A comparative analysis between two statistical deviation–based consensus measures in group decision making problems

The mean absolute deviation and the standard deviation, two statistical measures commonly used in quantifying variability, may become an interesting tool when defining consensus measures. Two consensus indexes which obtain the level of consensus in some problems of Group Decision Making are introduced in this paper by expanding the aforementioned statistical concepts. A comparative analysis reveals that the levels of consensus derived from these indexes are close to those obtained employing distance functions when a fuzzy preference relations frame is considered, so they turn out to be a useful tool in this context. In addition, these indexes are different from each other and with the distance functions considered. Thus, they are applicable tools in the calculation of consensus in our context and are different from those commonly used

A Variance-Based Consensus Degree in Group Decision Making Problems

The variance is a well-known statistical measure and is frequently used for the calculation of variability. This concept can be used to obtain the degree of agreement in groups that have to make decisions. In this study, we propose the use of a variance derivative as an alternative for the calculation of the degree of consensus for Group Decision Making problems with fuzzy preference relations. As revealed by a subsequent comparative study, the values obtained by this new method are comparable to the values obtained by means of frequently used methods that employ distance functions and aggregation operators, while it turns out to be a simpler application method

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Entropy Based Approach to Measuring Consensus in Group Decision-Making Problems

Entropy is a measure of randomness in a given set of data. An entropy measure could be appropriately used to assess consensus across a set of opinions. A Theil-based index is introduced in this paper to obtain the level of consensus in some problems of Group Decision Making. A comparative analysis reveals that the levels of consensus derived from this index are relatively similar to those obtained by using distance functions when a fuzzy preference relations frame is considered. This behavior suggests that this could be a useful tool in the aforementioned context

Study of Manhattan's consensus degrees through an extension based on the Uniform distribution

open access journalAn important aspect to be considered in Group Decision Making problems is the study of consensus. Since in these problems it is desirable that the final decision is widely accepted, improving the consensus degree in a fair way is a very interesting task. This paper analyses the improvement in the consensus degrees –obtained by applying Manhattan distance- when the experts’ preferences are slightly modified using one of the properties of the Uniform distribution. We carry out an experimental study that shows the enhancement in different cases to which Uniform extension is applied using different number of both, experts and alternatives

Improving Euclidean's consensus degrees in group decision making problems through a uniform extension.

In a Group Decision Making problem, several people try to reach a single common decision by selecting one of the possible alternatives according to their respective preferences. So, a consensus process is performed in order to increase the level of accord amongst people, called experts, before obtaining the final solution. Improving the consensus degree as much as possible is a very interesting task in the process. In the evaluation of the consensus degree, the measurement of the distance representing disagreement among the experts´ preferences should be considered. Different distance functions have been proposed to implement in consensus models. The Euclidean distance function is one of the most commonly used. This paper analyzes how to improve the consensus degrees, obtained through the Euclidean distance function, when the preferences of the experts are slightly modified by using one of the properties of the Uniform distribution. We fulfil an experimental study that shows the betterment in the consensus degrees when the Uniform extension is applied, taking into account different number of experts and alternatives

Measuring Consensus in Group Decision-Making Problems through an inequality measure

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Gini index, a measure of statistical dispersion intending to represent inequality within a group, used mainly in economics, becomes in this paper a tool to introduce a new index to measure the level of consensus in Group Decision Making problems. An empirical study reveals that the levels of consensus obtained by this index are similar to those derived through the use of a distance function when fuzzy preference relations are considered. The results obtained suggest that this new index can be satisfactorily used to measure the degree of consensus in this framework

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London