Regret Rate Research Articles

Levels of Satisfaction and Regret With Gender-Affirming Medical Care in Adolescence

There is a need to improve the evidence base for gender-affirming medical care provided to adolescents, including the experiences of those who have received this care. To examine rates of satisfaction, regret, and continuity of care in adolescents who received puberty blockers and/or gender-affirming hormones as part of gender-affirming medical care. This survey study used the 2023 online survey wave of an ongoing longitudinal study, the Trans Youth Project, among a community-based sample of transgender youth and their parents initially recruited throughout the US and Canada between 2013 and 2017. The satisfaction and regret data include responses from a youth or their parent representing 87% of the youth aged 12 years or older in the cohort who have received gender-affirming medical care (235 of 269 youths). Of these, 220 completed the 2023 survey (main sample); information about continuity of care was available for all youth. Data analysis was performed from April to August 2024. Satisfaction, regret, and continuity of care following puberty blockers or suppression and/or gender-affirming hormones. Self- or parent-reported satisfaction or regret with gender-affirming care and continuation of care. Among the 220 youths in the main sample (mean [SD] age, 16.07 [2.40] years; 30 [14%] multiracial, non-Hispanic; 18 [8%] White, Hispanic; 155 [70%] White, non-Hispanic; 17 [8%] other race and ethnicity, including Asian, Black [Hispanic and non-Hispanic], Hispanic with unknown race, multiracial Hispanic, or Native American; gender at last interaction: 68 [31%] boys, 132 [60%] girls, 20 [9%] gender diverse, eg, nonbinary) and their parents, very high levels of satisfaction and low levels of regret with puberty blockers and gender-affirming hormones as well as high levels of continuation of care were reported. Of these 220 respondents in the main sample, 9 were regretful of having received blockers (n = 8) and/or hormones (n = 3; 2 of these individuals reported regret with both), of whom 4 have stopped all gender-affirming medical care and 1 has continued to receive blockers but plans to stop. The 4 others have continued care, suggesting that regret is not synonymous with stopping care. The findings suggest that youth accessing puberty blockers and hormones as part of gender-affirming care tend to be satisfied with and not regretful of that care several years later. While regret was rare, these experiences need to be better understood.

Decision regret following surgical management of pilonidal disease.

Surgical decision making in the context of pilonidal disease (PD) can be challenging. Current evidence for the management of PD is inadequate and optimum treatment is not clear. This paper reports on patient experience of shared decision making (SDM) and decision regret following surgical management of PD. The Pilonidal Trial. Studying the Treatment Options (PITSTOP) study (ISRCTN95551898) is a prospective cohort study of patients with PD treated between May 2019 and March 2022. This subanalysis reports the results of quantitative data capture between baseline and 6 months post-procedure. Baseline data consisted of patient and disease characteristics, surgical procedure and impression of SDM. Post-procedure data consisted of operative outcomes and decision regret. Multiple linear regression analysis was used to analyse the relationship between clinical outcomes and decision regret. Overall, 677 patients were included, and follow-up data to 6 months were available for 476 (71%). Most (59.5%) patients underwent major excisional surgery; 45.1% of patients experienced a postoperative complication. Participant impression of SDM was positive, with a median CollaboRATE mean-score response of 3 (interquartile range: 3-4). Of the patients who underwent a 'leave open' approach, 20.6% were dissatisfied or very dissatisfied with their treatment. Postoperative complications (β = 3.21, 95% CI: -12.75 to 7.25, p < 0.001) and disease recurrence (β = 11.5, 95% CI: -10.6 to 9.4, p < 0.001) were both associated with higher rates of decision regret. The clinical outcomes, postoperative complications and recurrence, were associated with higher levels of decision regret. Surgeons treating patients with PD should practice SDM and ensure that patient priorities inform treatment approach.

Professional Burnout and Career Choice Regret in Urology Residents.

High rates of professional burnout and career choice regret among urology residents may increase professional dissatisfaction, shorten career longevity, and exacerbate urology workforce shortages. Understanding the prevalence of and risk factors for burnout may help develop interventions. Up to 48% of contemporary U.S. urology residents experience burnout symptoms, including up to 70% of second-year residents. Among overlapping personal, professional, institutional, and lifestyle risk factors, barriers to accessing medical and mental health care are frequently cited as an important association in residents. Limited intervention studies suggest that providing basic needs, such as on-call meals, and facilitating physical wellness and social engagement among residents may result in sustained reductions in burnout. Urology residents continue to experience high rates of burnout and career choice regret among medical specialties. Evidence-based interventions and sustainable policies that address primary risk factors are urgently needed.

Stochastic portfolio optimization: A regret-based approach on volatility risk measures: An empirical evidence from The New York stock market.

Portfolio optimization involves finding the ideal combination of securities and shares to reduce risk and increase profit in an investment. To assess the impact of risk in portfolio optimization, we utilize a significant volatility risk measure series. Behavioral finance biases play a critical role in portfolio optimization and the efficient allocation of stocks. Regret, within the realm of behavioral finance, is the feeling of remorse that causes hesitation in making significant decisions and avoiding actions that could lead to poor investment choices. This behavior often leads investors to hold onto losing investments for extended periods, refusing to acknowledge mistakes and accept losses. Ironically, by evading regret, investors may miss out on potential opportunities. in this paper, our purpose is to compare investment scenarios in the decision-making process and calculate the amount of regret obtained in each scenario. To accomplish this, we consider volatility risk metrics and utilize stochastic optimization to identify the most suitable scenario that not only maximizes yield in the investment portfolio and minimizes risk, but also minimizes resulting regret. To convert each multi-objective model into a single objective, we employ the augmented epsilon constraint (AEC) method to establish the Pareto efficiency frontier. As a means of validating the solution of this method, we analyze data spanning 20, 50, and 100 weeks from 150 selected stocks in the New York market based on fundamental analysis. The results show that the selection of the mad risk measure in the time horizon of 100 weeks with a regret rate of 0.104 is the most appropriate research scenario. this article recommended that investors diversify their portfolios by investing in a variety of assets. This can help reduce risk and increase overall returns and improve financial literacy among investors.

Gender affirming care for the minimally invasive gynecologic surgeon.

Given the current political climate and the release of an updated version of the World Professional Association for Transgender Health's guidelines, this review assesses recent updates in the care of transgender and gender diverse (TGD) patients, specifically related to care provided by gynecologists. The number of people identifying as TGD and pursuing gender affirming care is increasing. Contraception for these patients is underdiscussed and high rates of pelvic pain and irregular bleeding were identified. Rates of regret are low following gender affirming surgeries, and studies have repeatedly shown their benefits for gender dysphoria. A minimally invasive approach is recommended for gender affirming hysterectomy, and the decision to proceed with bilateral salpingo-oophorectomy should be based on shared decision making. Surgical techniques include ensuring an adequate margin when taking the infundibulopelvic ligament, and consideration for two-layer vaginal cuff closure. Gynecologists play a key role in the care of TGD patients. Recent reviews have found extensive gaps in our knowledge, including a lack of guidelines for cancer prevention, effects of testosterone on benign conditions, and the long-term effects of bilateral salpingo-oophorectomy on health outcomes for patients on testosterone.

(308) Vasectomy Regret: Is Having Children Protective?

Abstract Introduction Vasectomy is reliable form of male contraception with prior data suggesting low levels of regret in child-bearing men. We recently published similarly low regret in childless men. There is a paucity of data comparing these two cohorts head-to-head. Objective Compare incidence of post-vasectomy regret in men with children and childless men. Methods The records of all patients who underwent vasectomy via a single surgeon between 2006 – 2021 were retrospectively reviewed. We created two cohorts: one of childless and one of child-bearing men. Childless cohort was the limiting factor; thus we randomly chose an equal number from our child-bearing cohort. We analyzed demographics of age at time of vasectomy, marital status, number of children and time since vasectomy. Patients’ regret was queried, both immediately after vasectomy and present day. We devised a 6-question survey inquiring about regret and thoughts on vasectomy reversal and assisted reproductive technology (ART). The questions are listed in Table 1. Results There were 4,812 overall patients who underwent vasectomy in this time interval, with 205 (4.3%) who were childless. The response rate for child-bearing men was 41.9% (86/205) and 33.2% (68/205) for childless men. Average age for child-bearing men was 35.3 years and 36.6 years in childless men, with time since vasectomy at time of phone call was 6.2 and 5.5 years, for child-bearing and childless men, respectively. The majority of patients 150/205 (73.1%) were married in both childless, 150/205 (73.1%) and child-bearing, 192/205 (93.6%). Average number of children was 2. When comparing our cohorts, regret rates (answering 4 or 5) immediately were 1.2% in child-bearing vs. 4.4% in childless men (p&amp;lt;0.0001), compared to 3.5% vs. 7.4% in present day regret (p&amp;lt;0.0001). Conclusions Regret in childless men is more prevalent than child-bearing men, suggesting raising children is protective. Disclosure No.

DecentralDC: Assessing data contribution under decentralized sharing and exchange blockchain.

The issue of data quality has emerged as a critical concern, as low-quality data can impede data sharing, diminish intrinsic value, and result in economic losses. Current research on data quality assessment primarily focuses on four dimensions: intrinsic, contextual, presentational, and accessibility quality, with intrinsic and presentational quality mainly centered on data content, and contextual quality reflecting data usage scenarios. However, existing approaches lack consideration for the behavior of data within specific application scenarios, which encompasses the degree of participation and support of data within a given scenario, offering valuable insights for optimizing resource deployment and business processes. In response, this paper proposes a data contribution assessment method based on maximal sequential patterns of behavior paradigms (DecentralDC). DecentralDC is composed of three steps: (1) mining the maximal sequential patterns of sharing and exchange behavior paradigms; (2) determining the weights of these paradigms; (3) calculating the contribution of sharing and exchange databases combined with data volume. To validate our approach, two sharing and exchange scenarios of different scales are established. The experimental results in two scenarios validate the effectiveness of our method and demonstrate a significant reduction in cumulative regret and regret rate in data pricing due to the introduction of data contribution. Specifically, compared to the most competitive baseline, the improvements of mean average precision in two scenarios are 6% and 8%. The code and simulation scenarios have been open-sourced and are available at https://github.com/seukgcode/DecentralDC.

Tattoo Regret, Complications, and Removal: A Cross-Sectional Study among Tattooed Individuals in Saudi Arabia.

A tattoo is a pigment permanently deposited into the skin to create different patterns. The worldwide percentage of tattooed individuals, as well as the level of tattoo regret, complications, and removal, has increased. However, data from Saudi Arabia are lacking. To determine the rates of tattoo regret, complications, and removal among tattooed individuals in Saudi Arabia. A cross-sectional study using an online survey was conducted in Riyadh, Saudi Arabia. A link to the survey was distributed through social media and contained twenty questions about participants' demographics, tattoo practices, regret, removal, and complications. Data were analyzed using the Statistical Package for Social Sciences (SPSS). A P value <0.05 was considered statistically significant. A total of 181 tattooed individuals participated in the study. Most of them were females (95.6%), and 76.7% had their first tattoo at an age over eighteen years. A total of 47.5% had one tattoo session, and the most common body site was the eyebrows (57.5%). Fifty-eight percent regretted their tattoo, and 42.5% attempted to remove it. Upper extremity tattoos were significantly associated with regret (72.3%) (P=0.004) and removal (56.9%) (P=0.003). Tattoo removal was mostly due to cultural reasons (74%). Local itching (32%), pain (22.7%), and infection (10.5%) were reported and associated with tattoo regret (P < 0.05). Itching was significant in 65.4% of head and neck tattoos and 41.5% of upper extremity tattoos (P < 0.05). Participants were aware that laser is the best method for tattoo removal. Among tattooed individuals in Saudi Arabia, the rate of tattoo regret and removal is high, and the most reported complication is pruritus.

Fuzzy Decision Rule-Based Online Classification Algorithm in Fuzzy Formal Decision Contexts

Formal concept analysis (FCA) extracts interpretable rules by using implication relationships between concepts, which is an effective method for acquiring knowledge. In this paper, a fuzzy decision rule-based online classification algorithm called OFRCA is designed by combining online learning theory and FCA in a fuzzy formal decision context. First, the original weight vector of all attributes is obtained by fusing the original deterministic decision rules. Second, incremental fuzzy decision rules are obtained according to the added objects. Then for the incremental fuzzy decision rules, OFRCA updates the weight vector based on minimizing the loss function. At the end of the process, all the rules are fused into an attributeweighted classifier with the final weight vector. In this paper, we employ the regret to obtain a learning guarantee for OFRCA. The growth rate of OFRCA's regret converges to 0 as the number of iterations increases in the ideal state, which provides an effective learning guarantee for OFRCA. To verify the effectiveness of the proposed algorithm, this paper conducted numerical experiments and systematically analyzed the experimental results, which demonstrated that OFRCA achieved the highest advanced classification performance among the compared algorithms.

Decision regret up to 6years after sleeve gastrectomy.

Sleeve gastrectomy (SG) is one of the most popular types of weight loss surgery today but is neither risk-free nor universally effective. We previously demonstrated that 5% of Roux-en-Y gastric bypass (RYGB) patients and up to 20% of gastric banding patients report overall regret 4years after surgery. This study explores patients' attitudes toward their decision to have SG and decision regret rates up to 6years postoperatively. We surveyed 185 patients who were at least 6months post-SG (response rate 30%). We used a modified version of the Decision Regret Scale developed by Brehaut et al. We converted responses to a 0-100 scale so that higher scores (> 50) reflect greater regret. We characterized patients who expressed having overall decision regret (score > 50) vs. those who did not (≤ 50). Demographic and preoperative clinical information was extracted from the online medical records. Of 185 SG patients, only 13 (7%) reported regret scores > 50 (i.e. high decision regret). Mean time from SG to survey completion was 41months (range 6-76months). Unadjusted comparisons between the two groups revealed that patients with high regret scores had lower mean weight loss (32.1% vs. 48.9% EBMIL), and reported less improvement in quality-of-life (QoL), such as physical health (46.2% vs. 93.5% "somewhat" or "significantly" improved). The two groups were similar in short-term complications, but those reporting overall regret were more likely to report GI complaints such as bloating (61.5% vs. 30.4%). Finally, patients with regret scores > 50 were more likely to be further out from SG (median time since surgery 61.8 vs. 41.1months). In our study, very few patients reported regret (7%) up to 6years postoperatively, in line with prior reports after RYGB. Those with regret reported poorer QoL.

Rate-Optimal Bayesian Simple Regret in Best Arm Identification

We consider best arm identification in the multiarmed bandit problem. Assuming certain continuity conditions of the prior, we characterize the rate of the Bayesian simple regret. Differing from Bayesian regret minimization, the leading term in the Bayesian simple regret derives from the region in which the gap between optimal and suboptimal arms is smaller than [Formula: see text]. We propose a simple and easy-to-compute algorithm with its leading term matching with the lower bound up to a constant factor; simulation results support our theoretical findings.

Multidimensional Assessment of Patient-Reported Outcomes After Gender-Affirming Surgeries Using a Validated Instrument.

Limited literatures used validated instruments to evaluate patient-reported outcomes (PROs) for transgender and gender-diverse population undergoing gender-affirming surgeries (GASs). This study aimed to evaluate PROs using a newly validated psychometric instrument, Vanderbilt Mini Patient-Reported Outcome Measures-Gender (VMP-G). Vanderbilt Mini Patient-Reported Outcome Measures-Gender assesses 4 scales: quality of life, self-concept, satisfaction, and gender dysphoria. Scores range from 20 to 100, with higher scores representing superior PROs. Descriptive analysis was performed, and outcomes were compared in different races/ethnicities, gender identities, age, types of GAS, and time. Patients seeking GAS at Vanderbilt University Medical Center from October 11, 2021, to October 11, 2022, were included. Data were collected anonymously via the Research Electronic Data Capture survey tool at preoperative or postoperative clinic visits. A total of 207 patients completed VMP-G. Average age was 31.8 years (SD, ±11.5 years). Fifty-three percent of patients were postoperative GAS. In bivariate and linear regression analyses, postoperative patients scored higher on all scales compared with preoperative patients ( P < 0.001). After adjustment, postoperative patients scored 12.5 higher on VMP-G compared with preoperative patients ( P < 0.01). In subset analyses, GAS was associated with improved PROs in White, non-White, binary, and nonbinary and patients younger than 21 years ( P < 0.05). After GAS, patients younger than 21 years reported similar outcomes, compared with patients older than 21 years ( P > 0.05). No PROs differences were reported between patients who underwent top versus bottom surgery ( P = 0.2). Postoperative patients reported low rates of regret (2.8%). Scores on the VMP-G were sustained even 1 year after GAS. Each month after GAS was associated with a score improvement of 0.02 in the gender dysphoria domain after adjusting for patient demographics ( P = 0.02). Using a validated GAS-specific measure, we found that surgery sustainably improves patients' self-reported outcomes including gender dysphoria.

Phase Transitions in Bandits with Switching Constraints

We consider the classic stochastic multiarmed bandit problem with a constraint that limits the total cost incurred by switching between actions to be no larger than a given switching budget. For this problem, we prove matching upper and lower bounds on the optimal (i.e., minimax) regret and provide efficient rate-optimal algorithms. Surprisingly, the optimal regret of this problem exhibits a nonconventional growth rate in terms of the time horizon and the number of arms. Consequently, we discover surprising “phase transitions” regarding how the optimal regret rate changes with respect to the switching budget: when the number of arms is fixed, there are equal-length phases, in which the optimal regret rate remains (almost) the same within each phase and exhibits abrupt changes between phases; when the number of arms grows with the time horizon, such abrupt changes become subtler and may disappear, but a generalized notion of phase transitions involving certain new measurements still exists. The results enable us to fully characterize the trade-off between the regret rate and the incurred switching cost in the stochastic multiarmed bandit problem, contributing new insights to this fundamental problem. Under the general switching cost structure, the results reveal interesting connections between bandit problems and graph traversal problems, such as the shortest Hamiltonian path problem. This paper was accepted by J. George Shanthikumar, data science. Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2023.4755 .

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

There has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments. To evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy. For this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020. Decisional regret and satisfaction with decision to undergo gender-affirming mastectomy. Long-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders. A total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses. In this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.

Trial Participation and Outcomes Among English-Speaking and Spanish-Speaking Patients With Appendicitis Randomized to Antibiotics

Spanish-speaking participants are underrepresented in clinical trials, limiting study generalizability and contributing to ongoing health inequity. The Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial intentionally included Spanish-speaking participants. To describe trial participation and compare clinical and patient-reported outcomes among Spanish-speaking and English-speaking participants with acute appendicitis randomized to antibiotics. This study is a secondary analysis of the CODA trial, a pragmatic randomized trial comparing antibiotic therapy with appendectomy in adult patients with imaging-confirmed appendicitis enrolled at 25 centers across the US from May 1, 2016, to February 28, 2020. The trial was conducted in English and Spanish. All 776 participants randomized to antibiotics are included in this analysis. The data were analyzed from November 15, 2021, through August 24, 2022. Randomization to a 10-day course of antibiotics or appendectomy. Trial participation, European Quality of Life-5 Dimensions (EQ-5D) questionnaire scores (higher scores indicating a better health status), rate of appendectomy, treatment satisfaction, decisional regret, and days of work missed. Outcomes are also reported for a subset of participants that were recruited from the 5 sites with a large proportion of Spanish-speaking participants. Among eligible patients 476 of 1050 Spanish speakers (45%) and 1076 of 3982 of English speakers (27%) consented, comprising the 1552 participants who underwent 1:1 randomization (mean age, 38.0 years; 976 male [63%]). Of the 776 participants randomized to antibiotics, 238 were Spanish speaking (31%). Among Spanish speakers randomized to antibiotics, the rate of appendectomy was 22% (95% CI, 17%-28%) at 30 days and 45% (95% CI, 38%-52%) at 1 year, while in English speakers, these rates were 20% (95% CI, 16%-23%) at 30 days and 42% (95% CI 38%-47%) at 1 year. Mean EQ-5D scores were 0.93 (95% CI, 0.92-0.95) among Spanish speakers and 0.92 (95% CI, 0.91-0.93) among English speakers. Symptom resolution at 30 days was reported by 68% (95% CI, 61%-74%) of Spanish speakers and 69% (95% CI, 64%-73%) of English speakers. Spanish speakers missed 6.69 (95% CI, 5.51-7.87) days of work on average, while English speakers missed 3.76 (95% CI, 3.20-4.32) days. Presentation to the emergency department or urgent care, hospitalization, treatment dissatisfaction, and decisional regret were low for both groups. A high proportion of Spanish speakers participated in the CODA trial. Clinical and most patient-reported outcomes were similar for English- and Spanish-speaking participants treated with antibiotics. Spanish speakers reported more days of missed work. ClinicalTrials.gov Identifier: NCT02800785.

Dynamic Pricing with Unknown Nonparametric Demand and Limited Price Changes

Dynamic pricing with demand learning is a very common problem that retailers face. In this problem, the retailer aims to maximize cumulative revenue collected over a finite time horizon by balancing two objectives: learning demand and maximizing revenue. In their paper “Dynamic Pricing with Unknown Nonparametric Demand and Limited Price Changes,” Perakis and Singhvi study this problem when the retailer makes no parametric assumption on the demand and seeks to reduce the amount of price experimentation because of the potential costs associated with price changes. They construct a pricing policy that uses second order approximations of the unknown demand function and establish when the proposed policy achieves near-optimal rate of regret while making very limited price changes. They also perform extensive numerical experiments to show that their proposed policy substantially improves over existing methods in terms of the total price changes, with comparable performance on the cumulative regret metric.

Decision regret following opening wedge high tibial osteotomy: Older age as a risk factor

BackgroundUnderstanding risk factors that can predict decision regret after surgical procedures can potentially increase the quality of patient decision making and reduce decision regret after opening wedge high tibial osteotomy (OWHTO). The purpose of the present study was to identify the risk factors that predict the likelihood of decision regret after OWHTO. MethodQuestionnaires were administered to 98 eligible OWHTO recipients more than one year post-operatively. They answered “Yes” or “No” to the question “Would you go for the same choice (OWHTO) if you had to do it over again?” Univariate and multivariate logistic regression analyses were conducted using the decision regret questionnaire as the dependent variable against patient characteristics and surgery related factors. A receiver operating characteristic curve and area under the curve were constructed and calculated for age at surgery. Cut-off values were determined using the Youden principle and receiver operating characteristic curves. ResultsAmong the 98 respondents, 18 (18%) reported regretting their decision. Older age at surgery was the only predictive risk factor for decision regret (P < 0.01). The area under the curve for the model using age to predict failure was 0.722. The cut-off value was 71 years. Patients aged 71 years or more had a 7.841 odds ratio for decision regret (P < 0.01). ConclusionsOlder age emerged as a predictive risk factor for decision regret after OWHTO. Patients aged 71 years or older had a higher decision regret rate after OWHTO than younger patients and should more carefully weigh the suitability of OWHTO against other options.

Greedy Algorithm Almost Dominates in Smoothed Contextual Bandits

Online learning algorithms, widely used to power search and content optimization on the web, must balance exploration and exploitation, potentially sacrificing the experience of current users in order to gain information that will lead to better decisions in the future. While necessary in the worst case, explicit exploration has a number of disadvantages compared to the greedy algorithm that always “exploits” by choosing an action that currently looks optimal. We determine under what conditions inherent diversity in the data makes explicit exploration unnecessary. We build on a recent line of work on the smoothed analysis of the greedy algorithm in the linear contextual bandits model. We improve on prior results to show that the greedy algorithm almost matches the best possible Bayesian regret rate of any other algorithm on the same problem instance whenever the diversity conditions hold. The key technical finding is that data collected by the greedy algorithm suffices to simulate a run of any other algorithm. Further, we prove that under a particular smoothness assumption, the Bayesian regret of the greedy algorithm is at most in the worst case, where is the time horizon.

Colpocleisis in the surgical treatment of pelvic organ prolapse: clinical experience

Aim: The objective of this study was to present the clinical experience with colpocleisis by evaluating patient characteristics and long-term follow-up data. Materials and Methods: This is a retrospective cohort study evaluating patients who underwent obliterative surgery for pelvic organ prolapse (POP) between 2010 and 2017. Patients who underwent colpocleisis without hysterectomy (C) (n=68) and colpocleisis of vaginal vault (CVV) (n=22) were included in this study. Results: The mean age of the study population was 72.7 years (range 55-89). The majority of the patients underwent colpocleisis as their primary surgical procedure for POP, as only 5.6% of the study group had a history of previous prolapse surgery. The mean follow-up duration was 49.5 months (range 1.5-109). Patient satisfaction with the surgery was high, with 98.9% of patients expressing they were “very satisfied” and 1.1% “satisfied”. There were two cases of recurrence (2.2%), and both were in the C group. One patient (1.1%) reported regret after surgery due to her husband's remorse about choosing an obliterative procedure. The recurrence rates, patient satisfaction, and regret were comparable between C and CVV groups. Conclusion: Colpocleisis is a viable option for the surgical treatment of POP, offering a high rate of success and patient satisfaction in long-term. Despite being an obliterative procedure, colpocleisis has acceptance as the primary surgical procedure by patients regardless of their marital status, and regret rate after surgery is low. Therefore, colpocleisis should be thoroughly discussed and included in the preoperative counseling and surgical planning of all patients with POP.

Patient-reported Satisfaction and Regret Following Focal Therapy for Prostate Cancer: A Prospective Multicenter Evaluation

BackgroundSeveral reports are available regarding the treatment decision regret of patients receiving conventional treatments for localized prostate cancer (PCa); yet data on patients undergoing focal therapy (FT) are sparse. ObjectiveTo evaluate the treatment decision satisfaction and regret among patients who underwent FT for PCa with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). Design, setting, and participantsWe identified consecutive patients who underwent HIFU or CRYO FT as the primary treatment for localized PCa at three US institutions. A survey with validated questionnaires, including the five-question Decision Regret Scale (DRS), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5), was mailed to the patients. The regret score was calculated based on the five items of the DRS, and regret was defined as a DRS score of >25. Outcome measurements and statistical analysisMultivariable logistic regression models were applied to assess the predictors of treatment decision regret. Results and limitationsOf 236 patients, 143 (61%) responded to the survey. Baseline characteristics were similar between responders and nonresponders. During a median (interquartile range) follow-up of 43 (26–68) mo, the treatment decision regret rate was 19.6%. On a multivariable analysis, higher prostate-specific antigen (PSA) at nadir after FT (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.1–2, p = 0.009), presence of PCa on follow-up biopsy (OR 3.98, 95% CI 1.5–10.6, p = 0.006), higher post-FT IPSS (OR 1.18, 95% CI 1.01–1.37, p = 0.03), and newly diagnosed impotence (OR 6.67, 95% CI 1.57–27, p = 0.03) were independent predictors of treatment regret. The type of energy treatment (HIFU/CRYO) was not a predictor of regret/satisfaction. Limitations include retrospective abstraction. ConclusionsFT for localized PCa is well accepted by the patients, with a low regret rate. Higher PSA at nadir, presence of cancer on follow-up biopsy, bothersome postoperative urinary symptoms, and impotence after FT were independent predictors of treatment decision regret. Patient summaryIn this report, we looked at the factors affecting satisfaction and regret in patients with prostate cancer undergoing focal therapy. We found that focal therapy is well accepted by the patients, while presence of cancer on follow-up biopsy as well as bothersome urinary symptoms and sexual dysfunction can predict treatment decision regret.