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Background: To evaluate the quality of the decision-making processes of pharmaceutical companies during medicines development for evidence generation to support reimbursement of new medicines and the appraisal recommendation decis...
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Background: To evaluate the quality of the decision-making processes of pharmaceutical companies during medicines development for evidence generation to support reimbursement of new medicines and the appraisal recommendation decision-making process by health technology assessment (HTA) agencies. Methods: Two questionnaires were developed and subsequently piloted for the purpose of content validation. These were sent to 24 pharmaceutical companies and 16 HTA agencies. Results: Responses were obtained from 11 companies and 11 HTA agencies. Some similarities were identified between the decision-making processes of companies and agencies, such as the use of committees, having a primarily mixed (qualitative/quantitative) internal decisionmaking system, as well as the lack of systematic assessments of quality decision making and the relatively infrequent use of formal decision-making frameworks. Nevertheless, the results indicate differences as companies and agencies use diverse processes to arrive at the final decision either through consensus, majority vote, or an individual making the decision. The majority of companies and agencies believe that the quality of decision making can and should be measured. Moreover, organizations considered the occurrence of biases within their organization as pertinent. Finally, almost all the participants felt that there was room for improvement for their organization's quality of decision making. Conclusion: These findings are consistent with a published study on regulatory processes and support the need for more consistent and predictable decision-making processes during the life cycle of medicines. This could be achieved through capacity building, systematically evaluating the quality of decision making, and encouraging utilization of formal decision-making frameworks within companies and agencies.
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Purpose - The purpose of this paper is to explore the system requirements model. According to the concept of loss costs of Type I and Type II errors, it can define the optimal decision line, and reduce overall loss costs. Moreover...
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Purpose - The purpose of this paper is to explore the system requirements model. According to the concept of loss costs of Type I and Type II errors, it can define the optimal decision line, and reduce overall loss costs. Moreover, it can decrease the probability of Type I and Type II error by the systems thinking, and it can effectively reduce overall loss costs. Design/methodology/approach - The paper proposed a system demand model and constructed a decision-making system thinking model as well as a decision-making performance management model using the principle of system demand. Types of decision-making errors were analyzed to set judgments on the error risk and establish a model of improvement evaluation key factors, in order to reduce decision-making error risk and enhance decision quality. It also constructed the improved decision-making to assess the key factors, to reduce the risk of making errors in order to improve the quality of decision-making. Findings - Optimistic decision-makers (risk takers) tend to make Type II errors, whereas pessimistic decision makers (conservatives) tend to make Type I errors. Financial depressions are the time for optimistic decision makers (risk takers) and boom periods are the time for pessimistic decision makers (conservatives). Originality/value - The concept of the loss cost of two decision-making errors and related cost function models were proposed. Decision makers could make decisions with a more stable model, taking into consideration false alarms and the cost function of errors in order to determine the position of the decision-making line. It could effectively reduce decision-making error costs and increase the precision of decision-making.
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Many critical decisions require evaluation of accumulated previous information and/or newly acquired evidence. Although neural correlates of belief updating have been investigated, how these neural processes guide decisions involv...
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Many critical decisions require evaluation of accumulated previous information and/or newly acquired evidence. Although neural correlates of belief updating have been investigated, how these neural processes guide decisions involving Bayesian choice is less clear. Here, we used functional MRI to investigate neural activity during a Bayesian choice task involving two sources of information: base rate odds ('odds') and sample evidence ('evidence'). Thirty-seven healthy control individuals performed the Bayesian choice task in which they had to make probability judgements. Average functional MRI activity during the trials where choice was consistent with use of Odds, use of Evidence, and use of Both was compared. Decision-making consistent with odds, evidence and both each strongly activated the bilateral executive network encompassing the bilateral frontal, cingulate, posterior parietal and occipital cortices. The Evidence consistent, compared with Odds consistent, decisions showed greater activity in the bilateral middle and inferior frontal and right lateral occipital cortices. Decisions consistent with the use of Both strategies were associated with increased activity in the bilateral middle frontal and superior frontal cortices. These findings support the conclusion that both overlapping and distinct brain regions within the frontoparietal network underlie the incorporation of different types of information into a Bayesian decision. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Background: Patient preference (PP) information is not effectively integrated in decision-making throughout the medical product lifecycle (MPLC), despite having the potential to improve patients' healthcare options. A first step r...
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Background: Patient preference (PP) information is not effectively integrated in decision-making throughout the medical product lifecycle (MPLC), despite having the potential to improve patients' healthcare options. A first step requires an understanding of existing processes and decision-points to know how to incorporate PP information in order to improve patient-centric decision-making.
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Organizations often require decisions to be made by a group, and decision makers often have fuzzy preferences for alternatives and individual judgments when attempting to reach an optimal solution. In order to deal with the fuzzin...
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Organizations often require decisions to be made by a group, and decision makers often have fuzzy preferences for alternatives and individual judgments when attempting to reach an optimal solution. In order to deal with the fuzziness of preference of decision makers, this paper proposes an integrated fuzzy group decision-making method. This method allows group members to express fuzzy preferences for alternatives and individual judgments for solution selection criteria. It also allowed for the weighting of group members. The method then aggregates these elements into a compromise group decision which is the most acceptable for the group as a whole. This method has been implemented and tested. An example is presented to illustrate the method.
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There are lingering questions about the effectiveness of the watch, warning, and advisory system (WWA) used to convey weather threats in the United States. Recently there has been a shift toward alternative communication strategie...
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There are lingering questions about the effectiveness of the watch, warning, and advisory system (WWA) used to convey weather threats in the United States. Recently there has been a shift toward alternative communication strategies such as the impact-based forecast. The study reported here compared users' interpretation of a color-coded impact-based prototype designed for email briefings, to a legacy WWA format. Participants, including emergency managers and members of the public, saw a weather briefing and rated event likelihood, severity, damage, and population affected. Then they recommended emergency response actions. Each briefing described the severity of the weather event and the degree of impact on population and property. In one condition a color-coded impacts scale was added to the text description. In another, an advisory and/or warning was added to the text description. These were compared with the text-only control. Both emergency managers and members of the public provided higher ratings for event likelihood, severity, damage, and population affected and recommended a greater response for higher impact levels regardless of format. For both groups, the color-coded format decreased ratings for lower-impact events. Among members of the public, the color-coded format also led to increases for many ratings and greater response at higher levels relative to the other two conditions. However, the highest ratings among members of the public were in the WWA condition. Somewhat surprisingly, the only effect of the WWA format on emergency managers was to reduce action recommendations, probably because of the inclusion of the "advisory" in some briefings.
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The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has a...
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The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has arisen as the dominant approach for clinicians and patients to collaborate in care planning and implementation. This approach relies heavily on normative (rational) decision-making processes, and often leaves out descriptive influences that stem from personal, social, and environmental factors and explain how decisions are typically made in the real world. The lack of attention to descriptive decision-making limits SDM in many ways. A multi-level approach to expanding the practice of SDM is proposed, including tailoring the decision encounter based on patients' social, cultural, and environmental context; using relational elements strategically as part of the SDM process; and modifying incentive models to promote greater attention to descriptive impacts on decision-making. These modifications are expected to make SDM, and thus patient care, more inclusive, effective, and acceptable to diverse patients.
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With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on th...
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With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment. (C) 2018 Elsevier Inc. All rights reserved.
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PURPOSE: Do teams manage to reach better decisions than those made by individuals? Numerous studies have delivered inconclusive results. Meanwhile, participation in decision-making can take various forms and is not limited to cons...
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PURPOSE: Do teams manage to reach better decisions than those made by individuals? Numerous studies have delivered inconclusive results. Meanwhile, participation in decision-making can take various forms and is not limited to consensus group decisions, and the influence of the various forms of participation on the quality of decisions has been less frequently examined. The aim of the research was to determine the effect on decision quality of changing the form of direct participation in the decision-making process in the case of complex, multi-stage problems. METHODOLOGY: The article presents the results of a long-term experiment in which 598 teams of 2,673 people took part. The participants were asked to solve a decision problem using three decision-making styles: autocratic, consultative, and group. The participants played the role of members of a newly established project team that must plan its own work. The task concerned a problem that requires the analysis of a number of dependencies between sub-problems, in contrast to eureka-type problems. The decision problem was new to the participants, making it impossible to apply known solutions;a creative approach was therefore required. The decision was then compared with the optimal solution established by experts. Decision quality was based on the deviation of the proposed solution from the optimal solution. FINDINGS: The results of the experiment confirm the significant synergistic potential of increasing direct participation in decision-making for complex, multi-stage problems. A significant proportion of teams made better decisions as a result of increasing direct participation – replacing autocratic decisions with consultative and group decisions. The quality of consultative decisions was roughly in the middle of autocratic and group decisions. By using group decision-making, teams made better decisions than the average individual decision and came closer to the decision quality achieved by the best team members. This effect was universal, observed both in the strongest and weakest teams. It should be remembered that, while group decision-making has the potential for synergy, it is not always achieved. Group decision-making markedly reduced the risk of making highly misguided decisions, and it can be reasoned that direct participation protects against serious mistakes more than it guarantees the best possible results. IMPLICATIONS: Team leaders should be familiar with different decision-making styles, their advantages and disadvantages, and the scope of their application. This research suggests that increasing team members’ participation to a consultative role and even better, a full participatory role, increases the quality of the decision. With the growing complexity of organizations that have to deal with accelerating change, technology development and increased competition, creating structures that can flexibly respond to the challenges of the environment requires the participation of team members at all managerial levels. The use of consultative and group decision-making styles for complex and multi-stage problems supports this process. The group decision-making style can bring better quality, but it has its limitations and it is not always possible to use it. It requires a team of highly competent people who identify themselves with the interests of the organization. Otherwise, the consultative form will bring better results. ORIGINALITY AND VALUE: For the first time, an empirical study analyses the case of consultative decision-making, in which the team leader consults the individual opinions independently to finally come up with a final “team” decision. This approach is widely used by team leaders and managers in the field. This study shows that this approach constitutes an improvement over the individual (autocratic) one but still falls short of the group decision-making approach. Finally, this study which has been done with the largest number of participant teams (598 teams, 2,673 individuals), professionally active post-graduate students and over a 24-year period allows a sound statistical confirmation of the proposed decision quality improvement when moving from individual to consultative and group decision-making styles.
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Parkinson's disease (PD) is associated with motor and cognitive impairment caused by dopamine dysreg-ulation in the basal ganglia. Amongst a host of cognitive deficits, evidence suggests that decision-making is impaired in patient...
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Parkinson's disease (PD) is associated with motor and cognitive impairment caused by dopamine dysreg-ulation in the basal ganglia. Amongst a host of cognitive deficits, evidence suggests that decision-making is impaired in patients with PD, but the exact scope of this impairment is still unclear. The aim of this review was to establish which experimental manipulations commonly associated with studies involving decision-making tasks were most likely to generate impairments in performance in PD patients. This allowed us to address the question of the exact scope of the decision-making deficits in PD and to hypothesize about the role of the basal ganglia in decision-making processes. We conducted a meta-analysis of available literature, which revealed that the two key predictors of impairment in PD were the feedback structure of the decision-making task and the medication status of patients while performing the tasks. Rather than a global impairment in decision-making ability, these findings suggest that deficiencies in choice-behaviour in patients with PD stem from dysfunctions at the outcome evaluation stage of the decision-making process.
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