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At least 307 records · Page 17Linked to original sources
PubMed2005

Aeronautical decision making: instructor-pilot evaluation of five mnemonic methods.

INTRODUCTION: The ability to make good decisions is a critical component of pilot proficiency. Results of recent research suggest that aeronautical decision making (ADM) can be improved by training. The purposes of this research are to identify the best ADM mnemonic-based methods for training military pilots in decision making in tactical environments. METHODS: There were 60 instructor pilots in the Republic of China Air Force Academy who evaluated the suitability of 5 different ADM methods including SHOR (Stimuli, Hypotheses, Options, Response); PASS (Problem identification, Acquire information, Survey strategy, Select strategy); FOR-DEC (Facts, Options, Risks & Benefits, Decision, Execution, Check); SOAR (Situation, Options, Act, Repeat); and DESIDE (Detect, Estimate, Set safety objectives, Identify, Do, Evaluate). Each was evaluated for six different types of decisions: go/no go; recognition-primed; response selection; resource management; non-diagnostic procedural; and creative problem-solving. RESULTS: The instructor-pilots regarded the SHOR method as the best for time-limited and critical, urgent situations, while they preferred DESIDE for knowledge-based decisions that needed more comprehensive consideration and were less time limited. DISCUSSION: To optimize training effectiveness, it is necessary to provide instruction based around both the SHOR and DESIDE decision-making mnemonic methods to provide comprehensive instruction for coping with all situations in the demanding military aviation environment.

Accidents, Aviation↗
PubMed2004

Cognitive mediation of women's sexual decision making: the influence of alcohol, contextual factors, and background variables.

As a result of the current STI epidemic, women are at particularly high risk. Sexual relations with men are the greatest source of risk for women in contracting HIV or other STIs. Because the male condom is still the most effective means of protection against these diseases, prevention efforts for women need to concentrate on the ability to effectively negotiate condom use. To date, research has primarily addressed the role of knowledge, attitudes, and beliefs about condoms in predicting their use rather than the situation within which individuals make sexual decisions. Our first goal is to present a theoretical model focusing on the situational influences and cognitive processes occurring at the time of a woman's sexual interaction with a man. The underlying premise for this model is that sexual decision making is mediated by a series of primary and secondary appraisals during the sexual encounter. Our second goal is to discuss specific contextual influences on women's cognitions during the process leading to sexual decision making. We review the literature on the effects of alcohol consumption, relationship status, and sexual arousal on the cognitive appraisal process, as well as on sexual decision making. Finally, although our main interest is the specific situation and context, we also review the influence of background factors and experiences that are especially relevant to the cognitive appraisal process, including alcohol expectancies, sexual victimization, sexuality-related characteristics, relationship-related characteristics, and other personality traits. Examining women's cognitive processes at the time of a sexual encounter can yield information that will enhance women's power to protect themselves against HIV and other STIs.

Alcohol Drinking↗
PubMed2004

Decision-making deficits and overeating: a risk model for obesity.

OBJECTIVE: To demonstrate that human overeating is not just a passive response to salient environmental triggers and powerful physiological drives; it is also about making choices. The ventromedial prefrontal cortex has been strongly implicated in the neural circuitry necessary for making advantageous decisions when various options for action are available. Decision-making deficits have been found in patients with ventromedial prefrontal cortex lesions and in those with substance dependence--impairments that reflect an inability to advantageously assess future consequences. That is, they choose immediate rewards in the face of future long-term negative consequences. RESEARCH METHODS AND PROCEDURES: We extended this research to the study of overeating and overweight, testing a regression model that predicted that poor decision making (as assessed by a validated computerized gambling task) and a tendency to overeat under stress would correlate with higher BMI in a group of healthy adult women (N = 41) representing a broad range of body weights. RESULTS: We found statistically significant main effects for both independent variables in the predicted direction (p < 0.05; R2 = 0.35). Indeed, the decision-making impairments across the 100 trials of the computer task were greater in those with high BMI than in previous studies with drug addicts. DISCUSSION: Findings suggested that cortical and subcortical processes, which regulate one's ability to inhibit short-term rewards when the long-term consequences are deleterious, may also influence eating behaviors in a culture dominated by so many, and such varied, sources of palatable and calorically dense sources of energy.

Adult↗
PubMed1998

On the rationality of decision-making studies: Part 1: Decision models of treatment choice.

With reference to both critiques and empirical studies, the theoretical and methodological grounding of anthropological research on medical decision making is examined in this article, giving particular attention to the construction and evaluation of cognitively oriented decision models. A decision-modeling study carried out in the Mexican village of Pichátaro (in conjunction with James C. Young) frames an exploration of some of the tensions and points of contention about the aims and designs of cognitively oriented studies of decision modeling. While a decision model can provide a reasonably good guide to an understanding of treatment actions and the culturally based rationality that underlies them, such models fall short when they are oriented primarily around predicting treatment accounts. They should also attend to the jointly cultural, personal, social, and cognitive constructive processes through which meaning is conferred upon the occurrence of illness.

Anthropology↗
PubMed1993

Informed decision making in persons acquitted not guilty by reason of insanity.

Deciding to raise an insanity defense carries serious consequences. This is especially true for persons charged with minor offenses, for whom an acquittal not guilty by reason of insanity (NGRI) might lead to a longer period of incarceration than would conviction. Before raising an insanity defense, a defendant should be provided with information necessary to make an informed decision and should be competent to understand the consequences of the verdict. This study attempted, through retrospective review and concurrent evaluation, to determine the degree to which trial courts in Virginia attended to these important aspects of informed decision making before finding defendants charged with misdemeanors NGRI. The study also attempted to assess the degree to which defendants were competent and informed at the time of adjudication. In most instances, trial courts did not consider defendants' competence to make decisions regarding the insanity defense and did not consider whether defendants were informed about the consequences of a successful insanity defense at the time of adjudication. The average length of stay for these patients was (at least) 21 months; most would have been released earlier had they been committed civilly rather than committed as a result of insanity pleas. We stress the need to educate judges, attorneys and forensic evaluators to the importance of considering defendants competence to plead insanity and of providing information about the consequences of a successful plea. We also propose that laws be changed to recognize the importance of these elements in the decision making process regarding pleas of insanity.

Adult↗
PubMed1992

Patient involvement in decision-making in surgical and orthopaedic practice. Effects of outcome of operation and care process on patients' perception of their involvement in the decision-making process.

As part of the project Perioperative Risk,--an epidemiological study of complications associated with surgical and orthopaedic operations--the article reports a study of patients' perception of their involvement in decision-making in medical consultations, and how the outcomes of surgery and subsequent care determine patients' evaluation of the treatment. Patients' view of their involvement in the decision-making process was obtained before as well as after surgery. The results reveal that the more satisfied the patients were with the outcome of the operation, and the post-operative situation, the more they were inclined to assume responsibility for the decision to have surgery. The opposite response pattern, indicating a negative evaluation of either the operation or the post-operative care, resulted in an outcome where patients described others--especially the physician--as being responsible for the decision to have surgery. The results suggest that patients' evaluations of surgery are based upon a more global reaction to what happened during the entire care process. Dissatisfaction with either the operation or the post-operative care leads to a negative outcome in terms of patients' perceptions of their own involvement. This emphasizes the importance of all health care professionals seeing themselves as a team with complementary responsibilities for success in health care.

Decision Making↗
PubMed1995

Decision-making situations in health care.

Social workers in health care settings are constantly required to make clinical decisions about patient care and treatment. Although much attention has been devoted to the normative or ethical aspects of decision making in such settings, little attention has been given to the typical situational aspects of decisions social workers must make in health care. This article discusses four types of clinical decision situations--operational, strategic, authoritative, and crisis--and presents a model to assist in analyzing their components and requirements. Case vignettes drawn from practice experience illustrate each type of decision-making situation. The article concludes that knowledge of the situational aspects of practice decision making can be helpful to practitioners by enabling them to sort out courses of action and intervention.

Adult↗
PubMedDate not supplied

Supervision of students may protect academic physicians from cognitive bias: a study of decision making and multiple treatment alternatives in medicine.

OBJECTIVE: To determine how professional characteristics and practices of physicians alter the selection of medical treatments involving multiple alternatives. Situations involving multiple alternatives can increase the difficulty of making a decision, resulting in more choice deferral than when fewer alternatives are available. DESIGN, SETTING, PARTICIPANTS: A survey and scenario were mailed to a random sample of 314 primary and emergency care physicians affiliated with the Indiana University Medical Center. Using a scenario involving treatment decisions for a patient with osteoarthritis, the effects of multiple treatment alternatives on decision making were explored. Other physician factors included experience, workload, fatigue, continuing education, and supervision. MAIN OUTCOME MEASURES: Physicians' treatment decisions. RESULTS: Physician response was 61% (n = 192). In contrast to previous studies, physicians in the present study were equally likely to prescribe a new medication, regardless of whether they were deciding about 1 medication or between 2 similar medications (54.5% v. 56.0%, P = 0.841). However, physicians who supervise medical students were far less influenced by the cognitive bias associated with multiple choices than those who did not supervise medical students. Supervising physicians were more likely to defer making a decision when there was only 1 treatment option than when there were 2 (49.3% v. 37%, P = 0.143), whereas the opposite was true for nonsupervising physicians (33.3% v. 63%, P = 0.040). The number of hours spent supervising medical students and the number of years as a physician were also important factors in the decision-making process. CONCLUSIONS: Multiple treatment alternatives may result in a deferral of choice. However, this cognitive bias is attenuated by experience and supervision, thus enhancing decision making. Implicit and explicit learning gained through experience and the supervisory process appears to be a central mechanism by which the physicians are protected from this cognitive bias.

Academic Medical Centers↗
PubMedDate not supplied

Assessing the safety of children at risk of maltreatment: decision-making models.

Child protective service caseworkers must make difficult decisions about the safety of maltreated children. Decision-making models for helping staff members balance the dual roles of child protection and family preservation are increasing. Results of a review of 10 models suggest that although some criteria overlap in these models, there are also wide differences in definitions, purposes, and the level of research support for the criteria being used to guide decision-making.

Child Abuse↗
PubMed2001

Decision making for health care professionals: use of decision trees within the community mental health setting.

AIM OF THE PAPER: To examine the application of the decision tree approach to collaborative clinical decision-making in mental health care in the United Kingdom (UK). BACKGROUND: While this approach to decision-making has been examined in the acute care setting, there is little published evidence of its use in clinical decision-making within the mental health setting. The complexities of dual diagnosis (schizophrenia and substance misuse in this case example) and the varied viewpoints of different professionals often hamper the decision-making process. This paper highlights how the approach was used successfully as a multiprofessional collaborative approach to decision-making in the context of British community mental health care. DESIGN: A selective review of the relevant literature and a case study application of the decision tree framework. CONCLUSIONS: The process of applying the decision tree framework to clinical decision-making in mental health practice can be time consuming and client inclusion within the process is not always appropriate. The approach offers a method of assigning numerical values to support complex multiprofessional decision-making as well as considering underpinning literature to inform the final decision. Use of the decision tree offers a common framework that can assist professionals to examine the options available to them in depth, while considering the complex variables that influence decision-making in collaborative mental health practice. Use of the decision tree warrants further consideration in mental health care in terms of practice and education.

Attitude of Health Personnel↗
PubMed1989

Child abuse and neglect: an instrument to assist with case referral decision making.

A decision-making instrument was developed to assist reporting agencies and individuals in determining which child abuse and neglect charges would require immediate reporting to a child protection agency and which could be managed initially by the reporting agency. The instrument comprises a matrix scoring system that combines the experience classification of the reporting source and the degree of harm reported. The matrix scoring system was tested for 1 year to evaluate child abuse and neglect cases reported to the New York State Central Registry and Special Services for Children. The goal of the decision-making instrument is to decrease the number of unnecessary reportings to overburdened agencies without jeopardizing the interests of the child. The instrument should assist reporting sources in developing a systematic approach to case referral decision making and should minimize the subjectivity of such decisions.

Adolescent↗
PubMed2002

Evidence for sequential decision making in the medicinal leech.

Decision making can be a complex task involving a sequence of subdecisions. For example, we decide to pursue a goal (e.g., get something to eat), then decide how to accomplish that goal (e.g., go to a restaurant), and then make a sequence of more specific plans (e.g., which restaurant to go to, how to get there, what to order, etc.). In characterizing the effects of stimulating individual brain neurons in the isolated nervous system of the leech Hirudo medicinalis, we have found evidence that leeches also make decisions sequentially. In this study, we describe a pair of interneurons that elicited locomotory motor programs, either swimming or crawling, in isolated nerve cords. In semi-intact animals, stimulating the same neurons also produced either swimming or crawling, and which behavior was produced could be controlled experimentally by manipulating the depth of saline around the intact part of the leech. These same neurons were excited and fired strongly when swimming or crawling occurred spontaneously or in response to mechanosensory stimulation. We conclude that these brain interneurons help to decide on locomotion (i.e., they are "locomotory command-like neurons") and that the ultimate behavior is determined downstream, in a part of the decision-making hierarchy that monitors stimuli related to the depth of fluid surrounding the leech.

Animals↗