Treatment-related Decision-making Research Articles

"I Won't Put Myself or My Family Through That": Decision Preferences, Family Experiences, and Kidney Disease Decision-Making.

Chronic kidney disease (CKD) is a major public health concern that uniquely impacts older Black Americans, a population also likely to have family members also diagnosed with CKD. This study aimed to (1) describe how participants viewed their decision preferences considering the experiences of family, and friends previously diagnosed with CKD, and (2) to understand how these social complexities informed their own decisions for future CKD care. Utilizing a phenomenologically-informed approach, this study explored participants' perceptions of how patients and their family members' experiences with CKD influenced treatment-related decision-making. A reflexive, thematic content analysis was conducted to identify patterns across participant responses (N=52). Participants were pre-dialysis, diagnosed with stage four or five chronic kidney disease, and were receiving outpatient nephrology care at a large, urban midwestern hospital. Three primary themes emerged: (1) uncertainty regarding decision-making, (2) lived experience of racism, and (3) impact of quality of care, information, and education on decision-making. These three interconnected themes centered on factors that influenced why and how decisions related to chronic kidney disease were made and how racial identity and prior family experiences with CKD influenced these decisions. Over the next 40 years, the population of Black Americans aged ≥ 65 years will nearly triple. Because of the complex support requirements and burden(s) of care for CKD patients, there are implications for reshaping the negative and disorienting narratives that influence decision-making conflicts.

A Nomogram for Predicting Late-Onset Neurological Deficits in the Natural Course of Kyphosis or Kyphoscoliosis.

Retrospective single-center comparative analysis. To develop a nomogram model for predicting late-onset neurological deficits (LONDs) in patients with kyphosis or kyphoscoliosis. Patients with kyphosis or kyphoscoliosis might suffer from LONDs, and surgical correction may improve neurological function. Nevertheless, there exists a significant gap in the identification of predictive factors for LONDs in these patients. A consecutive series of 244 patients with kyphosis or kyphoscoliosis who underwent corrective surgery between April 2010 and June 2024 were included in our study. Relevant measurements, including the Cobb angle, deformity angular ratio (DAR), and level of the apex were assessed and calculated using X-ray imaging. Spinal cord morphology at the apex of the major curve was evaluated using preoperative axial T2-weighted magnetic resonance imaging (MRI) to categorize patients into three types based on the spinal cord shape classification system (SCSCS). To identify independent risk factors associated with LONDs, we employed univariate analysis followed by backward stepwise multivariate logistic regression analysis. A nomogram was established based on the identified independent risk factors to predict the likelihood of LONDs in patients with kyphosis or kyphoscoliosis. The mean age of the 244 patients was 46.4±17.8 years, with an observed incidence of LONDs at 57.8%. The backward stepwise multivariate logistic regression analysis indicated that age, etiological diagnosis and SCSCS were independent predictors of LONDs. Utilizing these independent risk factors, we constructed a nomogram model to estimate the probability of LONDs. The concordance index (C-index) of the model was 0.912 (95% CI, 0.876-0.947), indicating a satisfactory level of accuracy in predicting the likelihood of LONDs. The predictive factors for LONDs include age, etiological diagnosis and SCSCS. We developed a nomogram model to predict LONDs, which could be useful for patient counseling and facilitating treatment-related decision-making.

Computed tomography-based radiomic model for the prediction of neoadjuvant immunochemotherapy response in patients with advanced gastric cancer.

Neoadjuvant immunochemotherapy (nICT) has emerged as a popular treatment approach for advanced gastric cancer (AGC) in clinical practice worldwide. However, the response of AGC patients to nICT displays significant heterogeneity, and no existing radiomic model utilizes baseline computed tomography to predict treatment outcomes. To establish a radiomic model to predict the response of AGC patients to nICT. Patients with AGC who received nICT (n = 60) were randomly assigned to a training cohort (n = 42) or a test cohort (n = 18). Various machine learning models were developed using selected radiomic features and clinical risk factors to predict the response of AGC patients to nICT. An individual radiomic nomogram was established based on the chosen radiomic signature and clinical signature. The performance of all the models was assessed through receiver operating characteristic curve analysis, decision curve analysis (DCA) and the Hosmer-Lemeshow goodness-of-fit test. The radiomic nomogram could accurately predict the response of AGC patients to nICT. In the test cohort, the area under curve was 0.893, with a 95% confidence interval of 0.803-0.991. DCA indicated that the clinical application of the radiomic nomogram yielded greater net benefit than alternative models. A nomogram combining a radiomic signature and a clinical signature was designed to predict the efficacy of nICT in patients with AGC. This tool can assist clinicians in treatment-related decision-making.

Diagnostic utility of translabial ultrasound in pelvic organ prolapse: a prospective observational study

Background The increasing awareness of women’s health issues, specifically pelvic organ prolapse (POP) and urinary incontinence (UI), has spurred a surge in patients seeking specialised advice for these conditions, necessitating modern diagnostic approaches for such issues. This study explored the diagnostic utility of translabial ultrasound for POP, emphasising its correlation with clinical assessments based on International Continence Society (ICS) criteria. Methods Seventy-one patients with POP Quantification System (POP-Q) stage 0-IV with or without UI were prospectively enrolled at Jagiellonian University Medical College between 2014 and 2016. The study objectives included evaluating diagnostic accuracy and concordance across pelvic compartments, correlating the diagnoses with patient-reported symptoms, and identifying variables contributing to diagnostic discrepancies. Results Translabial ultrasound identified POP in 74.5% of the patients, aligning closely with clinical evaluations. Concordance was the highest in assessments performed in the medial compartment (85.8%), while assessments performed in the anterior (29.6%) and posterior (29.6%) compartments showed higher rates of discrepancies. Correlation analyses showed varying associations, with the posterior compartment exhibiting the least pronounced correlation (R = 0.72, p < 0.0001). Self-perceive POP showed no discernible differences in relation to ultrasonographic and clinical assessments. Among the respondents, 55.9% reported experiencing the sensation of POP. Mean POP levels determined using the two approaches precisely matched in 46.5% of these cases. Discrepancies involved variables such as self-perceived POP, number of deliveries, child weight at birth, UI, and sexual activity. Conclusions Translabial ultrasound showed robust correlation with clinical assessments for evaluating POP, especially for defining defects and facilitating treatment-related decision-making. Our findings highlight the reliability of this method, particularly for assessments in the medial compartment. The evidence did not indicate the superiority of either method in detecting POP disorders for symptomatic versus asymptomatic patients. Significantly, a higher POP-Q measurement in clinical examination was correlated with greater sexual activity.

European Neuroendocrine Tumor Society (ENETS) 2024 guidance paper for the management of well-differentiated small intestine neuroendocrine tumours.

Both the incidence and prevalence of well-differentiated neuroendocrine tumours from the small intestine (Si-NET) are gradually increasing. Most patients have non-functioning tumours with subtle GI symptoms and tumours are often discovered incidentally by endoscopy or at advanced disease stages by imaging depicting mesenteric lymph node and /or liver metastases while around 30% of the patients present with symptoms of the carcinoid syndrome. Adequate biochemical assessment and staging including functional imaging is crucial for treatment-related decision-making that should take place in an expert multidisciplinary team setting. Preferably, patients should be referred to specialised ENETS Centres of Excellence or centres of high expertise in the field. This guidance paper provides the current evidence and best knowledge for the management of Si-NET grade (G) 1-3 following 10 key questions of practical relevance for the diagnostic and therapeutic decision making.

Multiple Myeloma Treatment-Related Decision-Making and Preferences of Patients and Care Partners in the United States

BACKGROUND Multiple myeloma is a largely incurable disease characterized by periods of response followed by relapse and/or refractoriness to therapy. With many new treatments available, patients now have more flexibility to assess treatment benefits and risks and what aspects of a treatment are most important to them. The purpose of this non-interventional qualitative study was to examine treatment-related decision-making in patients with MM and care partners with varying experience with refractoriness. METHODS Patients with MM and care partners were recruited through the Gryt Health Cancer Community, social media, and participant referrals to join a qualitative study centered around a semi-structured interview. Adult patients with MM who self-reported treatment for MM in the United States were eligible; adults who self-reported being the primary care partner to an adult with a MM diagnosis who had received treatment in the United States were also eligible. Participants were stratified based on refractoriness to at least one proteasome inhibitor, immunomodulatory drug, and/or anti-CD38 monoclonal antibody (non-refractory; single or double refractory; triple refractory). An Institutional Review Board approved this study. RESULTS The study was completed by 42 participants, of which 32 were patients with MM (12 non-refractory; 10 single or double refractory; 10 triple refractory) and 10 were MM care partners (3 non-refractory; 3 single or double refractory; 4 triple refractory) (Table). Each care partner was paired to a patient participant, and 80% lived in the same household as the patient. All care partners had provided support since the MM diagnosis, if not before, and at minimum had been providing support for at least 2 years. More than half (60%) of care partners were currently working full-time, relative to only 20% of the paired patients. Patients and care partners made comments supportive of MM being approached as a chronic disease, which suggests an abrupt shift in perspective compared to historical sentiment. Participants wanted to retain or improve their quality of life (QoL) and focus less on the disease itself. Reasons for this shift in perspective include an increased sense of hope brought about by new treatments and community support, documented improvements in long-term survival, and better techniques for monitoring disease relapse, particularly minimal residual disease (MRD) status. More than 70% of participants expressed that treatment-related decision-making was shared, particularly as they were further from diagnosis, and felt comfortable asking their doctor(s) questions related to treatment options, even if treatment options were only discussed on an as-needed basis. Care partners were more actively involved in decision-making around significant events, such as diagnosis, stem cell transplant, and relapses. When making treatment decisions, participants were most concerned about extending remission and overall survival (OS), improving QoL, and minimizing MM symptoms and treatment-related side effects (Figure). Extending remission and OS and improving QoL were rated very important underscoring the value of shared decision-making as patient engagement is key in monitoring and enhancing QoL. Location of care and/or treatment, financial burden, possibility of hospitalization, potential impact on other medical conditions, and frequency and duration of treatment were of lesser concern. Participants were least concerned about the mode of administration of the treatment; none of the patients with double or triple refractory disease considered mode of administration to be fairly or very important. Those with triple refractory disease were more likely to be concerned about frequency and duration of treatment compared with other patients. Patient and care partner participants were generally aligned on priorities when making treatment decisions but had the least alignment on financial burdens with patients expressing more concern. CONCLUSIONS With the availability of new treatment options, patients are seeking therapies that both extend remission and OS and improve QoL, placing more importance on the need for patient engagement in the decision-making process. Treatment of MM is now often being approached from a chronic care perspective, perhaps reflective of changing attitudes about MM as a more treatable disease today.

Factors reported by family caregivers when partnering with patients in cancer treatment-related decision-making: Analysis of national survey data.

217 Background: Patient values (who/what matters most) are integral to cancer treatment decision-making, yet which factors matter most to family caregivers (FCG) remains understudied. To address this gap, we examined differences in factors considered very important by FCGs during cancer treatment decision-making by cancer stage and by FCG sociodemographics. Methods: Analysis of an internet-based 2021 U.S. national survey data of cancer FCGs (N=1,661) conducted by CancerCare. Factors were assessed using the following item: "When you were participating in making this [treatment] decision, how important to you were these factors regarding the person with cancer?" Fifteen factors were rated on a 4-point Likert scale from ‘very unimportant’ to ‘very important’, including patient-focused factors (e.g., quality of life, length of life, functional independence), caregiver-focused factors (e.g., impact on own daily life, own religious/spiritual beliefs), and other-focused factors (e.g., opinions/feelings of other family members/friends). Descriptive statistics and proportions were tabulated for each factor. Generalized linear mixed effect models tested factor importance endorsement by cancer stage (in remission vs. stages I/II vs. stages III/IV) and chi-square analyses determined associations between FCG sociodemographics and each of the most frequently endorsed factors, with adjustment for multiple inferences. Results: The five most important factors endorsed by FCGs were the patient’s quality of life (69%), physical wellbeing (68%), length of life (66%), emotional wellbeing (63%), and opinions/feelings of oncology team (59%). In factor endorsement comparisons by cancer stage, patient’s physical well-being, length of life, ability to continue working, ability to care for others, and the opinions/feelings of the oncology team were more often endorsed as very important by FCGs in the context of early-stage cancers (all p’s &lt;0.05). FCG age, race, gender, and ethnicity had small, significant associations with endorsement of different factors as ‘very important’, most especially towards “opinions/feelings of the oncology team” (all p’s &lt;0.05). Conclusions: Cancer FCGs identified patient’s quality of life, physical wellbeing, and length of life as the most important factors when partnering with their care recipients in cancer treatment decision-making. Several factors were perceived as less important in the context of later stage cancers, and there were notable differences in factors by FCG sociodemographic characteristics, particularly towards the opinions/feelings of the oncology team. Future decision support work is needed to identify the best timing (i.e., prior to vs. during clinic visits) and method (i.e., alone vs. facilitated) to elicit what matters most to patients and FCGs given existing clinical practice demands.

A novel nomogram for identifying high-risk patients among active surveillance candidates with papillary thyroid microcarcinoma.

Active surveillance (AS) has been recommended as the first-line treatment strategy for low-risk (LR) papillary thyroid microcarcinoma (PTMC) according to the guidelines. However, preoperative imaging and fine-needle aspiration could not rule out a small group of patients with aggressive PTMC with large-volume lymph node micro-metastasis, extrathryoidal invasion to surrounding soft tissue, or high-grade malignancy from the AS candidates. Among 2,809 PTMC patients, 2,473 patients were enrolled in this study according to the inclusion criteria. Backward stepwise multivariate logistic regression analysis was used to filter clinical characteristics and ultrasound features to identify independent predictors of high-risk (HR) patients. A nomogram was developed and validated according to selected risk factors for the identification of an HR subgroup among "LR" PTMC patients before operation. For identifying independent risk factors, multivariable logistic regression analysis was performed using the backward stepwise method and revealed that male sex [3.91 (2.58-5.92)], older age [0.94 (0.92-0.96)], largest tumor diameter [26.7 (10.57-69.22)], bilaterality [1.44 (1.01-2.3)], and multifocality [1.14 (1.01-2.26)] were independent predictors of the HR group. Based on these independent risk factors, a nomogram model was developed for predicting the probability of HR. The C index was 0.806 (95% CI, 0.765-0.847), which indicated satisfactory accuracy of the nomogram in predicting the probability of HR. Taken together, we developed and validated a nomogram model to predict HR of PTMC, which could be useful for patient counseling and facilitating treatment-related decision-making.

Self-efficacy of advanced cancer patients for participation in treatment-related decision-making in six European countries: the ACTION study

PurposeMany patients prefer an active role in making decisions about their care and treatment, but participating in such decision-making is challenging. The aim of this study was to explore whether patient-reported outcomes (quality of life and patient satisfaction), patients’ coping strategies, and sociodemographic and clinical characteristics were associated with self-efficacy for participation in decision-making among patients with advanced cancer.MethodsWe used baseline data from the ACTION trial of patients with advanced colorectal or lung cancer from six European countries, including scores on the decision-making participation self-efficacy (DEPS) scale, EORTC QLQ-C15-PAL questionnaire, and the EORTC IN-PATSAT32 questionnaire. Multivariable linear regression analyses were used to examine associations with self-efficacy scores.ResultsThe sample included 660 patients with a mean age of 66 years (SD 10). Patients had a mean score of 73 (SD 24) for self-efficacy. Problem-focused coping (B 1.41 (95% CI 0.77 to 2.06)), better quality of life (B 2.34 (95% CI 0.89 to 3.80)), and more patient satisfaction (B 7.59 (95% CI 5.61 to 9.56)) were associated with a higher level of self-efficacy. Patients in the Netherlands had a higher level of self-efficacy than patients in Belgium ((B 7.85 (95% CI 2.28 to 13.42)), whereas Italian patients had a lower level ((B −7.50 (95% CI −13.04 to −1.96)) than those in Belgium.ConclusionCoping style, quality of life, and patient satisfaction with care were associated with self-efficacy for participation in decision-making among patients with advanced cancer. These factors are important to consider for healthcare professionals when supporting patients in decision-making processes.

Cancer information-seeking profiles: A self-report measure of patients' distinct preferences for information about their cancer.

Contemporary cancer care approaches, such as value- and strengths-based health care, involve integrating patients' needs and preferences, as the cancer experience unfolds. Distinct cancer information-seeking behaviours among patients are increasingly found to influence patient-provider communication, treatment-related decision-making, health processes and outcomes, as well as patient satisfaction with cancer care services. My program of research has already documented diverse cancer information-seeking profiles (CISP) among patients. These profiles can easily be captured by a theory-driven and empirically sound self-report single-item measure presented herein. Guided by Self-Evaluation Theory (SET) - which posits that individuals vary in their motivation to seek information about the self - quantitative work established that SET motives could be reproduced in health-related contexts (N = 600). Qualitative inquiry subsequently explored information-seeking among individuals with various cancer diagnoses. Based on this series of studies, a CIPS measure (containing a general question which prompts individuals to choose the most representative statement based on five descriptions of distinct informational profiles) was tested in a large sample of individuals with diverse cancers. In this latter sample (N = 2,142), patients were administered the CISP and the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). The most frequently reported CISP was complementary (50.2%, i.e., search for cancer information that added to what patients already knew), followed by minimal (25.2%, i.e., no search for cancer information), then guarded (14.4%, i.e., avoiding negative and only seeking hopeful cancer information), peer-focused (6.4%, i.e., search for cancer information from similar others), and last, intense (3.8%, i.e., seeking as much cancer information as possible). These profiles were also differentially related to care satisfaction with intense profiles being the least satisfied across all cancer care domains. The CISP measure can readily assess patients' profiles in the search for (or avoidance of) information about their cancer so that more personalized interventions can be provided. Future research exploring how CISP evolves, as the cancer experience unfolds, is also worthy of further study.

Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Nurse-led multi-component behavioural activation programme to improve health outcomes in patients with atrial fibrillation: a mixed-methods study and feasibility analysis.

Patients with atrial fibrillation (AF) play passive roles in disease management. This study aimed to examine the feasibility and preliminary effects of an empowerment-based care model, titled 'the nurse-led multi-component behavioural activation (N-MBA) programme', on health-related quality of life, AF knowledge, psychological outcomes, medication adherence, and treatment decision-making in patients with AF. This mixed-methods study comprised a pilot randomized controlled trial and a qualitative study. Patients with AF who had a moderate-to-high risk of stroke but were not prescribed oral anticoagulants were recruited. Forty participants were recruited and randomized in a 1:1 ratio to receive either the N-MBA programme or standard care. The 13-week programme comprised care components that prepared patients for shared decision-making, an empowerment-based educational module on AF self-care, and continuous support through telephone calls. The programme was feasible, and the overall attendance rate was 82.5%. The participants gave excellent ratings in the satisfaction survey. The N-MBA group showed greater improvements in health-related quality of life (HRQoL) and AF knowledge than the standard care group at the immediate post intervention and 6-month follow-up time points. No significant between-group changes in medication adherence, anxiety, and depression were detected. Participants in the N-MBA group actively raised concerns about AF and its treatment with their attending doctors. The qualitative data were consistent with the quantitative data, indicating that the programme built a comprehensive knowledge base of AF and self-care behaviours. The N-MBA programme is feasible and acceptable to patients with AF. It improved patients' AF knowledge, treatment-related decision-making, and HRQoL. ClinicalTrials.gov NCT03924739.

Ectopic and impacted maxillary canines: A quality evaluation of online information.

To determine the quality of online information regarding ectopic and impacted maxillary canines (EIMCs). A cross-sectional survey on the Internet. An online search using eight terms was carried out using four search engines. The relevant content of websites satisfying the inclusion and exclusion criteria were assessed for quality by applying three quality of information instruments and one readability tool. Statistical analyses were performed through GraphPad Prism 9.0. In total, 77 websites were evaluated. Most of the assessed content was associated with oral and maxillofacial surgery (49.35%) and orthodontic websites (31.18%). The overall mean DISCERN score was 38.05 ± 9.76/80 with 59.73% of websites recording a poor or very poor score. Three (3.9%) websites contained the HONCode seal. Twelve (15.58%) websites satisfied at least three out of a maximum four JAMA benchmarks and 11 (14.29%) satisfied none. The mean SMOG score was 9.81 ± 1.52 (95% confidence interval = 9.46-10.16; range = 6.7-15.1). The quality of online information related to EIMCs was poor and the content was difficult to read. Professional societies and clinicians should consider the use of quality of information and readability tools to enable the provision for reliable, high-quality and readable online information. This will assist EIMC treatment-related decision-making and management by patients and their families.

Preoperative Prediction of Intracranial Meningioma Grade Using Conventional CT and MRI.

ObjectivePreoperative diagnosis of tumor grade can assist in treatment-related decision-making for patients with intracranial meningioma. This study aimed to distinguish between high-grade and low-grade meningiomas using conventional CT and MRI.MethodologyWe retrospectively analyzed 173 consecutive patients with intracranial meningioma (149 low-grade and 24 high-grade tumors) who were treated surgically at the National Hospital Organization Kyushu Medical Center from 2008 to 2020. Clinical and radiological features, including tumor doubling time (Td) and relative growth rate (RGR), were compared between low-grade and high-grade meningiomas.ResultsMultivariate logistic regression analysis showed that symptomatic tumor (p=0.001), non-skull base location (p=0.006), irregular tumor shape (p=0.043), tumor heterogeneity (p=0.025), and peritumoral brain edema (p=0.003) were independent predictors of high-grade meningioma. In 53 patients who underwent surgery because of tumor progression, progression to symptoms (p=0.027), intratumoral heterogeneity (p<0.001), peritumoral brain edema (p=0.001), larger tumor volume (p=0.005), shorter Td (p<0.001), and higher RGR (P<0.001) were significantly associated with high-grade meningioma. Receiver operating characteristics (ROC) curve analysis showed that the optimal Td and annual RGR cut-off values to distinguish high-grade from low-grade meningioma were 460.5 days and 73.2%, respectively (100% sensitivity and 78.6% specificity).ConclusionBased on our findings, conventional CT and MRI are useful methods to predict meningioma grades before surgery. High-grade lesions are associated with non-skull base location, irregular tumor shape, intratumoral heterogeneity, and peritumoral brain edema. High-grade meningioma should be suspected in tumors that exhibit Td <460.5 days or annual RGR >73.2% or those that develop intratumoral heterogeneity or surrounding brain edema on surveillance imaging.

Hypertension and beyond in Indian clinical practice study: a nationwide survey assessing knowledge, attitude and practices of physicians

Background: Hypertension is the leading cause for the ever-increasing burden of mortality due to stroke and cardiovascular diseases (CVD). Treatments are complicated due to comorbidities and can lead to patient noncompliance. Patients with low existing cardiovascular risk are prone to have higher lifetime cardiovascular risk, which timely assessment necessary.Methods: A digital cross-sectional survey questionnaire about knowledge, attitude and practice habits regarding cardiovascular risk assessment was administered to 400 physicians and cardiologists across India. The questionnaire assessed various topics such as practice of hypertension diagnosis and treatment based on guidelines, cardiovascular risk calculators, occurrence of comorbidities and patient awareness on cardiovascular risk prevention.Results: Out of the 400 physicians, 398 completed the survey. About 52% physicians considered presence of multiple risk factors as vital for having cardiovascular risk. American college of cardiology/American heart association (ACC/AHA) calculator was preferred by 51.6% study participants. Cardiovascular risk estimation was vital for treatment-related decision-making according to 71% participants, while only 7.7% participants calculated cardiovascular risk in &gt;90% of their patients. Approximately 44% survey participants calculated cardiovascular risk in hypertensive patients with 2 additional risk factors, while 5.6% calculated it in &gt;70% hypertensive patients without comorbidities. About 46.6% participants reported that 30%-50% of their patients were on fixed-dose combinations of two antihypertensive medications.Conclusions: Findings from the study indicate predisposition of medical professionals towards having a risk assessment tool designed for the Indian population to timely assess and forestall long-term effects of cardiovascular risk in hypertensive patients.

Cementing the relationship between conventional and advanced semen parameters

BackgroundAffordable conventional semen analysis remains a fundamental procedure to be performed routinely during the diagnosis of male infertility. Advanced semen analyses provide valuable clinical insights in treatment-related decision-making, but these are highly expensive and lack universal standardization. This study aimed at determining the relationship between conventional semen parameters, measured with assistance of computer-aided sperm analysis (CASA), and a set of advanced semen tests. Basic semen analysis (n = 124) was performed according to the World Health Organization (WHO) guidelines. Sperm DNA fragmentation and intracellular superoxide (O2−•) levels were assessed by flow cytometry. Seminal plasma thiobarbituric acid reactive substances (TBARS) levels as well as superoxide dismutase (SOD) and catalase (CAT) activity were measured by spectrophotometry. Spearman’s rank correlation coefficient was used, with significance set at p < 0.05.ResultsSemen pH correlated negatively with TBARS (p < 0.01). The proportions of total and progressively motile as well as rapid spermatozoa correlated positively with CAT activity (p < 0.05). Sperm viability correlated negatively with both O2−• (p < 0.05) and DNA fragmentation (p = 0.01), while normal morphology correlated negatively with O2−• levels (p < 0.05) and positively with CAT activity (p < 0.05). Straight-line velocity (VCL) and average-path velocity (VAP) correlated negatively with both O2−• (p < 0.01) and TBARS (p < 0.01). Amplitude of lateral head displacement (ALH) correlated negatively with O2−• (p < 0.01) and DNA fragmentation (p < 0.01), while its correlation with SOD activity was positive (p < 0.05).ConclusionThe results obtained from this study support the validity of some CASA parameters as sensitive indicators of changes in sperm oxidative status and DNA integrity. Predicting advanced from conventional parameters through the building of linear regression models should be considered for future studies.

Caregiver-Perceived Facilitators and Barriers to Oral Iron Therapy in Young Children with Iron Deficiency Anemia

BackgroundIn the U.S., 2 to 3% of children age 1 to 3 years are affected by nutritional iron deficiency anemia (IDA). Children of Hispanic/Latino ethnicity are disproportionately affected and have rates approximately double that of other racial and ethnic groups. IDA is associated with inferior neurodevelopmental outcomes, poorer executive functioning, and decreased visual and auditory processing time. Treatment with oral iron mitigates against the consequences of IDA. Non-adherence to oral iron often results in treatment failure, and incomplete therapy prolongs the extent of IDA consequences. We aim to characterize barriers to and facilitators of oral iron therapy in young children with nutritional IDA.MethodsInfants and children aged 9 months to 4 years (all racial and ethnic groups) with nutritional IDA (assessed by history and laboratory criteria) and treated with oral iron therapy in the outpatient hematology clinic at a large US tertiary care pediatric hospital are identified. English or Spanish-speaking caregivers of identified children are invited to participate with the goal of conducting half the interviews in each language. In person audio-recorded semi-structured interviews are conducted by a research coordinator trained in qualitative methods using an IDA interview guide developed by a multidisciplinary research team. The guide is divided into 6 broad categories: diagnosis, consequences, experience with oral iron therapy (barriers to and facilitators of adherence), motivation, and alternate treatment options. For Spanish-speaking caregivers, an in-person Spanish interpreter assists with the interview.Verbatim transcripts are reviewed manually by 2 members of the research team to perform thematic analysis and identify common patterns in responses. Interviews and qualitative analysis will continue until thematic saturation is achieved (i.e. no new themes emerge from subsequent interviews). Clinical data, including laboratory values and treatment regimen, are abstracted from the patient's electronic medical record. Here we present findings from the initial six months of the study (February to July 2017).ResultsNine caregivers to date have been approached, and all enrolled. Patients had a mean age of 20 months (range 12 to 32 months); 5 (55%) were male. Nine caregiver interviews were completed; six in English and three in Spanish. All caregivers self-identified as White and Hispanic/Latino. Median hemoglobin concentration at patients' first visit within the hematology clinic was 8.6 g/dL (range 5.4 to 10.4 g/dL). Median duration of oral iron therapy at the time of interview was 4 months (range 2 to 10 months).Caregivers expressed a range of emotions that included fear and anxiety at time of diagnosis and optimism with treatment resolution. Many stated desire to have received information on risk factors and prevention of iron deficiency prior to their child's development of IDA. Regarding the diagnosis of IDA, most caregivers had a basic understanding of the condition, though some misinformation was present. Widely variable consequences of IDA were described, which included: changes in skin color, decreased energy, and potential for more severe disease if undetected. Negative traits of iron therapy, specifically poor taste and difficulty in getting child to take the medication, were barriers. Transition to better tasting formulations overcame these barriers for some families. When presented with information on intravenous iron therapy, most caregivers demonstrated willingness for their child to receive it if oral iron failed. Most caregivers deferred treatment-related decision-making to the recommendation of the physician.ConclusionCaregiver-perceived barriers to oral iron adherence were poor taste and difficulty in getting the child to take the medication. Knowledge regarding the diagnosis of IDA was not a consistent barrier as most caregivers reported a basic understanding of the condition. Specific caregiver-identified motivating factors and facilitators to oral iron adherence have not yet been elucidated. Additional, more targeted qualitative interviews with caregivers will be performed to elicit such information. These results will inform future patient-centered interventions aimed at promoting treatment in children with IDA. DisclosuresNo relevant conflicts of interest to declare.

Prediction interval estimation of landslide displacement using adaptive chicken swarm optimization-tuned support vector machines

Accurate and reliable displacement prediction is vital for developing landslide early warning system, since displacement variations directly reveal the evolution of landslide. The past decade has seen the rapid development of displacement prediction technology. Most of the existing studies are based on deterministic point prediction models, with the goal of obtaining high-precision predictions. However, these pointwise predictions do not give any indication of credibility, which makes it difficult to make accurate decisions for subsequent landslide treatment. To address this problem, a prediction interval estimation method, instead of point prediction, for landslide displacement is proposed. In the methodology, double exponential smoothing is employed to deal with the nonlinear cumulative displacement, while two support vector machines are proposed to directly generate the displacement lower boundary and upper boundary. To obtain optimal model parameters, the adaptive chicken swarm optimization using chaotic mapping and adaptive inertia weight strategies is proposed to minimize a modified prediction interval-based objective function. A real-world landslide displacement data set is used to demonstrate the proposed method. Experimental results show that it is a promising tool for the construction of high-quality prediction intervals, which can inform the landslide treatment-related decision-making.

Impact of Physicians' Personalities and Behavioral Traits on Treatment-Related Decision-making for Elderly Acute Myeloid Leukemia.

Elderly patients with acute myeloid leukemia (AML) can be treated with intensive therapy, low-intensity therapy, or best supportive care. Medical decision-making might be affected by physicians' occupational and non-occupational factors. To explore the impact of physicians' personalities and behavioral traits on treatment-related decision-making for elderly AML patients. A nationwide cross-sectional survey. Hematologists in mainland China (N = 529; response rate 64.5%). The medical decision-making for elderly AML patients was evaluated using 6 clinical vignettes. Hematologists' attitudes toward risk and uncertainty, Big Five personality traits, and decision-making styles were assessed using binary lottery choices and well-recognized self-report inventories. The resulting binary regression model in predicting treatment intensity contained professional title group (OR = 0.012, 95% CI 0.001 to 0.136, P < 0.001), conscientiousness (OR = 0.336, 95% CI 0.121 to 0.932, P = 0.036), extraversion (OR = 0.403, 95% CI 0.166 to 0.974, P = 0.044), conscientiousness by title group (OR = 2.009, 95% CI 1.100 to 3.667, P = 0.023), and extraversion by title group (OR = 1.627, 95% CI 0.965 to 2.743, P = 0.068) as predictors of therapy intensity preference. Junior physicians with a higher level of extraversion (mean difference = 0.27; 95% CI 0.07 to 0.45; P = 0.009) or conscientiousness (mean difference = 0.19; 95% CI 0.01 to 0.36; P = 0.028) tended to prescribe more intensive therapy. Meanwhile, no significant correlation was found between physicians' personalities or behavioral traits and treatment-related decision-making in senior physicians. Physicians' personalities contribute to treatment-related decision-making for elderly AML patients, depending on the professional titles. More extravert or conscientious attending physicians tended to prescribe more intensive therapy. Meanwhile, the decisions made by chief and associate chief physicians were not impacted by their personal traits. Junior physicians should be aware of such potential influence when making medical decisions.

Emerging Mitochondria-Associated Molecular Target Therapies for Acute Myeloid Leukemia

The era of precision medicine for acute myeloid leukemia (AML) has arrived, and it is extremely important to detect actionable mutations relevant to treatment-related decision-making. However, the percentage of actionable mutations found in AML is approximately 50% at present, and therapeutic development is also needed for AML patients without such mutations. Nevertheless, recently approved drugs for AML treatment are less toxic than conventional intensive chemotherapy and can be combined with low-intensity treatments. Such combination therapies can improve prognosis, especially for elderly AML patients, who account for more than half of all AML cases. Thus, the treatment strategy for leukemia is changing drastically and showing rapid progress. In this review, we present novel mitochondria-associated molecular target therapies for AML, such as the use of BCL-2 and IDH inhibitors.