scholarly journals Early-, Late-, and Very Late-Term Prediction of Target Lesion Failure in Coronary Artery Stent Patients: An International Multi-Site Study

2021 ◽  
Vol 11 (15) ◽  
pp. 6986
Author(s):  
Elisabeth Pachl ◽  
Alireza Zamanian ◽  
Myriam Stieler ◽  
Calvin Bahr ◽  
Narges Ahmidi
Keyword(s):  
At Risk ◽  
Coronary Artery ◽  
Phase I ◽  
Decision Support Tool ◽  
Target Lesion ◽  
Post Intervention ◽  
Support Tool ◽  
Coronary Artery Stent ◽  
Target Lesion Failure ◽  
The Right

The main intervention for coronary artery disease is stent implantation. We aim to predict post-intervention target lesion failure (TLF) months before its onset, an extremely challenging task in clinics. This post-intervention decision support tool helps physicians to identify at-risk patients much earlier and to inform their follow-up care. We developed a novel machine-learning model with three components: a TLF predictor at discharge via a combination of nine conventional models and a super-learner, a risk score predictor for time-to-TLF, and an update function to manage the size of the at-risk cohort. We collected data in a prospective study from 120 medical centers in over 25 countries. All 1975 patients were enrolled during Phase I (2016–2020) and were followed up for five years post-intervention. During Phase I, 151 patients (7.6%) developed TLF, which we used for training. Additionally, 12 patients developed TLF after Phase I (right-censored). Our algorithm successfully classifies 1635 patients as not at risk (TNR = 90.23%) and predicts TLF for 86 patients (TPR = 52.76%), outperforming its training by identifying 33% of the right-censored patients. We also compare our model against five state of the art models, outperforming them all. Our prediction tool is able to optimize for both achieving higher sensitivity and maintaining a reasonable size for the at-risk cohort over time.

Multidimensional Phase I Dose Ranging Trials for Stroke Recovery Interventions: Key Challenges and How to Address Them

2021 ◽  
pp. 154596832110193
Author(s):  
Emily J. Dalton ◽  
Leonid Churilov ◽  
Natasha A. Lannin ◽  
Dale Corbett ◽  
Bruce C. V. Campbell ◽  
...  
Keyword(s):  
Decision Support ◽  
Phase I ◽  
Early Phase ◽  
Phase I Trial ◽  
Systematic Approach ◽  
Decision Support Tool ◽  
Maximum Tolerated Dose ◽  
Stroke Recovery ◽  
Support Tool ◽  
Dose Ranging

Despite an increase in the amount of published stroke recovery research, interventions have failed to markedly affect the trajectory of recovery poststroke. We argue that early-phase research to systematically investigate dose is an important contributor to advance the science underpinning stroke recovery. In this article, we aim to ( a) define the problem of insufficient use of a systematic approach to early-phase, multidimensional dose articulation research and ( b) propose a solution that applies this approach to design a multidimensional phase I trial to identify the maximum tolerated dose (MTD). We put forward a design template as a decision support tool to increase knowledge of how to develop a phase I dose-ranging trial for nonpharmaceutical stroke recovery interventions. This solution has the potential to advance the development of efficacious stroke recovery interventions, which include activity-based rehabilitation interventions.

Transparency Issues Within a Transport Buyer and Provider Relationship

2020 ◽  
pp. 78-95
Author(s):  
Eirill Bø
Keyword(s):  
Supply Chain ◽  
Decision Support ◽  
Decision Support Tool ◽  
Food Distribution ◽  
Household Waste ◽  
Support Tool ◽  
Time Parameters ◽  
The Right ◽  
The Cost ◽  
The Relationship

Transport is an important function in the supply chain. This chapter focuses on how to buy a transport service, how to form a transport contract, and how a transparent relationship will influence the risk and the relationship between transport provider and buyer. By developing a decision support tool (DST-model) and calculating the cost and the time parameters, the right price and the cost drivers will appear. The cases described in this chapter are a large Norwegian wholesaler for food, distribution to the retailer, and two Norwegian municipalities collecting household waste. In these cases, the buyer and the provider are acting blind in setting the transport price. This means that there is a huge risk for either a bankruptcy by the transport provider or an overpriced transport for the buyer.

scholarly journals Towards Designing Tools for Universities’ R&D Performance Measurement on Mobile Platform

2019 ◽  
Vol 13 (04) ◽  
pp. 178
Author(s):  
Mohd Faizal Omar ◽  
Siti Rasifah Ahmad Roshidi ◽  
Jastini Mohd. Jamil ◽  
Fazillah Mohmad Kamal ◽  
Mohd Nasrun Mohd Nawi ◽  
...  
Keyword(s):  
Decision Making ◽  
Performance Indicator ◽  
Decision Support Tool ◽  
Education Institution ◽  
Mobile Platform ◽  
Support Tool ◽  
Prototype Development ◽  
The Moment ◽  
The Right ◽  
The Impact

<p class="Abstract">At the moment, there is a great interest in most universities to achieve higher ranking for better international standings and visibility. With shrinking resources such as financial and infrastructures, there is also a huge demand for the university to move forward and perform better in Research and Development (R&amp;D) in each evaluation year. Key Performance Indicator (KPI) is an excellent tool to enculturate research in a Higher Education Institution (HEI). The culture must be built upon HEI’s strength and weaknesses. Hence, the right decision making tool must be develop to priorities different agendas such as QSWUR, THE, etc. Mobile platform provide an efficient way to engage with stakeholders particularly to measure HEI performance on R&amp;D. There are three main activities involves for developing a decision support tool for measuring R&amp;D impact in HEIs i.e. development of decision model using multi criteria decision making, dashboard prototype development including and UI/UX for mobile platform. This paper describe the importance of measuring the impact of R&amp;D, prioritization technique and the process of prototype development. It is anticipates that our work could mitigate the gaps and improve the research ecosystem in HEIs.</p>

scholarly journals Safety and Efficacy of Guidezilla Extension Catheter for the Percutaneous Treatment of Complex Coronary Lesions

2020 ◽  
Vol 23 (2) ◽  
pp. E147-E150
Author(s):  
Tao Chen ◽  
Weihao Xu ◽  
Yulun Cai ◽  
Qi Wang ◽  
Jun Guo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Percutaneous Treatment ◽  
Target Lesion ◽  
Lesion Length ◽  
Circumflex Artery ◽  
Chronic Total Occlusions ◽  
Left Circumflex Artery ◽  
Coronary Lesions ◽  
Procedural Success ◽  
The Right

Background: The GuidezillaTM support extension catheter is designed to provide extra back-up support and efficient device delivery during complex percutaneous coronary interventions (PCIs), such as in treatment of severe calcification, tortuous chronic total occlusions (CTOs), and coronary anomalies. The aim of this study was to describe our initial experience with the GuidezillaTM extension catheter in the treatment of complex coronary artery lesions. Methods: This study retrospectively analyzed data from 165 PCI cases that used the GuidezillaTM guide extension catheter between March 2015 and August 2017. We collected patient clinical characteristics, target lesion characteristics, and procedural details. Results: Eighty-six percent of patients had complex Type C lesions, and 13.9% had Type B lesions. Lesion length ranged from 8 mm to 130 mm (≤ 20 mm, 15.4%; 20–40 mm, 35.8%; > 40 mm, 49.1%). The right coronary artery (59.2%) was the most common intervention vessel followed by the left ascending artery (30.6%) and the left circumflex artery (10.2%). CTO accounted for 38% of all lesions, followed by distortions (28%), heavy calcification (24%), proximal stent thrombosis (9%), and coronary artery origin anomalies (1%). A total of 142 patients underwent successful PCI using the GuidezillaTM extension catheter. The success rate was 86%. Conclusion: The GuidezillaTM guide extension catheter was an effective and safe technique in the transradial treatment of complex coronary lesions. Use of the GuidezillaTM guide extension catheter can shorten the procedure time and ensure overall procedural success with a reduced complication rate in cases where adequate progress using angioplasty devices has not been achieved.

scholarly journals Impact of a Clinical Decision-Support Tool on Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients

2020 ◽  
Vol 36 (4) ◽  
pp. 141-147
Author(s):  
Brandon George ◽  
Samantha Gonzales ◽  
Krishna Patel ◽  
Stephanie Petit ◽  
Andrew J. Franck ◽  
...  
Keyword(s):  
Decision Support Tool ◽  
Bleeding Risk ◽  
Clinical Decision ◽  
Medical Patients ◽  
Post Intervention ◽  
Support Tool ◽  
Vte Prophylaxis ◽  
Risk Patients ◽  
Clinical Decision Support Tool ◽  
High Bleeding Risk

Background: Adherence to guideline-based venous thromboembolism (VTE) prophylaxis recommendations is often inadequate. Effective improvement strategies are needed. Objective: The purpose of this quality improvement initiative was to increase use of the facility’s preferred pharmacologic VTE prophylaxis, reduce unnecessary VTE prophylaxis use, and reduce use of pharmacologic VTE prophylaxis in high bleeding risk patients, in accordance with guideline-based recommendations. Methods: Clinical pharmacists spearheaded the development and implementation of a clinical decision-support tool (CDST) integrated within a Veterans Health Administration electronic health record (EHR). The CDST focused on VTE prophylaxis in acutely ill medical patients and guided prescribers to guideline-based recommendations. Following review and approval, the CDST underwent activation in the EHR. A subsequent intervention occurred, year 2 post-intervention, which embedded this CDST into the EHR admission process and admission menus. A drug message was added in the EHR to alert prescribers that low-molecular-weight heparin was the preferred agent. Measures were evaluated pre-intervention, year 1 post-intervention, and year 2 post-intervention. Results: After intervention, there were statistically significant increases in the proportion of patients receiving the facility’s preferred pharmacologic VTE prophylaxis agent, enoxaparin, and a statistically significant decrease in the proportion of unwarranted VTE prophylaxis. The proportion of inappropriate pharmacologic VTE prophylaxis in high bleeding risk patients decreased, but this result did not reach statistical significance. Conclusion: The improvements observed suggest the beneficial role of CDSTs integrated into the EHR to increase adherence to guideline-based VTE prophylaxis recommendations.

Performance Evaluation of the National Housing File (FNL) for the Development of E-Governance in the Housing Sector in Algeria

2019 ◽  
Vol 8 (4) ◽  
pp. 60-73
Author(s):  
Ouahiba Belhocine ◽  
Kahina Amal Djiar ◽  
Meriem Lagati
Keyword(s):  
Information Technology ◽  
Performance Evaluation ◽  
Decision Support Tool ◽  
Housing Sector ◽  
Housing Supply ◽  
Major Step ◽  
Support Tool ◽  
Noticeable Improvement ◽  
The Right ◽  
National Housing

The housing sector in Algeria has undergone huge transformations to improve the supply process. One of the major changes that has been operated is related to the introduction of information technology in the practice of controlling the eligibility of applicants for public housing. As a result, the National Housing File has been created, marking hereby a major step towards the development of e-governance in Algeria. Yet, despite this noticeable improvement, the housing supply process remains very complex. This is mainly linked to the multi-sectoral character of the procedure, which requires the involvement of various actors and institutions. The objective of this paper is to assess the strengths and weaknesses of the National Housing File, which has been conceived as a decision support tool to housing supply. The paper examines the process through which data is gathered and evaluation of potential beneficiaries is made. It sheds light on the issues that hinder the right functioning of the National Housing File and delay the development of e-governance in an effective way.

A decision support tool to determine cost-to-benefit of a family-centered in-home program for at-risk adolescents

2016 ◽  
Vol 56 ◽  
pp. 43-49 ◽  
Author(s):  
Fernando A. Wilson ◽  
Ozgur M. Araz ◽  
Ronald W. Thompson ◽  
Jay L. Ringle ◽  
W. Alex Mason ◽  
...  
Keyword(s):  
At Risk ◽  
Decision Support ◽  
Decision Support Tool ◽  
Support Tool ◽  
Home Program ◽  
At Risk Adolescents ◽  
Family Centered

Randomized trial of a hospice video decision aid for patients with advanced cancer and their caregivers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11513-11513
Author(s):  
Areej El-Jawahri ◽  
Olivia Vanbenschoten ◽  
Alyssa L. Fenech ◽  
Amanda L. Jankowski ◽  
Netana Markovitz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Advanced Cancer ◽  
Decision Aid ◽  
Hospice Care ◽  
Decision Support Tool ◽  
Verbal Description ◽  
Post Intervention ◽  
Support Tool ◽  
Video Group ◽  
The Impact

11513 Background: Although hospice provides high-quality end-of-life (EOL) care for patients with advanced cancer and their family caregivers, the service remains underutilized in part due to lack of adequate information provided to patients and families about hospice care. Methods: We conducted a single-site randomized clinical trial of a hospice video decision aid versus a verbal description in 150 hospitalized patients with advanced cancer and their caregivers. Patients without an available caregiver were still eligible to participate. Intervention participants (75 patients; 18 caregivers) received a verbal description about hospice plus a six-minute video depicting hospice care. Control participants (75 patients; 26 caregivers) received only the verbal description. The primary endpoint was patient preference for hospice care immediately after the intervention, adjusting for baseline preferences. Secondary outcomes included patient and caregiver knowledge and perceptions of hospice (Hospice Perception and Knowledge Questionnaire). Results: Between 2/2017 and 1/2019, we enrolled 55.7% (150/269) of potentially eligible patients and 44 caregivers. Post-intervention, patients assigned to the video group were more likely to prefer hospice care at the EOL (86.7% vs. 82.7%, OR = 2.85, P = 0.08), but this was not statistically significant. Patients in the video group reported greater knowledge about hospice (B = 0.50, P = 0.024) and were less likely to endorse that hospice care is only about death (6.7% vs. 21.6%, OR = 0.28, P = 0.035). Post-intervention, caregivers assigned to the video were more likely to prefer hospice care for their loved ones (94.4% vs. 65.4%, P = 0.031), reported greater knowledge about hospice (B = 1.94, P < 0.001), and were less likely to endorse that hospice care is only about death (0.0% vs. 23.1%, P = 0.066). Conclusions: Patients with advanced cancer and their caregivers who viewed a hospice video decision support tool were more informed about hospice care and reported more favorable perceptions of hospice. Future work should examine the impact of the video on hospice utilization and length-of-stay among patients with advanced cancer. Clinical trial information: NCT03040102.

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