Addressing health literacy in patient decision aids

MethodsWe reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.ResultsAim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.ConclusionLower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients

Managing Well Integrity using Reliability Based Models

Imperial Users onl

Cost-Effectiveness of Advanced Imaging Technologies in the Presurgical Workup of Epilepsy.

The cost-effectiveness and benefit of many diagnostic tests used in the presurgical evaluation for persons with epilepsy is for the most part uncertain as is their influence on decision-making. The options we have at our disposal are ever increasing. Advanced imaging modalities aim to improve surgical candidacy by helping us better define the epileptogenic zone and optimize surgical planning. However, judicious use is important. Randomized controlled trials delineating which mode of investigation is superior are lacking. Presurgical tests do have incremental value by increasing surgical candidacy and refining surgical planning. The yield of additional imaging will increase with complex localization. However, every case must be tailored by hypothesis, cost, and accessibility. Future studies using a quantitative cost-benefit framework are needed to determine the cost-effectiveness of advanced diagnostic tests (beyond magnetic resonance imaging) in the presurgical evaluation of those with epilepsy

Injury risk factors, screening tests and preventative strategies: A systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues

Purpose: To systematically review the scientific level of evidence for the ‘Top 3’ risk factors, screening tests and preventative exercises identified by a previously published survey of 44 premier league football (soccer) teams. Also, to provide an overall scientific level of evidence and graded recommendation based on the current research literature. Methods: A systematic literature search (Pubmed [MEDLINE], SportDiscus, PEDRO and Cochrane databases). The quality of the articles was assessed and a level of evidence (1++ to 4) was assigned. Level 1++ corresponded to the highest level of evidence available and 4, the lowest. A graded recommendation (A: strong, B: moderate, C: weak, D: insufficient evidence to assign a specific recommendation) for use in the practical setting was given. Results: Fourteen studies were analysed. The overall level of evidence for the risk factors previous injury, fatigue and muscle imbalance were 2++, 4 and ‘inconclusive’, respectively. The graded recommendation for functional movement screen, psychological questionnaire and isokinetic muscle testing were all ‘D’. Hamstring eccentric had a weak graded ‘C’ recommendation, and eccentric exercise for other body parts was ‘D’. Balance/proprioception exercise to reduce ankle and knee sprain injury was assigned a graded recommendation ‘D’. Conclusions: The majority of perceptions and practices of premier league teams have a low level of evidence and low graded recommendation. This does not imply that these perceptions and practices are not important or not valid, as it may simply be that they are yet to be sufficiently validated or refuted by research

Microservice Transition and its Granularity Problem: A Systematic Mapping Study

Microservices have gained wide recognition and acceptance in software industries as an emerging architectural style for autonomic, scalable, and more reliable computing. The transition to microservices has been highly motivated by the need for better alignment of technical design decisions with improving value potentials of architectures. Despite microservices' popularity, research still lacks disciplined understanding of transition and consensus on the principles and activities underlying "micro-ing" architectures. In this paper, we report on a systematic mapping study that consolidates various views, approaches and activities that commonly assist in the transition to microservices. The study aims to provide a better understanding of the transition; it also contributes a working definition of the transition and technical activities underlying it. We term the transition and technical activities leading to microservice architectures as microservitization. We then shed light on a fundamental problem of microservitization: microservice granularity and reasoning about its adaptation as first-class entities. This study reviews state-of-the-art and -practice related to reasoning about microservice granularity; it reviews modelling approaches, aspects considered, guidelines and processes used to reason about microservice granularity. This study identifies opportunities for future research and development related to reasoning about microservice granularity.Comment: 36 pages including references, 6 figures, and 3 table

Integrating IVHM and Asset Design

Integrated Vehicle Health Management (IVHM) describes a set of capabilities that enable effective and efficient maintenance and operation of the target vehicle. It accounts for the collection of data, conducting analysis, and supporting the decision-making process for sustainment and operation. The design of IVHM systems endeavours to account for all causes of failure in a disciplined, systems engineering, manner. With industry striving to reduce through-life cost, IVHM is a powerful tool to give forewarning of impending failure and hence control over the outcome. Benefits have been realised from this approach across a number of different sectors but, hindering our ability to realise further benefit from this maturing technology, is the fact that IVHM is still treated as added on to the design of the asset, rather than being a sub-system in its own right, fully integrated with the asset design. The elevation and integration of IVHM in this way will enable architectures to be chosen that accommodate health ready sub-systems from the supply chain and design trade-offs to be made, to name but two major benefits. Barriers to IVHM being integrated with the asset design are examined in this paper. The paper presents progress in overcoming them, and suggests potential solutions for those that remain. It addresses the IVHM system design from a systems engineering perspective and the integration with the asset design will be described within an industrial design process

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

OBJECTIVE: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). DEVELOPMENT OF THE PROTOCOL: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. CONCLUSIONS: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time

Integrating IVHM and asset design

Integrated Vehicle Health Management (IVHM) describes a set of capabilities that enable effective and efficient maintenance and operation of the target vehicle. It accounts for the collecting of data, conducting analysis, and supporting the decision-making process for sustainment and operation. The design of IVHM systems endeavours to account for all causes of failure in a disciplined, systems engineering, manner. With industry striving to reduce through-life cost, IVHM is a powerful tool to give forewarning of impending failure and hence control over the outcome. Benefits have been realised from this approach across a number of different sectors but, hindering our ability to realise further benefit from this maturing technology, is the fact that IVHM is still treated as added on to the design of the asset, rather than being a sub-system in its own right, fully integrated with the asset design. The elevation and integration of IVHM in this way will enable architectures to be chosen that accommodate health ready sub-systems from the supply chain and design trade-offs to be made, to name but two major benefits. Barriers to IVHM being integrated with the asset design are examined in this paper. The paper presents progress in overcoming them, and suggests potential solutions for those that remain. It addresses the IVHM system design from a systems engineering perspective and the integration with the asset design will be described within an industrial design process