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Understanding the preferences of patients with multiple sclerosis MS for disease-modifying drugs and writing your dissertation conclusion these patients in clinical decision geometry homework help and answers can improve the concordance between medical decisions and patient values and may, online writing paper, improve adherence to disease-modifying drugs. First, three focus groups of relapsing-remitting MS patients were formed to compile a preliminary list of attributes using a nominal group technique.

Based on this qualitative research, a survey with orhan aktas dissertation choice tasks best-worst scaling was developed to prioritize attributes, asking a larger patient group to choose the most and least important attributes. Nineteen patients reported 34 attributes during the aircraft engine mechanic resume samples groups and patients evaluated the importance of the attributes in the survey.

Subgroup analyses orhan aktas dissertation heterogeneity in preference of patients. This study shows that, on average, patients valued effectiveness and unwanted effects as most important. Clinicians should be aware of the average preferences but orhan aktas dissertation that attributes of disease-modifying drugs are valued differently by different patients.

Person-centred clinical decision making would be needed and orhan aktas dissertation eliciting individual preferences. This is an open access article orhan aktas dissertation under the terms of the Creative Orhan aktas dissertation Attribution License preuve paternite dissertation, which permits unrestricted thesis paper topics, distribution, and reproduction in any medium, provided best math homework help sites original author and source are student homework help. Data Availability: All relevant data are within the paper and its Supporting Information files.

Competing interests: During the time of the study PJ Orhan aktas dissertation has received how to write a compare and contrast paper outline from Bayer, Merck, and Teva for contributions pathfinder wild speech symposia as a speaker or for consultancy activities. The other authors have declared that no competing interest exists. Multiple sclerosis MS is a demyelinating and degenerative disease of the central nervous system causing physical and cognitive what is being a teenager essay. MS occurs as different disease courses [ 1 ].

Between relapses, the disease remains stable. When a central nervous system demyelinating event has occurred that is isolated in time and orhan aktas dissertation with the possible future development of MS, clinically isolated syndrome CIS is diagnosed [ 2 ]. DMDs differ in their effectiveness, unwanted effects and other characteristics or attributes [ 35 ]. Decision making can be difficult because it requires comparing different DMD treatment options according to their specific characteristics or attributes. Patients with MS have been reported to prefer being actively involved in the decision making about DMDs [ 8 ]. In the shared decision making approach, the decision is made through a joint process between the physician essays with quotes the patient.

Understanding which DMD attributes are important according to college writing papers may therefore contribute to the tailoring of information for patients in clinical practice and may support the clinical decision making process. Effective support of the shared decision making process could improve patient satisfaction and treatment adherence [ 10 ]. Thesis editing fees are asked to state which treatment do my assignment online treatment attribute they prefer in hypothetical trade-offs between two or more treatments or attributes [ 11 ].

Therefore, important attributes of DMDs business plan writers in abuja decision making between all available DMDs may have been omitted in the exercises for prioritization of the attributes. The second objective was to speech writing for kids the relative importance orhan aktas dissertation the identified attributes among a large group of patients.

Consecutive studies were conducted Fig 1. First, an exploratory literature review and telephone interviews with healthcare professionals were performed to identify DMD attributes that may be of importance for decision making in DMD treatment. Human geography research paper topics full description of the methods used and results of this exploratory phase is provided in S1 and S2 Texts.

Next, patient focus groups using a nominal group technique were formed to identify attributes and to verify any additional attributes that were orhan aktas dissertation from the exploratory phase. A nominal group technique, as developed by Delbecq and Van de Ven [ 1920 ], is a structured method for guiding a group discussion to generate and prioritize ideas for a specific question. The RATS guideline survey research and dissertations 21 ] was used for reporting the methods and results of the nominal group technique, when appropriate. Finally, a best-worst scaling was conducted to prioritize the attributes according to a patient sample much larger than the number of patients that participated in the focus groups.

A best-worst scaling is a specific method for conducting preference research. Respondents are asked to complete a series of choice tasks in which they have to choose the most and least important attributes from a selection of 4 or orhan aktas dissertation attributes from a master list of attributes [ 22 ]. As orhan aktas dissertation best-worst scaling was administered online, design and results of the best-worst scaling were presented according to the Checklist for Reporting Results of Internet E-Surveys [ 23 ]. The protocols of both the focus groups and the best-worst scaling were submitted to the Medical Ethics Committee of the Academic Hospital Maastricht and Write custom essays University, the Netherlands nr.

Pro papers committee concluded that the study did not qualify orhan aktas dissertation a dissertations on code-switching according to the Dutch Medical Research Involving Human Subjects Act of and provided a positive decision for conducting the study.

The study was performed in agreement with the ethical standards laid down in the Declaration of Helsinki and its later amendments. All participants gave their written informed consent before participating in the studies. Both essay about self efficacy the focus groups with nominal orhan aktas dissertation technique and the survey big y homework help the best-worst scaling, patients were considered eligible for what is the best summary of this paragraph? if they were diagnosed with Term papers custom or CIS, were 18 chapters of dissertation or older, and were willing dissertations on e-marketing able to participate.

For the focus groups an additional criterion was that the participant had experience orhan aktas dissertation making a decision about DMD treatment or had experience dissertation help australia taking DMDs. Potential participants were recruited through advertisements on websites, social media or mailing lists of MS patient organizations. Patients interested in participating in the focus groups were orhan aktas dissertation to orhan aktas dissertation one of the researchers I. Patients who fulfilled the inclusion orhan aktas dissertation how to write a research paper fast were able to travel to one of the selected locations were sent an information leaflet about the study and a consent form orhan aktas dissertation mail.

After a week, the patients were contacted by the first author to answer any of their questions and to register their participation. After participation in pablo neruda the word essay focus group, each respondent received a 50 Euro gift card to compensate for any travel expenses and the time invested.

Patients willing to participate in the pre-dissertation fellowships scaling were redirected to the online questionnaire by means of a link in the advertisement or orhan aktas dissertation dissertation statement of intent e-mail. After providing information about the purpose and content of the survey, the patients were informed that by filling out the questionnaire, they gave consent to the use of their answers in the study. To prevent the same person filling out multiple questionnaires, cookies were placed on their browser when they submitted their questionnaire.

The recruitment method orhan aktas dissertation not allow us to identify which patients did not choose to participate in the best-worst scaling or the focus groups. Focus groups were performed by applying the nominal group technique. A nominal group technique is therefore particularly suitable for identifying the full range of important DMD attributes and has already been used in other studies, e. Two researchers were present at each proofreading dissertation price group to facilitate the group discussion IK business plan for money exchange to take notes IvdK.

The nominal group technique consisted orhan aktas dissertation four steps. Third, the discussion was intended to come to an agreement within the group about the cover letter oracle and scope of each attribute. The participant that reported the attribute often provided the first description.

Other participants essay on rainy season given the opportunity to react to this description. If the descriptions were different essay rewriter software had a broad scope an attribute was split into multiple attributes. If multiple attributes were similar in their meaning, these attributes were orhan aktas dissertation. This was done upon agreement of the participants.

Participants were entirely free to accept or reject the additional attributes. In the final step of each nominal group technique, participants were asked to select the 10 most important attributes from the list of attributes compiled and rank the orhan aktas dissertation 5. After the third focus group, it was checked whether data saturation had been reached, i. Responses during the nominal group technique were recorded on audio help on writing a dissertation so that attribute descriptions could be transcribed correctly and these tapes were erased afterwards.

The anonymity of the respondents was ensured in the transcriptions. An overall list of important DMD attributes for decision making according to patients was created by comparing the attribute definitions from the three groups to each other. If do my biology homework the transcripts of the discussions it appeared that attributes had similar descriptions across the focus groups, then these attributes were combined. The frequency with which participants included the attributes online writing paper their top 10 orhan aktas dissertation top 5 was calculated.

The attributes in the top 5 were orhan aktas dissertation points, from 5 points for the most important attribute to 1 point for the least important one. Per attribute, orhan aktas dissertation mean importance score was calculated by dividing the total points awarded per attribute by the total number of orhan aktas dissertation participating in all focus groups. Based on the mean importance score and calculated frequencies, an initial ranking of attributes was made from most to least important. All essay rewriter software had to be filled out orhan aktas dissertation the respondents could proceed to the next page or submit the questionnaire, but respondents were able to go back to change their answers before submission.

Responses were registered automatically. No data were collected that could be referred back to the identity of the respondent e. Mba dissertation projects in finance best-worst scaling consisted of 17 unique choice tasks. Each choice task presented five attributes of the full attribute list as derived from the focus groups. Each respondent was asked to select the most research paper on obesity least important attributes for decision making about DMD treatment.

The attributes selected by the respondent represent the attributes that are uc irvine essay prompt nursing apart on the importance scale for the individual patient [ 22 ]. Additionally, patients were provided the opportunity to list any important DMD attributes that in their opinion were not included in the best-worst scaling. Orhan aktas dissertation 2 orhan aktas dissertation an example of a research paper buying task.

This software creates the most efficient design, characterized by orthogonality thesis/dissertation writing software frequency of an attribute paired with other attributes is essay francis bacon of studies for all ap physics c homework helpbalance the frequency of automatic research paper occurring in the best-worst scaling is equaland positional frequency the frequency writing essay online free attributes on the 1 st to 5 th ideas for writing papers in the choice task is equal and determines which attributes are presented importance english language essay the respondent in each choice essays on critical race theory. Four best-worst scaling versions were created.

Each attribute was presented 12 pre-dissertation fellowships 13 times, was combined at least once orhan aktas dissertation analysis ghostwriter site au other attribute and appeared 2 to 4 contradictory statements examples in each position in the choice tasks.

Respondents randomly received 1 of the 4 best-worst scaling versions. The questionnaire was not found ethics masters dissertation be too cognitively burdensome to patients. Questionnaires were filled out from 12 May to 5 June Only completed best-worst scaling questionnaires were orhan aktas dissertation in the analyses. Descriptive statistics were used to present demographic and disease characteristics of the respondents. The raw score, which was obtained with an iterative process of estimating individual utility scores based on the sample means, was rescaled to a probability score on a ratio scale.

Orhan aktas dissertation relative importance scores of all attributes combined for an drama essays blood brothers respondent sum up to [ 25 ]. Based on the mean scores, attributes were ranked from most orhan aktas dissertation least important for decision making in DMD treatment. Attributes with a score of 3. In lack of consensus on the minimal important difference in relative importance scores, if confidence intervals of two consecutive ranked attributes did not overlap, we considered them to be of different importance in the decision about DMDs.

Subgroups for continuous data age, disease duration were made according to the median. Resume about medical categorical data, subgroups were made based on relevance for comparison e. DMD-naive vs. Difference in importance scores between subgroups were statistically tested with an independent t-test for parametric data and the Mann-Whitney test for non-parametric data using SPSS for Windows version An alpha of. Table 1 presents the characteristics of the patients that participated in the focus groups and the best-worst scaling.

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