Development of a patient decision aid on the choice of diabetes medication for Filipino patients with type 2 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#<p> OBJECTIVE:</b> To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country.</p><p><strong>METHODOLOGY:</strong> A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing.</p><p><strong>RESULTS:</strong> Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population.</p><p><strong>CONCLUSION:</strong> Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.</p>

Uso de modelos de apoio a decisao para analise de alternativas tecnologicas de tratamento de residuos solidos urbanos na Regiao Sul do Brasil / Use of decision support models to analyze technological alternatives for municipal solid waste treatment in South Region of Brazil

Os modelos de apoio à decisão são importantes ferramentas que podem ser utilizadas para analisar alternativas tecnológicas na gestão e tratamento de resíduos sólidos urbanos (RSU) frente a diversas situações envolvendo aspectos políticos, econômicos, ambientais e sociais. Este estudo teve como objetivo propor tecnologias e arranjos tecnológicos para o tratamento adequado de RSU para a Região Sul do Brasil, por meio do levantamento de informações e uso de dois modelos de apoio à decisão: AHP (Analytic Hierarchy Process) e Promethee II (Preference Ranking Organization Method for Enrichment Evaluations). As tecnologias analisadas foram: reciclagem, compostagem, tratamento mecânico-biológico, digestão anaeróbia, incineração com geração de energia elétrica em ciclo combinado (energia elétrica e térmica), aterro sanitário com e sem geração de energia. Essas tecnologias foram hierarquizadas nos modelos com base em quatro critérios: ambientais, sociais, econômicos e políticos. Como resultado, foram propostos quatro arranjos tecnológicos possíveis para a Região Sul e que podem ser utilizados como referência para estudos nas demais regiões geográficas do Brasil. .

The decision support models are important tools that can be used to analyze technological alternatives in the management and treatment of municipal solid waste (MSW) against several situations involving political, economic, environmental and social aspects. This study aimed to propose alternatives for appropriate treatment of MSW in the South Region of Brazil by surveying information and using two decision support models: AHP (Analytic Hierarchy Process) and Promethee II (Preference Ranking Organization Method for Enrichment Evaluations). The studied technologies were: recycling, composting, mechanical-biological treatment, anaerobic digestion, incineration with electricity generation and combined cycle (electricity and heat) and landfill with and without power generation. These technologies were hierarchically ranked in the models based on four criteria: environmental, social, economic and political. As a result, we proposed four possible technological arrangements for the South Region and these can be used as reference for studies in other geographic regions of Brazil. .