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Biomedical subjects

S P Curley

Publications and source records attributed to S P Curley.

6 recordsLinked to original sources
PubMed1990

Seeking and applying diagnostic information in a health care setting.

Many studies have shown that people have difficulty judging the diagnostic value of conditional probability information with respect to one or more hypotheses. The present research addressed two aspects of performing the diagnostic task in a health care decision: (a) recognition of the information's importance, and (b) correct usage of that information. In experiment 1, health care providers, who are trained in, and regularly exposed, to conditional probabilities imparting diagnostic information, exhibited at least a rudimentary recognition of the need for this information in assessing diagnosticity. Experiment 2 indicated that health care and layperson subjects had difficulty in actually applying the information, however. This difficulty prompts a need for judgment aids and caution in using diagnostic information.

Bayes Theorem↗
PubMed1990

Knowledge resource preferences of family physicians.

Because of the pivotal role of medical knowledge in clinical problem solving, it is important to understand how clinicians decide to seek additional knowledge for patient care decisions and how they choose among the resources available to them. Using a self-administered questionnaire, 126 family physicians reported their use of 11 types of knowledge resources for answering patient-specific questions arising in clinical practice. They reported almost daily use of the Physicians' Desk Reference and more often than weekly use of colleagues. There was little use reported of Index Medicus or computer-based bibliographic retrieval systems. The research literature of medicine was used infrequently and rated among the lowest of resources in terms of credibility, availability, searchability, understandability, and applicability. In deciding among a subset of knowledge resources for answering a clinical practice question, resource cost variables related to clinical availability and applicability of the information to the problem at hand appeared to be more influential in the minds of physicians than factors related to quality of the resource. These findings have important implications for the development and deployment of knowledge resources intended to be useful and used in clinical practice.

Diagnosis↗
PubMedDate not supplied

Primacy effects in clinical judgments of contingency.

In contingency judgment a primacy effect exists when a conclusion about the relationship between clinical variables is inordinately influenced by cases seen earlier rather than later in a presentation sequence. In this study, medical and nursing trainees evidenced this behavior in a hypothetical clinical judgment situation. The behavior was tied to an attention decrement explanation, by which inattention to the later-presented cases leads to inaccurate recall of the relative frequencies of observed cases, which in turn induces a misjudgment of a disease-finding contingency. An explicit intervention based on this hypothesis, forcing attention to later cases by warning that recall of the case frequencies would be required, was effective in reducing primacy effects among medical students. A related, but less explicit, intervention was also tried. This intervention did not significantly reduce primacy effects among nursing students, but was somewhat effective among general undergraduate students performing a non-clinical contingency judgment task.

Decision Support Techniques↗
PubMedDate not supplied

Characterizing physicians' perceptions of ambiguity.

Ambiguity, typically characterized as imprecision in judged probabilities is distinguishable from that uncertainty typically measured using probabilities. It reflects the inadequacy of a point probability judgement and the assumptions upon which it is based. Ambiguity influences both patients' and physicians' decisions, but it is unknown how decision makers conceptualize ambiguity. Toward this goal, properties of three ambiguity indicators were examined: a confidence rating, a plausible range, and an interquartile range. Board-certified internists and fourth-year medical students evaluated simulated cases of suspected coronary artery disease. Their judgements provided insights into the three ambiguity indicators. The distribution-based interquartile range was largely redundant with the plausible range, and was least adequate. The confidence rating was not equivalent to the plausible range, and appeared to best reflect the construct of ambiguity as it has been defined.

Computer Simulation↗
PubMedDate not supplied

Physicians' use of medical knowledge resources: preliminary theoretical framework and findings.

The recurring decision of selecting among potential knowledge resources was modeled as a cost-benefit tradeoff, with associated observable features. Internal medicine and community family practice physicians (n = 228) completed a self-administered questionnaire designed to elicit reported use and cost-benefit features of nine knowledge resources. The subjects reported most frequent use of clinical colleagues, intermediate use of textbooks and journals, and least use of indexing systems. Resources' benefit-related qualities (extensiveness and credibility) were not related to reported use. In contrast, the model's access cost variables (availability, searchability, understandability, and clinical applicability) were significantly related to use. Results were generally favorable to the model's framework of knowledge resource selection. Multiple linear regression analysis suggested that physicians' use of clinical knowledge resources could be described by the physician's level of training, availability, applicability, and the resource medium (colleague, index, or text/journal).

Cost-Benefit Analysis↗