Reevaluating onsite wastewater systems: expert recommendations and municipal decision-making

Water Policy ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 1062-1078 ◽  
Author(s):  
Sridhar Vedachalam ◽  
Veeravenkata S. Vanka ◽  
Susan J. Riha
Keyword(s):  
Decision Making ◽  
Treatment Options ◽  
Small Sample ◽  
Essential Information ◽  
Onsite Wastewater ◽  
Onsite Wastewater Treatment Systems ◽  
Consulting Firms ◽  
The Usa ◽  
Wastewater Systems

Onsite wastewater treatment systems (OWTS) serve 20–25% of the households in the USA, and large parts of rural Canada, Australia, and Europe. Urbanization and newer environmental standards are leading many communities that currently rely on OWTS to think of alternatives. We study this decision-making in 19 municipalities across the USA through the unique lens of feasibility reports commissioned by the respective municipalities and authored by engineering/design consulting firms. The reports omitted certain essential information relevant to the decision-making process, and were not of high quality due to a lack of specificity on various parameters. However, the reports evaluated a balanced mix of decentralized and centralized treatment options, and the final recommendations were not biased in any particular direction. Most municipalities failed to take any follow-up action on the report recommendations, calling into question the motive behind commissioning these reports. Although not representative of the entire USA, the small sample of feasibility reports evaluated here is indicative in nature and provided significant insights about the inputs that help municipalities make decisions on complex issues.

scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

scholarly journals 0755 Pitolisant (Wakix) is an Effective Anti-Cataplexy Agent in Narcolepsy Type 1

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A287-A287
Author(s):  
G J Meskill
Keyword(s):  
Clinical Judgment ◽  
Small Sample Size ◽  
Treatment Options ◽  
Standard Of Care ◽  
The United States ◽  
Substantial Improvement ◽  
Small Sample ◽  
Adult Patients

Abstract Introduction Harmony Biosciences initiated the Pitolisant Expanded Access Clinical Evaluation (PEACE) program to allow treatment with pitolisant in adult patients with narcolepsy while pitolisant was an investigational medication in the United States. Starting in March 2019, Comprehensive Sleep Medicine Associates (CSMA) offered enrollment to patients who met the inclusion/exclusion criteria and who were deemed appropriate based on clinical judgment. All patients who enrolled were taking at least one standard-of-care agent for narcolepsy at enrollment. Many of the enrolled patients had refractory/challenging cases of narcolepsy. On August 14, 2019, Wakix received FDA approval for the treatment of excessive daytime sleepiness in adult patients with narcolepsy, which contrasts with the European label that states that Wakix is indicated for the treatment of narcolepsy in adults with or without cataplexy. Methods CSMA enrolled 21 patients in the PEACE program. The charts for all 10 narcolepsy type 1 (NT1) patients were reviewed. The 2 patients who did not have follow up after starting pitolisant were excluded. Results Of the 8 NT1 patients who had at least one follow up visit after initiating pitolisant, 6 reported substantial improvement or complete resolution of cataplexy compared to baseline. For example, one patient’s wife stated, “I forgot my husband was funny because he would avoid telling jokes until he started pitolisant.” Another stated, “I have not had an episode of cataplexy since starting pitolisant.” 5 of these patients were taking an anti-cataplectic agent at the time of starting pitolisant (sodium oxybate 3, venlafaxine 2). Conclusion While a relatively small sample size, these results demonstrate that in a “real world” uncontrolled population of refractory/challenging NT1 patients, pitolisant is an effective anti-cataplectic agent. As there are relatively few treatment options for NT1, clinicians should consider use of pitolisant for patients with cataplexy, and further consideration for adding an indication for pitolisant to treat cataplexy is warranted. Support Harmony Biosciences (PEACE trial)

scholarly journals Using DEMATEL Technique to Identify the Key Success Factors of Shared Decision-Making Based on Influential Network Relationship Perspective

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Wen-Yi Liu ◽  
Tao-Hsin Tung ◽  
Yen-Ching Chuang ◽  
Ching-Wen Chien
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Success Factors ◽  
Treatment Options ◽  
Multiple Attribute Decision Making ◽  
Medical Decision ◽  
Shared Decision ◽  
Care Plans ◽  
Multiple Attribute

In the field of medicine, shared decision-making (SDM) is an important issue primarily aimed at resolving the problem of information asymmetry between clinicians and patients in the selection of treatment options and follow-up nursing plans. Most previous studies on this topic have focused on key elements and the development and implementation of SDM scales. This study used the decision-making trial and evaluation laboratory (DEMATEL) method to establish a network of influence relationships among factors that are keys to the success of the SDM process. Survey data were obtained from a well-known brain hospital in China. The key factors of success included tailor information, flexibility approach, check understanding patient, document (discussion about) decision, present evidence, make or explicitly defer decision, and patient values and preferences. We determined that clinicians should provide a series of treatment options and follow-up care plans based on a patientʼs conditions and preferences. Clinicians should also actively communicate with patients and their families to ensure a thorough understanding of the entire treatment and nursing process. This study also highlights the academic value of the cross-disciplinary integration of medical decision issues and multiple attribute decision-making methodologies.

scholarly journals 0749 Case Simulations in Obstructive Sleep Apnea and Narcolepsy: Patients That Keep You Up at Night

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A285-A285
Author(s):  
R K Bogan ◽  
K Rorie ◽  
W E Faler ◽  
T Gross ◽  
J Perez ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Options ◽  
Educational Activity ◽  
Post Intervention ◽  
Continued Education ◽  
Obstructive Sleep ◽  
Performance Effects ◽  
And Performance ◽  
Using Data

Abstract Introduction 3 CME interventions used online case simulations to facilitate the recognition of residual EDS in patients with narcolepsy and OSA and to improve decision-making when developing strategies for long-term management of residual EDS. Methods Outcomes data were obtained from 3, 30-minute case simulations on residual EDS. Surveys assessing knowledge, confidence, and behavior were administered pre- and post-activity. A separate evaluation provided demographics and other variables used in the model. Data from a 2-month follow-up survey were analyzed to determine performance effects on the learner population (n = 30) compared to matched controls (n = 30). Statistical comparisons of data from baseline to post-intervention were made using McNemar’s tests and paired t-tests. Additionally, predictive modeling was applied to evaluate variables predictive of evidence-based decisions. A longitudinal analysis of results was conducted to evaluate knowledge and performance changes in sleep-related initiatives between 2016 - 2019. Results Learners outperformed controls in utilizing the Epworth Sleepiness Scale (ESS) and are more likely to interpret ESS scores to confirm EDS diagnosis and select appropriate treatment options in managing patients with EDS. Further, learners are more likely than controls to engage in shared decision-making with patients. When given a real-world case, learners are more likely than controls to identify symptoms and order correct tests. Learners were also more likely to select best treatment options for the patient more often than non-learners. Continued education needs to focus on treatment options for patients with narcolepsy. Conclusion Follow-up assessments were conducted to understand lasting performance in learners attributable to this education. Using data from learners compared to matched controls, we found the education had an effect size of 23% (Cohen’s d = 0.33). This indicates that for every 100 clinicians exposed to this education, 23 will perform more according to evidence than if they were not exposed. Support The educational activity described in this abstract was supported by an educational grant from Jazz Pharmaceuticals, Inc.

Evaluating the most popular diabetes websites in the USA: a content analysis

2020 ◽  
Vol 35 (6) ◽  
pp. 1394-1405
Author(s):  
Bree E Holtz
Keyword(s):  
Content Analysis ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Online Information ◽  
Essential Information ◽  
Wide Variability ◽  
The Usa ◽  
Multiple Query ◽  
Website Content

Abstract Over 1.5 million Americans are diagnosed with diabetes every year, and the majority of them go online to learn about their condition. Unfortunately, the online diabetes landscape is crowded, and the quality of website content is unknown—guidance for patients and healthcare providers regarding online diabetes information is needed. To address this, nine of the top diabetes websites in the USA were identified through a comprehensive, multiple-query search and a content analysis was conducted. Two coders, with high inter-coder reliability, evaluated these websites on six factors: (i) Design; (ii) Credibility; (iii) Accessibility; (iv) Literacy; (v) Engagement; and (vi) Diabetes Content. The analysis revealed that the websites presented most of the assessed design features. Few of the sites scored well on the credibility assessment, while the majority of sites did not note an author, editor or reviewer. With regard to accessibility, less than half of the items we assessed were met. Furthermore, the websites possessed wide variability in literacy, with an average readability grade level of 8.8. Most of the websites fared well in engagement, demonstrating multiple avenues to interact with the organization. All of the websites provided basic information regarding diabetes, but many did not include information for caregivers, providers or insurance information. In conclusion, patients and their family members will continue to seek online information about diabetes, its effects and treatment options. Therefore, this multiple-metric evaluation provides essential information for these individuals, and healthcare providers, who can now give better informed website recommendations to their patients and families.

scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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