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Results for “Decision Making”

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PubMed2007

Authoritarian dynamics and unethical decision making: high social dominance orientation leaders and high right-wing authoritarianism followers.

When dilemmas require trade-offs between profits and ethics, do leaders high in social dominance orientation (SDO) and followers high in right-wing authoritarianism (RWA) make decisions that are more unethical than those made by others? This issue was explored in 4 studies with female participants performing managerial role-playing tasks. First, dyads comprising a person who was either low or high in SDO and a person who was either low or high in RWA negotiated for a leadership position. People high in SDO were more likely to obtain leader positions than to obtain follower positions. No other effects were significant. Second, leaders high in SDO partnered with an agreeable (confederate) follower made decisions that were more unethical than those of leaders low in SDO. Third, followers high in RWA were more acquiescent to and supportive of an unethical (confederate) leader than were followers low in RWA. Fourth, high SDO leader-high RWA follower dyads made decisions that were more unethical than those made in role-reversed dyads because leaders had more influence. Implications of these results for conceptualizing SDO, RWA, and authoritarian dynamics are discussed.

Adolescent↗

PubMed2006

[Orthodontics founded on "proof" or therapeutic decision making based on the literature].

Faced to an abundant literature and to various clinical situations, practitioners are nowadays invited to implement an evidence based approach. This methodology, initially developed in Canada in the 80's, is getting widely used and is perfectly suited for Orthodontics and particularly for the evaluation of interceptive treatments. It is defined as the conscentious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. This approach, which requires four different steps, will initially be presented. A methodological guide that allows to grade the evidence among different research protocols, will then be introduced. At the top of the hierarchy, randomized clinical trials have shown to be the best tools available to evaluate treatment efficiency. Different research designs are finally put forward to evaluate interceptive treatments.

Databases, Bibliographic↗

PubMed2000

Value of stigmata in decision-making in gastrointestinal haemorrhage.

The stigmata of recent haemorrhage are endoscopically identified features that have a predictive value for the risk of further bleeding and thus help to determine which patients should receive endoscopic therapy. In conjunction with endoscopic features, clinical features related to the magnitude of bleeding and to patient co-morbidity have important independent effects on the risk of further haemorrhage. Stigmata have been best studied in the context of bleeding ulcers, the most common cause of upper gastrointestinal bleeding. Stigmata in ulcers are usually classified as active bleeding (spurting or oozing), a non-bleeding visible vessel, an adherent clot, a flat pigmented spot, or a clean base, in order of decreasing risk of further haemorrhage. Ulcer size and location may also affect the re-bleeding potential. Recent data suggest that both non-pigmented visible vessels and adherent clots have a higher risk of re-bleeding than was previously thought. The wide variation in prevalence and re-bleeding rates reported for various stigmata in the literature probably reflects variations in the definitions of stigmata and of re-bleeding, the vigour with which the ulcer bases are washed, the co-morbidity and ages of the patients, and the severity of bleeding encountered. Inter-observer agreement in the classification of stigmata is relatively poor and limits the utility of endoscopic features alone in making decisions regarding the management of patients with bleeding peptic ulcers. Imaging devices such as Doppler probes are being evaluated to refine the identification of underlying vessels and their re-bleeding potential, but the utility of these is currently uncertain. The findings of low-risk endoscopic stigmata in a haemodynamically and otherwise stable patient can in many cases allow out-patient management.

Decision Making↗

PubMed2002

"Mindless" decision making as a failure of contextual reasoning.

People often make decisions without reference to vital information, even when such information is readily available. In the present research, the authors addressed the possibility that this tendency may derive from failure to have pertinent information immediately available in the decision context. Participants rated the utility of decisions in either the presence or absence of simple pertinent information. The information provided required no training and was relatively obvious (e.g., if money is spent on a given item, that money will not be available for other expenditures). Presentation of such information in the immediate context of decisions significantly improved participants' abilities to understand their negative consequences. These results indicate that the presentation of pertinent information in immediate decision contexts, even information that is already available through participants' long-term memory, can improve the understanding of decision situations and reduce "mindlessness" in decision processes.

Adolescent↗

PubMed2005

The attraction effect in decision making: superior performance by older adults.

Previous work showed that older adults' choice performance can be wiser than that of younger adults (Tentori, Osherson, Hasher, & May, 2001). We contrasted two possible interpretations: a general expertise/wisdom view that suggests that older adults are generally more skilled at making decisions than younger adults and a domain-specific expertise view that suggests that older adults are more skilled decision makers only in domains in which they have greater knowledge. These hypotheses were contrasted using attraction effect tasks in two different domains: earning extra credit in a course and grocery shopping, domains presumed to be of different levels of knowledge to younger and older adults. Older adults showed consistent choice for both domains; younger adults showed consistent choice only for the extra credit problem. Several explanations of these findings are considered, including Damasio's somatic marker theory and age differences in reliance on heuristic versus analytic styles.

Adolescent↗

PubMedDate not supplied

Asthma patients' assessments of health care and medical decision making: the role of health literacy.

The objectives of this cross-sectional study were to measure health literacy and its associations with asthma patients' assessments of care and their desire to participate in making decisions about their treatment. A total of 175 patients completed the Test of Functional Health Literacy in Adults and questions about satisfaction with asthma status, access to care, quality of care, and the desire to participate in treatment decisions. Patients' mean age was 42 years and 83% were women. Lower literacy was associated with less satisfaction with asthma status and worse assessment of quality of care received for asthma and other medical conditions (p < or = .005). Patients with lower literacy also were more likely not to want to participate in decisions about their care (OR .29, 95% CI .13, .65). These relationships persisted after controlling for demographic and asthma characteristics. These results provide additional incentives for physicians to find better ways to explain asthma treatments to low literacy patients.

Adult↗

PubMed2006

Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.

Current public health and medical evidence rely heavily on efficacy information to make decisions regarding intervention impact. This evidence base could be enhanced by research studies that evaluate and report multiple indicators of internal and external validity such as Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) as well as their combined impact. However, indices that summarize the combined impact of, and complex interactions among, intervention outcome dimensions are not currently available. We propose and discuss a series of composite metrics that combine two or more RE-AIM dimensions, and can be used to estimate overall intervention impact. Although speculative and, at this point, there have been limited empirical data on these metrics, they extend current methods and are offered to yield more integrated composite outcomes relevant to public health. Such approaches offer potential to help identify interventions most likely to meaningfully impact population health.

Decision Making↗

PubMed1997

Hospitalizing the suicidal adolescent: decision-making criteria of psychiatric residents.

OBJECTIVE: The primary purpose of this research is to investigate the criteria used by general psychiatric residents in determining the appropriateness of hospitalization. METHOD: A questionnaire containing 64 vignettes describing adolescent suicide attempts was completed by a sample of 33 residents from a general psychiatry training program. Six variables known to relate to lethality of attempt were systematically varied within the vignettes: gender, depression, conduct disorder/substance abuse, previous attempts, suicidal relative, and family supports. Respondents were asked to judge the appropriateness of hospitalization for each vignette. RESULTS: Hospitalization preference was significantly predicted by all risk factors except for gender, with the presence of depression emerging as the most important predictor of hospitalization. Residents recommended hospitalization more frequently than did experienced child and adolescent clinicians. In comparison with experienced clinicians, residents placed more importance on depression, and less importance on conduct disorder/substance abuse, in making decisions to hospitalize. CONCLUSIONS: Although psychiatric residents use known risk factors for adolescent suicide in assessing need for hospitalization, there was clear support for further training initiatives for psychiatric residents concerning the assessment of suicidal adolescents.

Adolescent↗

PubMed2004

Managing health risks: junior doctors' views of risk and decision making.

Managing risk and making decisions presents an increasing challenge to doctors as they are encouraged to adopt a partnership approach with patients to dealing with risk, within a "risk society" constructed around individuality, uncertainty, blame and responsibility. In-depth interviews, stimulated by clinical vignettes, were used to explore the key position of doctors within this risk society. Analysis, sensitised through contemporary texts, revealed unexpected findings that portrayed doctors as reflexive jugglers of risk. Discourses in this study revealed indecision and uncertainty, balanced against needs to preserve professional roles and engage patients in addressing risk, whilst preventing widespread harm and conflict. In concluding, the alternative approaches to risk with older people will suggest a more trusting and positive process that presents a real opportunity for truly sharing risk and decisions that benefit both doctor and patient.

Aged↗

PubMed1981

Undergraduate education in the cost-effective use of laboratory and radiological investigations in clinical decision-making.

This paper describes a strategy for helping students to learn about laboratory and radiological investigations in diagnosis and management, and to make decisions about the use of investigations, taking into account such features as safety, patient comfort and cost. Learning takes place through the use of a programmed text, in which students commit decisions to paper, and then receive feedback on the results of their decisions. Acceptability to students and teaching staff has been evaluated, and future developments of the strategy are outlined.

Australia↗

PubMedDate not supplied

Patient-specific predictions for clinical decision-making.

There are many ways in which clinicians make decisions regarding therapy for an individual patient. Invariably, the decision is supplemented by collateral information which is obtained from clinical trials. Prospective and retrospective clinical studies take an unnecessary adversarial position but each method has its place. Parametric survival analysis can produce patient-specific predictions of an event of interest for an individual patient based on the risk factor profile of that patient, and these methods are just as applicable to prospective clinical studies as they are to retrospective clinical studies. Parametric survival analysis can estimate the distribution of time to an event, estimate the phases of hazard (instantaneous risk of the event), determine risk factors associated with the event in each of the identified phases of risk, predict the time-related probability of an event for a specific patient based on his or her risk factor profile, and by risk adjustment compare the effectiveness of different therapies.

Age Factors↗

PubMed2005

Clinical decision-making and myocardial viability: current perspectives.

Not all myocardium involved in a myocardial infarction is dead or irreversibly damaged. The balance between the amount of scar and live tissue, and the nature of the live tissue, determine the likelihood that contractile function will improve after revascularisation. This improvement (which defines viability) may be predicted with about 80% accuracy using several techniques. This review examines the determinants of functional recovery and how they may be integrated in making decisions regarding revascularisation.

Cell Survival↗

PubMed1991

Neuropsychiatric decision making: the role of disorder prevalence in diagnostic testing.

Although the performance of medical diagnostic tests is usually described in terms of their sensitivity and specificity, these accuracy indices by themselves are of little help to clinicians who need to make decisions about patient care. Estimating the probability that a patient with a positive or negative test has or lacks a disorder requires the clinician to include the pretest probability of the disorder in the interpretation of the test result. This article described several approaches to the problem of interpreting diagnostic data in actual clinical contexts.

Aged↗

PubMed2001

Weaning, complementary feeding, and maternal decision making in a rural east African pastoral population.

A small-scale, prospective study of breastfeeding and weaning practices was conducted in a seminomadic pastoral population in northern Tanzania (Datoga of Mbulu District, Arusha Region). Focus group participants suggested that weaning patterns are strongly influenced by seasonal factors, and individual mothers often stated an intention to introduce adult staple foods and terminate breastfeeding at the end of the long rains. However, a combination of maternal self-perception, assessment of infant well-being, and indicators of household food supply influenced the actual progression of weaning for individual children. The results suggest that interventions to promote exclusive breastfeeding and improve complementary feeding practices in rural East African pastoral populations could build on maternal attention to infant-centered cues and address household-level constraints on caregivers making decisions about young child feeding.

Adult↗

PubMed1991

Informed consent for treatment of childhood cancer: factors affecting parents' decision making.

Both the treatment for childhood cancer and the legal requirements for gaining parents' consent to treatment have become increasingly complex. The purpose of the exploratory investigation reported here was to identify influential circumstances surrounding the consent process in the pediatric setting, to describe the relationship of parental anxiety to these factors, and to delineate related practice and research implications. Twenty-eight parents of children entered on one of four protocols for the treatment of newly diagnosed acute lymphoblastic leukemia at the Childrens Hospital Los Angeles and the University of California San Francisco were asked to complete two questionnaires within 48 hours after consenting to treatment: the State-Trait Anxiety Index and the Parent Informed Consent Questionnaire. Results of the study confirmed clinical experience that parents are given complex information and asked to make decisions about their child's life in a highly anxious state. Although participants were generally satisfied with the informed consent process 48 hours after signing a consent form, further research is needed to document how well parents understand and remember key information, as well as the influence of time, experience, and changes in state anxiety on their perceptions of the adequacy of the consent process. In current clinical practice, simple strategies can be applied to improve the informed consent process for families of children with cancer.

Adult↗

PubMed2001

[Causal inference in medicine--decision making].

In the field of occupational medicine, either when we consider some preventive plans or when we make decisions to compensate for occupational diseases, it has been necessary to discuss causality between work and disease. Furthermore, epidemiologic causality has recently been used in risk assessment in occupational and environmental settings. We have shown that the law of causality in medicine is recognized as probability and continuous variables. Such a law of causality has been recognized in the same way as probability in physics, too, and has been regarded as a model of science. Physicists and mathematicians had claimed the importance of probability in causal inference as well as the principle of uncertainty before it was discovered. We, then, explained Etiologic Fraction (EF), Attributable Proportion for the Exposed Population (APE), Probability of Causation (PC), and so on. The PC has been used to ascertain the conditional probability in an individual case of a disease having been caused by a particular prior exposure, by using the experience of exposed populations to determine the appropriate relative risk, and this has been used for compensation for exposed cases. Next the applicability of information from a population to individuals was presented. Third, we provided a brief historical aspect of epidemiology. The evolutions in Epidemiology have been very rapid, so we pointed out that, in Japan, we could observe many incommensurable phenomena in epidemiologists and physicians depending on the era which was studied by them. Fourth, we discussed judgement and political application based on epidemiologic evidence, using Yanagimoto's classification is also taken or not should be estimated and compared. We presented several examples of reasoning in judgements. Lastly, we discussed several tasks and assignments for the future of epidemiology.

Causality↗

PubMed1999

Clinical decision making and ethics in communications between donor families and recipients: how much should they know?

Advances in organ recovery and transplantation have provided us with the skills and opportunity to save, extend, and improve the quality of life for many. But with these opportunities have come challenges to redefine our practice and relationships with donor and recipient families. Although most donor families and transplant recipients receive some information about each other, many still do not. In the past, communication between donor families and recipients has been anonymous and highly controlled, with much inconsistency among and within the transplant community, leaving many involved in the process confused and frustrated. Transplant professionals may wish to consider critically the common ethical values of autonomy, beneficence, salience and benefit of choice in making decisions about information shared with and contact between donor families and recipients.

Communication↗

PubMed1999

Tough choices: women, abusive partners, and the ecology of decision-making.

In a qualitative study, 35 women who had lived with violent partners were interviewed regarding their experience making decisions about their relationships to their abusers. This paper explores their stories, integrating the common themes with reports from other studies. The insights of the women participating in this and other research support an ecological understanding of the tough choices they face--a framework which respects the role of environmental factors (demands and resources) in helping or constraining choices at the same time as it recognizes the importance of powerful mediating factors (beliefs, values, and a sense of personal efficacy).

Adult↗