Preferred Course Of Action Research Articles

Systemic Therapy of Gastric Cancer—State of the Art and Future Perspectives

Background: The prognosis of patients diagnosed with locally advanced and metastatic gastric and esophago-gastric junction cancer is critical. The optimal choice of systemic therapy is essential to optimize survival outcomes. Methods: A comprehensive literature review via PubMed and analysis of major oncology congresses (European Society for Medical Oncology and American Society of Clinical Oncology websites) were conducted to ascertain the current status and latest developments in the systemic treatment of patients with localized or advanced gastric and esophago-gastric junction adenocarcinoma. Results: While neoadjuvant and perioperative chemotherapy for localized tumor stages is the preferred approach in the Western Hemisphere, adjuvant chemotherapy remains the preferred course of action in East Asia. The administration of chemotherapy, typically in the form of combinations comprising platinum and fluoropyrimidine compounds in combination with docetaxel, represents a standard of care. Investigations are underway into the potential of immunotherapy and other biologically targeted agents in the perioperative setting. To select the most appropriate therapy for advanced gastric cancer, including adenocarcinoma of the esophago-gastric junction, it is essential to determine biomarkers such as HER2 expression, PD-L1 combined positive score (CPS) (combined positive score), Claudin 18.2, and microsatellite instability (MSI). In the present clinical context, the standard first-line therapy is a combination of fluoropyrimidine and a platinum derivative. The selection of chemotherapy in combination with antibodies is contingent upon the specific biomarker under consideration. Conclusions: This article reviews the current state of the art based on recent clinical trial results and provides an outlook on the future of systemic therapy.

Confounding giant right atrial mass

BackgroundPrimary cardiac tumors are uncommon, with approximately 70–80% classified as benign. Myxomas constitute roughly half of all benign cardiac tumors, while cardiac hydatid cysts are exceptionally rare. Shortness of breath is a prominent symptom associated with these conditions. Echocardiography serves as the primary diagnostic tool, enabling early detection. The preferred course of action involves the surgical excision of the mass.Case presentationOur first case, a 51-year-old female presented to the cardiology outpatient clinic with complaints of shortness of breath and palpitations persisting for 3 months. Physical examination and tests were within normal limits. Echocardiography revealed a right atrial myxoma measuring 65 * 35 mm. Despite not affecting valve and ventricular functions, the mass was surgically resected. Our second case, a 55-year-old male admitted to the cardiology clinic with recurrent fever, shortness of breath, and chest pain. Physical examination and tests were normal. Echocardiography revealed an echogenic mass with a septate appearance adhering to the free wall of the right atrium. The patient, diagnosed with a hydatid cyst, underwent surgical resection.ConclusionsWe came across two different cases of RA masses which happened to be myxoma and hydatid cysts, and we managed accordingly. The right atrial myxomas typically present with nonspecific shortness of breath unless they cause valve obstruction. In cases where clinical findings suggest infection in the right atrial masses, it is essential to consider hydatid cyst as a potential diagnosis alongside the initial consideration of vegetation.

Report of the Special-purpose Committee on Names of Fungi with the Same Epithet, established at the XIX International Botanical Congress in Shenzhen, China

A Special-purpose Committee on Fungal Names with the Same Epithet was established at the XIX International Botanical Congress (IBC) in Shenzhen, China in 2017, with a mandate to report to the 12th International Mycological Congress (IMC) with recommendations on a preferred course of action with respect to names of pleomorphic fungi sharing the same epithet under the International Code of Nomenclature for algae, fungi, and plants. This report provides a synthesis of the deliberations from the Special-purpose Committee. We discuss the arguments for and against the proposed solution to the problems that have arisen regarding the nomenclature of fungi described in multiple morphs using the same epithet. We also propose a gentler method of addressing the problem using existing procedures.

Wizards of Climate Science: Ancient Magicians in the Court of Big Science

Myths inform real-world decision making. Scientific simulation models can do the same. Neither reflects their real-world targets perfectly. They are most useful in an apophatic sense: employing them as the best tools available without confusing their indications with Truth. The actions and choices of wizards often reflect those of scientists; drawing parallels is informative and several questions will be explored within this framework. How is a climate scientist to respond when offered a Faustian agreement promising limited insights? As scientists, how might we better communicate scientific limits regarding which aspects of the future we can see clearly and which we cannot? Should we risk casting doubt on the as-good-as-it-gets science underlying anthropogenic climate change? If an electorate requires certainty of a threat before it will vote for action, are lies of omission or misrepresentation justified? Is it ethical for scientists whose research is relevant to the policy process to pause their typical vigorous scientific criticism of overinterpretation by others (particularly in sciences downstream from physical science) when their science is thought not adequate for purpose? Should scientists merely advise, presenting the relevant science as neutrally as they can, or advocate by emphasizing evidence that supports their preferred course of action, or become activists overselling their science to achieve well-motivated policy ends by whatever means required?

Surgical management for a retained guidewire in vivo during percutaneous coronary interventions following acute myocardial infarction from descending thoracic aorta to external iliac artery: a case report

This case report describes the unique presentation of a 60-year-old woman who was referred from the cardiology department due to the retention of a guidewire following a coronary angiogram. The guidewire was inadvertently left in the right external iliac artery after the angiogram procedure. This report discusses the clinical presentation, diagnostic procedures, and successful management of this case without unusual complication. The successful removal of the retained guidewire culminated in a favourable outcome for the patient. Efforts to extract residual guide-wire fragments from the coronary circulation are generally the preferred course of action. Nevertheless, certain case reports and series have proposed that, in carefully selected patients, leaving the guide-wires in situ without attempting extraction may be a reasonable option when the likelihood of successful removal appears remote, considering anatomical and technical factors. For such cases, a more suitable approach involves administering systemic anticoagulation and antiplatelet agents, coupled with vigilant follow-up.

Pseudo-Ludwig's Angina: Spontaneous Sublingual Haematoma Elicited by Warfarin.

Sublingual haematomas, though uncommon, represent potentially serious complications arising from warfarin therapy.Distinguishing sublingual haematomas from infectious processes requires a high level of clinical suspicion and is crucial for prompt management.The preferred course of action involves reversing anticoagulation with a low threshold for implementing an artificial airway in cases of compromised airways.

A Qualitative Research Survey on Cardiologist's Ethical Stance in Cases of Moral Dilemmas in Cardiology Clinics.

This study sought to determine cardiologists' degrees of ethical awareness and preferred courses of action for ethical dilemmas frequently encountered in clinical settings. For this evaluation, an online survey was created and sent to cardiologists affiliated with various academic posts in Ankara, Turkey. The survey included ten cases with various ethical considerations selected from our book, "Clinic Ethics with Cases from Cardiology." Four possible action choices were defined for each case. Participants were asked to choose one or more of these preferences. In addition, a fictional change was made in each case's context without changing the original ethical issue, and participants were asked whether an attitude different from the first chosen one was preferred. The participation ratio was 49/185 (26%), consent ratio 47/185 (25,4%), and completion ratio 44/185 (23,7%). Nine of the ten scenario changes did not change participants' preferred action. For most questions, action preferences were concentrated between the two options. Although legal regulations did not reduce ethical dilemmas, they clarified physicians' action preferences. Similarly, as an obscure moral issue gained prominence, physicians were forced to draw clearer lines in their actions. External factors such as healthcare emergencies can change physicians' ethical dilemma-solving attitudes.

Closing the value-based circle in shared decision-making: a digital framework for informing the shared decision-making process through patient reported outcome and experience measures.

The spreading adoption of value-based models of healthcare delivery has incentivized the use of patient-reported outcomes and experience measures (PROMs and PREMs) in clinical practice, with the potential to enrich the decision-making process with patient-reported data. This perspective article explores PROs and the shared decision-making (SDM) process as components of value-based healthcare. We describe the potential of PROMs and PREMs within the decision-making process and present a digital framework for informing the shared decision-making process using aggregated data from a healthcare system PROMs and PREMs program, including early results from implementation in hospital network in Madrid, Spain. The proposed digital framework incorporates aggregated data from a hospital network PROMs and PREMs program as part of a digital patient decision aid (PDA) for patients with lymphoma. After the first hematologist appointment, participating patients access the PDA to review relevant information about clinical and patient-reported outcomes for each of the possible options, assign a personal order of priority to different outcomes, and then select their preferred course of action. Patients' answers are automatically uploaded to the EHR and discussed with hematologists at the next appointment. After beginning treatment, patients are invited to participate in the network PROMs program; participants' PROMs data are fed back into the PDA, thus "closing the circle" between the decision-making process and patient-reported data collection.During the first 14 months after launching the decision aid in October 2022, of 25 patients diagnosed with follicular lymphoma at the four participating hospitals, 13 patients decided to participate. No significant differences in age or sex were observed between groups. Average SDM Q-9 score for patients filling in the questionnaire (n = 6) was 36.15 of 45 points. Various obstacles toward widespread implementation of SDM exist such as time constraints, lack of motivation, and resistance to change. Support and active engagement from policy makers and healthcare managers is key to overcome hurdles for capturing patient-reported data and carrying out shared decision-making at healthcare system level. Early results of a digital framework for PRO-enriched SDM seem to be beneficial to the decision-making process.

Report of the Special‐purpose Committee on DNA Sequences as Types, established at the XIX International Botanical Congress in Shenzhen, China

AbstractA Special‐purpose Committee on DNA Sequences as Types was established at the XIX International Botanical Congress (IBC) in Shenzhen, China in 2017, with a mandate to report to the XX IBC with recommendations on a preferred course of action with respect to DNA sequences as potential types under the International Code of Nomenclature for algae, fungi, and plants. This report provides a synthesis of the deliberations from the Special‐purpose Committee on this issue. We discuss two potential options for dealing with the problem that many species, especially of microfungi and microalgae, can be discovered and delimited using eDNA sequencing but cannot currently be formally named due to the requirement in the Code that either a specimen or illustration be nominated as holotype. One option is to expand the definition of “type” to include DNA sequences, while a second option would allow some taxa to be named without types, the application of their names instead being determined using a DNA sequence. This report should be read in concert with two formal proposals for potential amendments to effect these options, published in this issue of Taxon.

DNA sequences as types: A discussion paper from the Special‐purpose Committee established at the XIX International Botanical Congress in Shenzhen, China

AbstractA special‐purpose Committee on DNA Sequences as Types was established at the XIX International Botanical Congress (IBC) in Shenzhen, China, in 2017, with a mandate to report to the XX IBC in Madrid in 2024 with recommendations on a preferred course of action with respect to potential amendments of the International Code of Nomenclature for algae, fungi, and plants to allow DNA sequences as types. This is the first in an expected series of papers from the Special‐purpose Committee on this issue. We set out the background to the establishment of the Committee, explore key issues around typification that are pertinent to the question of DNA sequences as types, enumerate pros and cons of allowing DNA sequences as types, and foreshadow options for future discussion and potential recommendations.

Uncertainty and probability in neonatal end-of-life decision-making: analysing real-time conversations between healthcare professionals and families of critically ill newborns

BackgroundA significant number of critically ill neonates face potentially adverse prognoses and outcomes, with some of them fulfilling the criteria for perinatal palliative care. When counselling parents about the critical health condition of their child, neonatal healthcare professionals require extensive skills and competencies in palliative care and communication. Thus, this study aimed to investigate the communication patterns and contents between neonatal healthcare professionals and parents of neonates with life-limiting or life-threatening conditions regarding options such as life-sustaining treatment and palliative care in the decision-making process.MethodsA qualitative approach to analysing audio-recorded conversations between neonatal team and parents. Eight critically ill neonates and a total of 16 conversations from two Swiss level III neonatal intensive care units were included.ResultsThree main themes were identified: the weight of uncertainty in diagnosis and prognosis, the decision-making process, and palliative care. Uncertainty was observed to impede the discussion about all options of care, including palliative care. Regarding decision-making, neonatologists oftentimes conveyed to parents that this was a shared endeavour. However, parental preferences were not ascertained in the conversations analysed. In most cases, healthcare professionals were leading the discussion and parents expressed their opinion reactively to the information or options received. Only few couples proactively participated in decision-making. The continuation of therapy was often the preferred course of action of the healthcare team and the option of palliative care was not mentioned. However, once the option for palliative care was raised, the parents’ wishes and needs regarding the end-of-life care of their child were obtained, respected, and implemented by the team.ConclusionAlthough shared decision-making was a familiar concept in Swiss neonatal intensive care units, parental involvement in the decision-making process illustrated a somewhat different and complex picture. Strict adherence to the concept of certainty might impede the process of decision-making, thereby not discussing palliation and missing opportunities to include parental values and preferences.

Outcomes of Conservative Management in a Clinically Stable Patient with Traumatic Liver Injury

Objective: The purpose of this research was to examine the success of non-surgical therapy for patients in stable condition who had come with serious liver injuries to the emergency department of a public tertiary care hospital in Karachi, Pakistan. Method: This retrospective research was carried out between February 2022 to August 2022 in department of General Surgery, Civil Hospital Ruth Pfau, DUHS, Karachi, after the ethical approval of the institute ethical review board. Patients were divided into two groups, group I receiving conservative care and group II undergoing surgery. Demographics, injury categorization, related lesions, surgical therapy, morbidity, mortality, and length of hospital stay were all were recorded through a questionnaire. Results: The average age of the 200 participants in the present research was 39.15± 10.47 years. There were 133 (66.5%) males who sustained injuries. The majority of patients (n=150, 75%) were found to have only mild liver damage (grades I–III), whereas 50 patients (25%) had more severe liver damage (grades IV–V). 150 patients (75%) were treated with conservative (NOM) care, whereas 50 patients (25%) had surgical intervention. Twenty-one deaths (10.5 %) were recorded in total. Conclusion: Conservative care is the preferred course of action for patients with stable hemodynamics, whereas surgical intervention is the treatment of choice for those with hemodynamic instability. Patients undergoing conservative treatment should be closely monitored. Mortality and morbidity rates were not significantly higher in patients whose conservative therapy failed.

Self-protective and self-sacrificing preferences of pedestrians and passengers in moral dilemmas involving autonomous vehicles.

Upon the introduction of autonomous vehicles into daily traffic, it becomes increasingly likely that autonomous vehicles become involved in accident scenarios in which decisions have to be made about how to distribute harm among involved parties. In four experiments, participants made moral decisions from the perspective of a passenger, a pedestrian, or an observer. The results show that the preferred action of an autonomous vehicle strongly depends on perspective. Participants’ judgments reflect self-protective tendencies even when utilitarian motives clearly favor one of the available options. However, with an increasing number of lives at stake, utilitarian preferences increased. In a fifth experiment, we tested whether these results were tainted by social desirability but this was not the case. Overall, the results confirm that strong differences exist among passengers, pedestrians, and observers about the preferred course of action in critical incidents. It is therefore important that the actions of autonomous vehicles are not only oriented towards the needs of their passengers, but also take the interests of other road users into account. Even though utilitarian motives cannot fully reconcile the conflicting interests of passengers and pedestrians, there seem to be some moral preferences that a majority of the participants agree upon regardless of their perspective, including the utilitarian preference to save several other lives over one’s own.

The ethics of semantics in medicine

In this paper, we discuss the largely neglected topic of semantics in medicine and the associated ethical issues. We analyse several key medical terms from the informed perspective of the...

Medicalization of sciatica and its treatment

Sciatica is a common back problem with a generally positive natural course. This interview study was performed to gain increased insight into ambivalent and reluctant medicalization on the interactional level regarding the perceptions of Dutch patients and physicians about sciatica and its treatment options as a case study. While the concept of medicalization was introduced decades ago, nuanced perspectives on medicalization on the interactional level—ambivalent and reluctant medicalization—were added recently. Interviews were conducted with 10 patients and 22 clinicians and analyzed using these perspectives. The findings show that patients and clinicians share the problem definition of sciatica, which is stated to be the essence of medicalization. They differ from each other regarding the preferred course of action after diagnosis. Ambivalent and reluctant medicalization both highlight that medicalization in practice is often an uncertain and contested process, with medical intervention as a compromise result. In this case, the problem was not in the diagnosis but in reaching a treatment compromise, considering how much discomfort due to sciatica a patient could handle.

The Gray Legion: Information Warfare Within Our Gates

The information environment, once viewed as an unassailed common for human knowledge, has revealed itself to be a vector for malicious narratives in the ongoing battle for global hegemony. Since 2014, the United States has been under siege from information attacks on multiple fronts, from cyber infrastructure and goods to the cognitive outlooks of its citizenry. Disinformation as a social media tool represents a novel and grave danger to democracy; it serves as a means for sowing unrest and influencing policy changes while enabling conventional conflict or—in the best case for those who would exploit and manipulate narratives—avoiding it entirely. In this article, we identify the harbinger of a dire threat that circles outside, and now inside, the United States' walls by exploring the theoretical dynamics of foreign, state-sponsored disinformation in democracies throughout the West. We examine the mechanisms through which this approach operates and why it is Russia’s preferred course of action.

An integrated framework for anticipating the future and dealing with uncertainty in policymaking

Policymakers need to make policies for an uncertain future, and policy analysts assist policymakers in choosing preferred courses of action. Despite a longstanding recognition that the futures field can contribute a great deal to policy analysis, futures work is not used to its full potential as an element of policy analysis. This is partly due to an absence of well-defined links between the fields and a common unambiguous typology. This paper proposes a framework for linking policy analysis, policymaking, and the futures field so that they can benefit mutually from a shared approach and tools. This integrated framework is intended to guide policy analysts on the appropriate use of futures approaches so that they can improve their analyses and contribute to better policies. At the same time, futures practitioners will be encouraged to align their approaches with the needs of policy analysts, thereby leading to increased uptake of futures work in policy analysis.

Incorporation Without Assimilation: Legislating Tribal Civil Jurisdiction Over Non-Members

For the last 40 years the Supreme Court has been engaged in a measured attack on the sovereignty of Indian tribes when it comes to tribal court jurisdiction over people who are not members of the tribe asserting that jurisdiction. The Congress has already enacted legislation partially restoring some tribal courts’ criminal jurisdiction over non-members. This Essay proposes to legislatively reconfirm the civil jurisdiction of tribal courts over such non-members. After examining the Supreme Court’s jurisprudence in this area and summarizing the Court’s main concerns with such tribal jurisdiction, this Essay explores various legislative options before settling on a preferred course of action. The proposal set forth in the last part of this Essay would reconfirm tribal court civil jurisdiction over non-members provided the tribal courts has established personal jurisdiction over the parties. However, tribal courts’ determinations on this subject would be appealable to federal courts. Furthermore, the Essay proposes to allow non-members being sued in tribal courts the option of removing their cases to federal courts under certain conditions.

Assessing for bruises on the soul: identifying and evidencing childhood emotional abuse

ABSTRACTThe term ‘emotional abuse’ is acknowledged by law in the Children Act 1989 and refers to the wider social concept of harm that occurs in the psychosocial domain. Emotional abuse is a contested notion and a form of harm that statutory child protection social workers find difficult to recognise and gather evidence of. Early preventative intervention approaches, which occur outside the legal system, are the preferred course of action in work with emotional abuse. However, child protection social workers may use their statutory powers and duties to implement interventions when cases are deemed to require attention within legal frameworks.Professionals routinely fear legal work in cases of emotional abuse, feeling inadequately equipped to engage effectively with the law. This article draws on rich research data, gathered for an Economic and Social Research Council funded doctoral project. The data offers an original perspective on the interaction between social work and law, adding to existing literature on the frictions that exists. Using psychosocial methods, the research explores social worker experiences of identifying and evidencing emotional abuse, with particular attention to the application of ‘attachment theory’. The article shines a light on some practice complexities of identifying and evidencing emotional abuse.

Improvement of Urban Environment and Preservation of Cultural Heritage through Experimental Economics by a Modified Contingent Valuation Method (CVM)

The preservation of cultural heritage is entailing excessive cost (paid by people through taxation) while is a source of additional income for both, the State and the people, due to tourism. Since the evaluation of this good cannot be in market terms, we apply a modified version of the Contingent Valuation Method (CVM), which is frequently used in Experimental Economics, in order to investigate the significance that people put on this good and how much they might be willing to pay for supporting activities concerning the preservation of such antiquities, that also improve the urban environment. For this purpose, we have developed a methodological framework under the form of an algorithmic procedure with 21 activity stages and 4 decision nodes, and proved its functionality by implementing it in the case of the Cononian Walls surrounding the peninsula of Piraeus, the main port of Athens, Greece. The results indicate that people are in favor of overturning the devaluation of the monument, by participating in relevant activities, including financial support. Nevertheless, a part of the interviewees disagrees with any financial contribution, judging that this expenditure should be covered exclusively by the State. All statistical processing of answers, obtained through a properly designed/circulated questionnaire, was carried out by Logit and Probit model regression analysis. Both models gave significant (at 0.05 level) dependence of willingness to pay (WTP) on preferred course of action (i.e., leaving the ruins situation as is, performing only the necessary remediation, proceeding with radical restoration).