Decision Aid Research Articles

Latin American networking and cooperative struggles in Argentina: A conversation with the Movimiento de Ocupantes e Inquilinos (MOI)

This conversation examines the Movimiento de Ocupantes e Inquilinos (MOI) in Argentina, a grassroots organization promoting cooperative, self-managed housing for over 30 years. Based on a conversation with Néstor Jeifetz, the article traces the origins of the MOI from the 1980s building occupations in Buenos Aires, through its connection to the broader Latin American cooperative housing movement, including the creation of the Latin American Secretariat for Popular Housing and Habitat (SELVIHP). The article explores how MOI’s efforts to reclaim vacant urban properties—such as the La Fábrica cooperative housing project—address the critical need for secure, affordable housing in a context of neoliberal economic policies and external debt crises. Jeifetz discusses the political ramifications of recent far-right victories in Argentina, which threaten hard-won social rights and self-managed housing initiatives, as well as the MOI’s role in resisting these policies through a framework of collective ownership, democratic decision-making, and mutual aid. By highlighting the intersections of housing with education, health, and labor, and situating the MOI’s work within a larger history of land and building occupations across Abya-Yala, this article provides a nuanced understanding of the ongoing struggles for housing justice in the face of both local and global neoliberal forces.

The evaluation of an eHealth tool to prevent and alleviate migraine complaints in adults

Abstract Background Migraines attacks cause great suffering in individual patients. There is great unfulfilled potential to increase patients’ knowledge about various personal triggers and subsequent treatments. The objective of this study is to pilot test an e-Health tool that aims to increase migraine patients’ knowledge. It takes into account personal preferences and contributes to informed decision-making in choosing the appropriate method. Considering the shortage of primary care physicians and other health care providers, such an e-Health tool could be of great value. Methods lessmigraine.nl consists of a website with information plus an electronic decision aid. It was evaluated on its content, development process and effectiveness, and its contribution to the patients’ empowerment process. A first round of usability testing was done using semi-structured interviews and thematic analysis with 12 patients from a Dutch General Practice until data saturation. After minor improvements to the e-tool, in a first implementation step subsequently 85 patients used the e-tool. Results Patients’ expectations were exceeded in terms of the content of the e-Health tool, as all patients discovered new potential migraine triggers. Most patients found the tool effective in the sense that it provided enough information to decide on an appropriate treatment. The implementation was successful in the sense that all 85 participants completed the e-tool. Most important triggers were stress, sleeping problems, changes in weather and flickering or bright light. Conclusions The majority of the migraine patients were satisfied with the e-Health tool. It enlarged their knowledge of prevention and treatment options and therefore empowered them in their decision-making process and communication with their GP. Other aspects of implementation need to be studied. This study needs to be repeated in other clinical settings. Key messages • Migraines cause great suffering in individual patients: Considering the shortage of primary care physicians and other health care providers, an e-Health tool could be of great value. • The e-Health tool increases patients’ knowledge about migraine, including personal triggers and subsequent treatments.

3.E. Scientific session: Environmental Health Tracking Systems: a tool for planetary health

Abstract Planetary health offers a good framework for better understanding the interconnection between human health and environmental changes, promoting effective cross-sector actions and partnerships, and ensuring policy coherence. Effective implementation of this conceptual framework requires monitoring and reporting on indicators relevant to planetary health that capture the scope, spatial and temporal scales of changes in natural systems that affect human health and well-being. An approach in that sense are the environmental public health tracking systems (EPHT), which imply the ongoing collection, integration, analysis, and interpretation of data at the same spatiotemporal scale about environmental hazards, and related human exposure and health effects, maintaining appropriate data protection measures. It aims to provide public-health decision makers with timely, accurate and systematic data for quantifying health impacts related to environmental factors. EPHT system are proposed as an essential tool for designing and monitoring policies and actions that prevent and reduce environmental health burdens (EHB) efficiently and cost-effectively, and as an alerting system against present and future climatic and health crisis. Pursuing such goals requires the use of health information systems that enable the monitoring and assessing of environmental health in multiple dimensions, considering specificities across different geographical and cultural settings. EPHT system requires defining a rationale on how to select the dimensions and indicators to be included. Common challenges for defining those indicators are related to the availability of data recording, data standardization, and the linkage, integration and sharing of databases. In parallel, it is also important to define a decision aiding tools in which evidence and data are understandable and inform about the extent to which specific policy goals are attained, tailoring such tools to the specific settings. Present session attends to answers to those challenges by sharing experiences from different contexts and countries Key messages • EPHT systems represent an effective tool for progressing in achieving planetary health goals and as a surveillance alerting system for future health crisis. • Adjusting EH data quality recording and analysis in EPHT systems is essential for improving resources assignment, and the effectiveness of healthy policies in reducing EHB.

Development of a risk-stratified shared decision-making tool for colorectal cancer screening

Abstract European guidelines stress the importance of informed decision-making in colorectal cancer (CRC) screening. However, tailored tools that facilitate decision-making for underserved people and general practitioners (GPs) in Flanders are lacking. This study aimed to develop a tailored shared decision-making (SDM) tool for CRC screening, specifically a video decision aid, using a co-creative process. The development involved two rounds of focus group discussions with underserved people and five local quality group meetings with GPs in various parts of Flanders, Belgium. Qualitative data were analyzed using a Modified-Grounded Theory Analytical (M-GTA) approach to identify key themes. Findings revealed four core themes. The first theme, ‘Recognizing the Barriers to Screening’, identifies challenges such as a lack of time, staff, and tools for GPs, as well as language and literacy barriers for underserved people. The second theme, ‘Learning from Existing Tools’, highlights successful elements like visuals and simple language and limitations such as low accessibility and poor navigation. The third theme, ‘Determining the Content and Design,’ reveals that GPs seek user-friendly tools for at-home viewing, while underserved people value personalized and clear information about CRC risk factors and screening costs. The final theme, ‘Identifying Strategies for Integration,’ stresses the importance of a structured, collaborative care approach for the successful integration of the tool. The proposed modifications for the SDM tool include enhancing its accessibility with multiple language options, using simple and relatable visuals, and providing personalized risk discussions for underserved people and GPs. Nonetheless, further testing is needed to confirm the effectiveness of the SDM tool in supporting preventive talks and informed decision-making in CRC screening among these target groups. Key messages • A structured, collaborative care approach is needed for successful SDM tool integration during preventive talks with underserved people. • Further testing is needed to confirm the tool’s effectiveness in supporting informed decision-making in CRC screening for underserved people.

Delivering shared decision-making before transcatheter aortic valve implantation using digital and remote techniques to enhance patient engagement and convenience

Abstract Introduction Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement for patients with aortic stenosis. However, the choice between TAVI, surgery, wait and watch or conservative management needs to be based upon multiple factors including comorbidity, life expectancy, anatomy, local experience and, critically, informed patient preference. In this context, engaging patients in a shared decision-making (SDM) process becomes essential, but this practice is generally underused. Purpose To comply with both international guidance and the National Institute for Health and Care Excellence (NICE) UK recommendations, in January 2023 we established a formal SDM pathway for TAVI, utilising digital solutions as much as possible to minimise the logistic impact for both hospital and patients. We aimed to quantitatively measure the compliance of the digital SDM meeting from the patients’ perspective with the NICE recommended essential and enhanced discussion standards. Methods Patients are contacted when the multidisciplinary heart team recommends TAVI, then offered digital or, where appropriate, physical patient decision aids and a link to a TAVI-specific explanatory video. One week later, patients are invited to a virtual comprehensive SDM meeting where a specialist nurse discusses aortic stenosis and treatment options with the patient as per the NICE recommended standards, allowing time for questioning and review. From December 2022 to June 2023, a custom developed questionnaire was administered to 20 patients prior to, and 28 patients after the implementation of the SDM meeting protocol, directly addressing the patients’ perception of adherence to the NICE standards. This was provided to the patients after the TAVI procedure via an online tool. The answers to the 12 core questions were converted into a Likert scale (1 to 5) and the global satisfaction scores for the 2 patient groups, reported as the average Likert score across the 12 questions, were compared with the Wilcoxon Rank-Sum Test. Results The global satisfaction score was significantly higher for the post-SDM group than for the pre-SDM group (mean 4.27 vs 3.55, p<0.001). The percentage of patients who gave positive (Likert 4-5) responses to each individual question was consistently higher in the post-SDM group. The percentage of patients giving negative (Likert 1-2) responses was substantially lower in the post-SDM group. Conclusions The SDM pathway and the virtual tools provided proved effective in delivering SDM in compliance with international guidance and NICE recommended standards from the patient’s perspective. A similar approach leveraging digital technology to minimise cost and enhance patient convenience could be implemented for other treatments and across other institutions.Questionnaire results

Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study.

Patients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. This study aims to develop and alpha test an educational website for patients with cancer. Learning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site's usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. The website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ≥70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. The feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website's suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs.

TableExtractNet: A Model of Automatic Detection and Recognition of Table Structures from Unstructured Documents

This paper presents TableExtractNet, a model that automatically finds and understands tables from scanned documents, tasks that are essential for quick use of information in many fields. This is driven by the growing need for efficient and accurate table interpretation in business documents where tables enhance data communication and aid decision-making. The model uses a mix of two advanced techniques, CornerNet and Faster R-CNN, to accurately locate tables and understand their layout. Tests on standard datasets, IIIT-AR-13K, STDW, SciTSR, and PubTabNet, show that this model performs better than previous ones, making it very good at dealing with tables that have complicated designs or are in documents with a lot of detail. The success of this model marks a step forward in making document analysis more automated. It makes it easier to turn complex scanned documents containing tables into data that are more manipulable by computers.

Feasibility and Acceptability of a Palliative Care Intervention Among Older or Adults with Advanced CKD and their Caregivers.

In non-nephrology settings, specialty Palliative Care (PC) improves decision-making, patient's quality of life (QoL), advance care planning (ACP), and certain indicators of the quality of end-of-life (EoL) care. This pilot RCT explored the feasibility and acceptability of a PC intervention, CKD-EDU, for older adults ≥75 years with eGFR ≤25 ml/min and their caregivers. Participants randomized to the control group received standard nephrology care and routine kidney therapy (KT) education, while those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss KT decisions and EoL planning. Patients were assessed at baseline, 4-6, 12-14, and 24-26 weeks. Main outcomes included intervention feasibility and acceptability, decision-conflict, and patient QoL. The mediating effects of reduced decision conflict on improved QOL were explored, as were the effects of CKD-EDU on ACP, EoL treatment intensity and 6-month-hospitalization. Statistical analyses encompassed descriptive analyses, adjusted repeated-measure-models, mediation analyses and logistic-regression models. Among the 127 eligible patients screened, 58 (44%) consented: 30 were randomized to CKD-EUD and 28 to the control arm. All patients completed baseline assessments, and 89% completed at least one intervention session (n=26/29), underscoring intervention adherence and feasibility. Similarly, assessments completion rates at 4 (83%, n=45/54) ), 12 (93%, n=42/45), and 24 (95%, n=40/42) weeks were high. The intervention received over 85% acceptability ratings for all questions. Patients exposed to CKD-EDU exhibited significant improvement in decisional conflict scale scores (P = 0.003) at 4-6 weeks and improvements in QoL at 24-26 weeks (P=0.02). Exploratory analyses were not statistically significant in this pilot, but all effect sizes were in the predicted direction. This study demonstrates the feasibility and acceptability of CKD-EDU. A larger scale trial is warranted to assess its effectiveness in improving key outcomes important to patients and families.

Gene expression profiling in B-cell non-Hodgkin lymphomas

Abstract BACKGROUND: Gene expression profiling has become a fundamental tool in cancer diagnosis and management. B-cell non-Hodgkin lymphoma (B-NHL) is a group of malignant neoplasms originating from the lymphoid tissues, mainly the lymph nodes and the gene expression technique was used to unravel its complexity and aid in clinical decision-making. OBJECTIVES: The aims of this study were to find the significance of gene expression profiling focusing on colony-stimulating factor 1 receptor (CSF1R), myeloid differentiation factor 88 (MyD88), and tumor necrosis factor-α (TNF-α) as a promising approach in B-NHL diagnosis and their comparison with healthy controls. PATIENTS, MATERIALS AND METHODS: The current clinical prospective study was mediated from June 1, 2021, to December 30, 2022, of NHL patients in Kurdistan, Iraq. Seventy-three patients were recruited from Nanakali Hospital for Blood Diseases and Cancer, Erbil. The integration of gene expression biomarkers uses quantitative real-time polymerase chain reaction technique to diagnose B-NHL. Specifically, we focused on three key genes MyD88, TNF, and CSF1R whose expression profiles were analyzed in B-NHL patients and controls. We leveraged a dataset to explore gene expression patterns in B-NHL and applied classification algorithms to distinguish between B-NHL patients and controls. RESULTS: The initial results show the overall lower CSF1R expression in B-NHL as compared to the controls and a significant reduction in CSF1R expression in females (≤50 years and >50 years). The result considers lower CSF1R expression in B-NHL males (≤50 years) and higher but not significant in males (>50 years). CONCLUSIONS: These B-NHL-expressed genes may be considered potential diagnostic markers with their meaningful comparisons to control groups, and they could be proposed to guide the management of patients and facilitate their stratification into clinical trials.

Environmental, social, and governance evaluation for European small and medium enterprises: A multicriteria approach

AbstractThe exposure to environmental, social, and governance (ESG) risks can be effectively measured by companies to identify opportunities for long‐term sustainable growth, along with the social and environmental impact. This process is crucial for listed small and medium‐sized enterprises (SMEs) wanting additional support in their ESG transition, and for European SMEs it will be required by the implementation of the Corporate Sustainability Reporting Directive (CSRD), starting from 2026. In this contribution, we propose to apply a multicriteria decision aiding approach to assess the sustainability profiles of SMEs. The methodology, which allows the measurements of a firm's ESG efforts (ESGness), is applied to a sample of European‐listed SMEs, controlling for potential sector‐specific effects, in order to understand what is the situation on the ESG front, and to identify ESG leaders and laggards. The model can provide valuable information for the firm, and for a broad spectrum of stakeholders, including policymakers and investors. The obtained rankings show some degree of robustness across different model parameterizations. The benefits of voluntary disclosure of sustainability information are investigated under a prudential scoring framework.

Use of long-acting triple therapy for chronic obstructive pulmonary disease (COPD) in practice: The ELETHON physicians' survey

Gaps in optimal COPD management have been identified in clinical practice, with discrepancies between guideline recommendations and routine care. The reasons for such discrepancies are incompletely understood. The ELETHON survey aimed to identify physicians' attitudes towards general concepts of COPD management and, in particular, initiation of inhaled triple therapies. ELETHON was a nationwide cross-sectional survey with general practitioners (GP) and pulmonary specialists (PS) working in the ambulatory outpatient setting in Germany, using a structured 17-item questionnaire (single or multiple choice questions) addressing the topics of secondary prevention, exacerbation detection, strategies for therapy escalation, choice of inhaled triple therapies and evaluation of treatment benefits. Questionnaires filled by n=2028 GPs and n=371 PS were analyzed. In both groups, secondary prevention was deemed important in COPD care (GP/PS 76.4%/90.6%), with inhalation technique, vaccination status, and appropriate inhaled pharmacotherapy as key components. Activity/rehabilitation was rarely mentioned by GPs (48.3% vs. 84.5%). Exacerbations and symptomatic worsening were the main triggers for therapy escalation, but were not recorded in a structured way. "Hospitalization" and "≥2 ambulatory exacerbations" were mentioned most frequently as thresholds. Neither GPs nor PS measured eosinophils in the majority of patients. Fixed triple combinations were preferred, with availability of different treatment steps in the same device as important decision aid. Treatment success was evaluated by exacerbations, quality of life, symptoms, lung function and rescue medication use, while COPD Assessment Test (CAT) score was rarely used by GPs and PS. The ELETHON survey identified gaps in COPD management in Germany. While secondary prevention is deemed important, escalation of inhaled therapy is undertaken rather late, the reported importance of vaccinations does not match current quota in German COPD patients, and non-pharmacological measures are often unused. Exacerbation and symptom documentation is rather subjective, validated questionnaires and blood eosinophils are of minor relevance. These results provide evidence of barriers and hidden potentials towards optimization of routine ambulatory care for COPD patients in Germany.

A WeChat platform program (WCPP) for full-process management of patients with cardiac valve interventional surgery based on psycho-cardiology: protocol of a mixed-method study

BackgroundValvular heart disease is the third most common cardiovascular disease; it significantly diminishes patients’ quality of life and imposes burdens on individuals, families, and healthcare systems. In recent years, psycho-cardiology has emerged as a prominent field in which to explore the link between mental illness and heart disease. This mixed-method study aims to assess the effectiveness of the WCPP, which includes hospital-to-home transitional care, remote intelligent monitoring, and decision aids, in improving the physical and mental health of patients.MethodsA mixed-method study was conducted at a cardiac valve interventional surgery (CVIS) center in Southwest China. A total of 154 CVIS patients participated, with the intervention group receiving the WCPP and the control group following the traditional CVIS management program. Both groups were followed up at 1, 3, 6, and 12 months. The primary outcome is measured via the Chinese version of the 36-item Short Form Health Survey (SF-36). The Secondary outcomes included the 6-min walk test (6MWT), modified Barthel index (MBI), major adverse cardiovascular events (MACE), patient satisfaction, and length of hospital stay (LOS). Additionally, qualitative research will assess the psychological state and experiences of the patients.DiscussionOur study is one of the few involving patients with CVIS and the first to apply psycho-cardiology through a full-process management platform. The study population is predominantly from Southwest China and includes a diverse range of demographic and socioeconomic backgrounds. Upon completion, this study will provide valuable insights into the use of a remote, full-process management platform for CVIS patients.Trial registrationChinese Clinical Trial Registry ChiCTR2400081052. Registered on 21 February 2024. The trial complies with the SPIRIT and CONSORT guidelines.

Evaluation of an Automated Decision Aid for the Further Referral of Emergency Room Patients: A Prospective Cohort Study.

Instruments for the initial evaluation of emergency room patients as an aid to their onward referral to ambulatory care structures are a matter of current interest. In this study, we assess the safety of the software application SmED-Kontakt+ for this purpose. SmED is an abbreviation for Strukuturierte Medizinische Ersteinschätzung Deutschland, "structured initial medical evaluation in Germany." In this prospective cohort study, we compared the recommendations of SmED-Kontakt+ concerning the time and place of further care with those of the treating physicians. The subjects were adult patients who were able to walk and had presented themselves to the emergency room. Whenever SmED-Kontakt+ assessed the situation less critically than the physicians, and in 5% of the remaining cases, the potential endangerment of patient safety was assessed by an expert panel (expected value <1%). In a total of 1840 cases, SmED-Kontakt+ agreed with the physicians' assessment in 353 (19%). The assessment of SmED-Kontakt+ was more critical in 1221 cases (66%) and less critical in 266 (15%; potential undertriage). There was potential endangerment in 49 cases (2.7%; 95% confidence interval [2.0; 3.5]). Potential endangerment was less common among patients in the more urgent recommendation categories [0.1; 2.6] and more common in the categories of a recommended outpatient physician visit or telephone consultation within or beyond 24 hours [2.4; 17.2]. SmED-Kontakt+ generally assessed these patients' needs for further care as more urgent than the treating physicians did. Nevertheless, the percentage of potentially endangered patients was higher than expected. We conclude that further care should be provided in timely fashion with an obligatory appointment. The sites of further ambulatory care should be immediately accessible and properly equipped. Patients should not be referred for further care at later times on the basis of an SmED-Kontakt+ assessment.

Clinic personnel attitudes and baseline implementation outcomes of a lupus decision aid

ABSTRACT To examine the association between clinical personnel’s general attitudes towards new interventions and implementation outcomes related to an evidence-based individualized, culturally tailored, computerized decision aid (DA) for the management of lupus. To assess attitudes, the validated Evidence-Based Practice Attitudes Scale (EBPAS) survey was emailed to personnel in 15 rheumatology clinics across the U.S. The survey also included questions related to three validated implementation outcomes: lupus DA acceptability, appropriateness and feasibility. The baseline round of the survey was fielded from August 2019 to January 2020 and yielded a 56.8% response rate (n = 76 respondents). We also collected organizational characteristics from each clinic and personnel-level control variables. Overall, respondents reported modest levels of lupus DA acceptability, appropriateness and feasibility (3.54, 3.45 and 3.40, respectively, on a scale of 1–5). Multilevel regression analyses demonstrated statistically significant positive relationships between a respondent’s openness to new practices/interventions and perceived lupus DA acceptability (β = 0.31, p < .01) and feasibility (β = 0.28, p < .05). Divergence (a respondent’s perceived difference between current and new practices) was not associated with clinic personnel perceptions of the DA. These findings suggest that understanding clinic personnel general attitudes toward new interventions is an important precursor to implementing evidence-based practices and may provide important diagnostic information about places to intervene in preparation for implementation and improving shared decision-making with patients.

Circular–Sustainable–Reliable Waste Management System Design: A Possibilistic Multi-Objective Mixed-Integer Linear Programming Model

Waste management involves the systematic collection, transportation, processing, and treatment of waste materials generated by human activities. It entails a variety of strategies and technologies to diminish environmental impacts, protect public health, and conserve resources. Consequently, providing an effective and comprehensive optimization approach plays a critical role in minimizing waste generation, maximizing recycling and reuse, and safely disposing of waste. This work develops a novel Possibilistic Multi-Objective Mixed-Integer Linear Programming (PMOMILP) model in order to formulate the problem and design a circular–sustainable–reliable waste management network, under uncertainty. The possibility of recycling and recovery are considered across incineration and disposal processes to address the main circular-economy principles. The objectives are to address sustainable development throughout minimizing the total cost, minimizing the environmental impact, and maximizing the reliability of the Waste Management System (WMS). The Lp-metric technique is then implemented into the model to tackle the multi-objectiveness. Several benchmarks are adapted from the literature in order to validate the efficacy of the proposed methodology, and are treated by CPLEX solver/GAMS software in less than 174.70 s, on average. Moreover, a set of sensitivity analyses is performed to appraise different scenarios and explore utilitarian managerial implications and decision aids. It is demonstrated that the configured WMS network is highly sensitive to the specific time period wherein the WMS does not fail.

Patient expectations and decisional regret in the management of ventral hernias.

Older adult patients have many factors to contemplate when considering elective ventral hernia repair. In this study, we aimed to understand whether our novel shared decision-making (SDM) aid helped reduce this population's decisional regret when choosing hernia management strategy. Patients ≥ 60years of age presenting for ventral hernia evaluation were randomized to two groups. The experimental group had their visit guided by our novel SDM aid. All patients took a survey prior to consultation outlining their treatment expectations. All patients were called within 6months to complete the Decision Regret Scale, which measures remorse after a healthcare decision. Seventy-two patients (36 control, 36 experimental) completed final follow-up. On initial expectations evaluation, 53 patients (74%) reported wanting surgical repair and 58 patients (81%) reported expecting surgical repair. Ultimately, 18 patients in the control group and 17 patients in the experimental group did not undergo surgery. The use of the SDM aid did not affect if patients chose observation (OR 0.44, p = 0.24) or result in a lower decision regret score (9.86 vs 9.31, p = 0.89). Surgery was associated with a lower decision regret score (3.38 vs 16.14; p = 0.001). Of those who did not undergo repair, patients initially wanting or expecting surgery had higher decision regret scores (22.83 vs 3.33, p < 0.001; 20.40 vs 5.50, p = 0.009). Nonoperative patients who chose observation had less regret than those needing medical optimization (9.50 vs 25.00, p = 0.04). There were no differences in decision regret scores based on initial wants or expectations for those who had surgical repair. Decisional regret following ventral hernia management is associated with patients' expectations prior to initial surgical consultation. The use of a decisional aid did not lower decision regret scores. These findings emphasize the need for upfront expectation setting and longitudinal programs to help patients reach their treatment goals.

Beyond Dialysis: Reshaping CKD Paradigms in Developing Nations

Dear Sir / Madam, Respected Editor, I am writing to bring attention to the critical need for increased research on conservative kidney management (CKM) in the context of patients with advanced chronic kidney disease (CKD). The recent advancements in developed nations have demonstrated that CKM is a novel and effective approach to caring for CKD patients, particularly those who choose not to pursue maintenance dialysis. Historically, medical care for individuals with CKD has adhered to a paternalistic model, where clinicians make treatment decisions independent of patient preferences. JS Scherer et al observed that a provider's assessment of a patient's frailty and response exerted a more substantial influence on the treatment provided than the patient’s comorbidities, functional status, and stated preferences. 2 Furthermore, another study showed that some individuals exhibited a preference for conservative care after shared-decision making, irrespective of the potential survival benefits offered by dialysis if it entailed frequent hospital visits or travel restrictions. 3 This underscores the significance of patient autonomy, where the pursuit of freedom can sometimes outweigh the emphasis on clinical outcomes. However, contemporary CKD management in the 21st century emphasizes shared decision-making and patient empowerment. While research suggests CKM can improve quality of life, reduce hospitalizations, and minimize invasive procedures, offering a valuable alternative to dialysis, its impact on survival becomes less clear for patients over 80 or those with multiple comorbidities.4 Additionally, the inclusion of patients and their families in collaborative decision-making processes has proven advantageous, supported by specialized decision aids that promote well-informed discussions regarding CKM with healthcare providers.5 Nephrologists face significant challenges in implementing effective conservative kidney management (CKM) due to a lack of clinical guidelines, training, evidence, and system-level infrastructure. This has resulted in limited awareness and discussion of CKM among patients and healthcare providers, hindering its adoption. With the global burden of chronic kidney disease (CKD) increasing significantly over the past three decades, particularly affecting low- and middle-income countries, there is a pressing need for innovative, cost-effective solutions. CKM emerges as a viable alternative where dialysis is often inaccessible or unaffordable, with the potential to significantly impact CKD management, especially in resource-limited settings such as Pakistan. I urge the scientific community and policymakers to recognize the importance of supporting and conducting research on conservative kidney management. ---Continue

Court of Justice

This overview highlights: (i) the ECJ State aid decision in the case of Apple – Commission v. Ireland and Others (C-465/20 P); (ii) the ECJ State aid decision on the UK CFC Group Financing Exemption – United Kingdom v. Commission and Others, ITV v. Commission and Others and LSEGH (Luxembourg) and London Stock Exchange Group Holdings (Italy) v. Commission and Others (Joined Cases C‑555/22 P, C‑556/22 P and C‑564/22 P); and (iii) the publication of important amendments to the rules of procedure related to a transfer of jurisdiction for preliminary rulings to the General Court.

Commission

This overview highlights: (i) the Commission’s published report on the future of European competitiveness, (ii) a presentation of the planned structure of the new College of Commissioners and (iii) the State aid decision on approval of the prolongation of the enterprise investment scheme and venture capital trust scheme in Northern Ireland.

SINGLE INSTITUTION RETROSPECTIVE ANALYSIS OF COMPLICATIONS ASSOCIATED WITH SURGICAL DEBULKING OF BRAIN METASTASIS

Abstract AIMS Surgical resection of brain metastasis is associated with complications, which worsen patient’s quality of life, results in oncological treatment delays and death. Surgical complication data aids decision making, leads to objective risk benefit analysis and informed consent. The aim of this study is to quantify rates, types and risk factors for complications related to surgical debulking of brain metastasis. METHOD Retrospective analysis on adult patients with brain metastasis, who underwent surgical debulking between 2017 and 2023 at Royal Preston Hospital. Data collected included demographics, diagnosis, 30-days post-operative complications, 30-days mortality, 30-days post-operative palliation, primary tumour, Karnofsky-Performance Score (KPS), first vs. repeat resection, use of drain and type of suture materials etc. Univariate analysis was carried out using Graphpad software. RESULTS Two-hundred and twenty-seven patients qualified. The most common primaries were lung (n=93, 41%), breast (n=43, 18.9%), and skin (n=31, 13.7%). The most common complications were Hospital-acquired pneumonia (HAP) (n=27, 11.9%), surgical site infection (SSI) (n=19, 8.4%), wound dehiscence (n=14, 6.2%), thromboembolic events (n=12, 5.3%) and CSF leak (n=8, 3.5%). Thirty days mortality and post-operative palliation (due to surgical complications) were both 3.5% each (n=8). Two-hundred and six (93.2%) had KPS ³70 whilst 15 (6.8%) had KPS &amp;lt; 70 [range 30-60 pre-operatively (median 60)). KPS &amp;lt; 70 was statistically significant for post-operative palliation (p=0.01), HAP (0=0.02) and urine infection (p=0.002), but not for 30-day mortality. Twenty-five (11.1%) patients undergoing repeat resections, experienced higher wound infections (p=0.002). CONCLUSION Surgical debulking is associated with significant post-operative complications, with 7% either dying or not receiving any further treatment, 18.1% percent developing serious wound complications (SSI, CSF leak, Wound dehiscence) and 19.4% experiencing significant medical complications (HAP/UTI/Thromboembolism). Pre- operative KPS &amp;lt; 70 and repeat resections are associated with statistically increased risk of complications.