scholarly journals Making Patient-Specific Treatment Decisions Using Prognostic Variables and Utilities of Clinical Outcomes

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2741
Author(s):  
Pavlos Msaouel ◽  
Juhee Lee ◽  
Peter F. Thall
Keyword(s):  
Decision Making ◽  
Clinical Outcomes ◽  
Specific Treatment ◽  
Patient Specific ◽  
Prognostic Information ◽  
Cell Renal Cell Carcinoma ◽  
Trade Offs ◽  
Patient Heterogeneity ◽  
Informed Patient

We argue that well-informed patient-specific decision-making may be carried out as three consecutive tasks: (1) estimating key parameters of a statistical model, (2) using prognostic information to convert these parameters into clinically interpretable values, and (3) specifying joint utility functions to quantify risk–benefit trade-offs between clinical outcomes. Using the management of metastatic clear cell renal cell carcinoma as our motivating example, we explain the role of prognostic covariates that characterize between-patient heterogeneity in clinical outcomes. We show that explicitly specifying the joint utility of clinical outcomes provides a coherent basis for patient-specific decision-making.

The role of hierarchical production planning in food manufacturing SMEs

2015 ◽  
Vol 35 (10) ◽  
pp. 1362-1385 ◽  
Author(s):  
Seamus O'Reilly ◽  
Anita Kumar ◽  
Frédéric Adam
Keyword(s):  
Decision Making ◽  
Production Planning ◽  
Large Scale ◽  
Product Variety ◽  
Food Manufacturing ◽  
Content Type ◽  
Hierarchical Production Planning ◽  
Trade Offs ◽  
Internal Integration

Purpose – In recent years there has been an increasing interest in make-to-stock and make-to-order combined strategies in food manufacturing operations. However, most scholarly work to-date has neglected the role of hierarchical production planning (HPP) in guiding small- and medium-sized enterprise (SME) implementation of such strategies. The purpose of this paper is to address food SME manufacturers’ readiness to adopt such strategies, in terms of internal integration and their capability to adopt formalised planning approaches. Design/methodology/approach – This study adopted an action research methodology to explore the potential impact of HPP in SME food manufacturers. Selected companies had identified product variety management as a challenge and also had recognised the need to enhance internal integration. Given this, the research team, from a theoretical perspective, proposed the use of HPP set within a broader decision-making conceptual framework to improve internal integration and planning. Findings – This paper adopts the fundamental position that HPP provides a useful framework in the establishment of strategic and tactical level constraints and priorities which then act as specific guides at the operational level, and presents empirical evidence in a food SME manufacturing context. In the cases the authors studies, the cascading effect of this decision-making framework focused attention on key metrics, encouraged greater internal integration and delivered tangible, significant improvements in performance. This was greatly facilitated by the provision of new key data on the cost of certain managerial trade-offs which these firms faced. Originality/value – SMEs are of a scale that requires a formalised planning approach; however production planning systems are typically designed for large scale enterprises. This paper addresses the need of SMEs in this regard. Well-established supply chain metrics were used to establish the benefits of both HPP and resulting improvement in internal integration and beyond, in terms of improvement in the quality of planning decisions.

When Being in a Positive Mood Increases Choice Deferral

2017 ◽  
Vol 45 (1) ◽  
pp. 208-225 ◽  
Author(s):  
Jordan Etkin ◽  
Anastasiya Pocheptsova Ghosh
Keyword(s):  
Decision Making ◽  
Positive Mood ◽  
Choice Processes ◽  
Trade Offs ◽  
Neutral Mood ◽  
Choice Deferral

Abstract Consumers’ choices are often accompanied by unrelated incidental moods. The positive mood caused by receiving a compliment, for example, may persist when one is choosing what service to book or which product to buy. How might being in a positive mood affect consumers’ subsequent, unrelated choices? The present research demonstrates that being in a positive mood can make consumers more likely to defer choice. Four studies show that when choosing requires trade-offs between important choice attributes, being in a positive (vs. neutral) mood makes choosing more difficult and therefore increases the likelihood of deferring choice altogether. The findings further understanding of how incidental factors shape choice processes and outcomes and the role of emotions in decision making.

scholarly journals The Potential Influence of Vitamin A, C, and D and Zinc Supplements on the Severity of COVID-19 Symptoms and Clinical Outcomes: An Updated Review of Literature

2020 ◽  
Vol 8 (3) ◽  
pp. 703-714
Author(s):  
Abeer Salman Alzaben
Keyword(s):  
Mortality Rate ◽  
Vitamin A ◽  
Clinical Outcomes ◽  
Potential Role ◽  
Randomized Clinical Trials ◽  
Respiratory Infections ◽  
Specific Treatment ◽  
Zinc Supplements ◽  
Different Doses

Coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is an ongoing viral epidemic that originated in China in December 2019. To date, no specific treatment is available for COVID-19. However, several studies have reported the benefits of vitamins A, C, and D and zinc in critically ill patients and in those with various infections, including respiratory infections and sepsis. The objective of this review is to discuss the potential role of vitamin A, C, and D and zinc supplementation in enhancing immune response, and reducing the severity of symptoms, and mortality rate in patients with COVID-19. Several clinical studies have shown that different doses of vitamins A, C, and D and/or zinc supplements reduce the ventilator, length of intensive care unit stay, and mortality rate. Future randomized clinical trials are warranted to conclusively establish protocols for the optimal doses of vitamin A, C, and D, as well as zinc supplements for improved clinical outcomes in patients with COVID-19.

OP160 Enhancing Innovation Through HTA: Experience From South Australia

2018 ◽  
Vol 34 (S1) ◽  
pp. 58-58
Author(s):  
Naomi Burgess ◽  
Deborah Chen
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Clinical Outcomes ◽  
State Government ◽  
New Technologies ◽  
Specific Treatment ◽  
South Australia ◽  
Health Technologies ◽  
Hospital Networks ◽  
Decision Making Criteria

Introduction:A statewide health technology assessment (HTA) program was implemented to increase equity of access and support robust assessment of technologies, with a focus on those that are high-cost, high-risk, or have state-wide impact.Methods:Local hospital networks and clinicians refer technologies to the South Australia Policy Advisory Committee on Technology (SAPACT) for assessment. Independently produced, comprehensive HTA reports are developed using internationally recognized evidence and critical appraisal methodologies. Clinical and economic systematic analyses are utilized, with extensive clinical consultation, to develop recommendations for new technologies and their role in models of care. Feasibility of adoption and local implementation are considered, including existing service delivery and appropriate training and credentialing. For approved technologies, SAPACT may also develop audit criteria and seek implementation reports on clinical outcomes.Results:The HTA framework has been successfully adopted across South Australia Health, increasing the incorporation of evidence-based decision making in the use of high-cost and high-risk health technologies. Over 35 evidence evaluations for high-risk and high-cost health technologies have been conducted for a broad range of treatment interventions. SAPACT develops and utilizes HTA decision-making criteria for transparency of Committee considerations. The program recommends adoption or rejection of technologies, or it may request a re-submission due to safety concerns or a lack of proven effectiveness. SAPACT has also granted temporary approval through adoption under clinical evaluation to inform investment decisions. A key component is working with clinicians to define specific treatment criteria and patient selection. SAPACT continues to strengthen relationships with all stakeholders, increase patient input through the development of public summary documents for technologies, and improve monitoring and reporting of clinical outcomes.Conclusions:The HTA program has been very productive and positively received. The success of the program is underpinned by its engagement with clinicians, hospital networks, and consumers. The completion of SAPACT HTA reviews and the publication of the SAPACT decision-making criteria have increased the credibility of decisions, supporting enhancements in patient care and cost efficiency for the state government.

scholarly journals A machine learning framework for automated diagnosis and computer-assisted planning in plastic and reconstructive surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Paul G. M. Knoops ◽  
Athanasios Papaioannou ◽  
Alessandro Borghi ◽  
Richard W. F. Breakey ◽  
Alexander T. Wilson ◽  
...  
Keyword(s):  
Machine Learning ◽  
Decision Making ◽  
Reconstructive Surgery ◽  
Clinical Decision Making ◽  
Specific Treatment ◽  
Operation Time ◽  
Clinical Decision ◽  
Patient Specific ◽  
Computer Assisted ◽  
Plastic And Reconstructive Surgery

Abstract Current computational tools for planning and simulation in plastic and reconstructive surgery lack sufficient precision and are time-consuming, thus resulting in limited adoption. Although computer-assisted surgical planning systems help to improve clinical outcomes, shorten operation time and reduce cost, they are often too complex and require extensive manual input, which ultimately limits their use in doctor-patient communication and clinical decision making. Here, we present the first large-scale clinical 3D morphable model, a machine-learning-based framework involving supervised learning for diagnostics, risk stratification, and treatment simulation. The model, trained and validated with 4,261 faces of healthy volunteers and orthognathic (jaw) surgery patients, diagnoses patients with 95.5% sensitivity and 95.2% specificity, and simulates surgical outcomes with a mean accuracy of 1.1 ± 0.3 mm. We demonstrate how this model could fully-automatically aid diagnosis and provide patient-specific treatment plans from a 3D scan alone, to help efficient clinical decision making and improve clinical understanding of face shape as a marker for primary and secondary surgery.

scholarly journals Advances in risk stratification of bladder cancer to guide personalized medicine

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1137 ◽  
Author(s):  
Justin T. Matulay ◽  
Ashish M. Kamat
Keyword(s):  
Bladder Cancer ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Specific Treatment ◽  
Invasive Disease ◽  
Intravesical Therapy ◽  
Sequencing Data ◽  
Prognostic Information ◽  
Genetic Sequencing ◽  
Muscle Invasive

Bladder cancer is a heterogeneous disease that poses unique challenges to the treating clinician. It can be limited to a relatively indolent papillary tumor with low potential for progression beyond this stage to muscle-invasive disease prone to distant metastasis. The former is best treated as conservatively as possible, whereas the latter requires aggressive surgical intervention with adjuvant therapies in order to provide the best clinical outcomes. Risk stratification traditionally uses clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. For bladder cancer, this informs decisions regarding the type of intravesical therapy that is most appropriate for non-muscle-invasive disease or whether or not to administer neoadjuvant chemotherapy prior to radical cystectomy. More recently, tumor genetic sequencing data have been married to clinical outcomes data to add further sophistication and personalization. In the next generation of risk classification, we are likely to see the inclusion of molecular subtyping with specific treatment considerations based on a tumor’s mutational profile.

DOZ047.108: Utilizing dynamic CT imaging to map tissue regeneration in a porcine model of esophageal loss

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
T Jensen ◽  
I Sharma ◽  
W Fodor ◽  
S Sundaram ◽  
T Roffidal ◽  
...  
Keyword(s):  
Animal Studies ◽  
Specific Treatment ◽  
Regenerative Process ◽  
Patient Specific ◽  
Complication Rates ◽  
Tubular Scaffold ◽  
Fully Connected ◽  
Very High ◽  
Correct Structure

Abstract Esophageal atresia (EA) is a congenital defect in which the esophagus is not fully connected. Current treatments to bring together long gaps between the esophagus have very high complication rates and the replacement tissue does not possess the correct structure or physiologic properties. Tissue engineering and regenerative medicine have been suggested as a new patient-specific treatment for EA utilizing the patient's own cells and a tubular scaffold. Our group recently published on the successful regeneration of an esophagus using a retrievable scaffold seeded with amniotic derived MSCsFurther evaluation with dynamic computed tomography has suggested that the regenerative process entails ingrowth of native esophageal cells from both proximal and distal ends including robust vascular ingrowth. This confirms our gene expression findings and lends support to our hypothesis that the regenerative process is driven by vascular ingrowth. The role of the cells seeded on esophageal scaffolds and how this affects the regenerative process is the focus of current investigation with animal studies that are ongoing.

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