Feedback Round Research Articles

Randomized control trial evaluating different modalities of real-time surgical feedback

IntroductionSurgical training is a constant exchange between trainers and trainees, and intraoperative surgical feedback is an integral part of learning. New technologies in robotic surgery allow for the delivery of visual aid and verbal feedback intraoperatively, but it has not yet been determined if feedback type affects the trainee learning process. Methods49 novice participants were recruited and randomized into four feedback groups: Verbal, Visual, Combination of verbal/visual, and no feedback (Control). Participants completed a suturing task three times (pre-test, feedback, post-test). Suturing videos were retrospectively graded utilizing a standard rubric, and performance scores were compared across feedback groups utilizing hierarchical modeling. ResultsEach group had similar pre-test performance (p>0.05). Comparison between pre-test and post-test performance revealed statistically significant improvements in performance across feedback groups for Retraction and Cinching, but Control did not improve (interaction test: p<0.001). Verbal and Visual demonstrated significant improvement in Spacing as compared to Control (p=0.004 and p=0.002). During the feedback round, Combination received statistically significantly less feedback as compared to Verbal and Visual before consistently utilizing the correct technique for Retraction (p<0.001, p=0.013). Combination also received statistically significantly less feedback as compared to Verbal for Cinching (p=0.006). Finally, participants in Visual and Combination required significantly less Clarification on the delivered feedback compared to those in Verbal (p=0.004, p=0.001). ConclusionReal-time surgical feedback—regardless of type—allows for marked improvement in correct technique. Additionally, a combination of both visual and verbal feedback may help surgical trainees learn more efficiently than verbal or visual feedback alone.

Making health information understandable: the COVID-19 patient guideline

Abstract Issue Evidence-based practice guidelines offer a reliable source of information, providing recommendations based on the most recent evidence. However, these guidelines are complex and difficult to understand for laypersons. This creates a knowledge gap, affecting shared-decision making, treatment acceptance, understanding of a disease and recommendations of disease prevention. Description of the problem Patient guidelines (PatG) aim to bridge this knowledge-gap by providing simplified versions of practice guidelines in lay language. This is a common practice internationally. An example is the German evidence-based COVID-19 practice guideline, published in 01/2024. In March, a multidisciplinary team, including a patient representative, created and reviewed a PatG outline, prioritising topics based on patient relevance, and discussed relevant information. The authors translated guideline recommendations into lay language, researched additional information, and created supporting graphics. A methodology chapter explaining both guidelines and a short medical term dictionary were also included. Results In 05/2024, the COVID-19 PatG, around 70 pages long, was finalized including information on treatment, diagnostics, intensive care, and support resources. A feedback round was initiated. Comments will be incorporated for the final version to be published in the national guideline registry by end of 05/2024. Updates of the PatG and practice guidelines will occur frequently. Lessons We faced challenges in simplifying medical concepts and interventions and accurately translating recommendations without losing key information. The length of the PatG may discourage readers. Despite these challenges, we are committed to enhancing accessibility, using simpler language, and adding supporting graphics to improve the PatG in the future. Key messages • Despite some challenges, patient guidelines pose as a reliable form of patient information. • The COVID-19 patient guideline is a reliable and evidence-based source of information.

Consensus-Based Guidelines for Communicating a Misdiagnosis of Multiple Sclerosis to Reduce Psychological Distress.

Multiple sclerosis (MS) misdiagnosis is common, and when discovered, frequently leads to substantial disruption to patients' lives and anxiety for clinicians. Our objective was to develop expert consensus-based guidelines about how to communicate a misdiagnosis of MS to a patient, to reduce the potential for both psychological distress and litigation. A modified Delphi method using a systematic literature review on doctor and patient experiences of the MS diagnosis communication was used to populate items for a first-round questionnaire. Our Delphi panel represented three perspectives (clinicians, people with MS, and published experts in health communication), and we recruited 18 panelists in total (6 per perspective). Consensus was defined a priori as 75% of panelists giving an item the same rating. A feedback round was undertaken with six external reviewers, naïve to the guideline development process, and the panelists. Items were reviewed by the study team and synthesized to create the finalized guidelines. Consensus was reached for 45 items rated as "very important" and presented in the feedback round. The study team synthesized the 45 items to 27 items. Ten items related specifically to the communication of the MS misdiagnosis and 17 items to generic guidelines highlighted as important in the MS misdiagnosis appointment. Seven recommendations form the guidelines presented here. Seven consensus-based recommendations offer guidance to practising neurologists in their communication with patients in a situation that has the potential to be highly distressing, for both clinician and patient.

Old but not out: Practical and theoretical implications for a caring and compassionate neighbourhood through civic engagement in later life

Background: The importance of civic engagement for caring and compassionate neighbourhoods is often overlooked in public and academic debate. Especially, civic engagement in later life in neighbourhoods is understudied. Research on this topic can shed light on the various obstacles and enablers that can stimulate or hinder civic engagement in later life at the local level. &#x0D; Aim: This workshop gives insight into the processes of in- or exclusion of civic engagement in later life at a neighbourhood level. Additionally, the goal is to stimulate reflection among participants about civic engagement in relation to caring neighbourhoods and compassionate communities and to jointly advance the state of knowledge. &#x0D; Participants: This session is relevant for people who civically engage in their respective neighbourhoods, as well as for practitioners, civil servants, politicians, researchers, and others who are interested in stimulating and understanding civic engagement in later life at the neighbourhood level. Those who have no experience with the subject are also welcome.&#x0D; Methods: The session starts with presentations of both researchers and a representative of a sociocultural organisation, to ensure both theoretical and practical coverage of the topic. Equipped with the background from the presentations, this workshop will continue by making personas to understand how a neighbourhood can create facilitators and barriers to civic engagement.&#x0D; 1.Introduction (10 min): The session starts with an introduction by prof. Dr. Sarah Dury about the meaning of compassionate and caring communities and how civic engagement activities like informal help and volunteering can play a role in it. &#x0D; 2.Three presentations (30 min): &#x0D; 1) The relationship of civic engagement in later life and the neighbourhood level (Toon Vercauteren, VUB): A presentation on how the neighbourhood interacts with civic engagement in later life with a focus on volunteering and informal helping behaviours.&#x0D; 2) Civic engagement in later life in a socially disadvantaged neighbourhood (Bas Dikmans, VUB): This presentation will focus on how the socially disadvantaged neighbourhood can pose obstacles to but also foster civic engagement in later life. &#x0D; &#x0D; 3) Practical examples of civic engagement in a socially disadvantaged neighbourhood in Schaerbeek (Ingrid Pecquet, Eva Bxl): Practical examples of civic engagement activities in later life that contribute to caring and compassionate communities will be presented. &#x0D; 3.Creating personas in groups (35 min): Together with the participants, we will construct personas, which are imaginary persons with characteristics and experiences of a particular group. In this workshop, we will focus on neighbourhood characteristics to understand how a neighbourhood can shape civic engagement in later life.&#x0D; 4.Plenary and closing session (15 min): The personas of each group will be briefly presented in the closing feedback round. The ideas generated during the session will be collected on a writing board that can be shared with the audience afterwards.&#x0D; End goal: This workshop will inform participants about what civic engagement in later life can look like in a neighbourhood. It will discuss the challenges and opportunities that arise in its practical application linked to caring neighbourhoods and compassionate communities.&#x0D;

Systematic symptom screening in patients with advanced cancer treated in certified oncology centers: results of the prospective multicenter German KeSBa project

PurposeGuidelines recommend a structured symptom screening (SC) for especially advanced cancer patients (CPs). The aim of this multicenter German prospective quality assurance project KeSBa (Kennzahl Symptom- und Belastungserfassung) was to gain knowledge on SC procedures in Oncology Centers (OCs) for advanced cancer patients and a first impression on the consequences of SC.MethodsThe KeSBa project consisted of three phases: pilot, 3 months screening and feedback phase. Participating OCs decided to use either the Minimal Documentation System (MIDOS) or the Integrated Palliative care Outcome Scale (IPOS) and defined the cutoff values for positive screening results.ResultsOut of 172 certified German OCs, 40 (23%) participated in the KeSBa pilot phase, 29 (16.8%) in the 3 months screening phase using MIDOS (n = 18, 58.6%) or IPOS (n = 11, 41.3%) and in the feedback round. 25/29 performed paper-based screening (86.2%). 2.963 CPs were screened. Results were documented for 1255 (42.2%, SC +) positive and 874 (29.5%, SC–) negative screenings depending on the center´s schedules: 452 SC + CPs (28.4%) and 42 SC– CPs (2.6%) had contact to specialized palliative care or other supportive specialist teams afterwards, 458 SC + CPs (28.8%) and 605 SC– CPs (38.1%) remained in standard oncology care. In the feedback round missing resources (personal and IT) and improved communication were mentioned most often.ConclusionRoutine SC is feasible in advanced CPs treated in OCs but associated with considerable workload. In 42.2% of CPs SC was classified as positive, indicating the need of further diagnostics or professional judgment. SC requires staff and IT resources.

Alternative Pedagogies Used by Teachers in Teaching History During the Covid-19 Pandemic

The topic of the alternative use of the pedagogies in the teaching system of Malaysia deals about the pedagogies used by the teachers help in the proper understanding of students and help them study in a more focused and distinct way. The teachers use the methods of reviewing the systems and analyzing the data that has been published, critically, to provide a deep learning knowledge to the students. The research has been done on the alternative pedagogies used in teaching processes and the impacts of these alternative pedagogies in the student motivation. In the findings and discussions, the research has been done based on the primary qualitative data that has been collected according to which the surveys have been conducted. After the completion of all the necessary practices and strategies of the teachers, a feedback round is conducted where the students are required to fill in the forms and answer about the various learning processes that impacted them and helped them grasp the desired knowledge. In case of primary data collection method, an interview has been where the history of pedagogical approach is analyzed. In summary part, the overall view of the study is discussed which fulfils the approaches of pedagogy by the teachers in the covid. This provides a continuity of education process and motivates the students to develop their skills and make a sustainable develop in future. The study provides an outcome of student’s satisfaction in their education in covid which also provide them psychological balance in learning.

Intermittent dynamical state switching in discrete-mode semiconductor lasers subject to optical feedback

Intermittent dynamics switching on the route to chaos in a discrete-mode laser with long time-delayed feedback is experimentally and numerically studied by analyzing the time series, power spectra, and phase portraits. The results show two types of dynamics switching: one or multiple times regular intermittent dynamics switching between stable state and square-wave envelope period-one oscillation within one feedback round time, and the irregular intermittent dynamics switching between stable state and quasi-periodic or multi-states or chaos with higher feedback ratio and bias currents. The relationship between the duty cycle of period-one oscillation and the feedback ratio has been analyzed. The map of the dynamics distribution in the parameter space of feedback ratio and bias current is plotted for a better understanding of dynamics evolution in long external cavity discrete-mode lasers.

Risk Tolerability Limits for Fire Engineering Design: Methodology and Reference Case Study

A simple framework for setting risk tolerability limits is proposed following a literature review of risk acceptance in fire safety engineering and a feedback round with international fire safety professionals. The framework provides practical guidance for the application of international fire safety guidance, such as the recently published UK guidance document on probabilistic risk assessment for the fire design of buildings, PD 7974-7:2019, which provides a state-of-the-art framework to assess adequate safety for complex fire engineering designs. However, the application of this guidance document is hindered by two main constraints: (1) PD7974-7:2019 requires risk tolerability limits to be set, but lacks guidance on defining them for a specific building project, and (2) no reference case studies are given that demonstrate the application of PRA methods to fire engineering design. In order to help fill this gap, a risk tolerability framework is developed and proposed herein. Finally, it is applied to a reference case study of a UK office building. Considering the developed framework, further research needs are identified. It is expected that the proposed risk tolerability framework and the presented reference case study can support the application of PRA to fire engineering design and ease stakeholder communication on setting risk tolerability limits.

Learning in peer teaching of patient relations and communication skills at the "Anamnesegruppen" Munich - proof-of-concept and lessons learned.

Background: Due to the ban on classroom teaching during the pandemic, the Munich “Anamnesegruppen” had to be switched to e-learning at short notice. There were no established concepts for this, which is why digitalization was piloted and evaluated for feasibility.Student “Anamnesegruppen”: “Anamnesegruppen” have existed for over 50 years and are organized as independent student peer teaching. In small groups of medical and psychology students, interviews with patients are conducted once a week during the semester. This is followed by a feedback and discussion round, in which ethical and professional questions are discussed in addition to the patient's medical history. The goal is to train the participants' ability to communicate and reflect.Adaptation to digital methods: The anamnesis seminars have been moved to a virtual group room using video conference. Patients were mainly recruited from the participants' circle of acquaintances. The group size was set at eight people each in four groups and supervised by a pair of student tutors. Confidentiality and data protection declarations were obtained in writing.Results: By switching to digital anamnesis groups, all four groups were successfully completed. Both the final supervision of the tutors and the electronic evaluation of the participants yielded positive feedback. Compared to the two previous evaluations of the semesters in classroom sessions, there were no significant differences in the evaluation.Discussion: The continuously good evaluation results, which did not differ between the digital format and the classroom course of the previous semesters, show that an ad hoc conversion to digital teaching is possible. We want to stress the fact that elements reflecting the doctor-patient relationship were successfully preserved. For the similarly structured Balint groups, virtual sessions may also be considered. Further research, especially prospective, is desirable in order to better understand the possibilities of digital teaching in this area.

Sexual harassment at work: Design of a new questionnaire to measure sexual harassment

Abstract Background Sexual harassment is a complex phenomenon and our knowledge is hampered by a lack of consensus on the definition and measurement. However, workplaces need reliable instruments that provide a nuanced understanding of sexual harassment and input for action to mitigate negative consequences. The aim of this project is to help workplaces prevent and manage sexual harassment, which include developing a new and comprehensive instrument to monitor sexual harassment (Inventory of Workplace Sexual Harassment). In this abstract, we explain the process of designing the questionnaire. Methods The design process follows three steps: (1) Identification of a theoretical and conceptual framework, (2) item development and (3) field testing. First, we identified relevant theoretical and conceptual frameworks, which we discussed with an expert group consisting of researchers and stakeholders (employer and trade unions). Second, we developed items based on expert inputs and previous surveys. We adapted the first version of the questionnaire following a feedback round with the expert group. Third, we will complete field testing in 2019-2020. Field testing encompasses cognitive interviews (n = 15) and in-depth interviews with men and women exposed to sexual harassment to assess clarity and relevance (in 2019), and a pilot study at 15 workplaces to assess prevalence and usability (in 2020). Results Based on the theoretical and conceptual model from Fitzgerald et al, we developed a preliminary version, consisting of 22 items that cover three domains: (1) unwanted sexual attention, (2) gender harassment and (2) sexual coercion. The survey draws on questions from SEQ-DoD and Bergen Sexual Harassment Scale. Results from field testing will be available for the conference. Conclusions The Inventory of Workplace Sexual Harassment will provide a comprehensive and validated measurement of workplace sexual harassment and will help workplaces prevent and manage sexual harassment. Key messages Sexual harassment is a complex and multifaceted phenomenon, but our knowledge is hampered by a lack of consensus on the definition and measurement. This study contributes with a new instrument measuring the prevalence of workplace sexual harassment and tools for prevention and management of sexual harassment.

Supervised teaching and feedback improve physiotherapists' reporting of the International Classification of Functioning, Disability and Health in physiotherapeutic electronic patient records: A proof-of-concept randomized controlled trial.

The International Classification of Functioning, Disability and Health (ICF) is a landmark for physiotherapy to describe the full spectrum of human functioning, but ICF patient record completion could improve. In this study, we examine the effect of supervised teaching and personalized feedback on physiotherapists' completion and reporting of ICF in electronic patient records. In this proof-of-concept randomized controlled trial, the intervention group (10 physiotherapists) received supervised teaching and four rounds of personalized feedback on reporting of ICF components in electronic patient records. In the intervention group, review on patient record completion (n = 670 records) was performed at baseline, after teaching, after each of four feedback rounds, and at long-term follow-up. In the control group (five physiotherapists), which received no supervised teaching nor personalized feedback, review (n = 140 records) was performed at baseline, after the third feedback round of the intervention group, and at follow-up. After the third round of feedback (95% vs 72% completion; β, 2.68; 95% CI, 0.62-4.74), patient record completion was significantly higher in the intervention group. This was also true for following ICF components: "activity" (93% versus 64% completion; β, 3.03; 95% CI, 1.52-4.54), "participation" (50% versus 14% completion; β, 3.67; 95% CI, 1.79-5.55), and "personal factors" (35% versus 20% completion; β, 2.10; 95% CI, 0.63-3.57). These statistically significant and clinically relevant effects persisted at long-term follow-up. For "environmental factors," effects after the third round of feedback (75% vs 30% completion; β, 1.88; 95% CI, 0.63-3.13) disappeared at follow-up. Reporting of "body functions and structures" improved similarly across groups. Supervised teaching and personalized feedback are active ingredients of an intervention to improve reporting of ICF components in physiotherapeutic patient records.

European Framework of Rehabilitation Services Types: the perspective of the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists.

Effectiveness in health services is achieved if desired clinical outcomes are reached. In rehabilitation the relevant clinical outcome is functioning, with the International Classification of Functioning, Disability and Health (ICF) as the reference system for the standardized reporting of functioning outcomes. To foster the implementation of the ICF in clinical quality management (CQM) across the rehabilitation services continuum, the UEMS-PRM Section and Board approved an ICF implementation action plan that includes the identification of types of currently provided rehabilitation services in Europe. The objective of this paper is to report on the development of a European framework of rehabilitation service types that can provide the foundation for the standardized reporting of functioning outcomes and CQM programs. A multistage consensus process involving delegates (participants) from the UEMS-PRM Section and Board as well as external experts across European regions comprised the development of an initial framework by an editorial group, two feedback rounds via e-mail and a deliberation by the UEMS-PRM Section and Board in its September 2018 meeting in Stockholm (Sweden). In the first feedback round, participants were asked whether: 1) the initial framework of service types exists in their respective country: 2) the description represents the service type: and 3) an existing service type was missing. Based on the first-round results, the framework proposal was modified by the editorial group. In the second feedback round, participants were asked to confirm or comment on each of the service types in the revised framework. Based on the second-round results, the framework proposal was again modified and presented for discussion, revision and approval at the Stockholm meeting. In the first feedback round, eight rehabilitation services were added to the framework proposal and two service types that were deemed "missing" were not included. In the second round, all seven initially proposed and six of the added service types were reconfirmed, while two of the added service types were not supported. Based on deliberations at the Stockholm meeting, some modifications were made to the proposed framework, and the UEMS-PRM general assembly approved a European Framework of Rehabilitation Service Types that comprises of: Rehabilitation in acute care, General post-acute rehabilitation, Specialized post-acute rehabilitation, General outpatient rehabilitation, Specialized outpatient rehabilitation, General day rehabilitation, Specialized day rehabilitation, Vocational rehabilitation, Rehabilitation in the community, Rehabilitation services at home (incl. nursing home), Rehabilitation for specific groups of persons with disability, Rehabilitation in social assistance, Specialized lifelong follow-up rehabilitation, and Rehabilitation in medical health resorts. The European Framework of Rehabilitation Services Types presented in this paper will be continuously updated according to new and emerging service types. Next steps of the UEMS-PRM effort to implement the ICF in rehabilitation include the specification of clinical assessment schedules for each service type and case studies illustrating service provision across the spectrum of rehabilitation service types. The European Framework will enable the accountable reporting of functioning outcomes at the national level and the continuous improvement of rehabilitation service provision in CQM.

A consensus statement on how to conduct inclusive health research.

The active involvement of people with intellectual disabilities in research, or inclusive research, is relatively common. However, inclusive health research is less common, even though it is expected to lead to appropriate healthcare and increased quality of life. Inclusive health research can build upon lessons learned from inclusive research. A total of 17 experts on inclusive (health) research without intellectual disabilities and 40 experts with intellectual disabilities collaborated in this consensus statement. The consensus statement was developed in three consecutive rounds: (1) an initial feedback round; (2) a roundtable discussion at the 2016 International Association for the Scientific Study of Intellectual and Developmental Disabilities World Congress; and (3) a final feedback round. This consensus statement provides researchers with guidelines, agreed upon by experts in the field, regarding attributes, potential outcomes, reporting and publishing, and future research directions, for designing and conducting inclusive health research. Consensus was reached on how to design and conduct inclusive health research. However, this statement should be continuously adapted to incorporate recent knowledge. The focus of this consensus statement is largely on inclusive health research, but the principles can also be applied to other areas.

A novel relevance feedback method for CBIR

In this paper, we address the challenge about insufficiency of training set and limited feedback information in each relevance feedback (RF) round during the process of content based image retrieval (CBIR). We propose a novel active learning scheme to utilize the labeled and unlabeled images to build the initial Support Vector Machine (SVM) classifier for image retrieving. In our framework, two main components, a pseudo-label strategy and an improved active learning selection method, are included. Moreover, a feature subspace partition algorithm is proposed to model the retrieval target from users by the analysis from relevance labeled images. Experimental results demonstrate the superiority of the proposed method on a range of databases with respect to the retrieval accuracy.

Effect of Bias Current on Complexity and Time Delay Signature of Chaos in Semiconductor Laser With Time-Delayed Optical Feedback

The effect of bias current on the complexity and time-delay signature of chaotic signals in semiconductor lasers with polarization preserved optical feedback has been studied experimentally and theoretically. The peak value of the autocorrelation coefficient and the normalized permutation entropy at the feedback round trip time are used to quantify the time delay signature and complexity, respectively. The results show that the time-delay signature is approximately in an inverse relationship with the complexity of chaos when the semiconductor laser is subject to low or strong optical feedback. However, the inverse relationship disappears when the laser operates at higher bias currents with intermediate feedback strength. The simulation results are qualitatively agreed with the experimental results.

Belated Analyses of Three Credit-Based Adaptive Polling Algorithms

We study the problem of credit-based adaptive polling in undirected arbitrary point-to-point asynchronous networks. Polling consists of two rounds, namely propagation (broadcast) and feedback (confirmation, response) rounds. By adaptive polling, a spanning tree of unknown topology is built dynamically during the propagation round, and feedback messages are free to choose their paths back to the initiator — a specific node who initiates the polling algorithm. The freedom in the feedback round relies on the use of credits in the propagation round. We re-visit three existing algorithms and analyse their average case communication bit complexities incurred by the credits in the propagation round, and these analyses match with the numerical results. We also give an optimal lower bound on the worst case bit message complexity for the case when the number of nodes in the network is unknown.

Concealment of Chaos Time-Delay Signature in Three-Cascaded Vertical-Cavity Surface-Emitting Lasers

The time-delay signature and the chaos bandwidth in three-cascaded vertical-cavity surface-emitting lasers have been investigated experimentally. A peak value of autocorrelation coefficient at the feedback round trip time and the ratio between this peak value and its background are used to quantitatively identify the time-delay (TD) signature of chaos. A new concept—peak to side-peak ratio is introduced for better quantification of the TD signature concealment. The peak to side-peak ratio is defined as the ratio between the peak value of autocorrelation coefficient at the TD and the peak value at a delay time other than the TD and zero delay time. Three injection cases, namely, small bandwidth, intermediate bandwidth, and wide bandwidth of the injecting chaos signals, have been used to study the effect of the bandwidth of the injecting chaos on the TD concealment. The experimental results show that the time-delay signature can be totally concealed in the slave laser subject to the intermediate bandwidth of chaotic optical injection over a wide frequency detuning range.

A graph-based relevance feedback mechanism in content-based image retrieval

Content-Based Image Retrieval (CBIR) is an important problem in the domain of digital data management. There is indeed a growing availability of images, but unfortunately the traditional metadata-based search systems are unable to properly exploit their visual information content. In this article we introduce a novel CBIR scheme that abstracts each image in the database in terms of statistical features computed using the Multi-scale Geometric Analysis (MGA) of Non-subsampled Contourlet Transform (NSCT). Noise resilience is one of the main advantages of this feature representation. To improve the retrieval performance and reduce the semantic gap, our system incorporates a Relevance Feedback (RF) mechanism that uses a graph-theoretic approach to rank the images in accordance with the user’s feedback. First, a graph of images is constructed with edges reflecting the similarity of pairs of images with respect to the proposed feature representation. Then, images are ranked at each feedback round in terms of the probability that a random walk on this graph reaches an image tagged as relevant by the user before hitting a non-relevant one. Experimental analyses on three different databases show the effectiveness of our algorithm compared to state-of-the-art approaches in particular when the images are corrupted with different types of noise.

A new SVM-based active feedback scheme for image retrieval

Relevance feedback has emerged as a powerful tool to boost the retrieval performance in content-based image retrieval (CBIR). Support vector machine (SVM) active learning is one popular and successful technique for relevance feedback in CBIR. Despite the success, for conventional SVM active learning, the users are usually not so patience to label a large number of training instances in the relevance feedback round. To overcome this limitation, a new SVM-based active feedback using ensemble multiple classifiers is proposed in this paper. Firstly, we select the most informative images by using active learning method for user to label, and quickly learn a boundary that separates the images that satisfy the user׳s query concept from the rest of the dataset. Then, a set of moderate accurate one-class SVM classifiers are trained separately by using different sub-features vectors. Finally, we compute the weight vector of component SVM classifiers dynamically by using the parameters for positive and negative samples, and combine the results of the component classifiers to form an output code as a hypothesized solution to the overall image retrieval problem. Experiments on large databases show that the proposed algorithms are significantly more effective than the state-of-the-art approaches.

Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts

BackgroundLarge numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries.MethodA multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel’s median votes were used to identify the final set of QIs.ResultsThe Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions.ConclusionInternational experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.