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Biomedical subjects

Clare Harries

Publications and source records attributed to Clare Harries.

4 recordsLinked to original sources
PubMed2006

Variations in cardiac interventions: doctors' practices and views.

OBJECTIVES: To investigate referral rates for cardiac interventions by clinical specialty, to document doctors' reasons for referrals and to explore doctors' perceptions of the factors that influenced their clinical decisions. STUDY DESIGN: Doctors completed a clinical decision-making exercise involving, in total, 6093 electronic patients with cardiac disease, and subsequently took part in the semi-structured interviews about influences on their decisions. Interviews were audio-recorded, transcribed and coded using a thematic approach, with the coding categories derived from the data. STUDY SETTING: Eighty-eight doctors (GPs, care-of-the-elderly specialists, cardiologists) participated in the full study, in seven areas in southern, central and northern England. Complete interview data were analysed for 76 of these. PRINCIPAL FINDINGS: Not all patients who were eligible for specific investigations or treatment received these. The extent of variations in clinical decisions differed by type of intervention. Apart from the general reasons for referrals, doctors raised nine main influences on their actual decision making. The most commonly reported influence ('barrier') was poor access to equipment for intervention, which increased thresholds for investigation and treatment. CONCLUSIONS: The current emphasis on achieving targets in the British NHS has led to a focus on easily measurable, but crude, process targets such as waiting lists. This study points to the need to include a broader quality assurance element to investigate the cluster of system failures which lead to variations in clinical decisions and thereby to inequitable treatment.

Cardiology↗
PubMed2006

Participant recruitment methods and statistical reasoning performance.

Optimal Bayesian reasoning performance has reportedly been elusive, and a variety of explanations have been suggested for this situation. In a series of experiments, it is demonstrated that these difficulties with replication can be accounted for by differences in participant-sampling methodologies. Specifically, the best performances are obtained with students from top-tier, national universities who were paid for their participation. Performance drops significantly as these conditions are altered regarding inducements (e.g., using unpaid participants) or participant source (e.g., using participants from a second-tier, regional university). Honours-programme undergraduates do better than regular undergraduates within the same university, paid participation creates superior performance, and top-tier university students do better than students from lower ranked universities. Pictorial representations (supplementing problem text) usually have a slight facilitative effect across these participant manipulations. These results indicate that studies should take account of these methodological details and focus more on relative levels of performance rather than absolute performance.

Adolescent↗
PubMedDate not supplied

Patients with right frontal lesions are unable to assess and use advice to make predictive judgments.

Frontal lobe damage impairs decision-making. Most studies have employed gambling and probabilistic tasks, which have an emotional (reward-punishment) component and found that patients with ventromedial sector lesions have exceptional difficulty performing normally on these tasks. We have recently presented an economic decision-making task to patients and normal volunteers that required them to not only forecast an economic outcome but also to weigh advice from four advisors about the possible outcome across 40 trials. We studied 20 patients with right frontal lobe lesions and 9 patients with parietal lobe lesions and compared their performance to 20 matched controls. Frontal lobe lesion patients were inconsistent at using advice and their forecasts were poor. Patients with dorsolateral but not orbito-frontal lesions showed some ability to assess advice. Patients with parietal lobe lesions were good at assessing advice but were slow at doing so; they were consistent but poor at using advice and their use of advice was unrelated to their forecasting. All three patient groups were overconfident in their own performance. In contrast, controls could both use and assess advice, their ability to use advice was mediated by their ability to assess it, and they were not overconfident. Group differences on an overall measure of accuracy on this task were associated with an ability to accurately plan. Differences in ability to assess and forecast were associated with planning and working memory performance. These findings indicate that patients with both right dorsolateral and orbito-frontal lesions may be impaired when required to make complex decisions related to forecasting and judgment. Our findings enlarge the scope of decision-making deficits seen in patients with frontal lobe lesions and indicate additional circumstances in which patients with frontal lobe lesions will have difficulty in deciding.

Adult↗