different material choosing and ranking methods;2)the predominantly used decision making tools addressing the optimal material selection for the engineering applications;3)merits and demerits of decision making tools used;4)the dominantly used criteria or objectives considered while selecting a suitable alternative material;5)overview of DEA on material selection field.The authors have surveyed literatures from different regions of the globe and considered literatures since 1988.The present review not only stresses the importance of material selection in the early design stage of the product development but also aids the design and material engineers to apply different decision making tools systematically.
基金The National Natural Science Foundation of China(No.61273209)the Scientific Research Foundation of Graduate School of Southeast University(No.YBJJ1528)the Scientific Innovation Research of College Graduates in Jiangsu Province(No.KYLX15-0191)
文摘A semantics-based model is proposed to enable weakened hedges, such as ＂more or less＂ and ＂roughly＂ in the context of linguistic multi-criteria decision making. First, the resemblance relations are defined based on the semantics of terms on the domain. Then, the hedges can be represented after the upper and loose upper approximations of a linguistic term are derived. Accordingly, some compact formulae can be derived for the semantics of linguistic expressions with hedges. Parameters in these formulae are objectively determined according to the semantics of original terms. The proposed model presents a more natural way to express the decision information under uncertainties and its semantics is clear. The proposed model is clarified by solving the problem of evaluation and selection of sustainable innovative energy technologies. Computational results demonstrate that the model can deal with various uncertainties of the problem. Finally, the model is compared with existing techniques and extended to the case when the semantics of terms are represented by trapezoidal fuzzy numbers.
