Decision-making Process Research Articles

Leadership Styles of Community Leaders and Sustainability of Community Development Projects in Southwest, Nigeria

This study investigates the relationship between the leadership styles of community leaders and the sustainability of community development projects in Southwest, Nigeria. Utilizing a descriptive survey design, data were collected from 300 community leaders and 1,500 community members across 60 communities in Ekiti, Osun, and Oyo states. The study identified autocratic leadership as the predominant style among community leaders in the region, followed by pseudo-democratic, with transformational leadership being the least adopted. Findings indicate a low level of sustainability for community development projects, attributed partly to leadership styles that may not effectively motivate community participation and project longevity. Statistical analyses, including Pearson’s correlation and multiple regression, reveal a significant positive relationship between leadership styles and project sustainability. Specifically, transformational leadership style emerged as the most significant contributor to project sustainability, while autocratic leadership showed less contribution. These results suggest that leadership style plays a crucial role in determining the success and longevity of community projects. Recommendations include promoting transformational leadership training for community leaders, fostering participatory decision-making processes, enhancing project management practices, and advocating for policy changes to support sustainable community development initiatives in Southwest, Nigeria. Overall, this study contributes to understanding the dynamics of community leadership and project sustainability in the context of Nigerian communities, offering insights for improving leadership practices to enhance community development outcomes

Evolution of sleep disordered breathing in infants with achondroplasia.

Children with achondroplasia (ACH) are at risk for sudden death in infancy due to sleep disordered breathing (SDB) and foramen magnum stenosis (FMS). Sleep studies and neuroimaging are performed in infants with ACH, but interpretation of infant studies is challenging. We sought to describe baseline data on polysomnography (PSG) indices in infants with achondroplasia as well as effects of age and surgery on these parameters. Retrospective data were abstracted from the multisite CLARITY ACH database from years 2008-2017. Both obstructive apnea hypopnea index (OAHI) and central apnea index (CAI) were extracted, and effects of age and surgical intervention (adenoidectomy [AD] or cervicomedullary decompression [CMD]) were analyzed. 172 PSGs from 86 infants were analyzed. In surgically naive children, OAHI decreased over the first year but then increased in the second year, while CAI was mostly stagnant over the first two years. There were no significant differences between age at first PSG or PSG indices for surgically naive infants versus those who underwent AD or CMD. OAHI decreased after AD and CAI decreased after CMD. Similar to average stature infants, our results demonstrate the need to interpret sleep study findings of children with ACH in the context of age, particularly for obstructive indices. Neither OAHI nor CAI differentiated those infants who subsequently underwent surgery, suggesting that there were other important clinical factors in the surgical decision-making process. Independent of age, AD resulted in improvement in OSA and CMD with improvement in central sleep apnea.

Task Offloading Strategy for UAV-Assisted Mobile Edge Computing with Covert Transmission

Task offloading strategies for unmanned aerial vehicle (UAV) -assisted mobile edge computing (MEC) systems have emerged as a promising solution for computationally intensive applications. However, the broadcast and open nature of radio transmissions makes such systems vulnerable to eavesdropping threats. Therefore, developing strategies that can perform task offloading in a secure communication environment is critical for both ensuring the security and optimizing the performance of MEC systems. In this paper, we first design an architecture that utilizes covert communication techniques to guarantee that a UAV-assisted MEC system can securely offload highly confidential tasks from the relevant user equipment (UE) and calculations. Then, utilizing the Markov Decision Process (MDP) as a framework and incorporating the Prioritized Experience Replay (PER) mechanism into the Deep Deterministic Policy Gradient (DDPG) algorithm, a PER-DDPG algorithm is proposed, aiming to minimize the maximum processing delay of the system and the correct detection rate of the warden by jointly optimizing resource allocation, the movement of the UAV base station (UAV-BS), and the transmit power of the jammer. Simulation results demonstrate the convergence and effectiveness of the proposed approach. Compared to baseline algorithms such as Deep Q-Network (DQN) and DDPG, the PER-DDPG algorithm achieves significant performance improvements, with an average reward increase of over 16% compared to DDPG and over 53% compared to DQN. Furthermore, PER-DDPG exhibits the fastest convergence speed among the three algorithms, highlighting its efficiency in optimizing task offloading and communication security.

Challenges to Indian Democracy: Analyzing Through the Lens of Human Security

The ideological conflicts that prevailed in the ancient society led to the development of many forms of political institutions and democracy is one such, which can be traced back to antiquity. Since ancient times, democracy has meant rule by the people. However, in modern times, democracy is a mixture of this ancient idea with individual liberty and human rights alongside it. Generally, democracy means rule by the people to ensure that every citizen takes part in the decision-making process either directly or indirectly through elected representatives. India is the largest democracy in the world. In the last more than 7 decades, it has worked successfully well to some extent. But today’s modern India has to face many challenges that need to be tackled to ensure true democracy. These challenges may include social and economic inequalities, poverty and unemployment, human insecurity, Illiteracy and ignorance, casteism, multiculturalism, communalism, population explosion, regionalism, corruption, and terrorism, etc. India needs to develop new proposals to reform democracy. Laws play important role in political reformation and may help to prevent wrong practices and encourage good ones. But mere legal changes alone do not help as the changes in laws may sometimes prove counterproductive and may negatively impact society. Therefore, the best laws empower people to carry out democratic reforms. The Right to Information Act is the best example that serves as a watchdog against the abuse of democratic principles. The challenges to democracy may be tackled by way of movements of activists or by politically conscious citizens. Some of the measures that can be taken to sustain a true parliamentarian democracy in India include: achieving 100% literacy; educating the masses about democratic rights; ensuring better protection of fundamental rights, and ensuring freedom of the press, etc. Moreover, democracy means that political institutions with democratic processes and every Indian citizen are to be democratic, reflecting basic democratic values of equality, liberty, fraternity, secularism, and justice in the social environment and individual behavior. At present democracy is being murdered by its own supporters like citizens and representatives simultaneously. The purpose of this article is to attempt an analysis of the problems and obstacles that the Indian democracy now faces, which has, of course, led to human insecurity as a whole, and to offer the required changes in order to guarantee that democracy in India can survive in the long term.

Perception of Ecosystem Services Provided by the Primary Sector in Floodplains: A Study of Sardinia

Agriculture, livestock, and forestry are crucial in mitigating hydrogeological risks, such as floods, particularly severe in the Mediterranean region. Still, the ecosystem services (ESs) provided by these activities are often undervalued. However, to assign them an economic value and ensure their effective incorporation into decision-making processes and territorial planning, they must first be recognized, appreciated, and deemed necessary by society. Despite several studies on ESs in the primary sector, research on agroecosystem flood regulation is limited, leaving key aspects unaddressed for decision-makers. No previous studies explicitly address the evaluation of ESs provided by agriculture, livestock, and forestry businesses in hydrogeological risky environments, especially in flood-prone areas. This study investigates the perception of the ESs provided by the above activities, focusing on those furnished in areas subject to hydrogeological instability. It also focuses on Sardinia (Italy), which is highly susceptible to hydrogeological instability. Through a quantitative survey of 270 residents and non-residents, the research provides evidence of society’s perception of the above ESs. Supporting ESs obtain greater appreciation in crop activities, particularly concerning the preservation of pollinating insects, soil fertility, biodiversity, and water quality. Among the regulatory Ess, appreciation is most prominent in fire risk management and flood risk regulation. Similar arguments can be made for livestock activities. Forestry activities are perceived as key players in managing flood risk, landslide risk, soil erosion, and climate change. The Multiple Correspondence Analysis indicates that appreciating one ES often leads to the recognition of others. Additionally, a set of Logit Regressions showed that while age and gender do not influence ESs perception, education level and awareness of climate change-related emergencies play a significant role. Those findings support more informed decision-making and fostering sustainable practices in areas at risk of hydrogeological disasters and lead to several important implications for practitioners, academics, and policymakers.

P0425 Factors Associated with Biopsy-Proven Cuffitis in Ulcerative Colitis Patients Following Colectomy with Ileal Anal-Pouch Anastomosis

Abstract Background Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment in patients with refractory/complicated ulcerative colitis (UC). Inflammation of the small rectal remnant below IPAA lines (“cuff”) is designated cuffitis. Despite its clinical significance and characteristic endoscopic and histologic features, risk factors are vague. This study aimed to decipher demographic, disease, and surgery-related risk factors for histologically proven cuffitis. Methods In a comprehensive pouch clinic at a tertiary referral center (Rabin Medical Center), consenting patients were followed prospectively, with routine clinical, laboratory, and endoscopic evaluations. Patients after IPAA due to UC having≥1 cuff biopsy during follow-up were included. Histological cuff samples were scored based on the validated NANCY index. Cuffitis, the primary outcome, was defined as evidence of moderate-to-severe histologic inflammation (NANCY score 3-4). Univariate Cox models were used to assess hazard ratios (HRs) of various factors with the occurrence of cuffitis. Results Of 400 patients followed at the pouch clinic, 182 consented to prospective follow-up, and 116 underwent cuff biopsy, each having a median of 2 biopsies. Most patients had histological evidence of moderate-to-severe cuffitis (n=76, 65.5%). Significant associations with cuffitis included disease duration ≤10 years before surgery (HR 15.4, 95%CI; 4.0-59.1, p<0.001); body mass index ≤ 18.5 (HR 3.83, 95%CI; 1.75-8.4, p<0.001); Arab descent (HR 3.2, 95%CI; 1.1-9, p=0.03); immediate postoperative complications (HR 2.0, 95%CI; 1.24-3.2, p=0.004); strong association with pre-operative biologic treatment was observed, with a single biologic (anti-TNF 90%) used before colectomy having a HR of 5 (95%CI;2.6-9.7, p<0.001) and multiple biologics having a HR of 14 (95%CI; 6.1-34, p<0.001). Interestingly, refractory UC as the indication for IPAA (vs dysplasia) was not independently associated with an increased risk of cuffitis. Conclusion Several demographic, disease, and surgery-related factors associated with post-IPAA cuffitis were identified. These may be incorporated into decision-making processes. Furthermore, closer postoperative follow-up may be warranted in specific patient subgroups. ese patients may benefit from closer post-operative follow-up.

Digital Twins and AI Decision Models: Advancing Cost Modelling in Off-Site Construction

The rising demand for housing continues to outpace traditional construction processes, highlighting the need for innovative, efficient, and sustainable delivery models. Off-site construction (OSC) has emerged as a promising alternative, offering faster project timelines and enhanced cost management. However, current research on cost models for OSC, particularly in automating material take-offs and optimising cost performance, remains limited. This study addresses this gap by proposing a new cost model integrating Digital Twin (DT) technology and AI-driven decision models for modular housing in the UK. The research explores the role of DTs in enhancing cost estimation and decision-making processes. By leveraging DTs and AI, the proposed model evaluates the impact of emergent technologies on cost performance, material efficiency, and sustainability across social, environmental, and economic dimensions. As proposed, this integrated approach enables a cost model tailored for OSC systems, providing a data-driven foundation for cost optimisation and material take-offs. The study’s findings highlight the potential of combining DTs and AI decision models to enhance cost modelling in modular construction, offering new capabilities to support sustainable and performance-driven housing delivery. The paper introduces a dynamic, data-driven cost model integrating real-time data acquisition through DTs and AI-powered predictive analytics. This dynamic approach enhances cost accuracy, reduces lifecycle cost variability, and supports adaptive decision-making throughout the OSC project lifecycle.

Pedestrian Collision and Future Work in the Restricted Indoor Space: A State-of-the-art Review on Influencing Factors, Behaviors and Methods

Abstract Emergency evacuation involves rapidly transferring of individuals from hazardous areas, where limited time and space can lead to collisions. Although previous researchers have studied the collision behavior of evacuees, there is a lack of systematic summary. This work uses CiteSpace visualization software to analyze the keywords in evacuation collision literature. Based on the frequency of keyword occurrence, we determine the research trend, classify the keywords, and analyze and summarize their influencing factors, behavioral characteristics, and research methods. Obviously, the evacuation environment and emergency guidance directly affect individual behavior and emotions, mainly affecting gait adjustment and decision-making processes, which in turn determine evacuation efficiency and collision risk. In the future, emphasis should be placed on post-collision psychological activities, coping strategies, and the application of virtual and mixed reality technologies to observe the interaction between individuals and the environment and strengthen evacuation research.

Empowering Agile-Based Generative Software Development through Human-AI Teamwork

In software development, the raw requirements proposed by users are frequently incomplete, which impedes the complete implementation of software functionalities. With the emergence of large language models, the exploration of generating software through user requirements has attracted attention. Recent methods with the top-down waterfall model employ a questioning approach for requirement completion, attempting to explore further user requirements. However, users, constrained by their domain knowledge, result in a lack of effective acceptance criteria during the requirement completion, failing to fully capture the implicit needs of the user. Moreover, the cumulative errors of the waterfall model can lead to discrepancies between the generated code and user requirements. The Agile methodologies reduce cumulative errors of the waterfall model through lightweight iteration and collaboration with users, but the challenge lies in ensuring semantic consistency between user requirements and the code generated by the agent. To address these challenges, we propose AgileGen, an agile-based generative software development through human-AI teamwork. Unlike existing questioning agents, AgileGen adopts a novel collaborative approach that breaks free from the constraints of domain knowledge by initiating the end-user perspective to complete the acceptance criteria. By introducing the Gherkin language, AgileGen attempts for the first time to use testable requirement descriptions as a bridge for semantic consistency between requirements and code, aiming to ensure that software products meet actual user requirements by defining user scenarios that include acceptance criteria. Additionally, we innovate in the human-AI teamwork model, allowing users to participate in decision-making processes they do well and significantly enhancing the completeness of software functionality. To ensure semantic consistency between requirements and generated code, we derive consistency factors from Gherkin to drive the subsequent software code generation. Finally, to improve the reliability of user scenarios, we also introduce a memory pool mechanism, collecting user decision-making scenarios and recommending them to new users with similar requirements. AgileGen, as a user-friendly interactive system, significantly outperformed existing best methods by 16.4% and garnered higher user satisfaction.

P1055 Refusing Stoma-Forming Surgery: Preliminary Findings from an Interpretative Phenomenological Analysis of Patients with Inflammatory Bowel Disease

Abstract Background Stoma-forming surgery (SFS) is often viewed as a last resort for managing severe Inflammatory Bowel Disease (IBD), encompassing Crohn’s Disease (CD) and Ulcerative Colitis (UC) (1). Despite its potential life-saving benefits, many patients refuse this intervention due to psychological, social, and cultural factors. While substantial research has explored the experiences of individuals living with a stoma, less is known about the perspectives of those who decline this procedure (2,3). This study investigates the decision-making process and lived experiences of IBD patients who refuse SFS. To explore the psychological, social, and contextual factors influencing IBD patients’ refusal of SFS and to understand how they navigate their disease while rejecting this treatment option. Methods Using Interpretative Phenomenological Analysis (IPA), semi-structured interviews were conducted with seven adult IBD patients (3 men, and 4 women) who declined SFS. Participants were recruited from a gastroenterology department and online forums. Interviews focused on their disease experience, decision-making processes, and perceptions of life with and without a stoma. Verbatim transcripts were analyzed to identify emergent themes. Results Preliminary analysis revealed four main themes: 1. Personal Perception: Fear of lifestyle changes, social stigma, and surgery; mixed feelings of acceptance and coping. 2. External Factors: Influences from healthcare professionals, diagnosis, and treatment processes. 3. Educational Gaps: Inadequate or improper information provided about SFS. 4. Hope: Optimism for disease remission and new treatment options. A recurring observation was a tendency towards “magical thinking,” where patients avoided discussing SFS to deny its existence. Despite rejecting surgery, participants expressed ambivalence and ongoing struggles with their decision. Conclusion Patients’ refusal of SFS is multifaceted, influenced by personal biases, external circumstances, and a lack of tailored education. Addressing these concerns through comprehensive psychological support and patient-centered communication may improve decision-making and treatment outcomes for this vulnerable population.

Modeling and simulation of risk-information processing in decision-making during pedestrian seismic evacuation

The behavior of pedestrians with incomplete information (PII) during earthquakes is complex, exhibiting multi-stage characteristics. Evacuees typically lack sufficient useful information and need interpret ambiguous information within the crowd. This paper proposes a three-stage model to simulate the information-processing behaviors of PII during post-earthquake evacuations. Based on the social force model, the multi-stage decision-making (MSDM) process includes three phases: delayed response, decision-making, and information seeking. Regression analyses are used to identify key environmental, procedural, and behavioral factors influencing MSDM. A data-driven agent-based model is then developed to evaluate the effects of building structure and crowd dynamics on PII’s information processing. The model’s validity is confirmed through comparisons with real earthquake evacuation footage. Results demonstrate that the proposed method accurately reflects real-world scenarios, offering a foundation for PII risk assessment and strategic planning in post-earthquake evacuation management.

Global priorities for ocean sustainability from Early Career Ocean Professionals

Abstract Intergenerational diversity is central to achieving long-term ocean sustainability. As such, one of the main goals and challenges in the UN Decade of Ocean Science for Sustainable Development (2021–2030) is fostering engagement and leadership across career stages and from diverse sectors. To understand the knowledge and professional development needs of the next generation, we surveyed the perspectives of 1344 Early Career Ocean Professionals (ECOPs) across 108 countries and territories. We assess the survey results, reflect on what has been done to address these needs halfway through the Ocean Decade, and suggest areas to further progress. We found that climate change and its social and ecological impacts are the unifying topical priority for ECOPs globally. ECOPs called for support and access to professional development. Despite progress in many initiatives, enhanced opportunities for collaboration across disciplines and sectors, mentorship and professional development, knowledge and resource-sharing across regions, inclusion in decision-making and policy processes, and support for socially impactful and applied research require further attention. In addition, the survey responses indicated that access to funding, infrastructure, and ocean science tools was not equitably distributed globally, with the need to prioritize the ECOPs in the Global South and island nations and states. The results from this global survey serve as a foundational step to reflect upon and continue to co-design and deliver a collective vision for ocean sustainability involving the next generation of ocean leaders throughout the second half of the UN Decade of Ocean Science for Sustainable Development and beyond.

Directional Handover Analysis with Stochastic Petri Net and Poisson Point Process in Heterogeneous Networks

Handover is crucial for ensuring seamless connectivity in heterogeneous networks (HetNet) by enabling user equipment (UE) to switch its connection link between cells based on signal conditions. However, conventional analytical approaches ignored the distinctions between macro-cell to small-cell (M2S) and small-cell to macro-cell (S2M) scenarios during a handover decision-making process, which resulted in handover failures (HoF) or ping-pong handovers. Therefore, this paper proposes a novel framework, Do-SPN-PPP, that combines stochastic Petri net (SPN) and the Poisson point process (PPP) to quantitatively analyze M2S and S2M handover performance differences. The proposed framework also reveals and predicts how handover parameters affect UE residence time in a cell within the HetNet, and it exhibits a higher predictive accuracy compared with the traditional conventional analytical approach. In addition, the Monte Carlo simulation verified the Do-SPN-PPP framework, and the proposed framework exhibits a 96% reduction in computation time while maintaining a 95% confidence interval and 0.5% error tolerance compared with the simulation.

N19 Analysis of Decision Conflict and Decisional Regret on treatment choices in patients with Acute Severe Ulcerative Colitis

Abstract Background Informed choice about treatment options in the setting of Acute Severe Ulcerative Colitis (ASUC) is often challenging for the patient due to state of heightened stress in this acute setting and the ongoing uncertainties about treatment outcomes, it is uncertain whether patients reconcile with their choice made in this acute setting. We aimed to evaluate decisional conflict and decisional regret among ASUC patients and examine whether decisional conflict contributed to regret. Methods Patients included in a prospective observational study of ASUC filled two psychometric instruments Decisional Conflict Scale (DCS) and Decisional Regret Scale (DRS). Patients were followed up for 12 months. Differences in DCS scores between patients who underwent colectomy versus those treated with medical therapy were evaluated. Changes in DRS scores at follow up was analysed and factors resulting in high decisional regret scores were evaluated. Results Of the 219 patients admitted with ASUC 87 completed the DRS at 12 months. Of these, 70 had no regrets about their treatment, 11 were neutral, and 6 regretted their decision fig1. Among patients who underwent colectomy, 12 patients completed the DCS at 90 days, with 8 agreeing that it was the right decision by 12 months. For biologic treatment, 70 patients completed the DCS at 90 days, with 63 agreeing it was the right choice, and 44 patients completed the DCS at 12 months, with 43 agreeing. A subgroup of 36 patients who were unsure about their treatment choice at 90 days showed a more divided response, with 17 agreeing it was the right choice by 12 months, while 11 remained uncertain. Conclusion This study highlights the psychological challenges faced by ASUC patients in their treatment decisions. Decisional conflict is highly prevalent, particularly among those uncertain about their treatment options. These findings suggest the need for developing tailored decision aid tools to facilitate improved shared decision-making processes in ASUC.

Application of human-in-the-loop hybrid augmented intelligence approach in security inspection system

A security inspection system exemplifies human-machine collaboration, and enhancing its safety and reliability through advanced technology remains a key research priority. While deep learning has incrementally improved the autonomous capabilities of security inspection equipment for automatic contraband detection, a gap persists between current technological capabilities and practical implementation. Recognizing that humans excel at learning, reasoning, and collaborating, while artificial intelligence offers normative, repeatable, and logical processing, we propose a human-in-the-loop hybrid augmented intelligence approach. This approach addresses the practical needs of security inspection systems by introducing a hybrid decision-making method that leverages two distinct strategies: “Reject-priority” and “Clear-priority.” These strategies play complementary roles in bolstering the decision-making process’s overall performance. Comparative experiments on a dataset from a specific security inspection site confirmed the hybrid method’s effectiveness, drawing several conclusions. This “Hybrid decision-making” method not only enhances risk perception, thereby widening the safety margin of the security inspection system, but also reduces the need for human labor, leading to increased efficiency and reduced labor costs. Additionally, it is less time-consuming, further improving the system’s overall efficiency. By integrating human and machine intelligence, this method significantly boosts decision-making effectiveness. Tailored to their unique characteristics, the method based on “Reject-priority” strategy is particularly well-suited for security inspection scenarios that demand stringent safety protocols, while the “Clear-priority” method is ideal for scenarios with high-volume traffic flow, where efficiency is paramount. As the volume of collected data grows, this approach will enable seamless adaptation of the method to evolving application needs.

P0719 The SAPHIR study: Assessment of Fresenius Kabi adalimumab biosimilar persistence in patients with inflammatory chronic diseases: Descriptive analysis of patients baseline characteristics

Abstract Background Biosimilar treatment initiation is based on a shared decision-making process, in which the patient’s acceptability to the treatment plays a major role. Indeed, negative perception of the biosimilar by the patient can generate a nocebo effect, which interferes with treatment results, leading to subjective worsening of the disease or poor tolerability. The SAPHIR study aimed to evaluate baseline patients’ characteristics predictive of biosimilar treatment persistence. Methods The SAPHIR study is a prospective, multicentre, observational cohort study. All patients with inflammatory rheumatic diseases and inflammatory bowel diseases were included after initiating treatment with Idacio® (adalimumab biosimilar) and were to be followed over a period of one year with assessments at 1, 6 and 12 months. We present here the patients baseline characteristics and their acceptability to treatment. Results Of the 582 patients enrolled, 18 presented a protocol deviation and were not analysed. The 564 patients analysed were divided into two groups based on the circumstances of the Adalimumab biosimilar prescription: the "initiation" group (n=318) not previously treated with biotherapy and the "switch" group (n=246) previously treated with originator adalimumab. Disease severity was assessed globally on a Likert scale. According to this evaluation, 61% (n=185) of patients in the "initiation" group versus 10% (n=25) in the "switch" group were considered markedly or severely ill. Baseline data from these patients are summarised in Table 1. Patients were questioned about chronic treatment in general: 38% (n=61) of patients in the "initiation" group and 13.5% (n=25) in the "switch" group do not know if their medications are effective or even doubt their benefit. The perception of the biosimilar was assessed by a serie of affirmations (self-completion questionnaire on the acceptability of switching to a biosimilar), summarised in Table 2. Conclusion Biosimilars still meet with reluctance from patients. This situation seems linked to a lack of information on the concept of biosimilarity. Numerous guidelines have been published to promote and facilitate the transition from biotherapy to its biosimilar. These preliminary results show that difficulties with treatment acceptability also exist and seem more pronounced in patients initiating biological treatment with a biosimilar. Table 1: Baseline data: BMI, Body Mass Index; SF-12, 12-Items Short Form Survey; HAD Scale, Hospital Anxiety and Depression Scale. Table 2: Perception of the biosimilar by the patient

Decision Regret About Treatment Amongst Women With Early Breast Cancer: An Integrative Review.

To synthesise evidence on decision regret about treatment amongst women with early breast cancer, including (1) the type of treatment related to decision regret, (2) the level of decision regret, and (3) factors associated with decision regret. Integrative review. Studies published between January 2000 and December 2023 were searched from five online databases to provide up-to-date evidence. The Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of the studies. The constant comparison strategy was employed for data analysis. A total of 26 studies were included. Breast cancer surgery was the most frequently studied treatment in relation to decision regret amongst women with early breast cancer, while adjuvant therapies were less studied. Most studies reported low levels of decision regret, while several studies found high levels. The proportion of women reporting decision regret varied considerably from 2.5% to 69% across the included studies. Factors associated with decision regret included various socio-demographic and clinical characteristics (age, ethnicity, employment, education, health literacy, cancer stage, and treatment types), decision-making experiences (patient involvement, patient preference, accessing information, and the use of decision support tools), and mental health. Decision regret occurs in women with early breast cancer after surgery and adjuvant therapies. A variety of factors should be considered during the treatment decision-making process to minimise decision regret. More robust studies are needed to disaggregate decision regret by treatment type and to evaluate the effectiveness of decision support tools in reducing decision regret in women with early breast cancer. Nurses and other healthcare professionals should be aware of the potential for decision regret related to surgery and adjuvant therapies in women with early breast cancer. The findings can help nurses and other healthcare professionals identify women at higher risk of experiencing decision regret and provide support during the treatment decision-making process to mitigate it. PRISMA 2020 Statement. No patient or public contribution to this review.

Characteristics and Outcomes of Pulmonary Embolism Patients Transferred After Activation of Pulmonary Embolism Response Team and Admitted from Local Emergency Department

Background: The primary role of a pulmonary embolism response team (PERT) is to support decision-making processes regarding acute pulmonary embolism (PE) patients and provide advanced rescue therapies when needed. Despite a great need for its availability among physicians, PERT’s usefulness is yet to be proven. Objectives: Our goal was to establish whether patients benefit from qualification by PERT for admission to a tertiary cardiology ward. Methods: Data of all patients hospitalized due to PE for 12 months (July 2023–June 2024) were retrospectively analyzed. We aimed to compare patients admitted primarily via the emergency department with those consulted by PERT and eventually transferred from other hospitals. The primary outcome was the use of advanced therapies. Results: We identified 167 patients (50.3% women) hospitalized with PE. Out of them, 102 (61.1%) came from the emergency department, while 65 (38.9%) patients were transferred after PERT consultation. The transferred patients generally had more severe conditions, as indicated by the ESC death risk group classification (intermediate-high and high risk, OR 19.2, 95% CI 8.3–44.2). They were more often qualified for at least one of the advanced therapies than the emergency department patients (OR 23.2, 95% CI 9.3–58.1). We found no significant differences in in-hospital mortality (6.9% versus 1.5%, OR 4.7, 95% CI 0.6–39.3). Conclusions: Establishing PERT as a reference unit providing advanced treatment resulted in successfully delivering more complex treatment to severely ill PE patients. Despite their unfavorable basic characteristics, neither length of hospitalization nor in-hospital mortality seem to differ when compared to unselected, less compromised cases.

Increasing dosing intervals for biologics in atopic dermatitis-why, who, when and how?

Biologics approved and in development for atopic dermatitis offer life-changing clinical efficacy with a relatively banal long-term safety profile requiring no laboratory monitoring. Biologic therapies also have their drawbacks, including high payor cost and the need to be administered as every other week subcutaneous injections. Addressing these concerns, studies of longer dosing intervals have been performed in the formal clinical trial setting and during real-world clinical care. Here, we review the current progress and evidence of dose elongation strategies in biologics for atopic dermatitis. We find that across a diverse investigational landscape, a large patient population exists that is able to maintain adequate disease control on a prolonged dosing interval. Evidence of clinical predictors of maintenance of disease control using this approach is emerging, although the impact of increased dosing intervals as a strategy to mitigate side effects is lacking. Patients experiencing good disease control are ideal candidates to engage in a shared decision-making process between patients and providers that will facilitate an individualized dosing approach in practice.

P1157 Limited Willingness to Switch from Intravenous to Subcutaneous treatment in Pediatric Inflammatory Bowel Disease

Abstract Background Recent advances in inflammatory bowel disease (IBD) therapies have provided patients with a variety of medications with different routes of administration. We aimed to assess parental preferences regarding medication administration routes and to identify factors influencing these preferences Methods This cross-sectional study surveyed parents of children with IBD using a comprehensive questionnaire that focused on treatment experiences, preferences, and attitudes towards switching from intravenous (IV) to subcutaneous (SC) administration. The questionnaire explored various regimens, including oral pills, SC injections at different intervals, and IV infusions Results This study included 147 parents of pediatric IBD patients. The median age of the children was 16 years (IQR 14-18), and 64 (43.5%) were female. Most children (94, 63.9%) had CD. The median duration of the disease was 4 years (IQR 2-6). When the parents were asked to indicate their preferred medication route and schedule, the highest score was assigned to SC administration every 8 weeks although this difference was not statistically significant when compared to PO administration daily (2.93 and 2.86 respectively, p=0.68). Both SC every 8 weeks and oral administration were significantly more favored than IV administration every 8 weeks and SC every 2 weeks (p<0.01 for all these pairwise comparisons). There was no statistically significant difference in preference between IV every 8 weeks and SC every 2 weeks (2.16 and 2.05 respectively, p=0.44). [Fig. 1]. Despite new options allowing for SC administration, 67% of parents preferred not to switch from IV, citing concerns about self-injection, desire for nurse presence, and longer intervals between infusions [Fig. 2]. No significant correlation was found between treatment preferences and disease-related factors such as disease type or activity. Medication doses were most frequently missed via the oral route, indicating challenges with adherence or patient preferences for this administration. Conclusion We evaluated the role of parental preferences on the choice of IBD medication administration routes in children, while highlighting the influence of prior treatment experience. The strong resistance to switching from IV to SC treatment, despite the availability of SC options, necessitates a patient-centered approach to clinical decision-making. Clinicians should actively involve parents in shared decision-making processes