scholarly journals Decision-Making Process for the Management of Acute Stroke in Patients on Oral Anticoagulant: From Guidelines to Clinical Routine

2022 ◽  
Vol 12 ◽  
Author(s):  
Igor Sibon ◽  
Mikael Mazighi ◽  
Didier Smadja
Keyword(s):  
Decision Making ◽  
Anticoagulant Activity ◽  
Oral Anticoagulants ◽  
Real Life ◽  
Haemorrhagic Stroke ◽  
Published Data ◽  
Decision Making Process ◽  
Anticoagulant Reversal ◽  
Clinical Practise ◽  
Current Guidelines

Background: The occurrence of both ischaemic (IS) and haemorrhagic stroke in patients on anticoagulation is a major issue due to the frequency of their prescriptions in westernised countries and the expected impact of anticoagulant activity on recanalization during an IS or on the outcomes associated with intracerebral haemorrhage (ICH). Several guidelines are available but sometimes differ in their conclusions or regarding specific issues, and their application in routine emergency settings may be limited by particular individual issues or heterogeneous local specificities.Methods: Based on the current guidelines and additional published data, the algorithms proposed in this paper aim to help the decision-making process regarding stroke management in the setting of concurrent anticoagulants by addressing specific clinical situations based on clinical variables commonly encountered in real-world practise.Results: For patients on non–vitamin K oral anticoagulants, reversion can be achieved with specific antidotes, but only idarucizumab, the specific dabigatran antidote, is indicated in both IS and ICH. Due to the low risk of a prothrombotic effect, idarucizumab can be immediately used in IS patients eligible for thrombolysis before the dabigatran concentration is known. To optimise ICH management, the time since symptom onset, with thresholds proposed at 6 and 9 hours based on the expected timing of haematoma expansion, could also to be taken into account.Conclusions: Anticoagulant reversal in patients presenting with a stroke remains a major issue, and algorithms based on a step-by-step approach may be useful for clinical practise. Real-life studies strongly support the benefits of idarucizumab availability in stroke units and emergency departments.

Neutrosophic Soft Block Matrices And Some Of Its Properties

2020 ◽  
pp. 39-49
Author(s):  
admin admin ◽  
Keyword(s):  
Decision Making ◽  
Crucial Role ◽  
Real Life ◽  
Decision Making Process ◽  
Mathematical Tool ◽  
Soft Sets ◽  
Neutrosophic Sets ◽  
Block Matrices ◽  
Inconsistent Information

In real life situations, there are many issues in which there are uncertainties, vagueness, complexities and unpredictability. Neutrosophic sets are a mathematical tool to address some issues which cannot be met using the existing methods. Neutrosophic soft matrices play a crucial role in handling indeterminant and inconsistent information during decision making process. The main focus of this article is to discuss the concept of neutrosophic sets, neutrosophic soft sets, neutrosophic soft matrices theory and finally to discuss about neutrosophic soft block matrics which are very useful and applicable in various situations involving uncertainties and imprecisions. In this article, neutrosophic soft block matrices, various types of neutrosophic soft block matrices, some operations on it along with some properties associated with it are discussed in details.

scholarly journals Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis

2020 ◽  
Vol 10 ◽  
Author(s):  
Diogo Alpuim Costa ◽  
José Guilherme Nobre ◽  
Susana Baptista de Almeida ◽  
Marisa Horta Ferreira ◽  
Inês Gonçalves ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Woman ◽  
Scoping Review ◽  
Ethical Issues ◽  
Case Reports ◽  
Grey Literature ◽  
Real Life ◽  
Published Data ◽  
Ethical Frameworks ◽  
Theoretical Approaches

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.

scholarly journals ‘Between a Rock and a Hard Place’: The Implications of Lost Autonomy and Trust for Professionals at Sea

2019 ◽  
Vol 33 (4) ◽  
pp. 648-665 ◽  
Author(s):  
Helen Sampson ◽  
Nelson Turgo ◽  
Iris Acejo ◽  
Neil Ellis ◽  
Lijun Tang
Keyword(s):  
Decision Making ◽  
21St Century ◽  
Real Life ◽  
Decision Making Process ◽  
Shipping Industry ◽  
Hard Place

This article describes changes associated with increased bureaucratisation and surveillance in the regulation and management of the 21st century shipping industry. Drawing upon 303 ‘real-life’ vignette-based interviews, it describes how these transformations are experienced by contemporary navigating officers, and engineers, working on commercial cargo vessels. The article draws attention to the dysfunctional effects of distrust in organisations, describing how lost trust and associated fears impact on the decision-making process of officers thereby inducing a degree of organisational paralysis. This finding may be of particular significance to employers who have introduced punishment-centred bureaucratisation in order to improve organisational efficiency and who are concurrently undermining it.

Zur ökonomischen Analyse moralkonformen Handelns

1995 ◽  
Vol 17 (2) ◽  
Author(s):  
Martin Leschke
Keyword(s):  
Decision Making ◽  
Economic Theory ◽  
Real Life ◽  
Social Dilemma ◽  
Decision Making Process ◽  
Wide Spread ◽  
Economic Perspective ◽  
Moral Dimension ◽  
Moral Behaviour ◽  
Moral Attitudes

AbstractHis article deals with general features of moral behaviour from an economic perspective. Moral rules act as an enforcement mechanism replacing external sanctions with internal emotional sanctions such as guilt and shame. It is shown in many experiments and real life situations that morals influence the decision-making process and the outcomes. Moral attitudes help to overcome social dilemma situations if the actors’ intrinsic motivation is relatively high and if these moral attitudes are wide-spread. It is argued that to reject the moral dimension means to restrict the relevance of economic theory. This paper emphasizes the importance of moral behaviour and offers a simple model of the effects of morality.

scholarly journals Tumor-Infiltrantig Lymphocytes Density as Determinant in Early Stage Colorectal Cancer Prognosis: A Single Centre Pilot Study

2019 ◽  
pp. 1-5
Author(s):  
Cristiana Lo Nigro ◽  
Vincenzo Ricci ◽  
Teresa Fabozzi ◽  
Daniela Vivenza ◽  
Mirella Fortunato ◽  
...  
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Tumor Infiltrating Lymphocytes ◽  
Cancer Prognosis ◽  
Stage Ii ◽  
Stage Iii ◽  
High Risk Population ◽  
Published Data ◽  
Decision Making Process ◽  
Prognostic Tool

Stage II colon cancer (CC) is a heterogeneous disease with different clinical behaviour. There is a high degree of uncertainty in recommending adjuvant chemotherapy, which is usually suggested in the high-risk population on the basis of TNM, stage and key biological markers. Published data suggest that specific tumor-infiltrating lymphocytes (S-TILs) (CD3+, CD8+, CD45RO+) may represent a valuable prognostic tool to drive the decision-making process. We performed an analysis on 13 cases of stage II and III CC that relapsed, and on 15 cases that did not. We analyzed the density of CD3+, CD8+ and CD45RO+ in the surgical samples after radical surgery by IHC in the center of the tumor (CT) and in its invasive margin (IM). For each marker, we identified two grading of staining, high density (HD) or low density (LD), where the cut-off was the median value observed. This analysis was carried out stratifying patients in two cohorts: stage II (12 patients) and stage III (16 patients). Density of CD3+, CD8+ and CD45RO+ in CT did not affect DFS and OS, except for OS in stage II pts for CD3+ (P=0.012). Conversely HD of CD3+, CD8+ and CD45RO+ in IM showed significant benefit in DFS compared to LD (P=0.001, P=0.013 and P=0.001 respectively) in stage II patients and, only for CD3+, also in stage III patients (P=0.048). Similarly, we observed a significant gain in OS in pts with HD CD3+ and CD45RO+ (P=0.05 and P=0.003) but not CD8+ (P=0.25) in IM for stage II patients. S-TILs might represent a valuable prognostic tool to drive the decision-making process especially for stage II CC disease, with a more pronounced role of S-TILs in IM compared to CT. Our results will be verified in ongoing large prospective study.

scholarly journals Prevention of thromboembolic complications during cardioversion and catheter ablation in patients with atrial fibrillation: review of key randomized trials

Kardiologiia ◽  
2020 ◽  
Vol 60 (10) ◽  
pp. 99-106
Author(s):  
V. A. Ionin
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Studies ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Real Life ◽  
Thromboembolic Complications ◽  
Russian Scientific ◽  
Online Databases ◽  
Current Guidelines ◽  
Selection Of

This review focuses on the relevance of sinus rhythm control in patients with atrial fibrillation in real-life clinical practice and specific clinical features of patients with this arrhythmia. The authors presented current guidelines on prevention of thromboembolic complications and a review of results from major clinical studies of direct oral anticoagulants. The search for literature and selection of clinical studies for 2009-2020 were performed on websites of the European and Russian Societies of Cardiology, the All-Russian Scientific Society of Arrhythmologists, and in online databases PubMed, EMBASE, eLibrary, and Google Scholar using the key words atrial fibrillation, anticoagulants, ablation, cardioversion, and efficacy and safety.

scholarly journals Fostering Palliative Care Through Digital Intervention: A Platform for Adult Patients With Hematologic Malignancies

2021 ◽  
Vol 3 ◽  
Author(s):  
Lefteris Koumakis ◽  
Fatima Schera ◽  
Heather Parker ◽  
Panos Bonotis ◽  
Maria Chatzimina ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Healthcare Providers ◽  
Real Life ◽  
Hematologic Malignancies ◽  
Decision Making Process ◽  
Joint Decision ◽  
Horizon 2020 ◽  
Patient Reported ◽  
Potential Impact

Patient-reported outcomes (PROs) are an emerging paradigm in clinical research and healthcare, aiming to capture the patient's self-assessed health status in order to gauge efficacy of treatment from their perspective. As these patient-generated health data provide insights into the effects of healthcare processes in real-life settings beyond the clinical setting, they can also be viewed as a resolution beyond what can be gleaned directly by the clinician. To this end, patients are identified as a key stakeholder of the healthcare decision making process, instead of passively following their doctor's guidance. As this joint decision-making process requires constant and high-quality communication between the patient and his/her healthcare providers, novel methodologies and tools have been proposed to promote richer and preemptive communication to facilitate earlier recognition of potential complications. To this end, as PROs can be used to quantify the patient impact (especially important for chronic conditions such as cancer), they can play a prominent role in providing patient-centric care. In this paper, we introduce the MyPal platform that aims to support adults suffering from hematologic malignancies, focusing on the technical design and highlighting the respective challenges. MyPal is a Horizon 2020 European project aiming to support palliative care for cancer patients via the electronic PROs (ePROs) paradigm, building upon modern eHealth technologies. To this end, MyPal project evaluate the proposed eHealth intervention via clinical studies and assess its potential impact on the provided palliative care. More specifically, MyPal platform provides specialized applications supporting the regular answering of well-defined and standardized questionnaires, spontaneous symptoms reporting, educational material provision, notifications etc. The presented platform has been validated by end-users and is currently in the phase of pilot testing in a clinical study to evaluate its feasibility and its potential impact on the quality of life of palliative care patients with hematologic malignancies.

The Business Transformation Framework on Knowledge and Intelligence-Driven Development (KIDD)

2021 ◽  
pp. 373-391
Author(s):  
Antoine Trad ◽  
Damir Kalpic
Keyword(s):  
Neural Networks ◽  
Mathematical Model ◽  
Decision Making ◽  
Research Method ◽  
Real Life ◽  
Decision Making Process ◽  
Multidisciplinary Research ◽  
Business Transformation

This chapter's authors based their research on an authentic and proprietary mixed multidisciplinary research method that is supported by intelligent neural networks combined with a heuristics module, they are named the Applied Mathematical Model (AMM). Where the proposed AMM is similar to the human empiric decision-making process, the AMM is supported by a real life case of a business transformation architecture in the domain of Knowledge and Intelligence Driven Development (KIDD) that is supported by the alignment of a various standards and technologies.

Vehicular Traffic Forecasting in Filling Station

2017 ◽  
pp. 243-262
Author(s):  
Peeyush Pandey ◽  
Tuhin Sengupta
Keyword(s):  
Decision Making ◽  
Real Life ◽  
Future Trend ◽  
Decision Making Process ◽  
Clear Understanding ◽  
Data Set ◽  
Traffic Forecasting ◽  
Single Data ◽  
The One ◽  
Forecasting Techniques

Forecasting is the one of the important part of decision making process. It helps managers to identify short term and long term future trends in the business activities. It may help in forecasting demand in retail store, predicting customer traffic at the petrol pump, calculation of probable population in upcoming years etc. There are plenty of studies published on forecasting techniques which are just introductory or highly mathematical and lacks in providing managerial perspective of solving business problems to the students. This chapter elucidates various forecasting techniques and its application in the field of management. In addition, various examples of real life problems are solved and analyzed with multiple forecasting techniques. Through this chapter students will have a clear understanding of the various nuances of different forecasting models in one single data set. Students will be able to identify future trend and seasonality in real life data set and evaluate more appropriate forecasting technique for the decision-making process.

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