PP17 Comprehensive Evaluation Of A Technology With Expanding Indications

2018 ◽  
Vol 34 (S1) ◽  
pp. 72-72
Author(s):  
Laurie Lambert ◽  
François Désy ◽  
Leila Azzi ◽  
Maria Vutcovici ◽  
Anabèle Brière ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evaluation Process ◽  
Field Evaluation ◽  
Quality Standards ◽  
Evaluation Framework ◽  
Risk Scores ◽  
Processes Of Care ◽  
National Quality ◽  
Cardiovascular Evaluation

Introduction:The use of transcatheter aortic valve implantation (TAVI) is evolving. Our Cardiovascular Evaluation Unit is implementing a comprehensive approach to inform decision-makers on optimal use of TAVI, including the development of quality standards. We are implementing a multifaceted evaluation framework in collaboration with clinical stakeholders.Methods:Our unit has carried out a continuous field evaluation in collaboration with the clinical teams at all six TAVI centers in Québec for the past four years (1 April 2013–31 March 2017), with regular feedback to the teams and sharing of results with each individual center. Hospital documentation was reviewed according to established national quality indicator definitions. Field evaluation data were combined with the results of systematic literature review to establish provincial standards for practice, through a deliberation process by an interdisciplinary committee of clinical experts from each center. Systematic surveillance of the literature is ongoing.Results:In the period 2013–2017, use of TAVI in Québec was limited to very elderly patients with significant comorbidities at high risk of operative mortality. We observed improvements in both processes of care (e.g. documentation of risk scores) and clinical outcomes (e.g. 30-day and 1-year mortality) over time. Our consensus standards recognize the potential value of TAVI for patients at moderate operative risk, identify uncertainties and recommend best practices for patient evaluation and clinical decision-making about choice of treatment.Conclusions:A comprehensive, long-term evaluation process of TAVI with feedback to centers is associated with improvements in processes of care and outcomes. In the present context of expanding clinical indications, we will continue to evaluate patient selection, processes and outcomes according to the newly-established provincial quality standards. This iterative approach facilitates continued evidence generation and decision-making for optimal use of an evolving intervention. We acknowledge the contribution of the members of the expert clinical committee.

OP47 Need For New Thrombectomy Centers? A Practical Decision Framework

2019 ◽  
Vol 35 (S1) ◽  
pp. 11-11
Author(s):  
Maria Vutcovici Nicolae ◽  
Lucy Boothroyd ◽  
Leila Azzi ◽  
Laurie Lambert ◽  
Michèle de Guise
Keyword(s):  
Decision Making ◽  
Real World ◽  
Critical Mass ◽  
Evaluation Process ◽  
Field Evaluation ◽  
Stroke Care ◽  
Healthcare Services ◽  
Performance Criteria ◽  
Sources Of Information

IntroductionStroke is a major contributor to mortality, disability and long-term use of healthcare services. As for all chrono-dependant conditions, clinical results are associated with timely access to appropriate care. Thrombectomy (EVT) is an effective treatment for large vessel occlusions, but can only be provided in highly-specialized centers by experienced personnel. We sought to develop a framework to aid decision-making on the appropriateness of opening new EVT centers in Québec, Canada.MethodsData sources included provincial administrative healthcare databases, population density statistics, field evaluation of Québec's four existing EVT care networks, and literature review concerning structural and performance criteria for EVT centers. We consulted EVT clinical teams, interdisciplinary stroke experts, patients, professional association representatives, healthcare managers and decision-makers.ResultsAccess to EVT is suboptimal in all 17 regions of Québec, with virtually no access in remote areas. Results of key performance indicators indicated favorable treatment delays after arrival at the EVT center. However, door-to-needle and door-in-door-out times were long for patients transferred from non-EVT centers. High use of ambulances indicated the potential to transport patients to the most appropriate center. In light of ‘real world’ results and other sources of information, the need for a new EVT center should consider the following criteria: sub-optimal EVT access within the region; transport time to an existing EVT center >1 hour; expected patient volume within 2 hours of transport; impact on volume of existing programs; availability of long-term financial support; availability of a critical mass of neurointerventionists, vascular neurologists, and neurosurgeons; demonstrated quality of stroke care; and, presence of a stroke unit.ConclusionsThe triangulation of literature, clinician experience and the Québec context enriched the evaluation process. Furthermore, this facilitated the development of a framework that was broadly applicable across regions to the real-world setting of decision-making in a complex system of care.

scholarly journals Desenvolvimento e Avaliação de uma Plataforma Colaborativa Digital para Educação e Tomada de Decisão Médica Baseada em Evidências

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based ◽  
Life Problems

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

A comprehensive performance evaluation framework of complex products based on a fuzzy AHP and DS theory

2016 ◽  
Vol 07 (03) ◽  
pp. 1650020 ◽  
Author(s):  
Yuhong Li ◽  
Guanghong Gong ◽  
Ni Li
Keyword(s):  
Decision Making ◽  
Performance Evaluation ◽  
Group Decision Making ◽  
Group Decision ◽  
Evaluation Process ◽  
Small Sample ◽  
Evaluation Framework ◽  
Complex Products ◽  
Interactive Operation ◽  
Comprehensive Performance

With the development of computer technique, performance evaluation of complex products is playing an increasingly critical role in ensuring product quality and improving development process. An extensible comprehensive performance evaluation framework with the integration of effective group decision-making algorithms could be a supporting tool to achieve an efficient evaluation process and reduce comprehensive evaluation difficulty. This paper aims to provide a evaluation framework with friendly interactive operation and extensive expansibility, which adopts a multi-expert evaluation approach based on fuzzy, analytical hierarchy process (FAHP) and Dempstere–Shafer (DS) theory (FADS) in order to consider experts’ relative importance degree. In addition, an extensible evaluation process and related auxiliary functions are implemented in the framework, including the establishment of an assessment index system, integration and calls of multiple types of testing data preprocessing methods and index assessment methods suitable for small sample data, graphical result display and data analysis, etc. Finally, performance evaluation cases of two models of airborne radar anti-jamming are presented to verify the feasibility and expansibility of our assessment framework. The group decision-making method shows its effectiveness compared with the experimental evaluation results by the FAHP researched method.

Custody Quagmire: Some Psycholegal Dilemmas

1982 ◽  
Vol 10 (3) ◽  
pp. 309-326 ◽  
Author(s):  
Rex Julian Beaber
Keyword(s):  
Decision Making ◽  
Clinical Evaluation ◽  
Child Custody ◽  
Clinical Decision Making ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Clinical Prediction ◽  
Raw Data ◽  
Multi Stage

The clinical evaluation of families in contested child custody cases raises a number of difficult dilemmas. The problem areas include determining the validity of the raw data, quantifying information, attaching weight to the numerous variables, determining the value of predicted outcomes, distinguishing between actuarial and clinical prediction, defining the scope of evaluator expertise, handling functional parents, and predicting the effects of the evaluation process itself. A multi-stage decision-making grid is proposed to help make such evaluations more systematic and less encumbered by data problems and unsupportable philosophic assumptions. Specific clinical and actuarial criteria are given for clinical decision making.

scholarly journals Development and Evaluation of a Crowdsourcing Platform for Education and Evidence-Based Medical Decision-Making

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 513-524
Author(s):  
Álisson Oliveira dos Santos ◽  
Alexandre Sztajnberg ◽  
Tales Mota Machado ◽  
Daniel Magalhães Nobre ◽  
Adriano Neves de Paula e Souza ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Medical Decision Making ◽  
Clinical Decision Making ◽  
Real Life ◽  
Evaluation Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Alternative Form ◽  
Evidence Based

ABSTRACT The medical education for clinical decision-making has undergone changes in recent years. Previously supported by printed material, problem solving in clinical practice has recently been aided by digital tools known as summaries platforms. Doctors and medical students have been using such tools from questions found in practice scenarios. These platforms have the advantage of high-quality, evidence-based and always up-to-date content. Its popularization was mainly due to the rise of the internet use and, more recently, of mobile devices such as tablets and smartphones, facilitating their use in clinical practice. Despite this platform is widely available, the most of them actually present several access barriers as costs, foreign language and not be able to Brazilian epidemiology. A free national platform of evidence-based medical summaries was proposed, using the crowdsourcing concept to resolve those barriers. Furthermore, concepts of gamification and content evaluation were implemented. Also, there is the possibility of evaluation by the users, who assigns note for each content created. The platform was built with modern technological tools and made available for web and mobile application. After development, an evaluation process was conducted by researchers to attest to the valid of content, usability, and user satisfying. Consolidated questionnaires and evaluation tools by the literature were applied. The process of developing the digital platform fostered interdisciplinarity, from the involvement of medical and information technology professionals. The work also allowed the reflection on the innovative educational processes, in which the learning from real life problems and the construction of knowledge in a collaborative way are integrated. The assessment results suggest that platform can be real alternative form the evidence-based medical decision-making.

scholarly journals Business rescue decision-making: Post-mortem evaluation of an ‘orgy’

2018 ◽  
Vol 21 (1) ◽  
Author(s):  
Marius Pretorius
Keyword(s):  
Decision Making ◽  
Evaluation Criteria ◽  
Evaluation Process ◽  
Management Control ◽  
Evaluation Framework ◽  
Post Mortem ◽  
Viability Analysis ◽  
Master Level ◽  
High Level

Background: Sensemaking of the extreme vagaries and external considerations that influence decision-making and judgement during business rescue events (BREs) are currently sparse but details about evaluation criteria are desperately needed.Aim: Learning from and applying post-mortem analysis (PMA) is investigated to propose an evaluation framework. Setting: Following the problems by and expectations of the Regulator to ‘govern’ the business rescue (BR) industry, a recent decision to decentralise the accreditation of business rescue practitioners (BRPs) changed the landscape significantly. Methods: From literature and interviews, the study identified seven interactive evaluation criteria from PMA thinking to be included in a conceptual framework. Results: Following the determination of the contextual difficulty evaluation, the measurement criteria included: taking management control, initial feasibility judgement, viability analysis, decision-making, BRP competencies, the rescue plan and compliance within the supreme task. One mediating factor, namely the BRP dominated. Secondly, the evaluation process can be costly to ensure validity of the data, collection and evaluators. Finally, BRE evaluators (executors/decision makers) require a high level understanding of contextual issues that may disproportionately influence an evaluation. Expert and master level competencies are required to inform the proper judgement of the evaluation criteria and variables. Conclusion: The study addresses educators’ need for a framework for PMA to guide the teaching of BRP competencies, direct the regulatory authorities (and professional bodies) accreditation framework for licensing BRPs, inform banks as creditors to enhance their information systems, advise upcoming BRPs on outcomes while courts may consider the framework as useful for judging issues.

scholarly journals Time-dependent changes in mortality and transformation risk in MDS

Blood ◽  
2016 ◽  
Vol 128 (7) ◽  
pp. 902-910 ◽  
Author(s):  
Michael Pfeilstöcker ◽  
Heinz Tuechler ◽  
Guillermo Sanz ◽  
Julie Schanz ◽  
Guillermo Garcia-Manero ◽  
...  
Keyword(s):  
Decision Making ◽  
Lower Risk ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Time Dependent ◽  
Risk Scores ◽  
Leukemic Transformation ◽  
Key Points ◽  
Risk Patients ◽  
Over Time

Key Points Hazards regarding mortality and leukemic transformation in MDS diminish over time in higher-risk but remain stable in lower-risk patients. This change of hazard indicates time-dependent attenuation of power of basal risk scores, which is relevant for clinical decision making.

The Relationship Between Hearing Loss Self-Management and Hearing Aid Benefit and Satisfaction

2019 ◽  
Vol 28 (2) ◽  
pp. 274-284 ◽  
Author(s):  
Elizabeth Convery ◽  
Gitte Keidser ◽  
Louise Hickson ◽  
Carly Meyer
Keyword(s):  
Decision Making ◽  
Hearing Loss ◽  
Hearing Aids ◽  
Clinical Decision Making ◽  
Hearing Aid ◽  
Well Being ◽  
Self Report ◽  
Self Management ◽  
Hearing Aid Benefit ◽  
The Relationship

Purpose Hearing loss self-management refers to the knowledge and skills people use to manage the effects of hearing loss on all aspects of their daily lives. The purpose of this study was to investigate the relationship between self-reported hearing loss self-management and hearing aid benefit and satisfaction. Method Thirty-seven adults with hearing loss, all of whom were current users of bilateral hearing aids, participated in this observational study. The participants completed self-report inventories probing their hearing loss self-management and hearing aid benefit and satisfaction. Correlation analysis was used to investigate the relationship between individual domains of hearing loss self-management and hearing aid benefit and satisfaction. Results Participants who reported better self-management of the effects of their hearing loss on their emotional well-being and social participation were more likely to report less aided listening difficulty in noisy and reverberant environments and greater satisfaction with the effect of their hearing aids on their self-image. Participants who reported better self-management in the areas of adhering to treatment, participating in shared decision making, accessing services and resources, attending appointments, and monitoring for changes in their hearing and functional status were more likely to report greater satisfaction with the sound quality and performance of their hearing aids. Conclusion Study findings highlight the potential for using information about a patient's hearing loss self-management in different domains as part of clinical decision making and management planning.

AAC Decision-Making and Mobile Technology: Points to Ponder

2014 ◽  
Vol 23 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Mary Ann Abbott ◽  
Debby McBride
Keyword(s):  
Decision Making ◽  
Mobile Technology ◽  
Communication System ◽  
Augmentative And Alternative Communication ◽  
Evaluation Process ◽  
Decision Making Process ◽  
Alternative Communication ◽  
Ipod Touch ◽  
Feature Match

The purpose of this article is to outline a decision-making process and highlight which portions of the augmentative and alternative communication (AAC) evaluation process deserve special attention when deciding which features are required for a communication system in order to provide optimal benefit for the user. The clinician then will be able to use a feature-match approach as part of the decision-making process to determine whether mobile technology or a dedicated device is the best choice for communication. The term mobile technology will be used to describe off-the-shelf, commercially available, tablet-style devices like an iPhone®, iPod Touch®, iPad®, and Android® or Windows® tablet.

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