Prioritization Process Research Articles

A comprehensive experience-based framework of actionable priorities to enhance Canada’s health and social care system: discussions with older persons, clinicians, managers, and decision-makers using nominal group technique

BackgroundExisting frameworks of older persons’ experiences in health and social care systems are usually based on single stakeholder perspectives and focused on limited aspects that are independent from one another. This study aimed to describe such experiences from the perspective of diverse stakeholders and develop a comprehensive experience-based framework for actionable priorities to enhance Canada’s health and social care system.MethodsWe adapted a nominal group technique with a qualitative approach. We formed four groups of stakeholders (4 older persons, 7 clinicians, 5 managers, 4 decision-makers) in the province of Quebec. First, participants individually completed a questionnaire to rank the six domains of an international set of metrics of quality of care for older persons in terms of their importance. Then, we conducted a remote discussion with each stakeholder group, obtained consensus on the priority domains, and explored personal/professional experiences explaining prioritization processes and what changes are needed. An inductive-deductive thematic analysis was conducted to develop a framework for actionable health and social care priorities.ResultsThe framework included six key categories revolving around a core category of ‘health equity’. (1) ‘Access to services and care’ focused on improved accessibility of healthcare navigators, primary and home care services, and end-of life care. (2) ‘Respect for older persons’ involved individuality and uniqueness, daily needs, advocacy in defence of vulnerability, and decision-making valuing care preferences. (3) ‘Involvement of family and friends’ encompassed formal recognition, responsibilities, and trajectories associated with caregiving. (4) ‘Communication and education’ consisted of adaptive communication between older persons, caregivers, and professionals and societal-level education and awareness-raising. (5) ‘Coordination and integration of care’ comprised health and social services organization, cross-sectoral approaches, and interdisciplinary collaboration. (6) ‘Responsiveness to evolving needs’ of older persons involved timely response to health transitions and promoting holistic approaches.ConclusionsThis study illustrates the complex challenges of caring for older persons. The framework suggests several areas for improvement in care practices and policies for older persons and caregivers. Proposed intervention targets include public healthcare system navigators, standardized goals of care practices respecting persons’ wishes, formal recognition of caregiver contributions, society-level education, cross-sectoral initiatives, and holistic approaches.

Application of the Analytic Network Process for Sub-Watershed Prioritization in the Huehuetan River Basin, Chiapas, Mexico

Sub-watershed prioritization is essential for developing watershed management plans that maximize impact with minimal resources. This study used a multicriteria decision-making approach to rank sub-watersheds by degradation status in the Huehuetan River Basin, Chiapas, Mexico. The eight sub-watersheds in the basin were classified using the Analytic Network Process (ANP) model, evaluating morphometry, hydrology, hillslope stability, soil water saturation, land-use change, and socioeconomic factors. The results identified hydrology and land-use change as the most influential criteria, with weights of 20.62% and 19.82%, respectively, driven mainly by surface runoff and deforestation. Swtr 08 and Swtr 07 were identified as the highest-priority sub-watersheds, covering 24.31% of the basin area, with 55.31% of Swtr 08 classified as unstable and showing a combined high-vegetation loss of 16.46 km2. The entire watershed showed an annual vegetation loss rate of 146 ha year−1. Increasing the weighting by 50% resulted in greater variability in priority rankings, with runoff and low vegetation showing maximum global ranges of −44.33% and 30.25%, respectively, instability decreasing by 33.94%, and peak flow increasing by 18.20%. These findings emphasize the need for focused interventions in the vulnerable subwatersheds of the upper basin to manage runoff, curb deforestation, and reduce soil instability.

A User-Driven Prioritisation Process implementation and optimisation for ATFM hotspot resolution

The current and forecast air traffic levels lead to demand-capacity imbalances, which are dealt with by delaying flights through the allocation of air traffic flow management (ATFM) slots. To mitigate the delay impact on airspace users (AUs) and passengers, User Driven Prioritisation Process (UDPP) solutions are under development, with the goal to enhance flexibility for airlines to prioritise their own flights in the ATFM regulations. UDPP solutions are developed in collaboration with AUs, achieving high maturity level and even operational use at some airports.While UDPP solutions in reality are still based on manual or semi-automated procedures, in this paper we show that when an airline has an accurate delay cost model at disposal, the prioritisation process can be fully automated via an integer programming model that provides the prioritisation that optimises the AUs’ UDPP exploitation. We use this automated process and the implementation of the UDPP mechanism to provide an estimation of the benefits of UDPP in terms of cost with respect to the current ATFM regulation process.

Development of a group-based behaviour change intervention for people with severe obesity informed by the social identity approach to health.

Interventions to support behaviour change in people living with chronic health conditions increasingly use patient groups as the mode of delivery, but these are often designed without consideration of the group processes that can shape intervention outcomes. This article outlines a new approach to designing group-based behaviour change interventions that prioritizes recipients' shared social identity as group members in facilitating the adoption of established behaviour change techniques (BCTs). The approach is illustrated through an example drawn from research focused on people living with severe obesity. A prioritization process was undertaken in collaboration with stakeholders, including behaviour change experts, clinicians, and a former patient to develop an evidence-based, group intervention informed by the social identity approach to health. Three phases of development are reported: (1) identification of the health problem; (2) delineation of intervention mechanisms and operationalization of BCTs for group delivery and (3) intervention manualization. The fourth phase, intervention testing and optimization, is reported elsewhere. A group-based behaviour change intervention was developed, consisting of 12 group sessions and 3 one-to-one consultations. The intervention aimed to support the development of shared social identity among recipients, alongside the delivery of evidence-based BCTs, to improve the likelihood of successful intervention and health outcomes among people living with severe obesity. A manualized intervention, informed by the social identity approach to health, was systematically designed with input from stakeholders. The development approach employed can inform the design of behavioural interventions in other health contexts where group-based delivery is planned.

Study of the impact of ClinGen Revisions on ACMG/AMP variant semi-automatic classification for Rare Diseases diagnosis

With the rapid development of massive sequencing technologies, the analysis of genetic variants for clinical diagnosis has exponentially escalated, particularly in the context of Rare Diseases (RDs). Diagnosing them involves identifying the genetic variants responsible for the underlying pathology development.In 2015, the American College of Medical Genetics (ACMG) established a set of recommendations to assess the evidence associated with each variant, aiming to achieve a standardized five tier classification. Over the past 5 years, ClinGen, the NIH-funded Clinical Genome Resource, has reviewed these criteria in order to make variant classification a more reproducible and rigorous process.This paper examines the impact of ClinGen-Rev modifications on variant classification, comparing them with the ACMG-2015 original recommendations. After analyzing sets of genetic variants, extracted from VCFs samples, using both criteria, we observed a change in 8.0 % of the clinical verdicts for these variants. ClinGen-Rev modifications correctly categorized 89.2 % of the curated variants, representing a significant improvement compared to the 65.6 % achieved by ACMG-2015. We also analyzed the modifications impact in a real like clinical setting, showing a significant overall reduction of VUS variants and thus potential reduction in analysis time. Finally, we discuss the underlying reasons for the most relevant changes in terms of specific labels and present their implications on the prioritization and selection process of variants, identifying some recommendations of key significant importance.

INTEGRATION OF QFD AND DEA METHODS TOGETHER TO PRIORITISE CUSTOMER EXPECTATIONS: THE CASE OF A SERVICE ORGANISATION

Quality Function Deployment (QFD) is a method used to transform customer expectations into technical requirements and to identify the technical requirements that need to be improved to meet these expectations. QFD stands out as a method that has found wide application in the literature and industry in terms of its advantage in transforming relatively more abstract customer expectations into concrete product and process parameters and its ease of application. One of the most important disadvantages of the method is that in the prioritization of technical requirements related to customer expectations, criteria such as the cost of the technical requirement in question, the implementation time of the necessary improvement activities, etc., are not considered. In this study, an approach in which Data Envelopment Analysis (DEA) methods are applied together with the QFD method to take into account the costs in the prioritization of technical requirements is presented. According to the results of a sample application carried out in a cafe business to test the approach, it is concluded that taking costs into account in the prioritization process should be prioritized in order to meet customer expectations.

Assessing the Effectiveness of MoSCoW Prioritization in Software Development: A Holistic Analysis across Methodologies

Effective software Requirement Prioritization plays a pivotal role in the success of the Software Development process, ultimately contributing to the successful delivery of high-quality products. Among the various methods for Requirement Prioritization, the MoSCoW method has gained widespread adoption due to its ease of use. However, its overall effectiveness remains a subject of inquiry. This paper presents a rigorous assessment of the MoSCoW Requirement Prioritization technique, drawing insights from software developers who engage in the Prioritization process. Our evaluation encompasses a distinct perspective: that of the developers tasked with Prioritization. The feedback solicited from developers encapsulates a diverse set of criteria, shedding light on the method's efficacy. Additionally, we perform sentiment analysis on the user experience of the Prioritization task to corroborate the method's accuracy and efficiency. Our study unfolds through a practical exercise involving the Prioritization of a predefined set of requirements using MoSCoW principles. A mixed method approach is employed for the purpose of assessing the effectiveness of MoSCoW. The findings of our quantitative research underscore the method's limitations, indicating that it may not be as effective and precise as previously believed. Furthermore, through qualitative analysis, we are able to highlight the complexities and challenges associated with MoSCoW-based Prioritization. The insights gained from this analysis prompt contemplation regarding the potential introduction of an evolved Requirement Prioritization method, while leveraging MoSCoW as a foundational framework. This research aims to inform the ongoing evolution of Requirement Prioritization methodologies, ultimately enhancing the efficiency and accuracy of Software Development processes.

Algorithm-Assisted Decision Making and Racial Disparities in Housing: A Study of the Allegheny Housing Assessment Tool

The demand for housing assistance across the United States far exceeds the supply, leaving housing providers the task of prioritizing clients for receipt of this limited resource. To be eligible for federal funding, local homelessness systems are required to implement assessment tools as part of their prioritization processes. The Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT) is the most commonly used assessment tool nationwide. Recent studies have criticized the VI-SPDAT as exhibiting racial bias, which may lead to unwarranted racial disparities in housing provision. In response to these criticisms, some jurisdictions have developed alternative tools, such as the Allegheny Housing Assessment (AHA), which uses algorithms to assess clients' risk levels. Drawing on data from its deployment, we conduct descriptive and quantitative analyses to evaluate whether replacing the VI-SPDAT with the AHA affects racial disparities in housing allocation. We find that the VI-SPDAT tended to assign higher risk scores to white clients and lower risk scores to Black clients, and that white clients were served at a higher rates pre-AHA deployment. While post-deployment service decisions became better aligned with the AHA score, and the distribution of AHA scores is similar across racial groups, we do not find evidence of a corresponding decrease in disparities in service rates. We attribute the persistent disparity to the use of Alt-AHA, a survey-based tool that is used in cases of low data quality, as well as group differences in eligibility-related factors, such as chronic homelessness and veteran status. We discuss the implications for housing service systems seeking to reduce racial disparities in their service delivery.

Applying SOLID principles for the refactoring of legacy code: An experience report

The presence of technical debt in legacy systems is an inevitable consequence of years of development. Metrics play a significant role in informing the prioritisation process of maintenance activities to reduce this debt. However, it is important to note that not all metrics are equally important or readily available in real industrial settings.This paper summarises an experience report of refactoring activities performed at a Dutch partnering company, aimed at identifying, prioritising and repaying parts of the architectural technical debt accumulated in two decades of development.Given the size of the refactoring task, a data-driven prioritisation was necessary, and based on the impact that the maintenance activity would have on the base system. However, the metrics available from the monitoring of the system formed a limited set, and were not always focused on architectural aspects. Even so, the impact analysis was performed and resulted in the selection of a subset of components that needed urgent maintenance.The refactoring of the identified components was centred around the well-known SOLID design principles, particularly the Dependency Inversion (DI) principle. Additionally, a set of recurring actions was established into ‘refactoring patterns’ and systematically applied to more than 5,000 source, header and custom domain language files.This work, albeit limited to the period where the activity was planned for, was well received by the industrial collaborator. The patterns have proven very valuable in the process of maintaining such a large project scope. The data-driven approach and the identified patterns have helped the team navigate this large space and consistently refactor similar architectural issues that fall under the same category.

Translating restrictive law into practice: An ethnographic exploration of the systemic processing of legally restricted health care access for asylum seekers in Germany

BackgroundAccess to health services for asylum seekers is legally restricted in Germany. The law is subject to interpretation, therefore the chance of receiving care is not equally distributed among asylum seekers. What services are provided to whom is ultimately decided by health professionals and government employees. The respective prioritization processes and criteria are not transparent. We sought to understand how legal restrictions are translated into daily practices and how this affects the health system. We aimed to outline the complex process of cost coverage for health services for asylum seekers and provide insights into common decision-making criteria.MethodsWe conducted an ethnographic exploration of routines in two outpatient clinics in two federal states over the course of three months, doing participant and non-participant observation. Additionally, we interviewed 21 professionals of health care and government organizations, and documented 110 applications for cost coverage of medical services and their outcome. In addition to qualitative data analysis and documentation, we apply a system-theoretical perspective to our findings.ResultsTo perform legal restrictions a cross-sectoral prioritization process of medical services has been implemented, involving health care and government institutions. This changes professional practices, responsibilities and (power) relations. Involved actors find themselves at the intersection of several, oftentimes conflicting priorities, since “doing it right” might be seen differently from a legal, medical, economic, or political perspective. The system-theoretical analysis reveals that while actors have to bring different rationales into workable arrangements this part of the medical system transforms, giving rise to a sub-system that incorporates migration political rationales.ConclusionsHealth care restrictions for asylum seekers are implemented through an organizational linking of care provision and government administration, resulting in a bureaucratization of practice. Power structures at this intersection of health and migration policy, that are uncommon in other parts of the health system are thereby normalized. Outpatient clinics provide low-threshold access to health services, but paradoxically they may unintentionally stabilize health inequities, if prioritization criteria and power dynamics are not made transparent. Health professionals should openly reflect on conflicting rationales. Training, research and professional associations need to empower them to stay true to professional ethical principles and international conventions.

One Health Best Practice Case Study: Advancing National One Health Coordination in the United States through the One Health Zoonotic Disease Prioritization Process

Abstract The U.S. government advances One Health coordination through the best practices of jointly developing shared priorities and utilizing formalized coordination platforms to connect partners from public health, agriculture, wildlife, environment, and other sectors at the national, subnational (e.g. state, tribal, local, and territorial), and non-governmental levels (e.g. academia, industry, non-governmental organizations, and the public) levels. Coordinated efforts were strengthened through the U.S. One Health Zoonotic Disease Prioritization (OHZDP) workshop in 2017, which led to the prioritization of eight zoonotic diseases and development of next steps and action plans for One Health collaboration across federal agencies (Prioritizing Zoonotic Diseases for Multisectoral, One Health Collaboration in the United States, 2017). This One Health best practice was used to prioritize the top endemic and emerging zoonoses of greatest concern for the United States, identify gaps, and define plans for U.S. government One Health collaboration to address the priority zoonotic diseases. Multiple actions that strengthened One Health coordination were enacted, including establishing the One Health Federal Interagency COVID-19 Coordination (OH-FICC) group. To further advance One Health in the United States, Congress mandated that the U.S. Centers for Disease Control and Prevention, the Department of the Interior, and the U.S. Department of Agriculture collaborate to develop the National One Health Framework to Address Zoonotic Diseases and Advance Public Health Preparedness in the United States as well as formalize a One Health, multisectoral coordination mechanism, the United States One Health Coordination Unit at the federal level (Appropriations Committee Report, 2021; Consolidated Appropriations Act, 2023). Enhancing national level One Health coordination in the United States has also helped advance collaboration with subnational and non-governmental levels to address timely One Health issues. Information © The Authors 2024. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License.

Comparative Analysis of Paddy Cultivation Sustainability through Integrating Eco-efficiency and Best-Worst Method Approaches

To investigate the sustainability of agricultural systems, it is necessary to prioritize production systems from various viewpoints. The current research, as a new approach, aimed at prioritizing different paddy cultivation areas in Iran based on sustainability criteria using the best-worst method (BWM), which is regarded as one of the modern multi-criteria decision-making techniques. Mazandaran, Fars, and Khuzestan areas in Iran with different climatic classes, i.e., Mazandaran, Fars, and Khuzestan, were considered in this study. Sustainability criteria included energy, exergy, economic, and environmental indices, and the prioritization process was done based on the eco-efficiency index and BWM method. In the evaluation of the eco-efficiency index, the amount of net income and the total environmental index were considered as economic and environmental indices, respectively. In the prioritization of the BWM method, ranking was done based on energy and exergy efficiency, benefit-cost ratio, and the total environmental index. The results of the eco-efficiency index investigation demonstrated that paddy production in Mazandaran province had the most sustainability and compatibility with the environment, followed by Fars and Khuzestan provinces, respectively. The results of the BWM method prioritization also indicated that Mazandaran province was the best and most sustainable area with a final index of 0.98, followed by Fars and Khuzestan provinces, which were placed in the next ranks of sustainable paddy cultivation areas with final indices of 0.93 and 0.85, respectively. In conclusion, the paddy production systems located in the humid subtropical region were found as the most sustainable systems in this area.

Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement.

In 2022, the US House of Representatives passed a bipartisan resolution (House of Representatives Resolution 1118 at the 117th Congress [2021-2022]) calling for meaningful nutrition education for medical trainees. This was prompted by increasing health care spending attributed to the growing prevalence of nutrition-related diseases and the substantial federal funding via Medicare that supports graduate medical education. In March 2023, medical education professional organizations agreed to identify nutrition competencies for medical education. To recommend nutrition competencies for inclusion in medical education to improve patient and population health. The research team conducted a rapid literature review to identify existing nutrition-related competencies published between July 2013 and July 2023. Additional competencies were identified from learning objectives in selected nutrition, culinary medicine, and teaching kitchen curricula; dietetic core competencies; and research team-generated de novo competencies. An expert panel of 22 nutrition subject matter experts and 15 residency program directors participated in a modified Delphi process and completed 4 rounds of voting to reach consensus on recommended nutrition competencies, the level of medical education at which they should be included, and recommendations for monitoring implementation and evaluation of these competencies. A total of 15 articles met inclusion criteria for competency extraction and yielded 187 competencies. Through review of gray literature and other sources, researchers identified 167 additional competencies for a total of 354 competencies. These competencies were compiled and refined prior to voting. After 4 rounds of voting, 36 competencies were identified for recommendation: 30 at both undergraduate and graduate levels, 2 at the undergraduate level only, and 4 at the graduate level only. Competencies fell into the following nutrition-related themes: foundational nutrition knowledge, assessment and diagnosis, communication skills, public health, collaborative support and treatment for specific conditions, and indications for referral. A total of 36 panelists (97%) recommended nutrition competencies be assessed as part of licensing and board certification examinations. These competencies represent a US-based effort to use a modified Delphi process to establish consensus on nutrition competencies for medical students and physician trainees. These competencies will require an iterative process of institutional prioritization, refinement, and inclusion in current and future educational curricula as well as licensure and certification examinations.

Sexuality Education Between Biopolitics and Psychopolitics: A Critical Inquiry into Chile’s Youth Friendly Spaces Program

This paper analyzes the population management logics present in the YFS framework, delving into its power dynamics, prioritization processes, and the (in)visibility of themes that influence its configuration and outcomes. Through a Governmentality Studies lens, it analyses the program’s shift from biopolitical to psychopolitical rationalities. A qualitative document analysis of 43 documents reveals the program’s strategies in addressing youth sexuality: the translation of youth sexuality, the identification of social determinants, the execution of extitutional action, and the fostering of participation as competence. These findings illustrate a sophisticated governance of sexuality education, leveraging psychopolitical tactics for nuanced youth engagement, emphasizing accountability, and fostering skill development. The analysis underscores the significance of evolving sexuality education practices toward more inclusive and adaptable approaches.

Development and application of a rapid research prioritisation process for identifying health research priorities in low- and middle-income countries: the RAPID-RP stakeholder analysis

Background Health research should be locally prioritised by key stakeholders to ensure the best use of available resources, maximum likelihood of research leading to uptake into policy and practice and relevance to the needs of the potential beneficiaries. Established approaches are complex and time-consuming, therefore not feasible in settings where prioritisation is uncommon and time is limited. Objectives We developed and applied a simple, rapid research prioritisation approach to elicit the views of stakeholders. Setting and participants This was a collaboration between a multidisciplinary group of United Kingdom academics, the International Primary Care Respiratory Group and primary care respiratory researchers from four low- and middle-income countries: Brazil, China, Georgia and North Macedonia. We identified 10 topics for research prioritisation through workshops involving 26 topic, methods and local context experts, and considering the programme remit, to develop, adapt and evaluate culturally appropriate community and behavioural approaches for the prevention, early identification and management of chronic obstructive pulmonary disease in primary care. Design and methods In each setting, local research teams convened stakeholder groups of patients, clinicians, managers/policymakers and researchers. Each group briefly discussed the 10 potential research study topics. Discussions were facilitated using short vignettes for each topic, and participants were encouraged to consider importance, feasibility and equity. Individual participants rated each study on a three-point traffic light scale, then ranked them following a facilitated discussion on what drove the ratings. The research team rated then ranked each study considering three further criteria (international novelty, potential for future funding and capacity building on a five-point scale). Within each group, ranks were summed to create a final rank order which guided our research programme and provided insight for future projects. Results In each country, four to eight members attended each stakeholder group. The engagement process was completed in less than 4 hours and feedback was very positive, especially from patients who valued the opportunity to contribute to research decision-making about their own condition. Ranking varied to some extent between groups and settings, but there was consistency around topics that were prioritised among the top five in all groups (identifying efficient chronic obstructive pulmonary disease screening test strategies, evaluations of lung age to aid smoking cessation, feasibility of locally adapted pulmonary rehabilitation, clinical education for primary care staff) and study topics that consistently ranked low (use of e-cigarettes for smoking cessation, weight management to improve chronic obstructive pulmonary disease symptoms and handwashing to reduce infections). Limitations Despite attempts to maximise inclusivity and diversity, stakeholders were mainly limited geographically to the centres where researchers were based, potentially limiting generalisability of views across the countries. Facilitator styles varied and may have influenced some of the discussions and potentially the ranking. Conclusions Despite some limitations, we demonstrated the feasibility and acceptability of the rapid research prioritisation approach stakeholder analysis for identifying locally relevant research priorities in low- and middle-income country settings. Future work Further validation is needed for aspects of the process. We have identified some useful lessons from our evaluation of the process, to facilitate future use of this approach. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/95.

Reasons influencing the nurses’ prioritization process while preventing and managing delirium: findings from a qualitative study

BackgroundNurses play an important role in the prevention and management of delirium episodes. However, some studies have reported that not all interventions recommended are applied due to time and resource constraints, resulting in patients receiving less care than required because other patients and/or interventions are prioritised. The concept of prioritization is part of the broader concept of decision-making as the ability to choose between two or more alternatives to ensure patient safety. Understanding the reasons influencing the prioritization process in patients at risk or with delirium may inform interventions to prevent and/or minimise the unfinished nursing care.AimThe purpose of this study was to explore the reasons that inform the prioritisation process among nurses when they are challenged to make decisions for patients at risk and with delirium.MethodsA descriptive qualitative study performed according to the COnsolidated criteria for Reporting guidelines, in 2021. An intentional sample of nurses working full-time with older patients in medical, geriatric, and post-acute care facilities affiliated with the National Health System was involved. Semi-structured interviews were conducted and narratives thematic analysed.ResultsA total of 56 nurses (55.4% in internal medicine, 26.8% in geriatrics and 17.8% in post-acute/intermediate care) participated with an average age of 31.6 years. The reasons informing the prioritisation process while providing preventive or managerial interventions towards a patient at risk of or with delirium are set at three levels: (1) unit level, as reasons belong to the inadequacy of the ‘Environment’, the ‘Human Resources’, and the ‘Organisation and Work Processes’, (2) nurse’s level, as issues in ‘Competencies’ and ‘Attitudes’ possessed, and (3) patient level, due to the ‘Multidimensional Frailty’.ConclusionNurses caring for patients at risk of and with delirium face several challenges in providing care. To prioritise preventive and managerial interventions, it is essential to implement multilevel and multifaced organizational and educational strategies.

A Generalizable Prioritization Protocol for Climate-Sensitive Zoonotic Diseases.

Emerging and re-emerging zoonotic diseases pose a significant threat to global health and economic security. This threat is further aggravated by amplifying drivers of change, including climate hazards and landscape alterations induced by climate change. Given the complex relationships between climate change and zoonotic disease health outcomes, a structured decision-making process is required to effectively identify pathogens of greatest concern to prioritize prevention and surveillance efforts. Here, we describe a workshop-based expert elicitation process in six steps to prioritize climate-sensitive zoonoses based on a structured approach to defining criteria for climate sensitivity. Fuzzy analytical hierarchy process methodology is used to analyze data provided by experts across human, animal, and environmental health sectors accounting for uncertainties at different stages of the prioritization process. We also present a new interactive expert elicitation interface that facilitates data collection and real-time visualization of prioritization results. The novel approach presented in this paper offers a generalized platform for prioritizing climate-sensitive zoonoses at a national or regional level. This allows for a structured decision-making support process when allocating limited financial and personnel resources to enhance preparedness and response to zoonotic diseases amplified by climate change.

Identifying interventions that improve medication safety & rational use of medicines in India.

Background & objectives Medication-related harm is known to be the cause for about 1/10th of hospitalizations. Some estimates from India show that about 90 per cent of medicines consumed are inessential or irrational and contribute towards high out-of-pocket expenditure on health. In this context, the Indian Council of Medical Research in 2022 constituted a National Task Force (NTF) to explore possible solutions that could improve safe and rational use of medicines (SRUMs). The objective of this study was to identify research ideas in the field of SRUM through a survey of relevant stakeholders, and further to prioritize the research ideas using a pre-identified set of criteria. Methods The responses from the identified stakeholders were assessed using the Child Health and Nutrition Research Initiative method, which is an established research priority-setting methodology. First, the NTF asked for two to six research ideas from relevant Indian and global stakeholders on solutions to improve SRUM. The ideas were checked for duplicates, re-phrased where necessary and classified into various sub-themes. Subsequently, the research ideas were scored by Indian experts with relevant technical expertise using a pre-defined set of five criteria: innovativeness, effectiveness, translational value, answerability and applicability. Each research idea received from a stakeholder was assigned a score under each of the five criteria. The overall research priority score was calculated as a mean of all five criteria-specific scores and converted into a percentage. Results The final output of the prioritization process was a list of research ideas or questions, ranked by their scores. Total 209 unique ideas were received from 190 respondents, which were scored by 27 experts. The top three research topics on medication safety focused on cost-effective strategies for improving antimicrobial stewardship, safe use of poly-pharmacy in geriatric patients and drug take-back policy interventions. Regarding the rational use of medicine, the top three topics included testing mobile application-based antimicrobial stewardship interventions, development of diagnostics for antimicrobial resistance, and behavioural interventions. Interpretation & conclusions Several priority ideas found in this study also align with those of global priority, e.g., safe disposal practices and enhanced pharmacovigilance, rational use of medicines. Patient engagement, which underlines many of the top scoring ideas found in this study, is also inclined with the top research priorities reported by the WHO priority exercise on research into the safe use of medicines. However, to the best of our knowledge, this is the first such work from a low- and middle- income country on medication safety and rational use of medicines. The findings of this research priority-setting exercise can help to guide research for the development of policy-relevant and novel interventions to improve SRUM in India.

Patient Management System Using Fuzzy Multiple Attribute Decision Making Method with SAW at Noura Aesthetic Clinic

This study presents the development and implementation of a Patient Management System (PMS) at Noura Aesthetic Clinic using the Fuzzy Multiple Attribute Decision Making (FMADM) method with Simple Additive Weighting (SAW). The aim is to enhance the decision-making process for patient treatment prioritization and management. The PMS integrates various patient attributes, including medical history, treatment urgency, and resource availability, into a comprehensive decision-making framework. By employing the FMADM method, the system addresses the inherent uncertainties and subjectivities in patient data, ensuring more accurate and reliable prioritization. The SAW technique further refines this process by assigning weighted scores to each attribute, facilitating a straightforward and effective comparison. This combination allows for a balanced assessment of multiple factors, promoting optimal resource allocation and improving overall patient care. The implementation at Noura Aesthetic Clinic demonstrated significant improvements in operational efficiency and patient satisfaction. The system's adaptability to diverse clinical settings and its user-friendly interface make it a valuable tool for healthcare providers. This study underscores the potential of advanced decision-making methodologies in transforming patient management practices, paving the way for more informed and equitable healthcare delivery.

Penggunaan Algoritma Fuzzy Simple Additive Weighting (F-Saw) Sebagai Pendukung Keputusan Dalam Prioritas Pembagian Zakat Fitrah

Zakat fitrah is an obligation for every capable Muslim to purify oneself and one's wealth. Determining the priority of zakat fitrah recipients often becomes a challenge due to various factors that must be considered. This research aims to use the Fuzzy Simple Additive Weighting (F-SAW) algorithm as a decision support tool in determining the priority for distributing zakat fitrah. By using the F-SAW method, it is hoped that the prioritization process can be more objective and efficient..