scholarly journals Improving the Scoring System with the Choosing by Advantages (CBA) elements to evaluate Construction-Flows using BIM and Lean Construction = Mejora del sistema Scoring con los elementos de selección por ventajas (CBA) para evaluar los flujos de construcción utilizando BIM y Lean Construction

2019 ◽  
Vol 3 (2) ◽  
pp. 9
Author(s):  
Xavier Brioso ◽  
Claudia Calderón-Hernández
Keyword(s):  
Decision Making ◽  
Scoring System ◽  
Teaching Strategy ◽  
Scoring Systems ◽  
Lean Construction ◽  
Scoring Method ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Choosing By Advantages ◽  
Building Engineering

AbstractThe multicriteria decision-making (MCDM) methods are used as Lean tools, specially, the Choosing by Advantages (CBA) method. CBA has been successfully applied to several construction management projects and it has proven many benefits over the traditional MCDM methods, among them, Scoring method, which is widely used in public and private projects. The main purposes are to improve the Scoring system with the CBA elements and to describe a teaching strategy applied in the School of Civil and Building Engineering. The present study proposes three methods to evaluate the best construction-flow option using 4D models and Lean Construction, based on the adaptation of the CBA system to the Scoring system. It offers a case study in which we select the best construction-flow option during structural work among four clusters of sectorization designs for a residential building. We compare and discuss how it is best to combine the Scoring and CBA approaches, which complement each other. The CBA and modified Scoring systems obtained very similar results. The methods were validated with the similar rankings, the improved collaboration, the survey responses from stakeholders and the transparency of the decision-making process. We recommend the inclusion of CBA elements in the overall framework, to create greater transparency and to reduce the time to reach consensus. The study suggests that MCDM methods combined with 4D models are useful means of achieving better comprehension of the construction flow and thus choosing the best construction alternatives.ResumenLos métodos de toma de decisiones multicriterio (MCDM) se utilizan como herramientas Lean, especialmente, el método de selección por Ventajas (CBA). CBA se ha aplicado con éxito a varios proyectos de gestión de la construcción y ha demostrado muchos beneficios sobre los métodos tradicionales de MCDM, entre ellos, el método de Scoring, el cual se usa frecuentemente en proyectos públicos y privados. Este trabajo tiene como objetivos principales mejorar el sistema de Scoring con los elementos de CBA y describir una estrategia de enseñanza aplicada en una escuela de Ingeniería Civil. El presente estudio propone métodos para evaluar la mejor opción de flujo de construcción utilizando modelos 4D y Lean Construction, basados en la adaptación del sistema CBA al sistema de Scoring. Se ofrece un estudio de caso en el que se selecciona la mejor opción de flujo de construcción entre cuatro grupos de diseños de sectorización para un edificio residencial. Se compara y discute sobre la mejor combinación de los enfoques de Scoring y CBA, los cuales se complementan entre sí. El CBA y el sistema de Scoring modificado obtuvieron resultados muy similares. Los métodos se validaron por medio de resultados similares, colaboraciones optimizadas, respuestas satisfactorias en las encuestas de las partes interesadas y por la transparencia del proceso de toma de decisiones que se percibió. Se recomienda la inclusión de elementos del CBA en el marco general del sistema Scoring, para crear una mayor transparencia y reducir el tiempo para llegar a un consenso. El estudio sugiere que los métodos MCDM combinados con modelos 4D son medios útiles para lograr una mejor comprensión del flujo de construcción y, por lo tanto, elegir las mejores alternativas..

Financiación de las entidades locales de Euskadi en el marcode la Ley 2/2016, de Instituciones Locales de Euskadi

2017 ◽  
pp. 471-501
Author(s):  
Iñaki GALDEANO LARIZGOITIA ◽  
Sebastián ZURUTUZA MUJIKA
Keyword(s):  
Decision Making ◽  
Local Government ◽  
Singular System ◽  
Decision Making Process ◽  
Basic Principles ◽  
Adequate Funding ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Local Funding ◽  
Institutional Participation

LABURPENA: Euskadiko Toki Erakundeei buruzko 2/2016 Legearekin batera Euskal Autonomia Erkidegoko barne instituzionalizazio-prozesua bukatu da, erakundeen beste bi mailekin (foru maila eta erkidego maila) modu harmonikoan egituratu behar den toki-gobernu eredua artikulatuz. Legeak toki-autonomiaren funtsezko bi alderdiak uztartzen ditu: eskumenak eta finantzaketa. Nolanahi ere, foru-erakundeek arlo honetan ekarpen garrantzitsuak egin ditzakete. Legeak izaera integrala dauka, eskumen sistema propio eta berezia osatzea eragingo duena; ezin da finantzaketatik banandu. Finantzaketa nahikoa eta autonomia izatea, finantza-iraunkortasuna eta aurrekontu-egonkortasuna dira Euskadiko Toki Erakundeei buruzko Legeak bermatu nahi dituen toki-ogasunen oinarrizko jarduketa-printzipioen osagaiak. Finantzaketa egokiaren bermea eskumen propioetan zein EAEko udalerriek baliatu dituzten beste eskumen batzuetan proiektatu da —legez edo foru-arauz eman ahal zaizkien eskumen berriak barne— baita transferitu edo eskuordetu daitezkeen eskumenetan ere. Toki-finantzaketaren arloan Euskadiko Toki Erakundeei buruzko Legetik eratorritako sistema instituzionala, oro har, Finantza Publikoen Euskal Kontseiluko erabakiak hartzean udal-ordezkariek daukaten parte hartzeak definitzen du. Horri dagokionez, Lurralde Historikoen Legea aldatzearen ondorioz, toki-finantzaketarako oso garrantzitsuak diren arlo askotako erabakiak hartzean udal-ordezkariak gehituko dira, eskubide osoko kide gisa (ahotsa eta botoa), dualtzat har daitekeen parte-hartze instituzionaleko eredu baten barruan. Eredu horren arabera gaiak banatu egiten dira: batetik, hiru maila instituzionalen parte hartzea behar duten akordioak, eta, bestetik, garrantzitsuak izanik soilik foru eta udal mailakoei dagozkienak (parte-hartze maila edo eredu horizontala ekarpenen legeetan). RESUMEN: La Ley 2/2016 de Instituciones Locales de Euskadi (LILE) culmina el proceso de institucionalización interna de la Comunidad Autónoma de Euskadi articulando un modelo de gobierno local que debe vertebrarse de manera armónica con los otros dos niveles dos niveles institucionales (foral y autonómico). Es una ley que, sin perjuicio de las importantes atribuciones que en este ámbito tienen las instituciones forales, integra los dos aspectos sustantivos de la autonomía local: competencias y financiación. Carácter integral que va a determinar la configuración de un sistema competencial propio y singular que no puede disociarse de su financiación. La suficiencia y autonomía financiera, junto con la estabilidad presupuestaria y la sostenibilidad financiera, constituyen los principios de actuación básicos de las haciendas locales que la LILE trata de garantizar. La garantía de financiación adecuada se proyecta tanto sobre las competencias propias que vienen ejerciendo los municipios vascos como sobre las nuevas competencias que les puedan ser atribuidas por ley o norma foral o que les puedan ser transferidas o delegadas. El sistema institucional, en materia de financiación local, que se deriva de la LILE, viene definido fundamentalmente por el modelo de participación de los re presentantes municipales en la toma de decisiones del Consejo Vasco de Finanzas Públicas. A este respecto, con la consiguiente modificación de la Ley de Territorios Históricos, se incorporan los representantes municipales, como miembros de pleno derecho (voz y voto) en la toma de decisiones acerca de un significativo número de materias de gran trascendencia para la financiación local, dentro de un modelo de participación institucional que podemos calificar de dual. Modelo conforme al cual se diferencia entre aquellas materias cuyos acuerdos precisan de la participación de los tres niveles institucionales y aquellas otras, de especial importancia (nivel de participación o modelo horizontal en leyes de aportaciones), cuyos acuerdos solamente competen a los niveles foral y municipal. ABSTRACT: Act 2/2016 on Local Entities of Euskadi (LILE) brings to an end the process of internal institutionalization of the Autonomous Community of Euskadi by articulating a local government model that has harmoniously to be built upon the other two levels of institutions (foral and autonomous). It is an act that, with no prejudice to the important attributions foral institutions have in this area, comprehends two substantive features of local autonomy: competences and funding. That comprehensive character is going to determine the configuration of an own and singular system of competences which cannot be dissociated from its funding. The financial sufficiency and autonomy, together with the budgetary stability are the basic principles of action of local government finances that LILE tries to guarantee. The guarantee for an adequate funding is projected both to own competences that Basque municipalities are already exercising and to new competences that can be attributed either by act or by foral rule or that can be transferred or delegated. The institutional system, in the field of local funding, that results from LILE is mainly defined by the model of participation by the municipal representatives in the decision-making process of the Basque Committee for Public Finances. In this regard, with the consequential amendment of the Act on Historic Territories, the municipal representatives will be incorporated as full members (with voice and vote) in the decision-making process in a significant amount of very important issues for the local funding within the model of institutional participation which can be qualified as twofold. A model according to whom those issues whose agreement requires the participation of the three institutional levels and those others, with particular relevance (level of participation or horizontal model in act of contributions) whose agreement does only affect the foral and municipal levels.

scholarly journals Dos cuestiones clave en la regulación jurídica de los partidos políticos: financiación y democracia interna = Two Key Issues in the legal Regulation of political Parties: Financing and internal Democracy

2015 ◽  
pp. 183
Author(s):  
Martin Morlok
Keyword(s):  
Decision Making ◽  
Political Parties ◽  
Essential Element ◽  
Legal Regulation ◽  
Democratic Process ◽  
Political Decision ◽  
Democratic State ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Political Decision Making

Political parties are an essential element for the correct functioning of a democratic state. Through them, citizens may express their interests and beliefs, but also participate in political decision-making. For these reasons, in order to ensure that the parties comply with theis duties, it is necessary the existence of its regulation, specifically of two of its most problematic areas: its financing and its internal democracy. This paper focuses on these two aspects starting from the idea that the democratic process is a competitive process and that in any democratic process, all citizens should have equal opportunities to express their beliefs and interests in the political field. To achieve this goal it is necessary, on the one hand regulate the financial system of political parties, which ultimately will determine the resources of the parties and their chance of success; and on the other hand, it is necessary regulate the process of decision-making within the same party, as this will be a mechanism that may reach to concrete the subjects who will occupy positions of political decision-making positions.Los partidos políticos constituyen un elemento indispensable para el correcto funcionamiento de un Estado democrático. A través de ellos, los ciudadanos expresan sus intereses y creencias, pero también participan en la toma de decisiones políticas. Por estos motivos, con el fin de garantizar que los partidos cumplan con sus funciones, se hace necesaria la existencia de una regulación de los mismos, concretamente de dos de sus ámbitos más problemáticos: su financiación y la democracia interna. Este trabajo se centra en estos dos aspectos partiendo de la idea de que el proceso democrático es un proceso competitivo y de que en todo proceso democrático, todos los ciudadanos deberían tener las mismas oportunidades para expresar sus creencias e intereses en el terreno político. Para conseguir este objetivo se hace necesario, por un lado regular el sistema financiero de los partidos políticos, que en último término, determinará los recursos de los partidos y su posibilidad de éxito; y, por otro lado, se hace necesario regular el proceso de toma de decisiones dentro del mismo partido, pues será este un mecanismo que podrá a llegar a concretar los sujetos que ocuparán cargos políticos de toma de decisión.

scholarly journals Estrategias gerenciales y actores sociales: trayectoria del modelo de relaciones laborales en Ford Hermosillo (1986-2001)

2016 ◽  
Vol 14 (24) ◽  
Author(s):  
Sergio A. Sandoval Godoy ◽  
Gabriela García Figueroa
Keyword(s):  
Decision Making ◽  
Labor Relations ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Action Strategies ◽  
Work Relationship ◽  
Transformation Processes

Resumen:En este trabajo se analizan las características y trayectoria del modelo de relaciones laborales en Ford Hermosillo, a la luz del papel que han desempeñado las distintas estrategias de acción y toma de decisiones de parte de la gerencia, trabajadores y sindicato. Con esto se intenta distinguir los procesos de experimentación, aprendizaje y de respuesta que han estado presentes en los últimos 15 años. Para tal propósito, se aborda el sistema de relaciones laborales como espacio que se transforma ante condiciones externas e internas estructuralmente inciertas donde se dirimen los procedimientos de trabajo y la negociación de intereses. También se analiza como espacio de politización que estructura los campos en conflicto y la configuración de la empresa. Bajo esta óptica se observa una praxis empresarial y laboral cualitativamente distinta a otras experiencias, que permite entender los procesos de acción y transformación de la empresa como fenómenos complejos que ponen de manifiesto la variedad de respuestas en el nivel de la relación capital-trabajo.Palabras clave : relaciones laborales; toma de decisiones; procedimientos de trabajo; procesos de transformación; relación capital-trabajo. Abstract:The characteristics and the course of the model of labor relations in Ford Hermosillo, in the light of the role played by the different action strategies and decision making by the management, the workers and the union are analized here. The objective is to characterize the processes of experimentation, learning and response in the last 15 years. With this aim, the system of labor relations as a space which changes under uncertain-structurally external and internacional conditions, where work procedures and negotiations are settled, is analysed here. Also, it is approached as an space for politization which structures the conflicting areas and the shaping of the company. From this viewpoint, there's an evident business and labor praxis qualitatively different to other experiences, so the action and transformation processes of the company can be understood as complicated phenomena which reveals the different responses at the capital-work relationship level.Key words: labor relations; decision making; work procedures; transformation processes; capital-work relationship.

A reduced scoring system for the Clock Drawing Test using a population-based sample

2012 ◽  
Vol 24 (11) ◽  
pp. 1738-1748 ◽  
Author(s):  
Alexandra Jouk ◽  
Holly Tuokko
Keyword(s):  
Scoring System ◽  
Scoring Systems ◽  
Population Based ◽  
Clinical Samples ◽  
Scoring Method ◽  
Clock Drawing Test ◽  
Clock Drawing ◽  
Dementia Screening ◽  
Drawing Test ◽  
Drawing Task

ABSTRACTBackground: Many scoring systems exist for clock drawing task variants, which are common dementia screening measures, but all have been derived from clinical samples. This study evaluates and combines errors from two published scoring systems for the Clock Drawing Test (CDT), the Lessig and Tuokko methods, in order to create a simple yet optimal scoring procedure to screen for dementia using a Canadian population-based sample.Methods: Clock-drawings from 356 participants (80 with dementia, 276 healthy controls) from the Canadian Study on Health and Aging were analyzed using logistic regression and Receiver Operating Characteristic curves to determine a new, simplified, population-based CDT scoring system. The new Jouk scoring method was then compared to other commonly used systems (e.g. Shulman, Tuokko, Watson, Wolf-Klein).Results: The Jouk scoring system reduced the Lessig system even further to include five critical errors: missing numbers, repeated numbers, number orientation, extra marks, and number distance, and produced a sensitivity of 81% and a specificity of 68% with a cut-off score of one error. With regard to other traditionally used scoring methods, the Jouk procedure had one of the most balanced sensitivities/specificities when using a population-based sample.Conclusions: The results from this study improve our current state of knowledge concerning the CDT by validating the simplified scoring system proposed by Lessig and her colleagues in a more representative sample to mimic conditions a general clinician or researcher will encounter when working among a wide-ranging population and not a dementia/memory clinic. The Jouk CDT scoring system provides further evidence in support of a simple and reliable dementia-screening tool that can be used by clinicians and researchers alike.

scholarly journals The WAVE model and its application; Simulation of the substances water and agrochemicals in the soil, crop and vadose environment

2003 ◽  
Vol 4 (1) ◽  
pp. 36 ◽  
Author(s):  
Anthony Timmerman ◽  
Jan Feyen
Keyword(s):  
Climate Change ◽  
Decision Making ◽  
Systems Approach ◽  
Simulation Models ◽  
Wave Model ◽  
Wave System ◽  
Mathematical Tool ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Soil And Water

<p>Expansion of human activities has major impact on the environment, generating changes that must be countered, such as climate change and dispersion of pollutants from industry and agriculture, through strategies that enable the conservation of soil and water reserves. The implementation of strategies with systems approach, covering mathematical simulation models, enables better decision making and a better understanding of the complexity and interaction of the different processes that affect the fate of nutrients, pollutants and chemicals in the environment - soil –  on cultures and dynamic water. The WAVE system is presented in this article as a mathematical tool that describes the transport and transformations of matter and energy in the soil, crops and unsaturated soil, however it is not support the processes of water groundwater, drains and rivers.</p><p> </p><p><strong>Aplicaciones del modelo WAVE: simulación del crecimiento del cultivo y del </strong><strong>movimiento del agua y los agroquímicos en la zona no saturada del suelo.</strong></p><p>La expansión de las actividades humanas tiene gran impacto en el medio ambiente, generando cambios que deben ser contrarrestados, como el cambio climático y la dispersión de contaminantes de la industria y la agricultura; a través de estrategias que permitan la conservación del suelo y de las reservas de agua. La implementación de estrategias con enfoque de sistemas, que abarque modelos de simulación matemáticos, permite una mejor toma de decisiones y una mejor comprensión de  la complejidad y la interacción de los diferentes procesos que afectan el destino de los nutrientes, contaminantes y sustancias químicas en el medio ambiente - suelo-  en los cultivos  y en las zonas de movimiento de aguas. El sistema WAVE se presenta en el presente artículo como una herramienta matemática que describe el transporte y transformaciones de la materia y la energía en el suelo, los cultivos y el suelo no saturado, sin embargo no es compatible con los procesos de las aguas subterráneas, drenajes  y ríos.</p>

scholarly journals Aplicación de la teoría de las decisiones a las SIEFORES en México

2017 ◽  
Vol 9 (17) ◽  
Author(s):  
Humberto Banda Ortiz ◽  
Luis Miguel González García ◽  
Denise Gómez Hernández
Keyword(s):  
Decision Making ◽  
Decision Theory ◽  
Expected Utility ◽  
Decision Making Process ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Decision Making Model

Abstract: There are different theories that try to explain the decision making process. These theories set out some possible decision scenarios. In this article we applied the decision theory to the different options offered by SIEFORES yields, in order to demonstrate performance and risk in some scenario. In this paper first at all we study decision theory, following we explain the SIEFORES system in Mexico. In the last part we apply decision making model to the SIEFORES.Keywords: Decision theory, SIEFORES, the expected utility theoremResumen: Existen diferentes teorías que, bajo razonamientos matemáticos, tratan de explicar el proceso de toma de decisiones. En dichas teorías se establecen algunos de los posibles escenarios de decisión. En el presente artículo se aplica la teoría de las decisiones a las diferentes alternativas que ofrecen los rendimientos de las SIEFORES, con el fin de demostrar el rendimiento y el riesgo que, bajo diversos escenarios, proporcionan dichas alternativas. En este trabajo se plantea primeramente la teoría de las decisiones. Seguidamente se hace un recorrido por el sistema de SIEFORES en México para ubicar al lector en la problemática que nos ocupa. Finalmente se aplica el modelo de toma dedecisiones a las SIEFORES.Palabras clave: Teoría de decisiones, SIEFORES, Teorema de la Utilidad Esperada

scholarly journals Development of a radiographic scoring system for new bone formation in gout

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Chang-Nam Son ◽  
Ken Cai ◽  
Sarah Stewart ◽  
John Ferrier ◽  
Karen Billington ◽  
...  
Keyword(s):  
Bone Formation ◽  
Scoring System ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Scoring Systems ◽  
Joint Analysis ◽  
New Bone Formation ◽  
Scoring Method ◽  
Tophaceous Gout ◽  
Ct Measurements

Abstract Background Features of new bone formation (NBF) are common in tophaceous gout. The aim of this project was to develop a plain radiographic scoring system for NBF in gout. Methods Informed by a literature review, scoring systems were tested in 80 individual 1st and 5th metatarsophalangeal joints. Plain radiography scores were compared with computed tomography (CT) measurements of the same joints. The best-performing scoring system was then tested in paired sets of hand and foot radiographs obtained over 2 years from an additional 25 patients. Inter-reader reproducibility was assessed using intraclass correlation coefficients (ICC). NBF scores were correlated with plain radiographic erosion scores (using the gout-modified Sharp-van der Heijde system). Results Following a series of structured reviews of plain radiographs and scoring exercises, a semi-quantitative scoring system for sclerosis and spur was developed. In the individual joint analysis, the inter-observer ICC (95% CI) was 0.84 (0.76–0.89) for sclerosis and 0.81 (0.72–0.87) for spur. Plain radiographic sclerosis and spur scores correlated with CT measurements (r = 0.65–0.74, P < 0.001 for all analyses). For the hand and foot radiograph sets, the inter-observer ICC (95% CI) was 0.94 (0.90–0.98) for sclerosis score and 0.76 (0.65–0.84) for spur score. Sclerosis and spur scores correlated highly with plain radiographic erosion scores (r = 0.87 and 0.71 respectively), but not with change in erosion scores over 2 years (r = −0.04–0.15). Conclusion A semi-quantitative plain radiographic scoring method for the assessment of NBF in gout is feasible, valid, and reproducible. This method may facilitate consistent measurement of NBF in gout.

scholarly journals Análisis de un ejemplo de optimización de producción industrial utilizando algoritmos genéticos

2017 ◽  
Vol 1 (1) ◽  
pp. 74-81
Author(s):  
Lina María Franco Arias
Keyword(s):  
Decision Making ◽  
Production Process ◽  
Production System ◽  
Adaptive Methods ◽  
El Sistema ◽  
Toma De Decisiones ◽  
Living Organisms

En este artículo se explica cómo llevar a cabo la optimización de la producción basada en la optimización de las variables involucradas en un proceso determinado. Para esto, se optimizaron las funciones que describen el proceso de producción. Para realizar dicha optimización, se utilizaron algoritmos genéticos, métodos adaptativos que pueden utilizarse para resolver problemas reales de búsqueda y de optimización, que imitan los procesos genéticos de los organismos vivos. La información del resultado de la optimización ayudó en la toma de decisiones, en la planeación y en la ejecución de las operaciones, en el sistema productivo. Abstract In this paper it explain how to perform optimization of production based on optimizing the variables that are involved in a given process, for that, the functions that describe the production process are optimized. To perform this optimization, geneticalgorithms are used which are adaptive methods that can be used to solve real problems search and optimization based on genetic processes imiting living organisms are used. Result information of the optimization helped in decision-making, in the planning and in the execution of operations in the production system.

Is There Need a Specific Scoring System for Acute Appendicitis During Pregnancy?

2020 ◽  
Author(s):  
Baris Mantoglu ◽  
Emre Gonullu ◽  
Yesim Akdeniz ◽  
Merve Yigit ◽  
Necattin Firat ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Pregnant Women ◽  
Predictive Value ◽  
Scoring System ◽  
Scoring Systems ◽  
Gestation Period ◽  
Categorical Variables ◽  
Scoring Methods ◽  
Scoring Method ◽  
In Pregnancy

Abstract BackgroundAcute appendicitis is the most common non-gynecological emergency during pregnancy. The diagnosis of appendicitis during pregnancy is challenging due to both physiological and laboratory changes. As such, the surgeon needs additional guidance, other than imaging methods, before deciding a surgical intervention. Various scoring methods have been defined and evaluated for the diagnosis of acute appendicitis for a long time. There is no definition of a score for the gestation period, and the comparison of the currently applied scoring methods during the gestation period is not available in the literature.The purpose of our study is to evaluate the efficacy of the most popular scoring systems applied in the diagnosis of acute appendicitis in pregnancy and the tips for introduction to a scoring method for the pregnancy period.MethodsThis single-center retrospective study consists of 79 pregnant patients who were admitted to the emergency department with abdominal pain between May 2014, May 2019 and were diagnosed with acute appendicitis and underwent an appendectomy together with 79 non-pregnant control group who underwent appendectomy for the last 1.5 years. Both laboratory and examination findings required for the scoring methods of the patients were obtained and calculated separately for each patient. Negative appendectomy rates were evaluated according to pathology results. Categorical variables were compared by the Chi-Square test. Categorical variables were presented as a count and percentage. A p-value <0.05 was considered significant. Receiver operator characteristic (ROC) curve analysis was used to identify the best cut-off value and assess the performance of the test score for appendicitis.ResultsThe Tzanakis Score is the strongest among the scoring systems used in non-pregnant women. The positive predictive value (PPV = 90.60) of the Tzanakis Score is 90.6% while the negative predictive value (NPV = 46.7) is 46.7%. RIPASA seems to be the strongest among the scoring systems used in pregnant women. While PPV of this scoring method is 94.40%, NPV is 44%, its sensitivity and specificity are 78.46% and 78.57%, respectively.ConclusionsAlthough the RIPASA score is considerable effective in pregnancy in the diagnosis of acute appendicitis among all scoring systems, a specific scoring system is necessitated for the gestation period.

399 Complex Limb Injuries – Limb Salvage vs Amputation: An Overview of the Factors Influencing Decision-Making and Outcomes

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Jamal ◽  
A Sheeraz
Keyword(s):  
Decision Making ◽  
Limb Salvage ◽  
Scoring System ◽  
Scoring Systems ◽  
Psychological Status ◽  
Limb Amputation ◽  
Secondary Outcome ◽  
Initial Examination ◽  
Joint Decision ◽  
Limb Injuries

Abstract Aim Complex limb injuries usually comprise of a combination of osseous, soft tissue, vascular and neural damage, necessitating prompt and accurate initial examination and decision-making to maximise optimal patient outcomes. We present the factors affecting the decision-making as well as the outcomes following primary limb amputation or salvage of complex extremity injuries, with an emphasis on the various scoring systems present that endeavour to offer prognostic and therapeutic guidance to orthopaedic surgeons. Method We performed the literature search on PubMed and Embase, and collated the relevant data comprising of demographics, injury, scoring system, primary and secondary outcome metrics and complications. Results Many scoring systems, each with variable factors, have been proposed to predict limb salvage vs amputation in complex extremity injury (MESS, PSI, LSI, NISSSA, HFS-97), however the landmark LEAP trial concluded in its final analysis that they could not validate them. Whilst the scores were useful in predicting limb salvage, they were inaccurate and unreliable in predicting amputation with low sensitivities Conclusions Many scoring systems attempt to provide guidance regarding decision-making in limb salvage vs primary amputation, however the LEAP study has shown poor predictive standards of these systems. As such, there is no gold standard algorithmic approach or scoring system when making this difficult decision – instead, the poor predictors of limb salvage have been identified, and the surgeons need to be judicious and make a joint decision considering these variables and other patient factors (social, economic, and psychological status).

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