Multi-criteria decision making under uncertainty in building performance assessment

Building performance assessment is complex, as it has to respond to multiple criteria. Objectives originating from the demands that are put on energy consumption, acoustical performance, thermal occupant comfort, indoor air quality and many other issues must all be reconciled. An assessment requires the use of predictive models that involve numerous design and physical parameters as their inputs. Since these input parameters, as well as the models that operate on them, are not precisely known, it is imprudent to assume deterministic values for them. A more realistic approach is to introduce ranges of uncertainty in the parameters themselves, or in their derivation, from underlying approximations. In so doing, it is recognized that the outcome of a performance assessment is influenced by many sources of uncertainty. As a consequence of this approach the design process is informed by assessment outcomes that produce probability distributions of a target measure instead of its deterministic value. In practice this may lead to a “well informed” analysis but not necessarily to a straightforward, cost effective and efficient design process. This paper discusses how design decision making can be based on uncertainty assessments. A case study is described focusing on a discrete decision that involves a choice between two HVAC system designs. Analytical hierarchy process (AHP) including uncertainty information is used to arrive at a rational decision. In this approach, key performance indicators such as energy efficiency, thermal comfort and others are ranked according to their importance and preferences. This process enables a clear group consensus based choice of one of the two options. The research presents a viable means of collaboratively ranking complex design options based on stakeholder’s preferences and considering the uncertainty involved in the designs. In so doing it provides important feedback to the design team

Examining the effects of enhanced provider-patient communication on postoperative tonsillectomy pain: protocol of a randomised controlled trial performed by nurses in daily clinical care

Contains fulltext : 182294.pdf (publisher's version ) (Open Access)INTRODUCTION: Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider's communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients' outcomes. METHODS AND ANALYSIS: Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse-patient interactions. ETHICS AND DISSEMINATION: Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication. TRIAL REGISTRATION NUMBER: NTR5994; Pre-results

Praktijkvariatie in het gebruik van remifentanil tijdens de partus: een beeld van de toepassing in de Nederlandse ziekenhuizen.

Doel: Onderzoeken (a) frequentie van het gebruik van patiëntgecontroleerde toediening van remifentanil (remifentanil-PCA) durante partu in Nederland; (b) wat motieven zijn om remifentanil-PCA al dan niet aan te bieden; (c) voor welke vrouwen remifentanil-PCA beschikbaar is; en (d) welke maternale monitoring wordt toegepast. Opzet: Beschrijvend vragenlijstonderzoek. Methode: Alle 81 Nederlandse ziekenhuizen met een verlosafdeling ontvingen een vragenlijst over de volgende onderwerpen: (a) beschikbare methoden voor farmacologische pijnbehandeling; (b) motieven van gynaecologen om remifentanil-PCA wel of niet aan te bieden; (c) de doelgroep voor remifentanil-PCA; (d) maternale monitoring; en (e) Perined-gegevens uit 2016. Wij vroegen de ziekenhuisapothekers naar aantallen ampullen remifentanil die zij in de periode 2016-2017 geleverd hadden. Resultaten: De vragenlijst werd door 81 gynaecologen (100%) ingevuld. In 59 (73%) van de 81 ziekenhuizen was remifentanil-PCA beschikbaar. In deze ziekenhuizen werd remifentanil-PCA bij gemiddeld 23% van de partussen toegepast (uitersten: 16-56%). In 34 (58%) van deze 59 ziekenhuizen was remifentanil-PCA voor alle vrouwen beschikbaar en in 25 (42%) voor een selecte groep. De meest genoemde motieven om remifentanil-PCA beschikbaar te stellen waren ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’, respectievelijk 55 keer (93%) en 46 keer (78%). In ziekenhuizen waar remifentanil-PCA niet beschikbaar was, waren ‘betere pijnbehandeling door epidurale analgesie’, ‘het risico op ernstige maternale bijwerkingen’ en ‘onvoldoende mogelijkheden voor observatie op verloskamers’ de belangrijkste motieven voor dit beleid. Conclusie: Er is aanzienlijke variatie in de toepassing van remifentanil-PCA durante partu in Nederland. Remifentanil-PCA is in het merendeel van de ziekenhuizen beschikbaar voor alle vrouwen. De belangrijkste motieven van gynaecologen zijn ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’. (aut. ref.

Examining the effects of enhanced provider-patient communication on postoperative pain: protocol of a randomized controlled trial performed in daily clinical care.

Introduction: Placebo effects (true biopsychological effects not attributable to the active ingredients of medical technical interventions) can be attributed to several mechanisms, such as expectancy manipulation and empathy manipulation elicited by a provider’s communication. So far, effects have primarily been shown in laboratory settings. The aim of this study is to determine the separate and combined effects of expectancy manipulation and empathy manipulation during preoperative and postoperative tonsillectomy analgesia care on clinical adult patients’ outcomes. Methods and analysis: Using a two-by-two randomised controlled trial, 128 adult tonsillectomy patients will be randomly assigned to one out of four conditions differing in the level of expectancy manipulation (standard vs enhanced) and empathy manipulation (standard vs enhanced). Day care ward nurses are trained to deliver the intervention, while patients are treated via the standard analgesia protocol and hospital routines. The primary outcome, perceived pain, is measured via hospital routine by a Numeric Rating Scale, and additional prehospitalisation, perihospitalisation and posthospitalisation questionnaires are completed (until day 3, ie, 2 days after the operation). The manipulation is checked using audio recordings of nurse–patient interactions. Ethics and dissemination: Although communication is manipulated, the manipulations do not cross norms or values of acceptable behaviour. Standard medical care is provided. The ethical committee of the UMC Utrecht and the local OLVG hospital committee approved the study. Results will be published via (inter)national peer-reviewed journals and a lay publication

Placebo effects of nurses' communication alongside standard medical care on pain and other outcomes: a randomized controlled trial in clinical tonsillectomy care

Health and self-regulatio

Placebo Effects of Nurses' Communication alongside Standard Medical Care on Pain and Other Outcomes : A Randomized Controlled Trial in Clinical Tonsillectomy Care

Health and self-regulatio

Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands

© 2018 Elsevier Ltd Background: During labour, remifentanil patient-controlled analgesia is used as an alternative to neuraxial analgesia. Remifentanil is associated with hypoventilation and respiratory depression but the frequency of serious maternal and neonatal adverse events is unknown. The aim of this study was to estimate the number of serious adverse events attributed to the use of remifentanil patient-controlled analgesia during labour in The Netherlands and to investigate the circumstances (e.g. monitoring, practice deviations) of these events and the subsequent management. Methods: In a nationwide survey among obstetricians, anaesthetists and clinical midwives the frequency of serious adverse events was assessed. A questionnaire was sent by email to all 61 Dutch hospitals in which remifentanil patient-controlled analgesia is, or has been, available for labour analgesia. All reported cases were assessed independently by two expert teams. Results: We received information from all hospitals. After independent assessments, 17 cases of single maternal desaturation; 10 maternal cases of apnoea, bradycardia and/or cardiac arrest; and two neonatal cases of respiratory depression, over a period of more than 10 years of remifentanil patient-controlled analgesia use, were identified as a serious adverse event. All serious adverse events were resolved without irreversible damage. Conclusions: The risk of a potentially life-threatening serious adverse event attributed to remifentanil patient-controlled analgesia seems to be low. All patients recovered without deficit. Adherence to strict monitoring and the attendance of trained healthcare providers is required to safely use remifentanil for labour analgesia

Praktijkvariatie in het gebruik van remifentanil tijdens de partus: Een beeld van de toepassing in de Nederlandse ziekenhuizen = [Practice application of remifentanil during labor: An overview of its application in Dutch hospitals]

DoelOnderzoeken (a) frequentie van het gebruik van patiëntgecontroleerde toediening van remifentanil (remifentanil-PCA) durante partu in Nederland; (b) wat motieven zijn om remifentanil-PCA al dan niet aan te bieden; (c) voor welke vrouwen remifentanil-PCA beschikbaar is; en (d) welke maternale monitoring wordt toegepast.OpzetBeschrijvend vragenlijstonderzoek.MethodeAlle 81 Nederlandse ziekenhuizen met een verlosafdeling ontvingen een vragenlijst over de volgende onderwerpen: (a) beschikbare methoden voor farmacologische pijnbehandeling; (b) motieven van gynaecologen om remifentanil-PCA wel of niet aan te bieden; (c) de doelgroep voor remifentanil-PCA; (d) maternale monitoring; en (e) Perined-gegevens uit 2016. Wij vroegen de ziekenhuisapothekers naar aantallen ampullen remifentanil die zij in de periode 2016-2017 geleverd hadden.ResultatenDe vragenlijst werd door 81 gynaecologen (100%) ingevuld. In 59 (73%) van de 81 ziekenhuizen was remifentanil-PCA beschikbaar. In deze ziekenhuizen werd remifentanil-PCA bij gemiddeld 23% van de partussen toegepast (uitersten: 16-56%). In 34 (58%) van deze 59 ziekenhuizen was remifentanil-PCA voor alle vrouwen beschikbaar en in 25 (42%) voor een selecte groep. De meest genoemde motieven om remifentanil-PCA beschikbaar te stellen waren ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’, respectievelijk 55 keer (93%) en 46 keer (78%). In ziekenhuizen waar remifentanil-PCA niet beschikbaar was, waren ‘betere pijnbehandeling door epidurale analgesie’, ‘het risico op ernstige maternale bijwerkingen’ en ‘onvoldoende mogelijkheden voor observatie op verloskamers’ de belangrijkste motieven voor dit beleid.ConclusieEr is aanzienlijke variatie in de toepassing van remifentanil-PCA durante partu in Nederland. Remifentanil-PCA is in het merendeel van de ziekenhuizen beschikbaar voor alle vrouwen. De belangrijkste motieven van gynaecologen zijn ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’