Decision Confidence Research Articles

Strategic Expert Committees and the Markets That Assess Them: A Laboratory Experiment

Committees of experts are widely used to make decisions. We experimentally investigate the relationship between decision making in committees and the assessment of the ability of committee members by evaluators, comparing observed behavior with theoretical predictions. Treatments vary in whether members care only about a state-dependent project payoff or also about assessments and whether evaluators can base their assessments only on the decision the committee makes or also on cheap-talk statements made by committee members on their confidence in the committee decision. Evidence for the equilibrium predictions is mixed; for example, contrary to theory, committees with a concern for their assessment do not distort their decisions more than committees without, whereas in line with theory, evaluators give higher assessments to committees that take the risky decision rather than the riskless. We analyze whether evaluators rationally base their assessments on observed behavior of committees using an orthogonality test. In treatments with cheap-talk statements, assessments are quite rational; in treatments without, they are too low on average. We investigate whether committees best reply to expected project payoffs and, in treatments in which members’ payoffs also depend on assessments, to predicted assessments conditional on observed committee behavior. In all treatments, committees respond to the possibilities to raise expected payoffs but do not use them as much as predicted by theory. We conclude by showing that the amount of information about committee members’ abilities that ends up in assessments is considerably larger when evaluators observe committees’ decisions and statements rather than only decisions. This paper was accepted by Yan Chen, behavioral economics and decision analysis. Funding: We gratefully acknowledge financial support from the Dutch Research Council (NWO) under the grant 400-09-338; and Erasmus University Rotterdam [Grant CSTO 2014–54]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.03007 .

Meta-Heart Team: enhancing multidisciplinary heart teams through virtual reality in the metaverse

Abstract Introduction Cardiovascular Multidisciplinary Heart Teams (MDHTs) are integral for patient management, but persistent challenges, including limited subspecialty expertise and time constraints, necessitate innovative approaches. This study explores the viability of conducting international Meta-Heart Team sessions utilizing virtual reality (VR) within the metaverse, aiming to address these challenges. Methods The Meta-Heart Team, comprising participants from diverse medical specialties and countries, engaged in VR sessions facilitated by VR headsets and web browsers. The immersive Aimedis metaverse platform recreated a three-dimensional hospital setting, complete with a dedicated Meta-Heart Team room featuring large screens displaying patient data such as coronary angiograms and echocardiograms. A 0-10 scale questionnaire evaluated participant experiences, covering technical quality, immersion, willingness to participate again, and overall satisfaction. Results The virtual environment effectively facilitated discussions on valvular heart disease cases among 10 participants, dedicating 15 minutes to each case. Technical stability was robust (90%), with only one participant experiencing internet disconnection. Positive participant feedback highlighted high ratings for technical quality (8.0±1.8) and engagement, a good immersive experience (8.0±1.3), willingness to participate again (9.2±0.8), and confidence in treatment decisions (80%). Despite a sense of digital fatigue reported by a few participants, the majority expressed that the VR session saved time compared to traditional meetings. Privacy concerns were acknowledged by 80% of participants. Discussion The virtual environment demonstrated potential in augmenting MDHT collaboration, providing advantages in global accessibility, multidimensional analysis, and adaptability. Participants recognized limitations in non-verbal communication and interpersonal connections but underscored the adaptability and effectiveness of the virtual setting. Technical challenges, including a single internet disconnection, emphasized the importance of a robust technical infrastructure. Privacy issues, digital fatigue, and potential exclusions were highlighted, prompting consideration of ethical guidelines and ongoing technological advancements. Conclusion Leveraging VR in the metaverse for MDHT sessions is feasible and offers substantial benefits. Despite challenges such as technical issues and privacy concerns, the Meta-Heart Team complements traditional interactions, ushering in a new era in collaborative decision-making while demanding ongoing attention to technological and ethical considerations.Two presenters explaining the processThe Metaverse-based Heart Team room

Gamification in the Design of Virtual Patients for Swedish Military Medics to Support Trauma Training: Interaction Analysis and Semistructured Interview Study.

This study explores gamification in the design of virtual patients (VPs) to enhance the training of Swedish military medics in trauma care. The challenges related to prehospital trauma care faced on the battlefield require tailored educational tools that support military medics' education and training. The aim of the study is to investigate how to design VPs with game elements for Swedish military medics to support learning in military trauma care. By understanding the reasoning and perceptions of military medics when interacting with VPs, this study aims to provide insights and recommendations for designing VPs with game elements that are specifically tailored to their needs. The study involved 14 Swedish military medics of the Home Guard-National Security Forces participating in a tactical combat care course. Participants interacted with 3 different VP cases designed to simulate military trauma scenarios. Data were collected through think-aloud sessions and semistructured interviews. The data were analyzed using interaction analysis, structured by the unawareness, problem identification, explanation, and alternative strategies or solutions (uPEA) framework, and reflexive thematic analysis to explore participants' reasoning processes and perceptions and identify possible game elements to inform the VP design. Mapping the military medics' reasoning to the uPEA framework revealed that study participants became more creative after making a mistake followed by feedback and after receiving a prompt to make a new decision. The thematic analysis revealed 6 themes: motivation, "keep on trying"; agency in interaction with VPs; realistic tactical experience; confidence, "I know that the knowledge I have works"; social influence on motivation; and personalized learning. Participants suggested that game elements such as scoring; badges; virtual goods; progress bars; performance tables; content unlocking; hints; challenge; control; imposed choice; narrative; avatars; sensation; randomness; difficulty adapting; competition; leaderboards; social pressure; progression; and renovation can promote engagement, motivation, and support confidence in decision-making. Gamification in the design of VPs represents a promising approach to military medical training, offering a platform for medics to practice medical and tactical decision-making in a risk-free environment. The insights gained by the study may encourage designing VPs with game elements, as well as including possibly wrong decisions, their consequences, and relevant feedback, that may support military medics' reflections and decision-making.

Validation of a software-based torsional measurement method of the lower limb: A retrospective study.

The aim of this study was to evaluate a software-based measurement tool of computed tomography imaging to assess torsional alignment of the lower limb-usually used for patients with posttraumatic deformities and patellofemoral issues-and compare these measurements with manual measurements of two experienced raters. This study was a retrospective analysis of 58 lower limbs (47 patients, 20 men and 27 women) aged between 19 and 97 years. Inclusion criteria were the clinical indication for torsion measurement of the lower limb. Legs with incomplete imaging and age less than 18 years were excluded. Femoral and tibial torsion were measured separately. Torsional alignment was assessed software-based at two time points by two raters. Rater one additionally assessed manual-based measurement at two time points. The software used was mediCAD 3D Knee Version 2.5.33 (Hectec). Subsequently, intra- and inter-rater reliability was calculated using the intraclass correlation coefficient (ICC). Validity testing was performed by means of precision, concordance correlation coefficient according to Lin (ccc) and Pearson correlation coefficient. High intra-rater reliability for software-based as well as manual-based evaluation of torsional alignment was found for the tibia as well as the femur (ICC ranging between 0.870 and 0.993). Inter-rater reliability also showed highly significant results of both manual and software-based measurements (ICC ranging between 0.851 and 0.993). For almost all comparisons (except the tibia left), software-based measurements showed higher ICC scores above 0.9, and, therefore, classified as 'excellent reliability'. For validity testing, correlation coefficients and precision showed very good correspondence of the measurements (all values > 0.9), without systematic deviations. Software-based measurement of torsional alignment according to the measurement method developed by H.-A. Waidelich proved to be a reliable and valid technique. Especially for inexperienced surgeons, software-based measurement, therefore, might improve confidence in reliable medical decisions in diagnostics and treatment. Level III.

How large language model-powered conversational agents influence decision making in domestic medical triage contexts

IntroductionEffective delivery of healthcare depends on timely and accurate triage decisions, directing patients to appropriate care pathways and reducing unnecessary visits. Artificial Intelligence (AI) solutions, particularly those based on Large Language Models (LLMs), may enable non-experts to make better triage decisions at home, thus easing the healthcare system's load. We investigate how LLM-powered conversational agents influence non-experts in making triage decisions, further studying different persona profiles embedded via prompting.MethodsWe designed a randomized experiment where participants first assessed patient symptom vignettes independently, then consulted one of the two agent profiles—rational or empathic—for advice, and finally revised their triage ratings. We used linear models to quantify the effect of the agent profile and confidence on the weight of advice. We examined changes in confidence and accuracy of triage decisions, along with participants' perceptions of the agents.ResultsIn a study with 49 layperson participants, we found that persona profiles can be differentiated in LLM-powered conversational agents. However, these profiles did not significantly affect the weight of advice. Notably, less confident participants were more influenced by LLM advice, leading to larger adjustments to initial decisions. AI guidance improved alignment with correct triage levels and boosted confidence in participants' decisions.DiscussionWhile LLM advice improves triage recommendations accuracy, confidence plays an important role in its adoption. Our findings raise design considerations for human-AI interfaces, highlighting two key aspects: encouraging appropriate alignment with LLMs' advice and ensuring that people are not easily swayed in situations of uncertainty.

MIDAS: Multi-layered attack detection architecture with decision optimisation

The proliferation of cyber attacks has led to the use of data-driven detection countermeasures, in an effort to mitigate this threat. Machine learning techniques, such as the use of neural networks, have become mainstream and proven effective in attack detection. However, these data-driven solutions are limited by: a) high computational overhead associated with data pre-processing and inference cost, b) inability to scale beyond a centralised deployment to cope with environmental variances, and c) requirement to use multiple bespoke detection models for effective attack detection coverage across the cyber kill chain. In this context, this paper introduces MIDAS, a cost-effective framework for attack detection, which introduces a dynamic decision boundary that is used in a multi-layered detection architecture. This is achieved by modelling the decision confidence of the participating detection models and judging its benefits using a novel reward policy. Specifically, a reward is assigned to a set of available actions, corresponding to a decision boundary, based on its cost-to-performance, where an overall cost-saving is prioritised. We evaluate our approach on two widely used datasets representing two of the most common threats today, i.e., phishing and malware. MIDAS shows that it effectively reduces the expenditure on detection inference and processing costs by controlling the frequency of expensive detection operations. This is achieved without significant sacrifice of attack detection performance.

Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention

BackgroundInterventions targeting healthcare professionals’ confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.MethodsUsing a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.ResultsWhile no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.ConclusionsThe CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

VALUE OF THE COMPANY : THE MEDIATING RETURN ON EQUITY

The grand theory in this research was built by combining Signal Theory, Stakeholder Theory, and Agency Theory as a conceptual basis for hypothesis development. Signal Theory highlights how information companies convey, such as implementing Good Corporate Governance (GCG), can influence investor confidence and investment decisions. This study aims to analyze the impact of CSR and GCG on company value (Tobin's Q), mediated by financial performance, with a focus on Islamic Social Responsibility (ISR), Independent Board of Commissioners (IBC), and Institutional Ownership (IO). They are using a quantitative method. The data is derived from the annual financial reports of 39 banking companies listed on the Indonesia Stock Exchange (IDX) from 2017 to 2021. The purposive sampling technique was chosen to ensure that the sample used was relevant and could provide valid data to test the relationship between the variables studied and answer the research hypothesis comprehensively. Secondary data was collected from www.idx.co.id, and path analysis was employed as the analytical method. The findings reveal that CSR, ISR, IBC, and IO positively and directly influence company value (Tobin's Q). These results underscore the critical role of CSR and GCG in shaping a company's financial performance and market value.

Neural basis of concurrent deliberation toward a choice and degree of confidence.

Decision confidence plays a key role in flexible behavior and (meta)cognition, but its underlying neural mechanisms remain elusive. To uncover the latent dynamics of confidence formation at the level of population activity, we designed a decision task for nonhuman primates that measures choice, reaction time, and confidence with a single eye movement on every trial. Monkey behavior was well fit by a bounded accumulator model instantiating parallel processing of evidence, rejecting a serial model in which the choice is resolved first followed by post-decision accumulation for confidence. Neurons in area LIP reflected concurrent accumulation, exhibiting covariation of choice and confidence signals across the population, and within-trial dynamics consistent with parallel updating at near-zero time lag. The results demonstrate that monkeys can process a single stream of evidence in service of two computational goals simultaneously-a categorical decision and associated level of confidence-and illuminate a candidate neural substrate for this ability.

Evaluation of utilization and consequences of CRP point-of-care-testing in primary care practices: qualitative interviews with general practitioners from Germany.

The use and advantages of point-of-care tests (POCTs) for C-reactive protein (CRP) in general practice, especially for upper respiratory tract infections (uRTIs), have been studied extensively. However, there is limited knowledge about test indications, prerequisites, and integration of these tests into everyday practice. This study aims to investigate the attitudes and experiences of general practitioners (GPs) in Germany regarding the use of semi-quantitative CRP-POCTs. The study places special emphasis on implementation in routine care, including testing procedures, feasibility, opportunities and barriers for specific consultation scenarios, as well as test indications and their impact on GP-patient communication. Qualitative interview study with 10 GPs (May/2023 to Aug/2023) METHOD: Ten German GPs who participated in an observational study on CRP-POCT use in general practices were interviewed using semi-structured interviews. Audio recordings were transcribed and content analysis was performed. Interviewed GPs stated that CRP-POCTs offer several advantages for various treatment cases. They improve diagnostic confidence and certainty of GPs' therapeutic decisions, and offer a broad spectrum of indications and application scenarios. Additionally, they have a positive impact on GP-patient communication, and their ease of use enables rapid implementation into existing workflows. On the other hand, CRP-POCT increase the time required for test performance and patient consultation. Due to the numerous benefits of semi-quantitative CRP-POCTs, interviewed GPs have a favourable attitude towards their regular integration into everyday practice. Implementation barriers include increased time and personnel expenses for testing and inadequate reimbursement by German statutory health insurance.

Transitions of Care From Hospital to Home: Can Continuous Glucose Monitoring Improve Outcomes for Patients With Diabetes?

The purpose of this study was to examine the impact of continuous blood glucose monitoring (CGM) on transitions of care as patients with diabetes are discharged from the hospital on insulin. This is a descriptive study with 2 cohorts of patients (transition to home with CGM and transition to home without CGM) who were assessed prior to discharge (baseline) and 30 days post discharge (follow-up). The key outcome measures were satisfaction with diabetes management, diabetes-related quality of life, frequency of blood glucose monitoring, and 30-day readmission rates. Patients in the CGM group reported significantly higher levels of satisfaction with diabetes self-care management and higher levels of diabetes-related quality of life compared to those patients discharged without CGM. The results of this study suggest that CGM enables a smoother transition from hospital to home for patients with diabetes placed on insulin at discharge. CGM was associated with higher satisfaction and diabetes-related quality of life, perhaps as a result of timely, ongoing information about glucose levels without the burden and pain of finger sticks. CGM may provide greater confidence in self-care decisions regarding insulin dosing, food intake, and exercise. Further research is needed to confirm our results and explore the additional factors associated with greater quality of life and satisfaction.

Individual differences in decision-making shape how mesolimbic dopamine regulates choice confidence and change-of-mind.

Nucleus accumbens dopamine signaling is an important neural substrate for decision-making. Dominant theories generally discretize and homogenize decision-making, when it is in fact a continuous process, with evaluation and re-evaluation components that extend beyond simple outcome prediction into consideration of past and future value. Extensive work has examined mesolimbic dopamine in the context of reward prediction error, but major gaps persist in our understanding of how dopamine regulates volitional and self-guided decision-making. Moreover, there is little consideration of individual differences in value processing that may shape how dopamine regulates decision-making. Here, using an economic foraging task in mice, we found that dopamine dynamics in the nucleus accumbens core reflected decision confidence during evaluation of decisions, as well as both past and future value during re-evaluation and change-of-mind. Optogenetic manipulations of mesolimbic dopamine release selectively altered evaluation and re-evaluation of decisions in mice whose dopamine dynamics and behavior reflected future value.

대학 전공트랙제 기반 융합전공자의 전공적응 지원을 위한 비교과 교육요구 분석: H대학의 제2트랙을 중심으로

Objectives The purpose of this study was to investigate the major adjustment and educational needs of students in convergence majors, and to suggest directions for the operation of educational programs aimed at major adjustment. Methods This study surveyed 83 students in convergence majors at H-University in Seoul, focusing on their major satisfaction, major adjustment, and educational needs for their major. For data analysis, the mean and standard deviation were calculated using the SPSS 22.0 statistical program. In addition, an independent sample t-test and univariate analysis of variance were conducted to confirm differences between groups. Results The results showed that, first, the students in convergence majors were generally satisfied with their major. second, major adjustment to the major track was high, satisfaction with course selection and goal orientation was high, but career decision confidence and support from the academic environment was relatively low. Third, in terms of extra-curricular requirements for adapting to the second major, students would like to have one to two hours of lectures, practical workshops and mentoring during the semester from industry or professional lecturers directly related to the second major. Conclusions The study will contribute to establishing a foundation for improving both curricular and extracurricular offerings for convergence major students.

SP1.12 - Who should manage recurrent foreign body ingestion? A questionnaire survey

Abstract Aims Recurrent foreign body ingestion (RFBI) associated with complex mental health illness is a common presentation to the emergency department. The aim of this study was to explore senior clinician’s experience and views on decision-making, support offered and management of patients with RFBI. Methods An anonymous survey, with questions on confidence in decision-making, support levels, and opinions on admitting specialty, was distributed to consultants and registrars in emergency medicine, gastroenterology, general surgery, and psychiatry. Results 189 responses with 166 complete surveys. 99% had encountered similar patients. 42% felt comfortable with decision-making. However, 35% felt stressed and 15% would delay or even avoid decision-making. Only 36% felt they received adequate support from legal and higher management teams and 84% were not aware of a management protocol. 60% were not confident in their knowledge of sectioning. 60% did not know when it is appropriate to call the police and 56% believe there is inadequate security staff support. 74% found difficulty referring to other specialties. 49% believe patients should be admitted under psychiatry, 29% believe admission should be under gastroenterology, and 22% believe they should be under surgery. Conclusion The majority of clinicians had encountered patients with RFBI but did not feel comfortable making management decisions for them. There is a lack of support, knowledge, and protocols surrounding management. There is difficulty referring between specialties and uncertainty on appropriate admitting specialty. There is a need for further research and guidance on management of these patients to increase collaborative teamworking and improve patient outcomes.

Information search under uncertainty across transdiagnostic psychopathology and healthy ageing

When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an ‘anxious-depression’ (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a ‘compulsive behaviour and intrusive thoughts’ (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

Effect of Choose-Your-Own-Adventure (CYOA) Activities on Pharmacy Student Knowledge

ObjectiveMany strategies are used in pharmacy education to maintain student engagement through active learning. Gamification, such as the choose-your-own-adventure activity (CYOAA), is one such method. The purpose of this study was to assess improvement in clinical knowledge and retention after the implementation of CYOAA. MethodsTwo CYOAAs were designed and implemented within second-year pharmacy courses. One activity was on venous thromboembolism (VTE) and the other on chronic obstructive pulmonary disease (COPD). Students completed a six question prequiz and postquiz for both activities mapped to core learning objectives and four similar but more difficult questions on corresponding exams. After the CYOAAs, the students completed a reflection and perceptions survey. ResultsSeventy-five students completed the VTE CYOAA and 77 completed COPD CYOAA. Over the three time points, there was a significant decrease in the mean assessment scores on the VTE activity (68% to 65% to 40%) versus a significant and sustained increase in mean assessment scores on COPD (62% to 83% to 85%). Of the 36 and 33 students who completed the postsurvey, the majority agreed or strongly agreed that they preferred CYOAA to traditional cases and that the activities improved their knowledge, critical thinking skills, and confidence in clinical decision-making. ConclusionThere was a mixed result in the mean assessment scores, with an increase seen with the COPD CYOAA and a decrease with VTE, as well as positive perceptions for VTE and COPD, indicating that this classroom innovation is well-liked and may improve knowledge outcomes.

Toward Constructing Frameworks for Task- and Design-Optimized Visualizations.

Visualization is crucial to augment and enhance human understanding and decision-making in today's data-driven world. However, the way data are visualized can influence and drastically change the conclusions people draw using data. The findings around visualization effectiveness are nuanced, and guidelines for effective visualization design depend on the visual channels used, chart types, and analysis tasks. This points to a significant need to understand the intersection of these factors to create optimized visualizations. We need a framework to define this intersection that fills the gap by providing a task-optimized visualization design for better quality and higher decision-making confidence that gives designers objective guidance. A task-optimized visualization design framework strategically integrates visual channels, visualization types, and specific low-level tasks to enhance data interpretation and optimize user task performance. We discuss constructing a visualization framework that considers both human perception for encoding techniques and the task being performed, enabling optimizing visualization design to maximize efficiency. Furthermore, we highlight a task-optimized framework's impact and potential applications.

From Plan to Pivot: How Model-Informed Drug Development Shaped the Dose Strategy of the Zibotentan/Dapagliflozin ZENITH Trials.

Getting the dose right is a key challenge in drug development; model-informed drug development (MIDD) provides powerful tools to shape dose strategies and inform decision making. In this tutorial, the case study of the ZENITH trials showcases how a set of clinical pharmacology and MIDD approaches informed an impactful dose strategy. The endothelin A receptor antagonist zibotentan, combined with the sodium-glucose co-transporter-2 inhibitor dapagliflozin, has yielded a robust and significant albuminuria reduction in the Phase IIb trial ZENITH-CKD and is being investigated for reduction of kidney function decline in a high-risk chronic kidney disease population in the Phase III trial ZENITH High Proteinuria. Endothelin antagonist treatment has, until now, been limited by the class effect fluid retention. ZENITH-CKD investigated a wide range of zibotentan doses based on pharmacokinetics in renal impairment, competitor-data exposure-response modeling, and clinical trial simulations. Recruitment delays reduced interim analysis data availability; here, supportive dose-response modeling recovered decision-making confidence. At trial completion, the low-dose arm enabled Phase III dose selection between Phase IIb doses. Dose-response modeling of efficacy and Kaplan-Meier analyses of tolerability identified a kidney-function-based low-dose strategy of 0.25 or 0.75 mg zibotentan (with 10 mg dapagliflozin) to balance benefit/risk in ZENITH High Proteinuria. The applied clinical pharmacology and MIDD principles enabled successful Phase IIb dose finding, rationalized and built confidence in the innovative Phase III dosing strategy and identified a potential therapeutic window for zibotentan/dapagliflozin, providing the opportunity for a significant improvement in the treatment of chronic kidney disease with high proteinuria.

Development of a Vignette-Based Instrument to Assess Psychiatric Involuntary Hospitalization Decision-Making

The decision to hospitalize a psychiatric patient against their will is an ethically and clinically complex problem. While there is variation in rates of involuntary hospitalization (IH) across different settings, we lack a tool to measure individual differences in IH decision-making. This study used a mixed-methods approach to develop and validate a vignette-based instrument designed to assess the decision to hospitalize psychiatric cases and confidence in IH decision-making. The instrument was tested locally inn= 31 psychiatrists, and the results were replicated in a national sample (n= 238). The results showed variation in IH rates across the eight vignettes. Mixed-effects models found significant variability in confidence ratings across both vignettes and participants, supporting the validity of this instrument to assess IH decision-making.

Through the eyes of Spanish-speaking patients, caregivers, and community leaders: a qualitative study on the in-patient hospital experience

BackgroundSpanish-speakers with non-English language preference and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Communication challenges during prolonged hospitalizations for complex illnesses negatively influence how this group engages in their care and decision-making while hospitalized. Limited literature capturing the perspectives of Spanish-speaking patients in this context exists. Given the impact of language barriers on care and medical decision-making, this study documents the experiences of Spanish-speaking patients with NELP and hospitalized with complex care needs as well as caregivers and community leaders.MethodsUsing community-engaged recruitment strategies and semi-structured interviews and a focus group, we gathered insights from Spanish-speaking patients hospitalized for prolonged periods, caregivers, and community leaders from three geographic regions. Data were deidentified, transcribed, translated, coded in duplicate, and analyzed guided by grounded theory using NVivo.ResultsWe interviewed 40 participants: 27 patients, 10 caregivers and 3 community leaders. We identified four major themes: (1) Disconnected experiences impeding interactions, communication, and decision-making (2) Inadequate interpreter services (3) Benefits and consequences of family at the bedside (4) Community -informed recommendations.ConclusionThe study showed that in-person interpreters were preferred to virtual interpreters; yet interpreter access was suboptimal. This resulted in ad hoc family interpretation. Participants noted language negatively impacted patient’s hospital experience, including decreasing confidence in medical decision-making. Recommendations from patients, caregivers, and community leaders included expanding interpreter access, bolstering interpreter quality and accuracy, and increasing resources for patient education.