The decision-making process consists of finding the best solution to an analyzed problem. This search is carried out in the face of countless interactions when analyzing an alternative criterion by criterion, under which weights are assigned that distinguish the degree of importance they have for the decision-makers. The definition of weight for each criterion gives rise to three lines of thought on the subject. There are objective, subjective, and hybrid methods. This discussion concerns the degree to which experts define the criteria weights. Based on this discussion, we developed a hybrid method to integrate the Entropy and CRITIC methods with the PROMETHEE method, called EC-PROMETHEE. The innovation of this method is that the combination of the Entropy and CRITIC methods does not result in a single set of weights. In reality, the weights generated by each method are used to define each criterion\'s upper and lower limits. The range of weights generated for each criterion is emulated \"n\" times and builds a set of weights that are applied to the ranking definition process. The model generates \"n\" rankings, defining a single ranking. In this article, we demonstrate a step-by-step application of a tool developed in Python called EC-PROMETHEE and use it as an example of the problem of choosing rotary-wing airplanes for application in the military police service.➢The method reduces discretion in determining the weights of the criteria;➢The innovation lies in the use of a range of weights for criteria;➢Consistency in defining the final ranking.

The key elements, or pillars, of food security are stated as food availability, food access, food utilization, and stability. These food security pillars are often linked to food security interventions at the national, community or household level. However, if the urban \'household\' is the unit of interest for any food security intervention, this research asks if a more holistic element, or pillar, is needed. The aim of this research has been to explore the socio-economic aspects of food security/insecurity that we have termed as a result of the research \"food acquirability\". Through the use of structured questionnaires (n = 120), and analysis of the data derived from local market and supermarket settings in the city of Awka, Nigeria, the concept of food acquirability has emerged and been conceptualized and critiqued. The contribution of this paper is to frame the concept of acquirability with regard to food security in Nigeria in order to develop a better understanding of the factors that impact household urban food security/insecurity and how they can be effectively mitigated. Factors of acquirability that emerged were culture, time poverty, resource availability and cooking skills, and household food preference and meal choice.

OBJECTIVE: The present study aims to estimate the public cost of depression in Romania during a seven-year time span to complement existing papers with data from Central and Eastern Europe and to identify and propose measures that allow efficient use of funds.
METHODS: We used data collected from the National Health Insurance System to analyze the main components of the cost.
RESULTS: Indirect costs exceed direct costs. Within the direct costs, hospitalization and medicines still have an important share but are decreasing due to the intervention of outpatient services such as psychiatrists and psychotherapists.
CONCLUSIONS: Since the goal is mental health, it is necessary to act early and quickly to decrease the burden in the long run. Annually, the mean direct cost of depression per patient is EUR 143 (part of it is represented by hospitalization, i.e., EUR 67, and psychotherapy, i.e., EUR 5), the mean cost of sick leaves per patient is EUR 273, and the total cost per patient is EUR 5553. Indirect costs (cost of disability and lost productive years) represent 97.17% of the total cost. An integrated approach to early diagnosis, effective treatment, monitoring, and prevention as well as included economic and social programs are needed to optimize indirect costs.

Introduction: Successful shared decision-making for critically ill intensive care unit (ICU) patients requires bidirectional communication. Through observation of ICU conversations, our study aimed to identify communication skill deficiencies in providers who care for patients in the ICU. Methods: This was an observational prospective study performed in a single urban academic medical center (671 beds) from June 2021 through August 2021. Twenty-three providers were recruited from medical and surgical ICU services (56 beds). Thirty-nine surrogate decision makers were identified. Provider skills were assessed using a customized observational tool that examined nonverbal communication, verbal communication, opening the discussion, gathering information, understanding the family\'s perspective, sharing information, reaching agreements on problems and plans, and providing closure. Results: Thirty-nine conversations were observed for six attending physicians, four fellow physicians, eight resident physicians, two nurse practitioners, and three physician assistants during the coronavirus 19 (COVID19) pandemic. A dedicated critical care provider engaged in 19 observed conversations; 20 discussions occurred with individuals rotating/consulting in the ICU. Communication skill did not depend on experience or area of expertise. Less than half of conversations achieved bidirectional communication proficiency. Scheduled conversations (n = 14) had significantly higher average communication scores than unscheduled encounters (n = 25). Conclusions: Superficial unidirectional communication with decision makers was commonly observed. Providers were less proficient at advanced communication skills needed for shared decision-making. We recommend that providers have more scheduled conversations, which were more productive in achieving bidirectional communication. A targeted simulation curriculum addressing these areas may improve patient, decision maker, and provider satisfaction, while promoting patient-centered care.

Conservation practitioners, natural resource managers, and environmental stewards often seek out scientific contributions to inform decision-making. This body of science only becomes actionable when motivated by decision makers considering alternative courses of action. Many in the science community equate addressing stakeholder science needs with delivering actionable science. However, not all efforts to address science needs deliver actionable science, suggesting that the synonymous use of these two constructs (delivering actionable science and addressing science needs) is not trivial. This can be the case when such needs are conveyed by people who neglect decision makers responsible for articulating a priority management concern and for specifying how the anticipated scientific information will aid the decision-making process. We argue that the actors responsible for articulating these science needs and the process used to identify them are decisive factors in the ability to deliver actionable science, stressing the importance of examining the provenance and the determination of science needs. Guided by a desire to enhance communication and cross-literacy between scientists and decision makers, we identified categories of actors who may inappropriately declare science needs (e.g., applied scientists with and without regulatory affiliation, external influencers, reluctant decision makers, agents in place of decision makers, and boundary organization representatives). We also emphasize the importance of, and general approach to, undertaking needs assessments or gap analyses as a means to identify priority science needs. We conclude that basic stipulations to legitimize actionable science, such as the declaration of decisions of interest that motivate science needs and using a robust process to identify priority information gaps, are not always satisfied and require verification. To alleviate these shortcomings, we formulated practical suggestions for consideration by applied scientists, decision makers, research funding entities, and boundary organizations to help foster conditions that lead to science output being truly actionable.
Los administradores ambientales y de los recursos y los practicantes de la conservación buscan frecuentemente contribuciones científicas para informar sus decisiones. Este sector de la ciencia sólo se vuelve práctico cuando lo incentivan los órganos decisorios que consideran vías alternas de acción. Muchos dentro de la comunidad científica equiparan abordar las necesidades científicas de los actores con la ciencia práctica como resultado. Sin embargo, no son todos los esfuerzos por abordar las necesidades científicas los que resultan en ciencia práctica, lo que sugiere que el uso sinónimo de estos dos constructos (ciencia práctica como resultado y abordar las necesidades científicas) no es trivial. Esto puede ocurrir cuando personas que dejan de lado a los órganos decisorios responsables de articular un problema prioritario de manejo y de especificar cómo la información científica anticipada servirá durante el proceso de decisión transmiten dichas necesidades. Sostenemos que los actores responsables de articular estas necesidades científicas y el proceso utilizado para identificarlos son factores decisivos en la capacidad de tener ciencia práctica como resultado, con un hincapié en la importancia que tiene examinar el origen y determinación de dichas necesidades. Con el deseo de mejorar la comunicación y la alfabetización transversal entre los científicos y los órganos decisorios, identificamos las categorías de actores que pueden declarar indebidamente las necesidades científicas (p. ej.: científicos aplicados con y sin afiliación regulatoria, personas influyentes externas, órganos decisorios renuentes, agentes suplentes de los órganos decisorios y representantes de organizaciones fronterizas). También destacamos la importancia de, y el acercamiento general a, realizar análisis de las necesidades o análisis de las brechas como método para identificar las necesidades científicas prioritarias. Concluimos que las estipulaciones básicas para legitimar la ciencia práctica, como la declaración de las decisiones de interés que impulsan a las necesidades científicas y el uso de un proceso firme para identificar las brechas informativas prioritarias, no siempre se cumplen y requieren una verificación. Para mitigar estas deficiencias, formulamos algunas propuestas prácticas a consideración de los científicos aplicados, órganos decisorios, entidades de financiamiento para la investigación y organizaciones fronterizas para propiciar las condiciones que resultan en una producción científica realmente práctica.
保护实践者、自然资源管理者和环境管理者常常寻求科学贡献来为决策提供信息。然而, 只有在决策者考虑替代性行动方案的情况下, 这套科学才具有可操作性。科学界的许多人将解决利益相关者的科学需求等同于提供可操作的科学, 但并非所有解决科学需求的努力都能提供可操作的科学, 表明这两个概念(提供可操作的科学和解决科学需求)的同义使用并不简单。当传递科学需求的人忽视了负责阐明优先管理问题并说明预期的科学信息将如何帮助决策过程的决策者时, 就会出现这样的情况。我们认为, 产出可操作科学的能力的决定性因素在于负责阐述科学需求的行动者和用于确定这些需求的过程, 这强调了分析科学需求的来源并进行判定的重要性。为了加强科学家和决策者之间的沟通和跨文化交流, 我们还确定了可能不能恰当阐明科学需求的行动者类型(例如, 存在及不存在监管关系的应用科学家、外部影响者、不情愿的决策者、代替决策者的代理人和边界组织代表)。我们还强调了进行需求评估或空缺分析的重要性及常用方法, 以此来确定优先的科学需求。本研究的结论是, 促进可操作科学的基本要求, 如阐明激发科学需求的利益决策以及通过稳健的过程来确定重要的信息空缺, 并不总能得到满足, 还需要进行验证。为了解决这些问题, 我们为应用科学家、决策者、研究资助机构和边界组织提出了一些实用的建议, 从而为产出真正的可操作科学创造条件。【翻译:胡怡思;审校:聂永刚】.

Planning problems in healthcare systems have received greater attention in the last decade, especially because of the concerns recently raised about the scattering of surgical interventions among a wide number of different facilities that can undermine the quality of the outcome due to the volume-outcome association. In this paper, an approach to plan the amount of surgical interventions that a facility has to perform to assure a low adjusted mortality rate is proposed. The approach explicitly takes into account the existing interaction among patients\' choices and decision makers\' planning decisions. The first objective of the proposed approach is to find a solution able to reach quality in health outcomes and patients\' adherence. The second objective is to investigate the difference among solutions that are identified as optimal by either only one of the actors\' perspective, i.e., decision makers and patients, or by considering both the perspectives simultaneously. Following these objectives, the proposed approach is applied to a case study on Italian colon cancer interventions performed in 2014. Results confirm a variation in the hospital planned volumes when considering patients\' behaviour together with the policy maker plan, especially due to personal preferences and lack of information about hospital quality.

A version of the Institute for Safe Medication Practices (ISMP) questionnaire adapted to the Austrian inpatient setting was used to sample the estimates of a group of experts regarding the level of medication safety in a level II hospital. To synthesize expert opinions on a group level reproducibly, classical Delphi method elements were combined with an item weight and performance weight decision-maker. This newly developed information synthesis method was applied to the sample dataset to examine method applicability. Method descriptions and flow diagrams were generated. Applicability was then tested by creating a synthesis of individual questionnaires. An estimate of the level of medication safety in an Austrian level II hospital was, thus, generated. Over the past two decades, initiatives regarding patient safety, in general, and medication safety, in particular, have been gaining momentum. Questionnaires are state of the art for assessing medication practice in healthcare facilities. Acquiring consistent data about medication in the complex setting of a hospital, however, has not been standardized. There are no publicly available benchmark datasets and, in particular, there is no published method to reliably synthesize expertise regarding medication safety on an expert group level. The group-level information synthesis method developed in this study has the potential to synthesize information about the level of medication safety in a hospital setting more reliably than unstructured approaches. A medication safety level estimate for a representative Austrian level II hospital was generated. Further studies are needed to establish convergence characteristics and benchmarks for medication safety on a larger scale.

To identify caregivers\' views on preferred surrogate decision makers for their children.
A respondent-anonymous survey was distributed to a convenience sample of adults who accompanied a child to general and subspecialty pediatric care at 2 different institutions or were at the bedside of a child in the pediatric intensive care unit at a third institution in Chicago.
We collected 462 valid surveys. The average age of the legal guardian and accompanying child was 36.8 years and 6.6 years, respectively. Most legal guardians designated \"other parent with legal authority\" as their first choice surrogate decision maker (70%). Respondent\'s sex, respondent\'s age, child\'s age, and child\'s ethnicity had no effect on first choice surrogate decision maker. \"Other parent with legal authority\" was less likely to be first choice surrogate if respondents had Medicaid insurance, less than a college degree, or lived in a non-nuclear household (P<.01 for all factors). The surrogacy ladder selected by 31% of legal guardians was \"other parent with legal authority,\" \"child\'s grandparent(s),\" and \"child\'s aunt(s) or uncle(s).\" No other sequence received more than 10% designation. Study site had no effect on surrogate preference (P = .30).
A surrogacy priority ladder for minors needs to include relatives who are often not included in state surrogacy statutes (eg, grandparents, aunts and uncles). The most popular surrogacy ladder will not be ideal for many families. Parents need to be informed and empowered to choose alternate surrogates, and documented preferences must be easily and widely accessible.

UNASSIGNED: Selection of first help in psychiatric illnesses depends on various sociodemographic and environmental factors. In integrated societies like India careers also contribute in deciding help-seeking behavior of psychiatric patients. In this study, we explored these factors and the role of education of decision maker, i.e., person who is final authority in deciding the course of management.
UNASSIGNED: This study aims to study sociocultural factors and patterns of help-seeking behavior of psychiatric patients in rural sub-Himalayan region.
UNASSIGNED: A cross-sectional study conducted in a tertiary care teaching hospital.
UNASSIGNED: Factors affecting help-seeking behavior such as age, sex, education, occupation, income, accessibility to psychiatric treatment, expenses on faith healers and general practitioners, and education of \"decision maker were assessed.
UNASSIGNED: Data were analyzed with GraphPad InStat, using appropriate statistical tests.
UNASSIGNED: In this study of 250 patients, psychiatrists were chosen as first help by 98 (39%), faith healers by 84 (34%), and general medical practitioners (GMPs) by 68 (27%) patients. Mean \"years of education\" of patients in psychiatrist group, faith healer group, and GMP group were 9.98, 8.81, and 7.99, respectively (P = 0.08). Mean \"years of education\" of decision makers for these groups were 11.64, 8.36, and 10.93, respectively (P < 0.001). Time required in reaching psychiatric facility form the residence of patient was maximum in those who consulted faith healers first compared to those who consulted psychiatrist (P < 0.001) or GMP (P < 0.01). Expenses on faith healers were significantly high compared to GMPs (P < 0.001).
UNASSIGNED: Psychiatrists, faith healers, and GMPs were equally chosen as first help for psychiatric illness. Education of decision maker and accessibility affect help-seeking behavior significantly. Faith healers were more expensive than GMPs.

OBJECTIVE: To evaluate the knowledge and performance of surgical residents regarding the person from whom informed consent should be taken for surgery and from whom the consent is taken in practice.
METHODS: This study was done in 2013. The population of this study was all residents of urology, surgery, orthopaedic surgery and gynaecology of Tehran and Iran University of Medical Sciences. The study tool was a self-administered questionnaire, containing questions on their knowledge and performance regarding informed consent acquisition from patients with different conditions in terms of age, sex, marital status and their capacity to make treatment decisions.
RESULTS: A total of 213 residents participated in the study (response rate=51.9%). The mean score of the participants\' knowledge was 72.95 out of 100. There was no significant correlation between the residents\' knowledge and performance. Regarding a competent married male patient, 98.2% of the residents knew that the person\'s consent was enough, but only 63.6% obtained informed consent only from the patient. These percentages were 69% and 19.7% for a competent married female patient, respectively. For a competent single male patient, 90.9% of the residents were aware that the patient\'s consent was enough, while only 40% of the residents obtained informed consent only from the patient. These percentages were 65.3% and 16% for a competent single female patient, respectively.
CONCLUSIONS: Despite the residents\' average knowledge of patient autonomy, this right is not observed for female patients, and their treatment is subject to consent acquisition from other family members.