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Literature suggests that using behavioral theory to inform research can improve the efficiency of knowledge translation (KT) interventions and guide their implementation. Therefore, we conducted a scoping review of the use of behavioral theories, models, and frameworks in the published literature to guide the implementation of evidence-informed decision-making (EIDM) interventions. We used a thorough two-step search strategy to retrieve articles fulfilling the inclusion criteria published through August 2022. Two reviewers initially screened the articles individually, followed by two reviewers who independently reviewed the articles' full text. We critically appraised 90 full-text articles from 3172 retrieved articles based on inclusion and exclusion criteria. We finally included 19 articles for qualitative synthesis, which included the elements of KT intervention, underlying theories/models of behavior change and the purpose of their use, and facilitators and barriers to KT intervention. Our results showed that no study explicitly focused on EIDM and simultaneously utilized behavioral theories to design or inform the implementation of an intervention. Furthermore, we found that the Theoretical Domain Framework, the Theory of Planned Behavior, the Behavioral Change Wheel, and the Capability, Opportunity, and Motivation Behavior Model were most frequently used to guide the implementation of KT interventions. Our study identified a vital gap that must be filled in relation to EIDM research on intervention implementation. Thus, our findings can support and enrich those planning to launch an EIDM initiative in terms of selecting the base theory/model/framework, anticipating the facilitators and barriers to implementation, and determining the most appropriate intervention component. [ABSTRACT FROM AUTHOR]

Objective: To compare cost‐effectiveness of oral sildenafil citrate, administered after onset of labor, with standard care to health system funders in the UK and Australia. Methods: We conducted a modeled cost‐effectiveness analysis, measuring costs and quality adjusted life years (QALYs), using a decision‐analytic model covering onset of labor to 1 month post‐birth. The relative risk of emergency cesarean section and operative vaginal birth was taken from a Phase 2 placebo controlled double blinded randomized control trial. Results: Both options of care resulted in the same QALYs gained over the model time period (0.08). Sildenafil citrate was cost‐saving compared with standard care, saving £92 per birth in the UK (AU$303 per birth in Australia). Sensitivity analyses did not identify any areas of uncertainty that stopped sildenafil citrate being cost saving compared with standard care. Threshold analysis revealed that sildenafil citrate would be cost saving up to a per birth drug or administration cost of £152.32 in the UK (AU$333.61 in Australia). Conclusion: Oral sildenafil citrate may be cost saving compared with standard care; however, the effects on neonatal outcomes still need to be demonstrated in large randomized trials. Synopsis: Oral sildenafil‐citrate may be cost saving compared with standard care; however, the effects on neonatal outcomes still need to be demonstrated in large randomized trials. [ABSTRACT FROM AUTHOR]

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Introduction: Decision aids are software or paper-based tools that enable patients and health care practitioners to work together to make optimal treatment decisions. Although there are decades of favorable research for the use of decision aids, there is wide variation in their development and implementation. Objective: To review the literature and provide a summary of best practices for the design, implementation, and assessment of decision aids. Methods: A literature search and screening process was employed with a focus on systematic review articles. The resulting articles were synthesized and summarized into recommendations regarding the optimal design, implementation, and appraisal of shared decision-making tools. Results: Designers of decision aids should initially focus on engagement by involving health care practitioners and patients to ensure the decision aids are pertinent to the situation and not perceived as time consuming. The International Patient Decision Aids Standards help ensure quality in design. Patients should be able to select information in a manner that suits them and view it in a way that allows them to evaluate trade-offs. In reporting of statistical risks, format bias should be avoided through careful and consistent choice of format and by adding visual representations. Decision aids should be tested in real settings with iterative improvements. For appraisal of the implemented decision aids, consider using the Control Preference and Decisional Conflict scales. Discussion: Further research is recommended regarding optimal engagement of users with decision aids and exploration of the distinct opportunities that computerized decision aids and online patient communities may present. Conclusion: Decision aids can be a valuable tool for shared medical decision making. Their quality and usefulness can be maximized by involving users in their creation and by attending to key considerations in their design, implementation, and appraisal. [ABSTRACT FROM AUTHOR]

Background: Early laparoscopic cholecystectomy (LC) is advocated in patients with an acute biliary presentation but may require some precaution. We aimed to assess the intra‐operative difficulty of cholecystectomy in patients who underwent early intervention, and to establish a prediction model for a 'complicated' LC. Methods: Retrospective analysis of prospectively collected data from patients presenting to the emergency department with acute biliary symptoms, and who subsequently underwent early LC between 2015 and 2018. Operative difficulty was assessed by standardized grading of intra‐operative findings (grades 1–4). Pre‐operative predictors for a 'complicated' LC (grades 3/4) were assessed using univariable and multivariable logistic regression analysis. A prediction model was created using variable regression coefficients. Cut‐off and accuracy of the model were assessed using a receiver operating characteristic curve. Results: A total of 185 patients were included and 59% presented with acute cholecystitis. In this cohort 113 (61%) patients underwent a 'complicated' LC. A prediction model for a 'complicated' LC (0–4.5 points) included: clinical diagnosis of acute cholecystitis (2 points), C‐reactive protein >10.5 mg/L (1.5 points) and pericholecystic fluid on pre‐operative imaging (1 point). A score ≥2.5 had a sensitivity of 77.7%, specificity of 81.7% and positive and negative predictive values of 87.0% and 69.9%, respectively. Conclusion: Early LC may be 'complicated' in up to 60% of cases. The presented prediction model uses readily available information in the emergency department and is a simple but accurate way to predict a likely 'complicated' LC in patients with acute biliary presentations. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chronic obstructive pulmonary disease require help in daily life situations to increase their individual perception of security, especially under worsened medical conditions. Unnecessary hospital (re-)admissions and home visits by doctors or nurses shall be avoided. This study evaluates the results from a two-year telemedicine field trial for automatic health status assessment based on remote monitoring and analysis of a long time series of vital signs data from patients at home over periods of weeks or months.Methods: After discharge from hospital treatment for acute exacerbations, 94 patients were recruited for follow-up by the trial system. The system supported daily measurements of pulse and transdermal peripheral capillary oxygen saturation at patients' homes, a symptom-specific questionnaire, and provided nurses trained to use telemedicine ("telenurses") with an automatically generated health status overview of all monitored patients. A colour code (green/yellow/red) indicated whether the patient was stable or had a notable deterioration, while red alerts highlighted those in most urgent need of follow-up. The telenurses could manually overwrite the status level based on the patients' conditions observed through video consultation.Results: Health status evaluation in 4970 telemonitor datasets were assessed retrospectively. The automatic health status determination (subgroup of 33 patients) showed green status at 46% of the days during a one-month monitoring period, 28% yellow status, and 19% red status (no data reported at 7% of the days). The telenurses manually downrated approximately 10% of the red or yellow alerts.Discussion: The evaluation of the defined real-time health status assessment algorithms, which involve static rules with personally adapted elements, shows limitations to adapt long-term home monitoring with adequate interpretation of day-to-day changes in the patient's condition. Thus, due to the given sensitivity and specificity of such algorithms, it seems challenging to avoid false high alerts. [ABSTRACT FROM AUTHOR]

Highlights • Contextual factors of patients' everyday lives are important in treatment decision making. • Often contextual factors are not discussed when making treatment decisions. • Clinicians should understand and address the contextual factors when discussing treatments. Abstract Background Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system that mainly affects young adults. While there is no cure for MS, disease modifying treatments (DMTs) reduce the relapse rate and partial accrual of disability. More effective DMTs may have higher risks including life-threatening infections or secondary autoimmunity. The complexity and novelty of available treatments cause challenges for clinicians when prescribing treatments and for people with MS (PwMS) when deciding what trade-offs they are willing and ready to make. Objective To explore the experience of people with relapsing remitting MS (PwRRMS) and their perspectives in choosing treatments. Methods Critical interpretive synthesis was employed to review and synthesis the published literature. Eighty-three publications were selected in a multi-step systematic process. Results Findings are presented in four interrelated areas: the influence of the clinical evidence-base in decision making; the meaning of DMT efficacy for PwRRMS; the influence of models of decision-making and information acquisition practices in PwRRMS; and the importance of psychosocial dimensions in DMT decision making. Synthesis of the findings revealed that alongside medical and individual reasoning, contextual circumstances play an important role in making treatment decisions. Conclusion This review identifies and explains the importance of diverse contextual circumstances (clinical, social, psychological) that are important for PwRRMS when making treatment decisions. The findings demonstrate the importance of eliciting, understanding and addressing such contextual factors. [ABSTRACT FROM AUTHOR]

Background: Although many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population. Method: This is a retrospective review of all patients from December 2010 to February 2012 of at least 15 years of age presenting to the general surgery service with RIF pain. Patient data were divided into derivation and validation groups. Univariate and multiple regression analyses identified significant predictors of appendicitis which were used to construct a CPR. A retrospective validation study was then performed and the CPR was refined accordingly. Finally, the accuracy of the CPR was tested. Results: The final components of the new CPR, the APPEND score, were Anorexia, migratory Pain, local Peritonism, Elevated C‐reactive protein, Neutrophilia and male gender (Dude). This CPR has an area under the receiver operating characteristic curve of 0.84. The CPR can stratify patients into low, intermediate and high‐risk groups which may standardize patient care and reduce the negative appendicectomy rate. Conclusion: A new CPR for predicting appendicitis, in patients presenting with RIF pain, has been derived and validated for use in our population. A prospective study to further evaluate its performance is required. [ABSTRACT FROM AUTHOR]

No clinical risk score is universally accepted for coronary artery disease. In 603 patients (mean age, 61.2 ± 12.3 yr) with stable coronary artery disease, we investigated the predictive power of clinical risk scores derived from the Framingham, the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID), and the Vienna and Ludwigshafen Coronary Artery Disease (VILCAD) studies. Secondary outcomes were the recurrence of an acute thrombotic event (coronary events, strokes, or transient ischemic attacks), or heart failure or death. The primary outcome was the combination of secondary outcomes. During follow-up (duration, 2.08 ± 0.97 yr), 42 patients had an acute thrombotic event; 22, heart failure or death; and 60, the primary outcome. The Framingham score predicted acute thrombotic events: hazard ratio (HR)=1.05; 95% confidence interval (CI), 1.01-1.08; P=0.03; net reclassification index (NRI, calculated to evaluate improvement in prediction gained by adding different risk scores to models constructed with variables excluded from the calculation of that score)=9.7% (95% CI, 9.6-9.8). The LIPID (HR=1.13; 95% CI, 1.04-1.22; P=0.005) and VILCAD scores (HR=1.99; 95% CI, 1.48-2.67; P <0.001) predicted heart failure or death with NRIs of 5.8% (95% CI, 5.7-5.9) and 18.6% (95% CI, 18.3-18.9), respectively. The primary outcome was predicted by the LIPID (HR=1.1; 95% CI, 1.03-1.17; P=0.005) and VILCAD scores (HR=1.39; 95% CI, 1.13-1.70; P=0.003). The NRIs (95% CIs) were 3.4% (3.3-3.5) and 19.4% (19.3-19.6), respectively. We conclude that the accuracy of these risk scores varies in accordance with the outcome studied. [ABSTRACT FROM AUTHOR]

In a healthcare environment that is trying to achieve better clinical outcomes and patient satisfaction, shared decision-making is a well-established concept that is gaining more interest. Multiple sclerosis is a preference-sensitive condition and provides the opportunity to implement decision aids at various decision points in the disease process. Literature about patient education and outcomes of shared decision aids in multiple sclerosis has been growing over the last decade. In this topical review, we present an overview of the current literature on shared decision-making in multiple sclerosis. While limitations to the generalizability and applicability of decision aids exist, there is evidence that decision aids and shared decision-making can be valuable tools in the clinical care of multiple sclerosis patients. [ABSTRACT FROM AUTHOR]

Objectives: A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2).Methods: This was a cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL data from two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to assign PUL as low risk with high confidence (high negative predictive value (NPV)) while classifying most EP as high risk (high sensitivity). The first triage step assigned PUL as low risk using a threshold of serum progesterone at presentation. The remaining PUL were triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low risk as an estimated EP risk of < 5%.Results: On validation, initial serum progesterone ≤ 2 nmol/L (step 1) classified 16.1% PUL as low risk. Second-step classification with the risk model selected an additional 46.0% of all PUL as low risk. Overall, the two-step protocol classified 62.1% of PUL as low risk, with an NPV of 98.6% and a sensitivity of 92.0%. When the risk model was used in isolation (i.e. without the first step), 60.5% of PUL were classified as low risk with 99.1% NPV and 94.9% sensitivity.Conclusion: PUL can be classified efficiently into being either high or low risk for complications using a two-step protocol involving initial progesterone and hCG levels and the hCG ratio. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives A uniform rationalized management protocol for pregnancies of unknown location (PUL) is lacking. We developed a two-step triage protocol to select PUL at high risk of ectopic pregnancy (EP), based on serum progesterone level at presentation (step 1) and the serum human chorionic gonadotropin (hCG) ratio, defined as the ratio of hCG at 48 h to hCG at presentation (step 2). Methods This was a cohort study of 2753 PUL (301 EP), involving a secondary analysis of prospectively and consecutively collected PUL data from two London-based university teaching hospitals. Using a chronological split we used 1449 PUL for development and 1304 for validation. We aimed to assign PUL as low risk with high confidence (high negative predictive value (NPV)) while classifying most EP as high risk (high sensitivity). The first triage step assigned PUL as low risk using a threshold of serum progesterone at presentation. The remaining PUL were triaged using a novel logistic regression risk model based on hCG ratio and initial serum progesterone (second step), defining low risk as an estimated EP risk of < 5%. Results On validation, initial serum progesterone ≤ 2 nmol/L (step 1) classified 16.1% PUL as low risk. Second-step classification with the risk model selected an additional 46.0% of all PUL as low risk. Overall, the two-step protocol classified 62.1% of PUL as low risk, with an NPV of 98.6% and a sensitivity of 92.0%. When the risk model was used in isolation (i.e. without the first step), 60.5% of PUL were classified as low risk with 99.1% NPV and 94.9% sensitivity. Conclusion PUL can be classified efficiently into being either high or low risk for complications using a two-step protocol involving initial progesterone and hCG levels and the hCG ratio. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Market agents with renewable resources face amplified uncertainty when forecasting energy production to securely place bids in electricity markets. To deal with uncertainties, stochastic modelling has been applied to optimize the bidding strategy of these market agents. However, studies found in the literature usually focus on day-ahead and balancing markets, leaving aside intraday markets that could be used to correct bidding positions as uncertainty gets resolved. This paper proposes a multistage stochastic decision-aid algorithm based on linear programming to optimize the bidding strategy of market agents in three different electricity markets - day-ahead, intraday, and balance markets. The market agent represents a Virtual Power Plant with wind, solar PV, and storage technologies, and its participation in three electricity markets was compared to the participation in DA and BM markets only. Results show that participating in all three markets increased the profit achieved by the VPP agent by 10.1% while also decreasing the incurred imbalances by 63.8%. The results demonstrate that having accurate tools to deal with the multi-settlement framework of electricity markets while considering the uncertainties of daily operations is key to a successful integration of renewable energy resources into electricity markets and power systems. • Multistage stochastic optimization model for optimal bidding of VPP agents. • The participation in day-ahead, intraday and balance markets is considered. • Scenarios for wind and solar energy and market prices model uncertainties. • Results of the proposed approach are compared with participating in the day-ahead and balance markets only. [ABSTRACT FROM AUTHOR]

This paper reports on the application of decision counseling based on the analytic hierarchy process (AHP) to assist men in deciding whether or not to schedule a prostate cancer screening exam. The study is based on data that we collected from 129 men enrolled in the intervention arm of two randomized, controlled trials. First, we administered a baseline survey to gather data on participant sociodemographic characteristics and perceptions about prostate cancer and screening. Subsequently, a health educator conducted a session with each man to review an informational booklet on prostate cancer screening. Then, the health educator used an AHP-based decision process that identified the most important factors (both pro or con) that might influence prostate cancer screening preferences, clarified preferences related to scheduling a prostate screening exam, and elicited a scheduling decision. We performed univariable and multivariable logistic regression analyses to identify variables associated with the decision. Of the 129 men enrolled, 85 men (66 percent) decided to schedule a prostate cancer screening exam. Multivariable analyses showed that preference strengths and favorable perceptions of prostate cancer screening predicted the decision to screen. [ABSTRACT FROM AUTHOR]

Objective: We aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident., Methods: A qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile., Results: Fifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement., Conclusions: Agreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:101-108).

Background: Although more than half of the cases of pneumonia in children can be due to virus, most of them receive antibiotic treatment. A previously published clinical prediction rule bacterial pneumonia score (BPS) allows the identification of children with pneumonia who do not require antibiotics, but its impact has not been evaluated. We assessed whether the use of the BPS for the initial management of patients with pneumonia results in decreasing the use of antibiotics than under standard management of this condition without increasing patients' risks., Methods: This was a randomized, parallel-group, observer-blind, controlled clinical trial comparing the use of antibiotics in children aged 3-60 months treated for pneumonia in an outpatient setting, according to two methods of initial management. Patients were assigned randomly to management according to the BPS (antibiotic indication with a BPS ≥ 4 points) or routine management (antibiotic indication based on the institutional guidelines). We calculated the proportion of the use of antibiotics in each group and evaluated each patient's clinical outcome., Results: We included 120 patients (60 BPS and 60 controls) with a mean age of 24.2 ± 14.1 months. The use of antibiotics was significantly lower in the BPS group (46.6% vs. 86.6; OR 0.13; 95% CI: 0.05-0.35; P < 0.001). We observed an unfavorable outcome in 10 patients (8.3%), 5 in each group (P = 1.0; OR: 1.0 95% CI: 0.2-3.6)., Conclusion: The use of antibiotics was significantly lower in the group managed according to the BPS compared to the conventionally treated group, without increasing the rate of treatment failure., (© 2013 Wiley Periodicals, Inc.)