A change point-based analysis procedure for improving the success rate of decision-making in clinical trials with delayed treatment effects
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PROVIDER: S-EPMC10520459 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:Resolving tradeoffs between smaller immediate rewards and larger delayed rewards is ubiquitous in daily life and steep discounting of future rewards is associated with several psychiatric conditions. This form of decision-making is referred to as delayed reward discounting (DRD) and the features of brain structure associated with DRD are not well understood. The current study characterized the relationship between gray matter volume (GMV) and DRD in a sample of 1038 healthy adults (54.7% female) using cortical parcellation, subcortical segmentation, and voxelwise cortical surface-based group analyses. The results indicate that steeper DRD was significantly associated with lower total cortical GMV, but not subcortical GMV. In parcellation analyses, less GMV in 20 discrete cortical regions was associated with steeper DRD. Of these regions, only GMV in the middle temporal gyrus (MTG) and entorhinal cortex (EC) were uniquely associated with DRD. Voxelwise surface-based analyses corroborated these findings, again revealing significant associations between steeper DRD and less GMV in the MTG and EC. To inform the roles of MTG and EC in DRD, connectivity analysis of resting state data (N = 1003) using seed regions from the structural findings was conducted. This revealed that spontaneous activity in the MTG and EC was correlated with activation in the ventromedial prefrontal cortex, posterior cingulate cortex, and inferior parietal lobule, regions associated with the default mode network, which involves prospection, self-reflective thinking and mental simulation. Furthermore, meta-analytic co-activation analysis using Neurosynth revealed a similar pattern across 11,406 task-fMRI studies. Collectively, these findings provide robust evidence that morphometric characteristics of the temporal lobe are associated with DRD preferences and suggest it may be because of their role in mental activities in common with default mode activity.
| S-EPMC5895082 | biostudies-literature
Project description:Parental decisions in animals are often context-dependent and shaped by fitness trade-offs between parents and offspring. For example, the selection of breeding habitats can considerably impact the fitness of both offspring and parents, and therefore, parents should carefully weigh the costs and benefits of available options for their current and future reproductive success. Here, we show that resource-use preferences are shaped by a trade-off between parental effort and offspring safety in a tadpole-transporting frog. In a large-scale in situ experiment, we investigated decision strategies across an entire population of poison frogs that distribute their tadpoles across multiple water bodies. Pool use followed a dynamic and sequential selection process, and transportation became more efficient over time. Our results point to a complex suite of environmental variables that are considered during offspring deposition, which necessitates a highly dynamic and flexible decision-making process in tadpole-transporting frogs.
| S-EPMC5969290 | biostudies-literature
Project description:To improve the single-procedural success and long-term outcomes of catheter ablation techniques for AF, there is a need for durable, contiguous and transmural lesions encircling the pulmonary veins (PV). Measurement of contact force (CF) between the catheter tip and the target tissue can optimise ablation procedures. A new approach to obtain single-procedure durable PV isolation (PVI) using the latest CF technology combined with the CARTO VISITAG™ Module with Ablation Index (Biosense Webster) has been shown in small studies to almost eliminate recurrence of paroxysmal AF at 1-year follow up and to make PVI procedures more reproducible. The use of a standardised workflow is expected to increase the reproducibility of results and to increase the efficiency of PVI procedures.
| S-EPMC5739903 | biostudies-other
Project description:ObjectiveTo identify features of clinical decision support systems critical for improving clinical practice.DesignSystematic review of randomised controlled trials.Data sourcesLiterature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews.Study selectionStudies had to evaluate the ability of decision support systems to improve clinical practice.Data extractionStudies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature.ResultsSeventy studies were included. Decision support systems significantly improved clinical practice in 68% of trials. Univariate analyses revealed that, for five of the system features, interventions possessing the feature were significantly more likely to improve clinical practice than interventions lacking the feature. Multiple logistic regression analysis identified four features as independent predictors of improved clinical practice: automatic provision of decision support as part of clinician workflow (P < 0.00001), provision of recommendations rather than just assessments (P = 0.0187), provision of decision support at the time and location of decision making (P = 0.0263), and computer based decision support (P = 0.0294). Of 32 systems possessing all four features, 30 (94%) significantly improved clinical practice. Furthermore, direct experimental justification was found for providing periodic performance feedback, sharing recommendations with patients, and requesting documentation of reasons for not following recommendations.ConclusionsSeveral features were closely correlated with decision support systems' ability to improve patient care significantly. Clinicians and other stakeholders should implement clinical decision support systems that incorporate these features whenever feasible and appropriate.
| S-EPMC555881 | biostudies-literature
Project description:Background and objectivesBehavioral stage of change (SoC) algorithms classify patients' readiness for medical treatment decision-making. In the precontemplation stage, patients have no intention to take action within 6 months. In the contemplation stage, action is intended within 6 months. In the preparation stage, patients intend to take action within 30 days. In the action stage, the change has been made. This study examines the influence of SoC on dialysis modality decision-making.Design, setting, participants, & measurementsSoC and relevant covariates were measured, and associations with dialysis decision-making were determined. In-depth interviews were conducted with 16 patients on dialysis to elicit experiences. Qualitative interview data informed the survey design. Surveys were administered to adults with CKD (eGFR≤25 ml/min/1.73 m(2)) from August, 2012 to June, 2013. Multivariable logistic regression modeled dialysis decision-making with predictors: SoC, provider connection, and dialysis knowledge score.ResultsFifty-five patients completed the survey (71% women, 39% white, and 59% black), and median annual income was $17,500. In total, 65% of patients were in the precontemplation/contemplation (thinking) and 35% of patients were in the preparation/maintenance (acting) SoC; 62% of patients had made dialysis modality decisions. Doctors explaining modality options, higher dialysis knowledge scores, and fewer lifestyle barriers were associated with acting versus thinking SoC (all P<0.02). Patients making modality decisions had doctors who explained dialysis options (76% versus 43%), were in the acting versus the thinking SoC (50% versus 10%), had higher dialysis knowledge scores (1.4 versus 0.5), and had lower eGFR (13.9 versus 16.8 ml/min/1.73 m(2); all P<0.05). In adjusted analyses, dialysis knowledge was significantly associated with decision-making (odds ratio, 4.2; 95% confidence interval, 1.4 to 12.9; P=0.01), and SoC was of borderline significance (odds ratio, 5.8; 95% confidence interval, 1.0 to 32.6; P=0.05). The model C statistic was 0.87.ConclusionsDialysis decision-making was associated with SoC, dialysis knowledge, and physicians discussing treatment options. Future studies determining ways to assist patients with CKD in making satisfying modality decisions are warranted.
| S-EPMC4317741 | biostudies-literature
Project description:ObjectiveAlcohol use disorder (AUD) is an etiologically heterogeneous psychiatric disorder defined by a collection of commonly observed co-occurring symptoms. It is useful to contextualize AUD within theoretical frameworks to identify potential prevention, intervention, and treatment approaches that target personalized mechanisms of behavior change. One theoretical framework, behavioral economics, suggests that AUD is a temporally extended pattern of cost/benefit analyses favoring drinking decisions. The distribution of costs and benefits across choice outcomes is often unequally distributed over time and has different probabilities of receipt, such that delay and probability become critical variables. The present study examines the relations between different forms of economic discounting (delayed reward, delayed cost, and probabilistic reward) and individual symptoms of AUD to inform etiological models.MethodParticipants (N = 732; 41% female, 4.2% Black, 88.1% White, 8% Hispanic) completed an online survey with measures of AUD symptoms and economic discounting. We examined relations between economic discounting and AUD symptoms with zero-order correlations, in separate models (factor models), and in models controlling for an AUD factor (factor-controlled models).ResultsDelayed reward discounting was positively associated with the give up AUD criteria across all three levels of analysis. Probability discounting was associated with social/interpersonal problems across two out of three sets of analyses. Consistent with the broad discounting literature, effect sizes were small (range = -.15 to .13).ConclusionsThese results support the idea that AUD criteria are etiologically distinct, resulting in varying AUD profiles between persons that are differentially associated with behavioral economic discounting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
| S-EPMC9851925 | biostudies-literature
Project description:The design of sequential experiments and, in particular, randomised controlled trials involves a trade-off between operational characteristics such as statistical power, estimation bias and patient benefit. The family of randomisation procedures referred to as Constrained Randomised Dynamic Programming (CRDP), which is set in the Bayesian decision-theoretic framework, can be used to balance these competing objectives. A generalisation and novel interpretation of CRDP is proposed to highlight its inherent flexibility to adapt to a variety of practicalities and align with individual trial objectives. CRDP, as with most response-adaptive randomisation procedures, hinges on the limiting assumption of patient responses being available before allocation of the next patient. This forms one of the greatest barriers to their implementation in practice which, despite being an important research question, has not received a thorough treatment. Therefore, motivated by the existing gap between the theory of response-adaptive randomisation (which is abundant with proposed methods in the immediate response setting) and clinical practice (in which responses are typically delayed), the performance of CRDP in the presence of fixed and random delays is evaluated. Simulation results show that CRDP continues to offer patient benefit gains over alternative procedures and is relatively robust to delayed responses. To compensate for a fixed delay, a method which adjusts the time horizon used in the optimisation objective is proposed and its performance illustrated.
| S-EPMC7612844 | biostudies-literature
Project description:Speed-accuracy trade-offs strongly influence the rate of reward that can be earned in many decision-making tasks. Previous reports suggest that human participants often adopt suboptimal speed-accuracy trade-offs in single session, two-alternative forced-choice tasks. We investigated whether humans acquired optimal speed-accuracy trade-offs when extensively trained with multiple signal qualities. When performance was characterized in terms of decision time and accuracy, our participants eventually performed nearly optimally in the case of higher signal qualities. Rather than adopting decision criteria that were individually optimal for each signal quality, participants adopted a single threshold that was nearly optimal for most signal qualities. However, setting a single threshold for different coherence conditions resulted in only negligible decrements in the maximum possible reward rate. Finally, we tested two hypotheses regarding the possible sources of suboptimal performance: (1) favoring accuracy over reward rate and (2) misestimating the reward rate due to timing uncertainty. Our findings provide support for both hypotheses, but also for the hypothesis that participants can learn to approach optimality. We find specifically that an accuracy bias dominates early performance, but diminishes greatly with practice. The residual discrepancy between optimal and observed performance can be explained by an adaptive response to uncertainty in time estimation.
| S-EPMC3383845 | biostudies-literature
Project description:ObjectivesTo test the hypotheses that decision making ability declines in old age and that a higher level of cognitive reserve is associated with a reduced rate of decline.MethodsAs part of an ongoing cohort study, 982 older adults without dementia at study enrollment completed measures of purpose in life and cognitive activity which were used as markers of cognitive reserve. At annual intervals thereafter, they completed 6 tests of decision making.ResultsIn a factor analysis of baseline decision making scores, 3 measures (financial/health literacy, financial/health decision making, scam susceptibility) loaded on an "analytic" factor and 3 (temporal discounting small stakes, temporal discounting large stakes, risk aversion) loaded on a "preferences" (for temporal discounting and avoiding risk) factor. During a mean of 4.7 years of follow-up (standard deviation = 2.9), analytic factor scores decreased (mean = 0.042-unit per year, standard error [SE] = 0.006, p < .001) and preferences factor scores increased (mean = 0.021-unit per year, SE = 0.006, p < .001), with a correlation of 0.13 (p < .001) between rates of change. Evidence of an association between cognitive reserve and decision making was mixed with purpose in life related to change in analytic decision making, whereas past (but not current) cognitive activity was related to change in decision making preferences.DiscussionDecision making analysis and preferences change over time in late life. Change over time in decision making components is relatively independent and differentially related to age and cognitive reserve.
| S-EPMC10561891 | biostudies-literature
Project description:People often rely on numeric metrics to make decisions and form judgments. Numbers can be difficult to process, leading to their underutilization, but they are also uniquely suited to making comparisons. Do people decide differently when some dimensions of a choice are quantified and others are not? We explore this question across 21 preregistered experiments (8 in the main text, N = 9,303; 13 in supplement, N = 13,936) involving managerial, policy, and consumer decisions. Participants face choices that involve tradeoffs (e.g., choosing between employees, one of whom has a higher likelihood of advancement but lower likelihood of retention), and we randomize which dimension of each tradeoff is presented numerically and which is presented qualitatively (using verbal estimates, discrete visualizations, or continuous visualizations). We show that people systematically shift their preferences toward options that dominate on tradeoff dimensions conveyed numerically-a pattern we dub "quantification fixation." Further, we show that quantification fixation has financial consequences-it emerges in incentive-compatible hiring tasks and in charitable donation decisions. We identify one key mechanism that underlies quantification fixation and moderates its strength: When making comparative judgments, which are essential to tradeoff decisions, numeric information is more fluent than non-numeric information. Our findings suggest that when we count, we change what counts.
| S-EPMC11572960 | biostudies-literature