Health Care Treatment Decisions Research Articles

Efficient Disease Prediction Framework to Suggest Early Treatment Decisions in Healthcare

This study proposes a novel framework for disease prediction intended to aid healthcare providers in making early treatment decisions. In order to efficiently identify early disease indicators and provide prompt suggestions for treatment interventions, the framework incorporates machine learning algorithms, clinical data analysis, and predictive modeling techniques (Smith, Johnson, & Davis, 2023). For the purpose of creating the framework, a comprehensive dataset made up of clinical records, demographic data, and test results from a large patient cohort was gathered. The dataset was analyzed using a variety of machine learning methods, and predictive models for various diseases were created. As evaluation criteria, accuracy, precision, recall, and F1-score were used to gauge how well these models performed. The experimental findings show that the suggested framework has a high degree of disease prediction accuracy. Additionally, by recommending early treatment selections. The approach offers the potential to improve patient outcomes and lower healthcare expenditures based on anticipated illness outcomes. The study benefits healthcare professionals, policymakers, and academics looking to use data-driven strategies for better disease management and patient care by providing an effective method for disease prediction and early treatment decisions.

How microsimulation translates outcome estimates to patient lifetime event occurrence in the setting of heart valve disease.

Treatment decisions in healthcare often carry lifelong consequences that can be challenging to foresee. As such, tools that visualize and estimate outcome after different lifetime treatment strategies are lacking and urgently needed to support clinical decision-making in the setting of rapidly evolving healthcare systems, with increasingly numerous potential treatments. In this regard, microsimulation models may prove valuable additions to current risk-prediction models. Notable advantages of microsimulation encompass input from multiple data sources, the ability to move beyond time-to-first-event analysis, accounting for multiple types of events, and generating projections of lifelong outcomes. This review aims to clarify the concept of microsimulation, also known as individualized state-transition models, and help clinicians better understand its potential in clinical decision-making. A practical example of a patient with heart valve disease is used to illustrate key components of microsimulation models, such as health states, transition probabilities, input parameters (e.g., evidence-based risks of events), and various aspects of mortality. Finally, this review focuses on future efforts needed in microsimulation to allow for increasing patient-tailoring of the models by extending the general structure with patient-specific prediction models and translating them to meaningful, user-friendly tools that may be used by both clinician and patient to support clinical decision-making.

Interface of Law and Psychiatric Problems in the Elderly.

Interface of Law and Psychiatric Problems in the Elderly.

Recruitment and retention of culturally diverse older adults into aging research: Investigation planning to explore intergenerational influence

AbstractBackgroundAfrican American [AA], Latino/Hispanic [LH], and Caribbean [CN]) older adults remain underrepresented in aging clinical research, leading to a knowledge gap regarding best treatments for these populations. Studies have found that culturally diverse older adults often consult family members when making healthcare treatment decisions. However, family members’ involvement when recruiting AA, LH and CN populations into health research studies is relatively unexplored as a potential recruitment strategy. The overall purpose of this research is to understand how intergenerational influence (IGI) – defined as the influence of one generation on another in terms of the transfer of skills, attitudes, preferences, values, and behaviors – can be leveraged to recruit and retain culturally diverse older adults into aging research.MethodsSpecific aims are to 1) explore IGI among 360 AA, CN and LH adults 2) test messages in key markets and 3) enroll 3,000 AA, CN and LH adults > 65 into a statewide health registry. To start, we established the infrastructure to conduct this research: organize a tri‐institutional team developing materials to conduct mixed methods (focus group guides; surveys) to answer specific aim 1; establish a statewide governing council; recruit a qualitative team; and obtain approval from the lead Institution’s Ethics Review Board.ResultOur tri‐institutional team comprises researchers from various disciplines who created focus group guides, survey materials, and online tools for use with focus group participants (Specific Aim 1). We have also established the Florida Statewide Governance Aging (FL‐SAGE) Council consisting of 25‐members throughout Florida, who will inform all aspects of this research. We have also recruited 12 facilitators who have conducted qualitative work with our populations of focus, AA, CN and LH older adults. Another aspect of this tri‐institutional collaboration is the ability to achieve ethics approval from one institution, allowing for more concise monitoring.ConclusionWe hope to demonstrate that our IGI model can be leveraged as an additional strategy to recruit and retain culturally diverse older adults into aging research. Before that, we recognize the significance of establishing a sound infrastructure to conduct this work. We hope our findings will assist other researchers working with diverse populations.

Biomedical Cyber-Physical Systems in the Light of Database as a Service (DBaaS) Paradigm

Background: A database (DB) to store indexed information about drug delivery, test, and their temporal behavior is paramount in new Biomedical Cyber-Physical Systems (BCPSs). The term Database as a Service (DBaaS) means that a corporation delivers the hardware, software, and other infrastructure required by companies to operate their databases according to their demands instead of keeping an internal data warehouse.
 Methods: BCPSs attributes are presented and discussed. One needs to retrieve detailed knowledge reliably to make adequate healthcare treatment decisions. Furthermore, these DBs store, organize, manipulate, and retrieve the necessary data from an ocean of Big Data (BD) associated processes. There are Search Query Language (SQL), and NoSQL DBs. 
 Results: This work investigates how to retrieve biomedical-related knowledge reliably to make adequate healthcare treatment decisions. Furthermore, Biomedical DBaaSs store, organize, manipulate, and retrieve the necessary data from an ocean of Big Data (BD) associated processes.
 Conclusion: A NoSQL DB allows more flexibility with changes while the BCPSs are running, which allows for queries and data handling according to the context and situation. A DBaaS must be adaptive and permit the DB management within an extensive variety of distinctive sources, modalities, dimensionalities, and data handling according to conventional ways.

Eliminating biasing signals in lung cancer images for prognosis predictions with deep learning

Deep learning has shown remarkable results for image analysis and is expected to aid individual treatment decisions in health care. Treatment recommendations are predictions with an inherently causal interpretation. To use deep learning for these applications in the setting of observational data, deep learning methods must be made compatible with the required causal assumptions. We present a scenario with real-world medical images (CT-scans of lung cancer) and simulated outcome data. Through the data simulation scheme, the images contain two distinct factors of variation that are associated with survival, but represent a collider (tumor size) and a prognostic factor (tumor heterogeneity), respectively. When a deep network would use all the information available in the image to predict survival, it would condition on the collider and thereby introduce bias in the estimation of the treatment effect. We show that when this collider can be quantified, unbiased individual prognosis predictions are attainable with deep learning. This is achieved by (1) setting a dual task for the network to predict both the outcome and the collider and (2) enforcing a form of linear independence of the activation distributions of the last layer. Our method provides an example of combining deep learning and structural causal models to achieve unbiased individual prognosis predictions. Extensions of machine learning methods for applications to causal questions are required to attain the long-standing goal of personalized medicine supported by artificial intelligence.

Culturally safe end-of-life care for First Nations persons living on reserve.

End-of-life (EOL) care involves not just the final few days of a person's life but also living with a terminal illness over an extended period of time. Importantly, in addition to medical care and relief of physical suffering, it focuses on quality of life, honoring personal healthcare treatment decisions, supporting the family, and psychological, cultural and spiritual concerns for dying people and their families. The goal of this commentary is to raise rehabilitation therapists' awareness of the need for culturally safe EOL care services for First Nations persons who live on reserve and to identify strategies to help resolve this unmet need.

The influence of patients’ immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland

This study examines the influence of patients’ immigration background and residence permit status on physicians’ willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians’ time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.

Traditional medicine and childcare in Western Africa: mothers' knowledge, folk illnesses, and patterns of healthcare-seeking behavior.

BackgroundIn spite of the strong role of traditional medicine in childcare in the pluralistic healthcare system in Western Africa, little information is known on mothers’ domestic plant knowledge. Identifying local perspectives and treatments of children’s illnesses, including folk illnesses, is essential to having a comprehensive understanding of how mothers make healthcare treatment decisions. We aimed to identify which infant illnesses Beninese and Gabonese mothers knew to treat with medicinal plants and for which illnesses they sought biomedical care or traditional healers.MethodsWe conducted 81 questionnaires with mothers in Bénin and Gabon and made 800 botanical specimens of cited medicinal plants. We calculated the number of species cited per illness and the proportion of participants knowledgeable on at least one herbal remedy per illness. Using qualitative data, we described folk illnesses in each country and summarized responses on preferences for each of the three healthcare options.ResultsParticipants from both countries were most knowledgeable on plants to treat respiratory illnesses, malaria, diarrhea, and intestinal ailments. Mothers also frequently mentioned the use of plants to encourage children to walk early, monitor the closure of fontanels, and apply herbal enemas. Major folk illnesses were atita and ka in Bénin and la rate and fesses rouges in Gabon. Traditional healers were reported to have specialized knowledge of cultural bound illnesses. Malaria was frequently cited as an illness for which mothers would directly seek biomedical treatment.ConclusionMothers largely saw the three systems as complementary, seamlessly switching between different healing options until a remedy was found. Folk illnesses were found to give insight into local treatments and may reveal important neglected diseases. Due to high reported levels of knowledge on treating top statistical causes of infant mortality and folk illnesses, mothers’ medicinal plant knowledge should be included in the analysis of healthcare-seeking behavior for childcare.

AB0750 Management Improvements Associated with A Biological Therapy Multidisciplinary Commission in Psoriatic Arthropathy Patients in the Hospital of Sagunto

BackgroundUntil 2010 the cost of biological treatments in Psoriatic Arthropathy (PA) was increased annually by 11% in our hospital. In 1st January 2011, a Hospital Commission of Biological Therapies involving...

Rationierung im deutschen Gesundheitswesen unter besonderer Berücksichtigung der Onkologie: Sichtweisen deutscher Entscheidungsträger – eine qualitativen Interviewstudie

Germany is at the beginning of a discussion about possible rationing in the health-care system. Cancer treatment, which is often cost-intensive but not always cost-effective, is frequently considered as a field for rationing. Against this background, we conducted semi-structured, guideline-based interviews with different stakeholders of the German health-care system and analysed them with the help of grounded theory techniques. The goal of the study was to collect the experiences and opinions of members of the German Medical Review Board of the Statutory Health Insurance Funds (MDK), leading officials in central administrations of the German health-care sector and health politicians (members of the Parliamentary Committee for Health of the Federal German Parliament, the Bundestag) regarding cost-considerations in treatment decisions in health care with a special focus on oncology. (1) Cost-considerations have a limited role in the daily routine of the interviewed experts; (2) the interviewed personnel of the MDK were open to discuss rationing, while the group of leading officials was ambivalent and the health politicians rejected rationing and its discussion altogether; (3) the awareness of the opportunity costs of medical services varied with the profession of the interviewee: the members of the MDK saw opportunity costs primarily within the field of medicine, the leading officials noted the opportunity costs for other social services, and the health policy makers interpreted opportunity costs under fiscal budgetary aspects; (4) according to the interviewees, decisions on rationing require a legal basis, which should be based on a broad public discussion and an interdisciplinary debate among experts; (5) defining criteria for rationing was regarded as being outside of the professional competence of the interviewees; however, a preference with regard to the criterion of cost-effectiveness became apparent. The results of this study indicate that the strongest opposition to a debate on rationing in Germany does not stem from the medical, but rather from the political sector. The criteria for rationing suggested in the theoretical debate are in need of a context-sensitive examination and specification for the field of oncology. A possible approach to constructively promote the debate on rationing is a stronger focus on social opportunity costs of health care. The exact role of experts in a discourse on rationing, which was emphasised by the interviewees, requires a thorough determination. It is necessary to differentiate between the roles of impartial experts and stakeholders. Decisions on rationing can ultimately only be legitimised politically by parliament.

Clinical and economic impact of the use of etanercept 25 mg once weekly in rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis patients

Objective: To determine the clinical and economic impact of etanercept 25 mg/week (ETN25) on rheumatoid arthritis (RA), psoriatic arthropathy (PA) and ankylosing spondylitis (AS) patients in sustained clinical remission.Methods: Observational, retrospective cohort of patients treated with etanercept 50 mg/week (ETN50) who achieved and maintained clinical remission (Disease Activity Score 28 < 2.6 or BASDAI < 2) over a period of 1 year and had slow worsening of structural changes were enrolled in an off-label program (January 2006 to June 2013) to switch from ETN50 to ETN25. Economic impact was assessed using Enbrel® official prices for Spain.Results: From 1 January 2006 to 1 June 2013, 98 RA, 40 PA and 47 AS patients were treated with ETN50; 39 (24%) patients (20 women; age = 53 ± 7 years; 24 RA, 7 PA, 8 AS) received ETN25 for at least 0.5 years (2.6 ± 2.0 years; range = 0.5 – 7.3 years). As of 1 June 2013, 29 (74%) patients continued on ETN25. RA patients: 17 patients continued on ETN25, 5 patients discontinued use due to reactivation of RA (4 switched back to ETN50 and 1 switched to adalimumab; all regained clinical remission) and 2 patients discontinued use due to adverse reactions. PA patients: four patients continued on ETN25, two patients discontinued use due to reactivation of PA (switched back to ETN50, regaining clinical remission) and one patient discontinued use due to adverse reaction. All AS patients continued on ETN25. The total savings associated with ETN25 over the 7-year observation period were €622,073, resulting in the ability to treat 52 additional patients with ETN50 for one year without increasing total ETN costs.Conclusion: ETN25 produces cost savings while maintaining clinical response in a high proportion of patients after at least one year under clinical remission with ETN50. At a time when the cost of therapy is an unavoidable component of healthcare treatment decisions, ETN25 could be a cost-effective option for selective RA, PA and AS patients.

Living wills in the nursing profession: knowledge and barriers

The aims of this study were to understand Spanish nurses’ knowledge about living wills and legal regulations and to explore their experiences, needs and challenges in these situations using quantitative and qualitative approaches. The first part of the study was a descriptive survey administered to a convenience sample of nurses (454 individuals) who worked in hospitals and other primary care clinics in the Principality of Asturias in northern Spain. The survey tested their knowledge of living wills and related major legal issues. At the end of the survey, the nurses were asked to provide a personal email address if they were interested in participating in a personal interview. In the second part of this study, we used a qualitative phenomenological approach based on Husserl’s framework. The results indicate that nurses are not sufficiently knowledgeable about the use of LWD in clinical practise. As a consequence, they are unable to support patient autonomy in health care treatment decisions.

P02-240 - Neuropsychological performance variability is associated with reduced treatment consent capacity

The capacity of older adults to make health care treatment decisions is often impaired in dementia and has been linked to performance on specific neuropsychological tasks. Within-person across-test neuropsychological performance variability has been shown to predict future dementia. This study examined the relationship of within-person across-test neuropsychological performance variability to treatment decision (consent) capacity in community-dwelling older individuals. Men (N = 79) and women (N = 80) with (N = 83) or without (N = 76) probable mild to moderate dementia completed a neuropsychological test battery and a standardized capacity assessment that evaluates each of the following treatment decisional abilities separately: Understanding, Reasoning, Appreciation, and Expression of Choice. Standard scores were used to compute mean neuropsychological performance and within-person across-test variability. Neuropsychological performance and within-person variability were independently associated with continuous and dichotomous measures of capacity. The results of this study provide support for the emerging view that multiple distinct cognitive abilities are required to support this function, and indicate that the sensitivity and accuracy of consent capacity assessments can be improved by evaluating each of these components separately.

Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines

BackgroundMaking healthcare treatment decisions is a complex process involving a broad stakeholder base including patients, their families, health professionals, clinical practice guideline developers and funders of healthcare.MethodsThis paper presents a review of a methodology for the development of urological cancer care pathways (UCAN care pathways), which reflects an appreciation of this broad stakeholder base. The methods section includes an overview of the steps in the development of the UCAN care pathways and engagement with clinical content experts and patient groups.ResultsThe development process is outlined, the uses of the urological cancer care pathways discussed and the implications for clinical practice highlighted. The full set of UCAN care pathways is published in this paper. These include care pathways on localised prostate cancer, locally advanced prostate cancer, metastatic prostate cancer, hormone-resistant prostate cancer, localised renal cell cancer, advanced renal cell cancer, testicular cancer, penile cancer, muscle invasive and metastatic bladder cancer and non-muscle invasive bladder cancer.ConclusionThe process provides a useful framework for improving urological cancer care through evidence synthesis, research prioritisation, stakeholder involvement and international collaboration. Although the focus of this work is urological cancers, the methodology can be applied to all aspects of urology and is transferable to other clinical specialties.

Religion, Spirituality and Health Care Treatment Decisions: The Role of Chaplains in the Australian Clinical Context

This paper summarizes the views of Australian health care chaplains concerning their role and involvement in patient/family health care treatment decisions. In general terms the findings indicated that the majority of chaplains surveyed believed that it was part of their pastoral role to help patients and their families make decisions about their health care treatment. Differences in involvement of volunteer and staff chaplains, Catholic and Protestant, male and female chaplains are noted, as are the perspectives of chaplaincy informants regarding their role in relation to health care treatment decisions. Some implications of this study with respect to quality patient centered care, chaplaincy utility, and training are noted.

The Adolescent Perspective on Participation in Treatment Decision Making: A Pilot Study

Few research studies have obtained data directly from the adolescent with cancer regarding decision making. The developmental stage of these patients focuses on developing independence, yet the health care decisions required for cancer treatment preclude independent decision making. The purpose of this pilot, or exploratory, study was to determine whether the research question is appropriate and whether participants between 13 and 15 years of age were capable of providing rigorous data. The results suggest that treatment decision making was not a concern for these patients and that they were capable and appropriate study participants. Semistructured interviews were performed with 3 adolescents diagnosed with cancer within the previous 3 to 6 months. These data were qualitatively analyzed using Colaizzi's technique, which identified themes perceived as critical by these participants. Independent behavior, such as decision making, is not relevant at this health care juncture. However, support, information, and education are desired. These should be routinely available using means appropriate for adolescents. Infusing information and education into the health care plan from time of diagnosis may allow the adolescent to become knowledgeable about the disease process. This may enable him or her to participate in health care treatment decisions, when appropriate.

P-002: The effect of individual characteristics on benefit-risk trade-offs for modifying the progression of Alzheimer’s disease

While the tremendous burden of Alzheimer's disease (AD) on patients, families and society is acknowledged, there is little quantitative evidence of the level of risk individuals are willing to accept for treatment benefits. In anticipation of AD disease modifying treatments, quantitative data on the preferences of older Americans without AD for potential treatment benefits and risks can assist healthcare professionals, policy makers and regulators in understanding the extent of perceived AD burden, establishing research priorities, and ultimately informing regulatory and healthcare treatment decisions. Identify individual characteristics that influence willingness to accept hypothetical risks in exchange for potential benefits of AD disease modifying treatments. A nationally representative panel of 2,146 US respondents ≥ 60 years of age (average 70 years), completed an Internet-based stated-choice questionnaire. Respondents chose between pairs of hypothetical treatment alternatives, including different, 7 year, AD disease-progression profiles and first year risk occurrence of two specific serious adverse events: death/permanent severe disability due to stroke or encephalopathy. The maximum acceptable risk (MAR) that respondents are willing to accept in exchange for treatment benefits was calculated for various clinical benefit levels. Results were stratified based on respondent characteristics and familiarity with AD. Higher MARs indicating greater risk acceptance, were observed for tradeoffs involving higher levels of clinical benefit. Mean MAR of death/disability due to stroke for treatments preventing disease progression beyond the mild state was 46.8% (40.3–54.3); that is, respondents were willing to accept an increase in the chance of death or disability of 46.8% for the benefit of preventing disease progression. Individual characteristics that had statistically higher MARs of death or disability due to stroke were found among younger versus older respondents (MAR 56.2%, 35.8%, respectively), more educated versus less educated (MAR 60.9%, 34.4%), and respondents familiar with AD versus less familiar (MAR 52.8%, 37.8%). Personal experience with AD and other responder characteristics were associated with higher risk acceptance. Respondents were willing to accept significant increases in the risk of death or disability in exchange for treatments that modify the course of AD. These data may help inform decisions regarding the value of disease modifying treatments for AD.

Genetic Nondiscrimination Legislation: A Critical Prerequisite for Pharmacogenomics Data Sharing

Russ B Altman1†, Neal Benowitz2, David Gurwitz3, Jeantine Lunshof4, Mary Relling5, Jatinder Lamba5, Eric Wieben6, Sean Mooney7, Kathleen Giacomini2, Scott Weiss8, Julie A Johnson9, Howard McLeod10, David Flockhart7, Richard Weinshilboum6, Alan R Shuldiner11, Dan Roden12, Ronald M Krauss13 & Mark Ratain14 †Author for correspondence 1Stanford University, Department of Genetics and Bioengineering, Clark S172, Stanford, CA 94305-5444, USA E-mail: Russ.Altman@ stanford.edu 2University of California, San Francisco 3Tel-Aviv University 4VU University Medical Center 5St Jude Children’s Research Hospital 6Mayo Clinic 7Indiana University School of Medicine 8Harvard Medical School 9University of Florida 10University of North Carolina 11University of Maryland 12Vanderbilt School of Medicine 13Children’s Hospital Oakland Research Institute 14University of Chicago On 31st January 2007, the US Senate Health, Education, Labor and Pensions Committee approved the Genetic Information Nondiscrimination Act (GINA) by a vote of 19:2. It was unanimously approved by the US Congress Committee on Education and Labor 2 weeks later. This legislation, aimed at preventing genetic discrimination in employment and insurance [1], will be imperative for protecting altruistic individuals who volunteer for genetic research [2]. There is an emerging consensus among researchers that genetic data must be accessible to individual research participants upon their request [3], while not putting them at risk with respect to their employment, insurance and additional personal aspects [4]. The GINA balances individual freedoms and privacy rights with societal needs for affordable and more effective healthcare and helps to pave the way for more personalized medicine [5]. Indeed, genetic information can be used to improve healthcare, in particular with regard to reducing the alarming rates of adverse drug reactions, which led to 6.7% of all US hospital admissions during 2004–2005 [6], consistent with earlier studies in the UK [7]. Increased use of individual genetic information about drug-metabolizing and drug-target gene alleles as part of healthcare treatment decisions may substantially reduce such morbidity [8]. However, building up the required knowledge depends on the analysis of large individual genotype/phenotype data sets from patient cohorts and requires open data sharing so that large, meaningful and less biased data sets are available to researchers [9]. Lack of open data sharing, in particular between the private and public sectors, hinders our ability to assemble large aggregated data sets [9]. A key obstacle for data sharing is concern about depositing data sets from individual study participants into public databases; some researchers fear they will be held responsible in cases where the data are re-identified (using computational data-mining techniques) and subsequently used (by employers or insurers) to discriminate against study participants. We therefore believe that legislation that offers protection to individuals or groups who share genetic information – against both re-identification and discrimination – is essential for efforts to move genomic medicine into practice. Legislation barring discrimination or stigmatization based on genetic information has been proposed for years, but enactment has become particularly urgent in view of rapidly falling genotyping costs [10], the scope of ongoing genome-wide association studies [11] and the increasing availability of comprehensive personal data in the public domain [4]. We therefore strongly support the current efforts to establish a solid legal framework as a primary means to protect individuals against misuse of their genetic information and as an essential tool for allowing open data sharing in pharmacogenomics.

Schiavo Case Still Triggers Review of Ethics

Schiavo Case Still Triggers Review of Ethics