Decision-making Pathways Research Articles

Revolutionizing Business Intelligence: Integrating IoT, Blockchain, and AI for enhanced insights

The convergence of Internet of Things (IoT), Blockchain, and Artificial Intelligence (AI) is revolutionizing the landscape of business intelligence, offering innovative pathways for data-driven decision-making and operational efficiency. This paper explores the synergistic integration of these transformative technologies, highlighting their combined potential to enhance business insights, security, and scalability. IoT enables real-time data collection from diverse sources, creating vast datasets that fuel AI-driven analytics for predictive and prescriptive decision-making. Blockchain ensures the integrity, transparency, and security of data transactions, addressing critical challenges in data governance and trust. By combining these technologies, organizations can achieve unprecedented levels of accuracy and reliability in business intelligence, driving smarter insights and fostering competitive advantages. Applications span various sectors, including supply chain management, financial services, healthcare, and retail, where IoT sensors, blockchain protocols, and AI algorithms collaboratively optimize processes and mitigate risks. Case studies demonstrate the effectiveness of this triad in enhancing operational efficiency, reducing fraud, and improving customer experiences. The study also discusses challenges such as interoperability, data privacy, and the need for scalable architectures to manage the complexity of integrating these technologies. It concludes by proposing strategies for successful implementation, emphasizing the role of innovation, collaboration, and robust infrastructure in unlocking the full potential of IoT, Blockchain, and AI in business intelligence.

Outcomes following the introduction of an interdisciplinary shared decision-making clinic for older patients with colorectal cancer.

Colorectal cancer (CRC) incidence is highest in older patients, who also have high rates of concurrent multimorbidity and frailty. Shared decision making is important when deciding treatment. The aim of this study was to compare outcomes before and after introduction of a shared decision-making (SDM) pathway, which includes an anaesthetist and geriatrician, for older patients with CRC at Waikato Hospital. Retrospective review of patients over 70 years of age considered for surgical resection was performed before (2018) and after (2020) introduction of the SDM pathway. Primary outcome was days alive out of hospital (DAOH) at 12 months. Data were collected on demographics, disease factors, specialist assessments, frailty and cognitive function, treatment, deviation from colorectal multi-disciplinary meeting (MDM) recommendation and outcomes. In total, 169 patients were included. There were 103 males and the median age was 79 years (range 70-95). After the introduction of the SDM clinic, more patients underwent non-operative management (16.1% vs 4.9%, p=0.02) and had management that deviated from MDM recommendation (18.4% vs 4.9%, p=0.01). DAOH was marginally higher after introduction of the SDM clinic (358 vs 352, p=0.02). There was no difference in survival. An interdisciplinary SDM clinic for older patients with CRC is feasible in a tertiary hospital in New Zealand and may increase non-operative management and DAOH without impacting overall survival.

Cognitive Map of Perceptions of Social Networks as a Means of Justice in Sexual Offenses

The decision to share deeply personal experiences of sexual violence publicly is complex and multifaceted. This study provides valuable insights into this phenomenon. Interviews conducted with fifteen victims of sexual assault in Israel provide insights into the decision-making pathways of victims. The existing literature on sexual victims of sexual assault in Israel offers insights into their decision-making pathways but often lacks integration between theoretical concepts and practical outcomes. This article contributes to this field by proposing a detailed cognitive map that illuminates the specific decisions made by victims in choosing where to disclose their assault. The cognitive map presented in this study provides a comprehensive view of victims’ decision-making pathways. This study is part of a larger research project that involves interviewing communication consultants and analyzing posts from the social network platform Instagram to better understand the perceptions and behaviors of sexual assault victims. The interviews brought up four main themes: the existence of communicative justice and its importance as an arena for achieving justice; social media is critical for achieving justice, sometimes even more than the institutional arena; procedural justice is more important than outcome justice; voice is a leading principle in procedural justice principles.

The Impact of Marketing Mix And Perceived Value on Customer Decision-Making for Community Enterprise Products and Sustainable Development in Singburi Province, Thailand

Objective: Thailand’s 13th National Economic and Social Development Plan (2023–2027) aims to drive sustainable economic growth. This study aims to (1) analyze the current distribution channels for community enterprise products in the Sra Jang sub-district of Singburi Province, (2) improve and expand these distribution channels, and (3) promote the sustainable development of community enterprises in the region. Method: The research population includes potential consumers of local community products across Thailand, selected using convenience sampling. Participants were chosen from various regions, including tourist destinations and general locations , resulting in 400 respondents. To address incomplete data, an additional 50 participants were included, making a final sample of 450. The Structural Equation Modeling (SEM), which recommend a sample size between 200 and 400.Data was gathered using a validated questionnaire, pre-tested with 40 participants, yielding reliability values between 0.7 and 1.00. The questionnaire was reviewed by an academic advisor and deemed suitable .Descriptive statistics summarized demographics, while SEM tested hypotheses and examined complex relationships, with model fit evaluated using indices like CFI and RMSEA . Results: the model’s Goodness of Fit Indices (CMIN/df = 3.466, GFI = 0.956, RMSEA = 0.079) demonstrated consistency with empirical data. Path analysis revealed that the Marketing Mix directly impacts Perceived Value with a coefficient of 0.560 and influences Customer Decision-Making both directly (coefficient of 0.382) and indirectly through Perceived Value (coefficient of 0.280), for a total effect of 0.661. Perceived Value also directly impacts Customer Decision-Making with a coefficient of 0.501. Contribution: Based on these findings, businesses should prioritize optimizing their Marketing Mix strategies to enhance Perceived Value and improve Customer Decision-Making , focusing on product quality, pricing, distribution, and promotion. Emphasizing perceived value and refining strategies through data analytics can help maintain a competitive advantage and strengthen customer decision-making pathways.

Experiences and outcomes of patients participating in a perioperative shared decision-making pathway.

The Complex Decision Pathway (CDP) is a novel perioperative shared decision-making pathway that was established in the Bay of Plenty, New Zealand in 2018. Unique features of the pathway include the use of a structured communication tool to facilitate a goals-of-care conversation in addition to medical assessment, and the use of a tikanga Māori framework for Māori patients. From May 2019 until May 2022, 81 patients attending the CDP clinic were recruited to a prospective study of their demographics, health status and experience at the time of presentation, along with outcomes and opinions over the subsequent 12 months. Participants were mostly elderly and frail with multiple comorbidities, and just over half of participants chose to undergo surgery. Participants who chose, or were recommended, not to undergo surgery were older, more comorbid and had worse outcomes over the subsequent 12 months. Qualitative data suggested an overall positive patient experience of the pathway, and an economic analysis demonstrated its cost-effectiveness. Overall, the data presented here suggested that the CDP assisted in risk-stratifying patients into operative and non-operative groups, provided a positive patient experience, and was a cost-effective intervention.

OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach

Abstract Background The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods. Method A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods. Results The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment. Conclusion COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.

A Novel Optometry-Led Decision-Making Community Referral Refinement Scheme for Neovascular Age-Related Macular Degeneration Screening.

The prevalence of neovascular age-related macular degeneration (nAMD) continues to increase. Hospital Eye Services are operating above capacity, innovative solutions to minimise the high proportion of false negative referrals, improve the care pathway and increase capacity for those patients who need ongoing care are essential are essential. A two-phase retrospective longitudinal analysis of all patients referred and assessed for nAMD between; April 2019 to March 2020 (Phase 1) n=394, and April 2020 to March 2021 (Phase 2) n= 414, within Swansea Bay University Health Board (SBUHB). All patients with suspect nAMD were referred to the hospital based nAMD clinic in phase 1, and a community optometry nAMD decision making pathway in phase 2. All clinical records were reviewed, and data collated for subsequent analysis. Age, sex, date of referral, diagnosis, and treatment date were all recorded and analysed. During phase 1, 104 new nAMD cases needing treatment were diagnosed with 85% (n=88) receiving treatment within 2weeks of initial referral. During phase 2, 230 new nAMD cases requiring treatment were diagnosed with 94% (n=216) receiving treatment within 2weeks of initial referral. Both the proportion of nAMD cases diagnosed (χ² = 70.8; p<0.001) and proportion of those treated within 2weeks of initial diagnosis (χ² = 7.57; p<0.05) were significantly higher during phase 2. There are advantages to a community optometry nAMD decision-making pathway with regard to 1) decreasing the number of patients requiring HES attendance, 2) increasing the number of patients able to access treatment for nAMD within 2weeks of initial referral 3) an increased rate of diagnosis confirmation of nAMD and 4) a decrease in the rate of false-positive referrals.

A dynamic decision-making approach for cabin unlawful interference emergency disposal using dynamic Bayesian network

Disposal of unlawful interference incidents is essential for is crucial for the advancement of aviation security. Effective emergency disposal requires a comprehensive approach that includes the perspectives of airlines, airports, and passengers. In this context, each component of the disposal process can fail randomly. The objective of this research is to optimize emergency disposal decisions to enhance the efficiency of civil aviation operations, reduce accidents, and lower costs. Given the dynamic complexity of unlawful interference incidents, a dynamic fault tree consisting of 26 nodes was constructed to analyze the emergency disposal process. To explore the relationships and priorities of each event, the Dynamic Fault Tree is converted into a dynamic Bayesian network. Based on historical statistical data, simulation analysis is conducted in three aspects: posterior probability, sensitivity, and importance. Simulation results reveal that the top three critical nodes in cabin unlawful interference incidents are “structural damage to the cabin,” “inadequate training by airlines,” and “untimely airport police takeover of disruptive passengers.” Further analysis shows that (1) most of the critical nodes are associated with airlines. (2) The decision-making rationale and pathways of the critical nodes can be clearly observed and prioritized. (3) Besides airlines, other entities such as airports can implement targeted emergency disposal measures. Through quantitative analysis and simulation, this study provides decision-making guidance for participating groups on dynamic emergency disposal, thereby enhancing civil aviation security.

Integrating importance- performance analysis into transboundary natural resource management of water trails: Case study at the Chattahoochee river national recreation area water trail in Atlanta, GA (USA)

Despite growth in National Water Trail designations year after year along with paddlesports popularity, there is little research on water trail users' experiences within transboundary managed water trail systems. Specifically, there is a lack of evidence regarding which experiential attributes paddlers' find important and how these transboundary zones perform on those attributes. This is problematic because the entities managing transboundary water trail zones do not know if there are common attributes that are important to all water trail users and if they are providing satisfactory water-based recreational experiences based on these expectations. With this gap in mind, this research integrates the domain of Transboundary Natural Resource Management for National Water Trail Systems with the analytical method of Importance-Performance Analysis (IPA) to explicitly compare paddlers’ perceptions (n = 360) of 12 water trail attributes between two different management zones (city park vs. federal National Park Service) of the Chattahoochee River National Recreation Area Water Trail in Atlanta, GA (USA). Results revealed that paddlers within both management zones place high importance on the biophysical attribute of water quality yet are equally dissatisfied with the performance of water quality, a reported decades long issue for the Chattahoochee River. Additionally, paddlers within the National Park Service zone expressed greater dissatisfaction with the lack opportunities available for quiet spaces and paddling in undeveloped areas. Results also indicated that water trail visitors had various levels of expectations and perceptions of river setting attributes that differed by management zones. A focused understanding of how physical, social, and managerial attributes of National Water Trails are perceived by recreational users (e.g., paddlers) aids transboundary natural resource efforts in collaborative decision making to better balance river conservation and recreation management for the future sustainability of National Water Trails. Management implications•The increasing popularity of river-based recreation and National Water Trail Systems spanning multiple jurisdictional zones justifies the need to proactively discuss transboundary visitor use management and collaboration across resource management entities (e.g., federal, municipal, private, state, etc.).•Importance-Performance Analyses (IPA) are a cost-effective and relatively intuitive method for managers across multiple jurisdictions to collaboratively manage the satisfactory performance of recreational setting attributes, while also allowing visitors to express their opinions and perspectives on current and future managerial elements.•Managers can gain a stronger understanding of the process to evaluate river setting indicators through analytical methods (e.g., IPA) that may save them time and money, as well as provide a logical decision-making pathway to prioritizing action within the Interagency Visitor Use Management Framework (IVUMF) for parks, rivers, and other protected areas.

Diagnostic performance of contrast enhancement to differentiate benign and malignant renal lesions in CT and MRI: a systematic review and meta-analysis of diagnostic test accuracy (DTA) studies.

To perform a systematic review and meta-analysis of the diagnostic performance of contrast enhancement to differentiate benign and malignant renal lesions using CT and MRI. A systematic literature search of databases was performed between January 1, 1980 and September 26, 2022. We included studies reporting the accuracy of CE thresholds on CT and MRI indeterminate renal lesions, with pathologic examination and follow-up as the reference standard. Studies meeting the inclusion criteria underwent quality assessment with the Cochrane recommendation for diagnostic accuracy study Quality Assessment 2. We excluded studies with high risk of bias. Summary estimates of diagnostic performance were obtained with the bivariate Bayesian model for CT and MRI. Effects of different thresholds and index test modalities were investigated through subgroup analysis. Eleven studies (1372 patients) using CT and six studies (218 patients) using MRI were included. Of the eleven studies, 15 parts from 9 studies were considered for the CT meta-analysis, and 6 parts from 3 studies for the MRI meta-analysis. Diagnostic performance meta-analysis on enhancement found a 96% summary sensitivity (95% CI 92, 98) and a 92% summary specificity (95% CI 85, 96) in 2056 renal lesions for CT; and 82% summary sensitivity (95% CI 65, 89) and an 89% summary specificity (95% CI 77, 95) in 634 lesions for MRI. CT and MRI have high accuracy to determine enhancement and classify renal lesions, and both modalities can be used with confidence for this purpose. There are still some controversies about the optimal thresholds. Future research should evaluate outcomes and decision-making pathways to determine whether basing clinical decisions on a specific threshold on CT and MRI would do more harm than good.

Building retrofit optimization considering future climate and decision-making under various mindsets

Building retrofit is effective in reducing building energy use and improving comfort levels for existing buildings. However, conducting multi-objective optimization for individual buildings can be challenging due to the laborious computational cost of using white box models and the difficulty in visualizing and understanding the decision-making process. Additionally, the impact of climate change has not been fully considered for the post-retrofit lifecycle. This research proposes a pragmatic automated scheme that integrates a feature selection method based on marginal abatement cost analysis and variance-based sensitivity analysis, multi-objective optimization supported by non-dominated sorting differential evolution (NSDE) algorithm, tailor-made decision-making support under different mindsets, and tree-based retrospection scheme of decision-making pathways. The simulation engine used in this study is a low-order white box modeling tool developed by the research team. The proposed scheme was applied to two educational buildings with different thermal characteristics, and the results showed that a certain number of sampling sizes were needed to achieve reliable feature selection results. The hierarchical clustering based decision-making support scheme has demonstrated robustness in visualizing and supporting decision-making for Pareto front. Two retrofit mindsets - aggressive and balanced - were assumed in the decision-making process, and the proposed method produced distinct final solutions accoridng to the two mindsets. This framework can support informed decision-making, helping stakeholders implement sustainable practices and transition to a low-carbon built environment.

Commercial Diagnostics and Emerging Precision Medicine Technologies in Psoriasis and Atopic Dermatitis.

While psoriasis and atopic dermatitis (AD) are two common dermatological conditions, their diagnosis and therapeutic decision-making pathways are often complex. As a result, there has been increased focus on the development of precision medicine approaches for psoriasis and AD. Two companies at the forefront of dermatology precision medicine research are Mindera Health and Castle Biosciences. Here, we review the technologies developed by these two companies using a dermal diagnostic patch and superficial skin scrapings, respectively, their research published to date, and their future research goals. Research from both companies shows promise in predicting the response of inflammatory skin disease to biologics using minimally invasive techniques. However, challenges to adoption include insurance coverage and patient trust in the technologies. While there are several differences between Mindera Health and Castle Biosciences, they have a shared goal of utilizing minimally invasive technologies to sample skin and predict response to biologic treatments using a panel of optimized biomarkers.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study

IntroductionContraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake.MethodsA qualitative exploratory study was conducted among women of reproductive age (15–49 years) and men (15–60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14.ResultsWe found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out.ConclusionsThis study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees.Trial registrationThis study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number—SS809ES.

An Exploration of Contraceptive Choice Pathways in Adolescents and Young Adults

To visualize contraceptive choice pathways among adolescent and young adults (AYA) designated female at birth (DFAB) as a means of exploring the relationships between current contraceptive use, desired contraceptive, and ultimately, chosen contraceptive method. A retrospective cross-sectional study was conducted of AYA DFAB (N = 2369), aged 14-24 years, presenting for initial visit at a contraceptive clinic with standardized efficacy-based counseling. Sankey diagrams were utilized to visualize patient flow through the contraceptive decision-making process. Outcomes of interest were current contraceptive method, desired contraceptive prior to contraceptive counseling, and then chosen contraception. Chi-Square tests were conducted to quantify the strength of the relationships identified by the Sankey diagrams. Sankey diagrams demonstrated a fair amount of change from current contraceptive to desired contraceptive and from current contraceptive to chosen contraceptive. A stronger relationship was evident between desired contraceptive method and chosen method; most patients did not change their desired contraceptive after receiving counseling except AYA who were undecided about their desired contraceptive who flowed variably into all available methods. Chi-Square test assessing the association between desired and chosen contraceptive method was significant at P-value < .001, validating the patterns identified with the Sankey diagrams. We identified distinct contraceptive decision-making pathways among AYA which could inform the framework for a more tailored counseling approach. These findings are aligned with national medical organizations' recommendations for provision of non-coercive, patient-centered contraceptive counseling to promote adolescent reproductive autonomy.

WOMEN'S EXPERIENCES OF DECISION-MAKING ON EMBRYO CRYOPRESERVATION: A DESCRIPTIVE QUALITATIVE STUDY

Objective: The aim of this research is to clarify the experiences of women in deciding on the Embryo Cryopreservation (EC) procedure and the meanings they attribute to their frozen embryos. Methods: In this study, descriptive phenomenological design and thematic analysis approach were adopted based on Husserl’s philosophical perspective. Random sampling technique and maximum diversity sampling methods were also used. Data was collected between April and October 2021 through semi-structured in-depth interviews. Results: Analysis of the interviews led to the emergence of five themes and 10 sub-themes. The theme were the following: ‘‘Decision-making pathways in embryo cryopreservation’’, ‘‘Motivators in the embryo cryopreservation process’’, ‘‘Reflections on embryo cryopreservation’’, ‘‘Conceptualization of the frozen embryo’’, and ‘‘Expectations from the healthcare system’’. Conclusion: In this study, it was found that women were uncomfortable with EC when the decision was made only by the doctor, who did not provide sufficient information about the EC process. It has been determined that women have a positive conceptualization of the embryos as the quality of frozen embryos increases.

Mapping decision-making pathways: Determination of intervention entry points for diagnostic tests in suspected serious infection

Background PROTECT (Platform Randomised evaluation of clinical Outcomes using novel TEChnologies to optimise antimicrobial Therapy) has brought together a team of researchers to design a platform trial to rapidly evaluate and adopt into care multiple diagnostic technologies, bringing immediate benefit to patients. Rapid diagnostic tests will be used to identify patients at risk of deterioration from severe infection, before they become critically unwell. The platform will assess their comparative clinical and cost-effectiveness relative to current standard of care. Preliminary work, conducted under a Health Technology Assessment Application Acceleration Award, provided key evidence to optimise the design of the PROTECT platform. Methods Qualitative methods which involved consulting key stakeholders in the field of serious infection addressed the key priorities. A high-level care pathway analysis focusing on serious infection in secondary care, captured the points of contact, actions, decisions, and potential outcomes associated with a patient’s care. Results Two use cases of rapid diagnostic tests for serious infection were identified; (1) in acute emergency medicine to decide on antimicrobial initiation and/or escalation of care, and (2) in hospitalised patients to monitor treatment response. Within the emergency department, clinicians believed a test would be used as an adjunct to existing standard of care and would be used to either rule-in or rule-out serious infection. The “ideal” test should be rapid, point-of-care, cheap to procure, have capacity for high usability, and ability to be performed and interpreted by all staff. Facilitators to the adoption of infection diagnostic tests is their clinical need, and the main potential barrier is poor change management and behavioural change. Conclusions Any new test should provide robust evidence of its effectiveness and have the potential to benefit the clinical pathway for patients, clinicians, and hospitals as a whole, to be considered for adoption as a new standard of care.

COVID-19 Vaccine decision-making: trust among the transgender and disability communities in India

ABSTRACT Background Historical marginalisation and ongoing trust deficits in health and government systems shape present-day vaccine perceptions among marginalised communities. This paper sought to understand the role of trust in decision-making about COVID-19 vaccine uptake in the transgender and disability communities in India. Methods Using a participatory approach we interviewed 24 community representatives, identifying themselves as transgender individuals or as persons with disability, and 21 key informants such as vaccine programme managers, vaccine providers, and community advocates. We undertook an inductive thematic analysis of the data using a socio-ecological model. Results Fear of side effects in relation to specific needs of the two communities and mistrust of systems involved in vaccination shaped four different pathways for vaccine decision-making. Mistrust of systems was influenced by past negative experiences with the health system, creating contexts in which information and misinformation are shared and interpreted. Participants negotiated their doubts about safety and mistrust of systems by interacting with different sources of influence showing patterns of decision-making that are dynamic, context-dependent, and intersectional. Conclusion These findings will help in determining the content, strategies and approaches to equitable vaccine communication for these two communities. The two communities ought to be included in vaccine trials. Vaccine information must respond to the specific needs of these two communities which could be enabled by collaboration and engagement with community members and influencers. Finally, long-term investment towards the needs of marginalised communities is vital to dismantle cycles of marginalisation and distrust and in turn improve vaccine acceptance and uptake.

Implementation of high sensitivity troponin into routine clinical practice - results of the extended CARdiac MArkers guideline uptake in Europe group (CARMAGUE) survey

BackgroundMeasurement of cardiac troponin (cTn) by a high sensitivity method is now the recommended strategy for the detection of myocardial injury. An international survey was undertaken to assess how this has been implemented. MethodsA questionnaire based around 14 domains on cardiac biomarkers was distributed electronically with the aid of professional societies accessed by a web link within the invitation. Results were returned electronically then extracted into a relational database for analysis. ResultsResponses were obtained from 663 laboratories across 76 countries ranging from 1 to 69 largest country. The majority of responses (79.6%) came from the European area. Responses were grouped into broad geographic areas for analysis. Most responses came from hospitals providing a local and regional service of which the majority provided angioplasty. cTn measurement was the dominant biomarker. The majority of laboratories include creatine kinase (CK) in their cardiac profile and approximately 50% also offer the MB isoenzyme of CK. The majority of laboratories (91.9%) measure cTn by a high sensitivity method. Sex specific reference ranges were typically implemented for cardiac troponin I but not for cardiac troponin T. The preferred unit of measurement was nanograms/L. A structured decision-making pathway utilising high sensitivity cTn measurement was used by 83.3% of laboratories who responded. Single sample rule out is common but the majority used serial sampling strategy based on measurement on admission and three hours. ConclusionsMeasurement of cTn by a high sensitivity method is now well established internationally, the use of rapid diagnostic protocols lags behind.

Use of ChatGPT in Urology and its Relevance in Clinical Practice: Is it useful?

One of the many artificial intelligence based tools that has gained popularity is the Chat-Generative Pre-Trained Transformer (ChatGPT). Due to its popularity, incorrect information provided by ChatGPT will have an impact on patient misinformation. Furthermore, it may cause misconduct as ChatGPT can mislead physicians on the decision-making pathway. Therefore, the aim of this study is to evaluate the accuracy and reproducibility of ChatGPT answers regarding urological diagnoses. ChatGPT 3.5 version was used. The questions asked for the program involved Primary Megaureter (pMU), Enuresis and Vesicoureteral Reflux (VUR). There were three queries for each topic. The queries were inserted twice, and both responses were recorded to examine the reproducibility of ChatGPT's answers. Afterwards, both answers were combined. Finally, those rwere evaluated qualitatively by a board of three specialists. A descriptive analysis was performed. ChatGPT simulated general knowledge on the researched topics. Regarding Enuresis, the provided definition was partially correct, as the generic response allowed for misinterpretation. For VUR, the response was considered appropriate. For pMU it was partially correct, lacking essential aspects of its definition such as the diameter of the dilatation of the ureter. Unnecessary exams were suggested, for Enuresis and pMU. Regarding the treatment of the conditions mentioned, it specified treatments for Enuresis that are ineffective, such as bladder training. Therefore, ChatGPT responses present a combination of accurate information, but also incomplete, ambiguous and, occasionally, misleading details.

Recommendations for asthma monitoring in children: A PeARL document endorsed by APAPARI, EAACI, INTERASMA, REG, and WAO.

Monitoring is a major component of asthma management in children. Regular monitoring allows for diagnosis confirmation, treatment optimization, and natural history review. Numerous factors that may affect disease activity and patient well-being need to be monitored: response and adherence to treatment, disease control, disease progression, comorbidities, quality of life, medication side-effects, allergen and irritant exposures, diet and more. However, the prioritization of such factors and the selection of relevant assessment tools is an unmet need. Furthermore, rapidly developing technologies promise new opportunities for closer, or even "real-time," monitoring between visits. Following an approach that included needs assessment, evidence appraisal, and Delphi consensus, the PeARL Think Tank, in collaboration with major international professional and patient organizations, has developed a set of 24 recommendations on pediatric asthma monitoring, to support healthcare professionals in decision-making and care pathway design.