Academic literature on the topic 'While Ordered Weighted `1'

Background:Development of a standardized approach to assess key elements of disease activity in rheumatology clinical trials has been the goal of Outcome Measures in Rheumatology Clinical Trials (OMERACT), American College of Rheumatology (ACR), and European League Against Rheumatism (EULAR).1,2,3The core sets of measures developed include assessments and composite indices incorporating use of patient-reported outcomes (PROs) and clinical measures and clinicians’ assessments to quantify disease activity over time.2PROs are important indicators of disease activity and variability, and they are increasingly used to evaluate treatment effectiveness. Little is known about PROs that patients with rheumatic conditions find most important to convey their experience with their condition and its treatment.Objectives:To examine PROs selected by patients with rheumatic conditions in the ArthritisPower registry to identify symptoms they found most important to track digitally.Methods:Adult US patients within the ArthritisPower registry with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), osteoporosis (OP), osteoarthritis (OA), and fibromyalgia syndrome (FMS) were invited via email to participate in this study. Enrolled participants (pts) were prompted to select ≤10 PRO symptom measures they felt were important to track for their condition at baseline via the ArthritisPower app. At 3 subsequent time points (Month [m] 1, m2, m3), pts were given the option to continue tracking their previously selected PRO measures or to add, remove and/or select different measures. At m3, pts completed an exit survey to prioritize ≤5 measures from all measures selected during study participation and to specify other symptoms not available that they would have wanted to track. Measures were rank-ordered based on number of pts rating the item as their 1st, 2nd, 3rd, 4th or 5th choice and weighted by multiplying the rank number by its inverse for a single, weighted summary score for each measure. Values were summed across all pts to produce a summary score for each measure.Results:Among pts who completed initial selection of PRO assessments at baseline (N=253), 184 pts confirmed or changed PRO selections across m1-3. Mean (SD) age of pts was 55.7 (9.2) yrs, 89.3% female, 91.3% White, mean disease duration of 11.6 (10.6) yrs. The majority (64.8%) self-reported OA, followed by RA (48.6%), FMS (40.3%), PsA (26.1%), OP (21.0%), AS (15.8%) and SLE (5.9%), not mutually exclusive, and were similar to the overall ArthritisPower population. The average number of instruments (SD) selected for baseline completion was 7.0 (2.5), 7.1 (2.4) at m1, 7.2 (2.4) at m2, and 7.0 (2.5) at m3. The top 5 PROs ranked by pts overall as most important (weighted summary score) for tracking were Fatigue (71), Physical Function (58), Pain Intensity (50), Pain Interference (49), Duration of Morning Joint Stiffness (41) (Figure 1). Fatigue, Physical Function, and Pain were consistently in the top 5 across diseases while Depression was more frequent among pts with OA, AS and FMS. Pts’ PRO selections showed stability over time except for the RA Flare measure which decreased from 70.5% of RA pts at baseline to 13.6% at m3.Conclusion:The symptoms prioritized by pts included fatigue, physical function, pain, and joint stiffness. Pts‘ choices were consistent over time. These findings provide insights into symptoms rheumatology patients find most important and will be useful to inform design of future patient-centric clinical trials and real-world evidence generation.References:[1]Boers M, et al. J Rheumatol Suppl. 1994;41:86–89.[2]Felson DT, et al. Arthritis Rheum. 1993;36:729–740.[3]Tugwell P, et al. J Rheumatol. 1993;20:555–556.Disclosure of Interests:W. Benjamin Nowell: None declared, Carol L. Kannowski Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Kelly Gavigan: None declared, Zhihong Cai Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Anabela Cardoso Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Theresa Hunter Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Shilpa Venkatachalam: None declared, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jennifer Workman Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB

For the multiattribute group decision-making problem in an interval Pythagorean fuzzy environment, the existing experts and scholars have extended the weighted average (WA), ordered weighted average (OWA), generalized ordered weighted average (GOWA), weighted ordered weighted average (WOWA), and other operators to interval fuzzy environment, while the research on the application and promotion of interval Pythagorean fuzzy with generalized weighted ordered weighted average (GWOWA) operator has not been carried out, GWOWA operator not only retains the advantages of WOWA operator but also introduces artificial variables, which increases the ability of decision-makers to control the aggregation of fuzzy information. Therefore, the GWOWA operator model based on interval Pythagorean fuzzy sets is constructed. First, it is proved that interval Pythagorean fuzzy generalized weighted average operator (IVPFGWA) and interval Pythagorean fuzzy generalized ordered weighted average operator (IVPFGOWA) are special cases of IVPFGWOWA operator, and their idempotence, monotonicity, and boundedness are proved; second, a group decision-making method based on interval Pythagorean fuzzy GWOWA operator is presented. Finally, an example is given to illustrate the effectiveness and scientificity of this method. It is found that the interval Pythagorean fuzzy decision-making method of the GWOWA operator alleviates the loss of information in the decision-making process to a great extent. At the same time, with the increase in the value of artificial variables, the gap between the best scheme and other schemes continues to increase, making the decision-making results more obvious, scientific, and accurate.

INTRODUCTION: A massive transfusion protocol (MTP) is defined as a transfusion which exceeds the patient's estimated blood volume within 24 hours. The use of cold-stored, low-titer Group O whole blood (LTOWB) is well established for massive transfusion in military and civilian trauma. However, we do not yet have data supporting the use of LTOWB for non-trauma patients requiring a massive transfusion. Herein lies the importance of this retrospective cohort study as it seeks to answer important questions about the use of LTOWB in non-trauma patients. The primary aim of the study is to establish if mortality 24h and 30d after LTOWB MTP is no worse than after standard, component MTP. Secondary aims include degree of hemolysis, length of stay and, because there is 5% increase in mortality for every minute that blood products are not provided to a trauma patient after an MTP has been activated, time to delivery. METHODS: A retrospective chart review identified non-trauma patients requiring a MTP from July 1, 2018 to June 30, 2019, comparing those who received at least one unit of LTOWB ("LTOWB" cohort) to those who received a standard component MTP ("Component" cohort). Each delivery of a component MTP contains 6u of RBCs, 6u of plasma and 1u of platelets. Each LTOWB delivery contains 5u of leukoreduced (using a platelet-sparing filter) LTOWB. Our primary outcomes were 24h and 30d mortality, adjusted for age and Elixhauser comorbidity score. Secondary outcomes included length of stay, hemolysis, and delivery time. Medical records were abstracted for demographics, Total Bilirubin levels, discharge codes, 24h and 30d mortality, and length of stay. Hemolysis was the difference between highest Total Bilirubin in the 5 days following the MTP and the lowest total bilirubin level for the two days prior or on the day of the MTP. Delivery time was calculated as the number of minutes between the time the MTP was ordered in the electronic ordering system and the delivery of the first box of blood products as noted in hospital transportation logs. Discharge codes were used to calculate a weighted Elixhauser comorbidity score as previously described. Statistical analysis was performed utilizing logistic regressions, poisson regression, general linear models, and t-tests as appropriate (Table 2, Table 3). RESULTS: Between 7/1/2018 and 6/30/2019, 93 unique patients received 114 MTPs, of which 19 received at least one unit of LTOWB (Table 1). Seven patients had emergency-issue blood delivered outside of hospital transportation so were included in the analysis. The indication for the MTP was most commonly gastrointestinal bleeding, followed by intra-procedural bleeding and organ bleeding (spleen, pancreas, retroperitoneum, lung, brain and ovarian). Adjusting for age and Elixhauser comorbidity score, there was no statistically significant difference in 24 h mortality (13.4% higher odds in LTOWB cohort compared to component; 95% confidence interval (CI): 0.28, 4.64; p: 0.86) or 30 d mortality (14% higher odds in LTOWB cohort compared to component; 95% CI: 0.34, 3.77; p: 0.83), Table 2. There was no statistically significant difference between cohorts in length of stay (for every 1.0 day patients who received LTOWB were admitted, patients who received components were admitted for 0.97d; 95% CI: 0.86, 1.09; p: 0.58), time to delivery, or degree of hemolysis. CONCLUSIONS: For non-trauma patients receiving a massive transfusion, our data suggest that receiving at least one unit of LTOWB does not impact 24 h or 30 d mortality. Length of stay and change in bilirubin were nearly the same for both cohorts suggesting that LTOWB is as safe as component therapy. Although we hypothesized that LTOWB would be delivered faster, we have a small sample size and because component MTP is the default at our institution for non-trauma patients, LTOWB was usually delivered only in subsequent deliveries, not the first one. Therefore, we would not expect to see a difference. Although this is a small study from one institution, it is the first investigation of LTOWB in non-trauma patients. Overall, our data indicates that LTOWB may be a reasonable alternative to component therapy outside of trauma as it does not significantly alter patient outcomes but still eases manufacturing and transfusion logistics. Future research is needed to further establish the effects of LTOWB in this population. Disclosures No relevant conflicts of interest to declare.