BACKGROUND & AIMS: BACKGROUND:Low utilization of effective coronary heart disease (CHD) prevention strategies may be due to many factors, but chief among them is the lack of patient involvement in prevention decisions. We undertook this study to test the effectiveness of an individually-tailored, computerized decision aid about CHD on patients' discussions with their doctor and their plans for CHD prevention. METHODS:We conducted a pilot randomized trial in a convenience sample of adults with no previous history of cardiovascular disease to test the effectiveness of an individually-tailored, computerized decision aid about CHD prevention against a risk factor list that patients could present to their doctor. RESULTS:We enrolled 75 adults. Mean age was 53. 59% were female, 73% white, and 23% African-American. 66% had some college education. 43% had a 10-year CHD risk of 0-5%, 25% a risk of 6-10%, 24% a risk of 11-20%, and 5% a risk of > 20%. 78% had at least one option to reduce their CHD risk, but only 45% accurately identified the strategies best supported by evidence. 41 patients received the decision aid, 34 received usual care. In unadjusted analysis, the decision aid increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% (absolute difference 16%; 95% CI -4% to +37%) and increased the proportion who had a specific plan to reduce their risk from 24% to 37% (absolute difference 13%; 95% CI -7% to +34%). In pre-post testing, the decision aid also appeared to increase the proportion of patients with plans to intervene on their CHD risk (absolute increase ranging from 21% to 47% for planned medication use and 5% to 16% for planned behavioral interventions). CONCLUSION:Our study confirms patients' limited knowledge about their CHD risk and effective risk reduction options and provides preliminary evidence that an individually-tailored decision aid about CHD prevention might be expected to increase patients' discussions about CHD prevention with their doctor and their plans for CHD risk reduction. These findings should be replicated in studies with a larger sample size and patients at overall higher risk of CHD.

背景与目标：

BACKGROUND & AIMS: Systematic reviews can be a very useful decision-making tool because they objectively summarize large amounts of information, identify gaps in medical research, and identify beneficial or harmful interventions. Consumers can use systematic reviews to help them make health care decisions. Policymakers can use systematic reviews to help them make decisions about what types of health care to provide. Despite the potential value of systematic reviews, little evidence of their direct impact on the decisions made by consumers and policymakers is available. We discuss strategies for optimizing the use of systematic reviews by increasing the awareness and identification of reviews, learning to critically evaluate the findings of reviews, and overcoming barriers to the incorporation of reviews into the decision-making process. In addition, the participation of consumers and policymakers in the design, conduct, and reporting of systematic reviews can help to produce reviews that are relevant and understandable to target audiences. Because decisions that involve health care policies and issues are complex processes in which information (such as that provided by systematic reviews) plays only a part, strategies for increasing the use of systematic reviews should be evaluated for their usefulness in the decision-making process.

背景与目标： 系统评价可以是一个非常有用的决策工具，因为它们客观地总结了大量信息，确定了医学研究中的差距，并确定了有益或有害的干预措施。消费者可以使用系统的评论来帮助他们做出医疗保健决策。政策制定者可以使用系统的审查来帮助他们决定提供哪些类型的医疗保健。尽管系统审查具有潜在的价值，但几乎没有证据表明它们对消费者和政策制定者做出的决定有直接影响。我们讨论了通过提高对评论的认识和识别，学会批判性地评估评论的结果以及克服将评论纳入决策过程的障碍来优化系统评论使用的策略。此外，消费者和政策制定者参与系统审查的设计，进行和报告可以帮助产生与目标受众相关且易于理解的评论。由于涉及医疗保健政策和问题的决策是复杂的过程，其中信息 (例如由系统审查提供的信息) 仅起一部分作用，因此应评估增加使用系统审查的策略在决策过程中的有用性。

BACKGROUND & AIMS: BACKGROUND:In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. METHODS:A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. RESULTS:Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. CONCLUSION:This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts.

背景与目标：

BACKGROUND & AIMS: :Possible options in a decision often organize as a hierarchy of subdecisions. A recent study concluded that perceptual processes in primates mimic this hierarchical structure and perform subdecisions in parallel. We argue that a flat model that directly selects between final choices accounts more parsimoniously for the reported behavioral and neural data. Critically, a flat model is characterized by decision signals integrating evidence at different hierarchical levels, in agreement with neural recordings showing this integration in localized neural populations. Our results point to the role of experience for building integrated perceptual categories where sensory evidence is merged prior to decision.

背景与目标： : 决策中的可能选项通常组织为子决策的层次结构。最近的一项研究得出的结论是，灵长类动物的感知过程模仿了这种层次结构，并并行执行子决策。我们认为，直接在最终选择之间进行选择的平面模型对报告的行为和神经数据更为宽容。至关重要的是，扁平模型的特征是决策信号在不同的层次级别上集成了证据，与神经记录一致，表明这种集成在局部神经种群中。我们的结果指出了经验在建立综合感知类别中的作用，在这些类别中，感官证据在做出决定之前就已合并。

BACKGROUND & AIMS: PURPOSE:To assess how different diagnostic decision aids perform in terms of sensitivity, specificity, and harm. METHODS:Four diagnostic decision aids were compared, as applied to a simulated patient population: a findings-based algorithm following a linear or branched pathway, a serial threshold-based strategy, and a parallel threshold-based strategy. Headache in immune-compromised HIV patients in a developing country was used as an example. Diagnoses included cryptococcal meningitis, cerebral toxoplasmosis, tuberculous meningitis, bacterial meningitis, and malaria. Data were derived from literature and expert opinion. Diagnostic strategies' validity was assessed in terms of sensitivity, specificity, and harm related to mortality and morbidity. Sensitivity analyses and Monte Carlo simulation were performed. RESULTS:The parallel threshold-based approach led to a sensitivity of 92% and a specificity of 65%. Sensitivities of the serial threshold-based approach and the branched and linear algorithms were 47%, 47%, and 74%, respectively, and the specificities were 85%, 95%, and 96%. The parallel threshold-based approach resulted in the least harm, with the serial threshold-based approach, the branched algorithm, and the linear algorithm being associated with 1.56-, 1.44-, and 1.17-times higher harm, respectively. Findings were corroborated by sensitivity and Monte Carlo analyses. CONCLUSION:A threshold-based diagnostic approach is designed to find the optimal trade-off that minimizes expected harm, enhancing sensitivity and lowering specificity when appropriate, as in the given example of a symptom pointing to several life-threatening diseases. Findings-based algorithms, in contrast, solely consider clinical observations. A parallel workup, as opposed to a serial workup, additionally allows for all potential diseases to be reviewed, further reducing false negatives. The parallel threshold-based approach might, however, not be as good in other disease settings.

背景与目标：

BACKGROUND & AIMS: :This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

背景与目标： : 这项研究是 “促进老龄移民能力” 计划的一部分，该计划采用以人为中心的小组会议和一次个人家访，以延长从芬兰或西巴尔干地区移民到瑞典的70岁以上人群的日常活动独立性。为了了解计划的结果，该研究旨在探索参与者在计划中使用健康促进信息的日常经验。采用扎根理论的方法，对12名年龄在70-83岁的人参加该计划六个月至一年后进行了采访。参与者体验了如何使用促进健康的信息是一个动态的过程，如何决定立即采取行动以满足自己或他人的健康相关需求或推迟采取行动。还确定了五个子过程: 获得内在力量，应对可用资源的挑战，关注值得了解的内容，应对健康风险以及确定为他人辩护的机会。结果表明，该计划可以发展个人技能，以支持为克服健康相关挑战而移民的老年人。他们进一步证明了在个人资源阻碍行动之前支持其健康素养的重要性，并呼吁研究克服环境对健康的障碍的方案。

BACKGROUND & AIMS: :Much of our science and technology relies on the visualization of complex data, and chemical biology, more than most fields, often deals with complex datasets. There are, however, other ways of making information available to our senses beyond the visual. Rare individuals naturally have sensory crossover, whose synesthesia permits them, for example, to see colors or shapes when hearing sounds or to sense a specific taste with a specific word. Many scientists, technologists and inventors, however, make a conscious attempt to convert one type of sensory-like input to a different sensory output. A laser light show, for example, converts sound to sight; infrared imaging converts heat to sight. Two recent examples of such intentional synesthesia are discussed in this context: sight-tasting and smell-seeing.

背景与目标： : 我们的许多科学技术都依赖于复杂数据的可视化，而化学生物学比大多数领域更多地处理复杂数据集。但是，还有其他方法可以使我们的感官获得视觉以外的信息。稀有个体自然具有感觉交叉，例如，其联觉使他们能够在听到声音时看到颜色或形状，或者用特定的单词感知特定的味道。但是，许多科学家，技术人员和发明家都有意识地尝试将一种类似感觉的输入转换为不同的感觉输出。例如，激光表演将声音转换为视线; 红外成像将热量转换为视线。在这种情况下，讨论了这种故意联觉的两个最近的例子: 视觉品尝和嗅觉观察。

BACKGROUND & AIMS: BACKGROUND:Road traffic injuries contribute substantially to the disease burden in India. This paper describes the road safety issues discussed by members of the Indian Parliament, and highlights the gaps that need to be addressed to make road safety visible as a public health problem to policy-makers in India. METHODS:All questions asked to and information provided by the Ministry of Road Transport and Highways, and questions relating to accident asked to the Ministry of Health and Family Welfare of the Government of India were reviewed for the two Houses of the Indian Parliament for the years 2002 to 2004. RESULTS:Of the 1529 questions asked to the Ministry of Road Transport and Highways, only 140 (9.1%) were related to road safety, whereas 1076 (70.5%), 181 (11.8%), 51 (3.3%) and 81 (5.3%) were related to other aspects of the national highways, state roads, vehicles and other issues, respectively. Data on the magnitude of road crashes dealt only with the number of crashes and fatalities and not with the age, sex and type of road users affected by road traffic injuries. The parliamentarians were informed that human error was the main cause of road crashes in India; however, the robustness of this information is questionable. Strategies to prevent road crashes focused mainly on training of drivers with little attention to other factors that cause road crashes. The discussion on legislations also focused on drivers, ignoring other road users. Ten of the 4741 questions (0.2%) asked to Ministry of Health and Family Welfare were related to accident, the majority of which were about the setting up of trauma care services. CONCLUSION:An appropriate policy and intervention response by policy-makers is not possible with data that are presented in a manner that do not highlight the true nature of the problem, and are neither comprehensive nor robust. Majority of the proposed road safety interventions by the Ministry of Road Transport and Highways are based on the traditional view of human error as a major cause of road crashes highlighting the lack of a scientific public health approach towards prevention of road crashes. It would be useful to build the technical capacity of the Ministry of Road Transport and Highways in road safety to use the available data more effectively, and to facilitate generation of further relevant data about the magnitude, underlying causes and impact of road traffic injuries, for policy-makers to better understand the critical issues for planning effective road safety policies and interventions to reduce the high burden of mortality and morbidity due to road crashes in India.

背景与目标：

BACKGROUND & AIMS: :The computational prediction of gene and protein function is rapidly gaining ground as a central undertaking in computational biology. Making sense of the flood of genomic data requires fast and reliable annotation. Many ingenious algorithms have been devised to infer a protein's function from its amino acid sequence, 3D structure and chromosomal location of the encoding genes. However, there are significant challenges in assessing how well these programs perform. In this article we explore those challenges and review our own attempt at assessing the performance of those programs. We conclude that the task is far from complete and that a critical assessment of the performance of function prediction programs is necessary to make true progress in computational function prediction.

背景与目标： : 作为计算生物学的一项核心工作，基因和蛋白质功能的计算预测正在迅速发展。理解基因组数据的泛滥需要快速可靠的注释。已经设计了许多巧妙的算法来从蛋白质的氨基酸序列，3D结构和编码基因的染色体位置推断蛋白质的功能。但是，在评估这些程序的性能方面存在重大挑战。在本文中，我们探讨了这些挑战，并回顾了我们自己评估这些程序性能的尝试。我们得出的结论是，该任务远未完成，并且必须对功能预测程序的性能进行严格评估，才能在计算功能预测方面取得真正的进展。

BACKGROUND & AIMS: OBJECTIVES:The objectives of the study were (1) to assess similarities and differences between breast cancer patients and their husbands in terms of doctor-patient/spouse relationships and shared decision making; and (2) to investigate the association between breast cancer patients and husbands in terms of preference of type of doctor, doctor-patient relationship, and shared decision making regarding medical treatment. METHOD:Fifty-seven women with breast cancer, and their husbands, completed questionnaires measuring doctor-patient/spouse relationships (paternalism, autonomy), and decision making regarding medical treatment. RESULTS:Patients believe they have a key role in the medical decision-making process (93%) and that the participation of their husbands, and their agreement with the decision, is important (84% and 89%, respectively). Both breast cancer patients and their husbands prefer a shared decision-making process to paternalistic or autonomy-based approaches. CONCLUSION:In contrast to legal and bioethical approaches, which focus on the patient as the primary decision maker, this study reflects a practical recognition of the role of the breast cancer patient's husband in the decision-making process. It also reflects a relational rather than an individualistic perception of patient autonomy.

背景与目标：

BACKGROUND & AIMS: :Mutagenic activity was monitored during the time course of the vinification process of a Portuguese red wine using the Ames assay. Dependence upon faecalase treatment for detection of mutagenicity was evaluated concurrently with HPLC analysis of the flavonoids rutin and quercetin. Rutin (quercetin-o-3-rutinoside) is liberated from the grapes during the first 10 days of the process and is hydrolysed as the vinification process proceeds. This explains the levels of the free quercetin in the wine and mutagenicity in the absence of faecalase treatment. Mutagenicity in the presence of faecalase during the first 26 days of the process correlates with the levels of rutin, and in the absence of faecalase the highest mutagenic activity detected (160th day) coincides with the highest level of free quercetin. Our results do not rule out the possibility that other mutagens are present in wines, in particular oxidative-type mutagens.

背景与目标： : 使用Ames测定法在葡萄牙红酒的酿造过程中监测诱变活性。与类黄酮芦丁和槲皮素的HPLC分析同时评估了对粪便醛酶处理检测致突变性的依赖性。芦丁 (quercetin-o-3-rutinoside) 在该过程的前10天从葡萄中释放出来，并随着酿酒过程的进行而水解。这解释了葡萄酒中游离槲皮素的水平以及在没有粪醛酶处理的情况下的致突变性。在该过程的前26天中，在存在粪便醛酶的情况下的致突变性与芦丁的水平相关，并且在不存在粪便醛酶的情况下，检测到的最高诱变活性 (第160天) 与游离槲皮素的最高水平一致。我们的结果并不排除葡萄酒中存在其他诱变剂的可能性，特别是氧化型诱变剂。

BACKGROUND & AIMS: BACKGROUND AND OBJECTIVES:Horizon scanning systems need to handle a wide range of sources to identify new or emerging health technologies. The objective of this study is to develop a validated Medline bibliographic search strategy (PubMed search engine) to systematically identify new or emerging health technologies. METHODS:The proposed Medline search strategy combines free text terms commonly used in article titles to denote innovation within index terms that make reference to the specific fields of interest. Efficacy was assessed by running the search over a period of 1 year (2009) and analyzing its retrieval performance (number and characteristics). For comparison purposes, all article abstracts published during 2009 in six preselected key research journals and eight high impact surgery journals were scanned. Sensitivity was defined as the proportion of relevant new or emerging technologies published in key journals that would be identified in the search strategy within the first 2 years of publication. RESULTS:The search yielded 6,228 abstracts of potentially new or emerging technologies. Of these, 459 were classified as new or emerging (383 truly new or emerging and 76 new indications). The scanning of 12,061 journal abstracts identified 35 relevant new or emerging technologies. Of these, twenty-nine were located within the Medline search strategy during the first 2 years of publication (sensitivity = 83 percent). CONCLUSIONS:The current search strategy, validated against key journals, has demonstrated to be effective for horizon scanning. Even though it can require adaptations depending on the scope of the horizon scanning system, it could serve to simplify and standardize scanning processes.

背景与目标：

BACKGROUND & AIMS: This paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.

背景与目标： 本文概述了决策理论在医疗保健中的应用范围。首先，讨论了决策理论的主要方法和假设。其次，对医疗保健决策进行了回顾。值得注意的是，决策理论可以应用于医疗保健专业人员或非专业人员。考虑了决策理论在临床实践，护理管理和资源配置中的应用。第三，确定了一些可以回报进一步研究的领域。其中包括个人和群体决策中的社会过程，结果的时间分布以及能够处理决策的复杂和动态特征的技术的发展。在上述基础上，得出了一些结论。

BACKGROUND & AIMS: INTRODUCTION/BACKGROUND:The impact of having a child with atypical genitalia due to a life-threating chronic medical condition like congenital adrenal hyperplasia (CAH) is poorly understood. OBJECTIVE:The aim of the study was to determine parental stress and impact of CAH on parental decisions, including decisions regarding female genital restoration surgery (FGRS). STUDY DESIGN:The authors surveyed consecutive parents of girls with CAH ≤3 years presenting at a tertiary referral center for FGRS consultation (2016-2019). The survey was developed by three families of daughters with CAH and six clinicians. Nine potentially stressful past experiences were rated on a 6-point Likert scale ('not at all' to 'extremely' stressful). Overall parental stress and strain (broader negative consequences) were reported using validated instruments (Perceived Stress Scale and Caregiver Strain Questionnaire Short Form, respectively). Impact of CAH on past decisions about childcare, social interactions, and who changes diapers were also assessed. Non-parametric tests were used for analysis. RESULTS:Twenty-nine parents (median age: 32years) of 22 consecutive children participated (Prader 3/4/5: 59.1%/36.4%/4.5%). After the study, 20 girls (90.9%) underwent FGRS at a median age of 8 months. The most stressful experiences were having an adrenal crisis ('very much' stressful), waiting for the CAH diagnosis, and making sense of the diagnosis (both 'quite a bit') (Figure 1). Remaining issues were 'somewhat' stressful. Deciding whether to proceed with FGRS was ranked as the least stressful issue. Overall parental stress was similar to overall stress previously reported by spousal caregivers of stroke or heart failure survivors (P ≥ 0.15). Overall parental strain was similar to parents of adolescents receiving mental health counseling (P = 0.77). Congenital adrenal hyperplasia impacted decisions about babysitting, daycare, who changed diapers, and choosing a pediatrician (P ≤ 0.02), but did not impact parental social interactions (P ≥ 0.11). Diapers were typically changed by parents (100.0%) and grandmothers (50.0%). Parents anticipated that some individuals currently not allowed to change diapers would be allowed after FGRS: grandfathers (+18.2%), aunts/uncles (+27.3-32.8%), cousins (+18.2%), and family friends (+45.5%). DISCUSSION:The authors present the first assessment of parental stress with respect to different aspects of care of a daughter with CAH. Larger studies are required to determine if the parental stress associated with these experiences varies over time and how these stressors rank relative to each other through the child's development. CONCLUSION:Parents experience multiple stressors after having a daughter with CAH. Parental stress surrounding a decision about FGRS appears less severe than events pertaining to the diagnosis and medical management of CAH. Congenital adrenal hyperplasia impacts multiple parental decisions.

背景与目标：

BACKGROUND & AIMS: :A formal modeling approach was used to characterize decision-making processes in bipolar disorder. Decision making was examined in 28 bipolar patients (14 acute and 14 remitted) and 25 controls using the Iowa Gambling Task (Bechara et al., 1994), a decision-making task used for assessing cognitive impulsivity. To disentangle motivational and cognitive aspects of decision-making processes, we applied a formal cognitive model to the performance on the Iowa Gambling Task. The model has three parameters: The relative impact of rewards and punishments on evaluations, the impact of recent and past payoffs, and the degree of choice consistency. The results indicated that acute bipolar patients were characterized by low choice consistency, or a tendency to make erratic choices. Low choice consistency improved the prediction of acute bipolar disorder beyond that provided by cognitive functioning and self-report measures of personality and temperament.

背景与目标： : 使用正式建模方法来表征双相情感障碍的决策过程。使用Iowa赌博任务 (Bechara等，1994) 在28位双相情感障碍患者 (14位急性和14位缓解) 和25位对照中检查了决策，这是一种用于评估认知冲动的决策任务。为了消除决策过程的动机和认知方面，我们将正式的认知模型应用于爱荷华州赌博任务的表现。该模型具有三个参数: 奖励和惩罚对评估的相对影响，近期和过去收益的影响以及选择的一致性程度。结果表明，急性双相情感障碍患者的选择一致性低，或倾向于做出不稳定的选择。低选择一致性改善了急性双相情感障碍的预测，超出了认知功能和自我报告的人格和气质测量所提供的预测。