Implicit persuasion in medical decision-making An overview of implicitly steering behaviors and a reflection on explanations for the use of implicitly steering behaviors

Analysis and support of clinical decision makin

Validation of Non-residential Cold and Hot Water Demand Model Assumptions

AbstractExisting guidelines related to the water demand of non-residential buildings are outdated and do not cover hot water demand for the appropriate selection of hot water devices. Moreover, they generally overestimate peak demand values required for the design of an efficient and reliable water installation. Recently, a procedure was developed based on the end-use model SIMDEUM to derive design rules for peak demand values of both cold and hot water during various time steps for several types and sizes of non-residential buildings, i.e. offices, hotels and nursing homes. In this paper, the assumptions of building standardisation, on which the design rules are based, are validated. This was done with measurements of cold and hot water demands on a per second base and with surveys. The good correlation between the simulated water demand patterns and the measured patterns indicates that the basis of the design rules, the SIMDEUM simulated standardised buildings, is solid. Surveys were held to investigate whether the construction of the standardised buildings based on the dominant variable corresponds with practice. Surveys show that it is difficult to find relations to equip the standardised buildings with users and appliances. However, the validation proves that with a proper estimation of the number of users and appliances in only the dominant functional room of the standardised buildings, SIMDEUM renders a realistic cold and hot water diurnal demand pattern. Therefore, the new design rules based on these standardised buildings lead to reliable and improved designs of building installations and water heater capacity, resulting in more hygienic and economical installations

What makes a patient ready for shared decision making?: A qualitative study

Objectives: Shared decision making (SDM) requires an active role from patients, which might be difficult for some. We aimed to identify what patients need to be ready (i.e., well-equipped and enabled) to participate in SDM about treatment, and what patient- and decision-related characteristics may influence readiness.Methods: We conducted semi-structured interviews with patients and professionals (physicians, nurses, general practitioners, and researchers). Interviews were analyzed inductively.Results: We identified five elements of patient readiness: 1) understanding of and attitude towards SDM, 2) health literacy, 3) skills in communicating and claiming space, 4) self-awareness, and 5) consideration skills. We identified 10 characteristics that may influence elements of readiness: 1) age, 2) cultural background, 3) educational background, 4) close relationships, 5) mental illness, 6) emotional distress, 7) acceptance of diagnosis, 8) clinician-patient relationship, 9) decision type, and 10) time.Conclusions: We identified a wide range of elements that may constitute patient readiness for SDM. Readiness might vary between and within patients. This variation may result from differences in patientand decision-related characteristics.Practice implications: Clinicians should be aware that not all patients may be ready for SDM at a given moment and may need support to enhance their readiness. (C) 2020 The Authors. Published by Elsevier B.V.Analysis and support of clinical decision makin

Validation of non-residential cold and hot water demand model assumptions

Existing guidelines related to the water demand of non-residential buildings are outdated and do not cover hot water demand for the appropriate selection of hot water devices. Moreover, they generally overestimate peak demand values required for the design of an efficient and reliable water installation. Recently, a procedure was developed based on the end-use model SIMDEUM to derive design rules for peak demand values of both cold and hot water during various time steps for several types and sizes of non-residential buildings, i.e. offices, hotels and nursing homes. In this paper, the assumptions of building standardisation, on which the design rules are based, are validated. This was done with measurements of cold and hot water demands on a per second base and with surveys. The good correlation between the simulated water demand patterns and the measured patterns indicates that the basis of the design rules, the SIMDEUM simulated standardised buildings, is solid. Surveys were held to investigate whether the construction of the standardised buildings based on the dominant variable corresponds with practice. Surveys show that it is difficult to find relations to equip the standardised buildings with users and appliances. However, the validation proves that with a proper estimation of the number of users and appliances in only the dominant functional room of the standardised buildings, SIMDEUM renders a realistic cold and hot water diurnal demand pattern. Therefore, the new design rules based on these standardised buildings lead to reliable and improved designs of building installations and water heater capacity, resulting in more hygienic and economical installations.</p

The multifocal approach to sharing in shared decision making: a critical appraisal of the MAPPIN'SDM

ObjectiveShared decision making integrates health care provider expertise with patient values and preferences. The MAPPIN'SDM is a recently developed measurement instrument that incorporates physician, patient, and observer perspectives during medical consultations. This review sought to critically appraise the development, sensibility, reliability, and validity of the MAPPIN'SDM and to determine in which settings it has been used.MethodsThis critical appraisal was performed through a targeted review of the literature. Articles outlining the development or measurement property assessment of the MAPPIN'SDM or that used the instrument for predictor or outcome purposes were identified.ResultsThirteen studies were included. The MAPPIN'SDM was developed by both adapting and building on previous shared decision making measurement instruments, as well as through creation of novel items. Content validity, face validity, and item quality of the MAPPIN'SDM are adequate. Internal consistency ranged from 0.91 to 0.94 and agreement statistics from 0.41 to 0.92. The MAPPIN'SDM has been evaluated in several populations and settings, ranging from chronic disease to acute oncological settings. Limitations include high reading levels required for self-administered patient questionnaires and the small number of studies that have employed the instrument to date.ConclusionThe MAPPIN'SDM generally shows adequate development, sensibility, reliability, and validity in preliminary testing and holds promise for shared decision making research integrating multiple perspectives. Further research is needed to develop its use in other patient populations and to assess patient understanding of complex item wording.Analysis and support of clinical decision makin

Information preferences about treatment options in diffuse cutaneous systemic sclerosis: a Delphi consensus study

Objectives: The aim of this study was to identify and prioritize aspects essential for decision making in patients with diffuse cutaneous systemic sclerosis (dcSSc) and to gain insight into information preferences of treatment options which could guide development of a leaflet for patients.Methods: A three-round Delphi study was conducted with a panel of patients with dcSSc. The questionnaire was based on a systematic literature search regarding benefits and harms of four main treatment options in dcSSc: methotrexate, mycophenolate mofetil, cyclophosphamide pulses and stem cell transplantation. Patients were asked to identify information that is essential for making a treatment decision. After the third round, a live, online discussion was held in order to reach consensus on these items and to discuss the content and design of the leaflet. Consensus was defined as > 75% agreement among panel members.Results: Of the 36 patients invited, 78% (n = 28) participated in one or more rounds, 67% (n = 24) completed the first, 69% (n = 25) the second and 75% (n = 27) the third round. In the last round, median age of participants was 51 years (interquartile range, 18) and median disease duration 4 years (interquartile range, 5); 52% were female. Patients had been treated with mycophenolate mofetil (67%), methotrexate (44%), cyclophosphamide (41%), autologous stem cell transplantation (26%), rituximab (4%) or were treatment-naive (7%). Eight patients joined the live panel discussion. The panel reached consensus on seven benefits (prolonged progression-free survival, improved quality of life, improved daily functioning, improved pulmonary function, improved skin thickness, improved mobility and reduced fatigue) and four harms (treatment-related mortality, infections, cardiac damage, increased risk of cancer) as essential information for decision making. Also a design of a leaflet was made.Conclusion: This study identified information about treatment options in dcSSc that should be addressed with patients. Our results can be used to develop effective patient information.Analysis and support of clinical decision makin

On the relative importance of monetary transmission channels in Turkey

The main objective of this study is to provide additional evidence on the operation and relative importance of monetary transmission channels in Turkey. The results of the VAR analysis conducted using monthly data between January 2004 and November 2013 suggest that the traditional channels of interest rates, exchange rates, and credit do work in Turkish economy. However, the most striking finding of the study is the relative importance of exchange rate channel in the transmission of monetary policy decision into real economy. Variance decomposition analysis shows that the explained variance by real effective exchange rates is higher for all variables as compared to the variance explained by interest rates. However, interest rates seem to be still a useful tool to manage monetary policy given its role in controlling the changes in exchange rates. The granger causality analysis points into the fact that while interest rates have a role in leading the volatility of exchange rates, exchange rates have an impact on foreign debt holdings of banks and credit growth. On the other hand, foreign debt positions of banks and other sector firms together with credit growth granger causes industrial production. The study has some remarkable ramifications in terms of monetary policy design

Fostering patient choice awareness and presenting treatment options neutrally: a randomized trial to assess the effect on perceived room for involvement in decision making

Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment. Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naive participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance. Results A total of 324 patients and 360 disease-naive respondents participated (mean age, 52 +/- 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 +/- 2.1 on a 3-15 scale). The results showed that choice awareness communication had a positive (M-present = 5.2 v. M-absent = 5.0, P = 0.042, eta(2)(partial) = 0.006) and physician preference communication had no (M-present = 5.0 v. M-absent = 5.1, P = 0.144, eta(2)(partial) = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (M-present = 4.7 v. M-absent = 5.3, P = 0.006, eta(2)(partial) = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust. Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.Experimentele farmacotherapi

Treatment decision-making in diffuse cutaneous systemic sclerosis: a patient's perspective

Objectives. To examine the treatment decision-making process of patients with dcSSc in the context of haematopoietic stem cell transplantation (HSCT).Methods. A qualitative semi-structured interview study was done in patients before or after HSCT, or patients who chose another treatment than HSCT. Thematic analysis was used. Shared decision-making (SDM) was assessed with the 9-item Shared Decision Making Questionnaire (SDM-Q-9).Results. Twenty-five patients [16 male/nine female, median age 47 (range 27-68) years] were interviewed: five pre-HSCT, 16 post-HSCT and four following other treatment. Whereas the SDM-Q-9 showed the decision-making process was perceived as shared [median score 81/100 (range 49-100)], we learned from the interviews that the decision was predominantly made by the rheumatologist, and patients were often steered towards a treatment option. Strong guidance of the rheumatologist was appreciated because of a lack of accessible, reliable and SSc-specific information, due to the approach of the decision-making process of the rheumatologist, the large consequence of the decision and the trust in their doctor. Expectations of outcomes and risks also differed between patients. Furthermore, more than half of patients felt they had no choice but to go for HSCT, due to rapid deterioration of health and the perception of HSCT as 'the holy grail'.Conclusion. This is the first study that provides insight into the decision-making process in dcSSc. This process is negatively impacted by a lack of disease-specific education about treatment options. Additionally, we recommend exploring patients' preferences and understanding of the illness to optimally guide decision-making and to provide tailor-made information.Analysis and support of clinical decision makin