SEARCH · PubMed Health

Results for “Decision Making--determinants”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

29 records · Page 2Linked to original sources

PubMedDate not supplied

Factors associated with the use of court bypass by minors to obtain abortions.

Interviews with minors at four Minnesota abortion clinics revealed that 43 percent used the court bypass option that is part of that state's parental notification statute. The proportion who did so increased with age and was most common among lower socioeconomic groups. A discriminant function analysis showed that perceived maternal supportiveness was a key difference between those who went to court and those who notified their parents. Young women who attended religious services frequently were less likely than those who did not tell their parents of their abortion plans. Minors who notified only one parent--and still had to go to court under Minnesota law, which requires notification of both parents--were more likely than those who told neither to come from a single-parent household and to have good communication with their mother.

Abortion, Legal↗

PubMed1990

Influence of human immunodeficiency virus infection on reproductive decisions.

This article discusses the role of the practitioner in the pregnancy decision-making process of the HIV-infected woman. Literature on women's decisions is reviewed, and variables that influence decisions are discussed. The author concludes that HIV infection does not have a significant impact on pregnancy decisions. Other cultural and psychosocial variables may have more importance.

Attitude to Health↗

PubMedDate not supplied

Legal aspects of grading and student progression.

In today's litigious environment, nurse educators must understand the legal issues involved in determining grades and deciding academic progression. Although the courts have consistently ruled that educators are the most qualified people to evaluate what constitutes academic success, the potential remains for students to legally challenge their grades. This article reviews legal cases and shows the change in the student-institution relationship from one of a child-surrogate parent (in loco parentis) to one in which students' rights and institutional responsibility are balanced. The courts continue to support the concept that educators are uniquely qualified to make determinations concerning grading and progression and defer to decisions made by the academic community. However, a series of legal decisions based on due process and contract law now protects students from arbitrary and capricious decisions made without a formal grievance process. The implications for nurse educators and administrators are far-reaching and include such issues as specific policies within syllabi, divisional policies, institutional policies, and adherence to formal grievance procedures.

Civil Rights↗

PubMed2001

Decision-making for mentally incompetent people: the empty formula of best interests?

This paper considers the way in which the best interests test has been used in making health care decisions for mentally incompetent individuals in the Irish and English Courts where this is the test of choice. It looks in brief at the development of the test and the way in which the House of Lords has "de-theorised" the question of best interests in cases such as Re F (Mental Patient: Sterilisation) and Airedale N.H.S. Trust v. Bland, leaving little in the way of assistance for lower courts. The test adopted by the Irish courts has also lacked a strong theoretical underpinning. However, the existence of a written constitution has meant that there has at least been recognition of the role of rights in determinations such as In Re a Ward of Court. Having noted the inadequacies in the current test as it is applied, the article then considers the question of whether the best interests test has been inadequately applied or whether it is fatally flawed and should be dispensed with as a method of making determinations for mentally incompetent people. The article looks at two alternatives to the best interests test; namely, purely rights based decision making and substituted judgment. Both will be seen to be flawed and it will be argued that the best interests test should be maintained but that a more careful theoretical and analytical approach is required.

Decision Making↗

PubMed1997

Ambulatory system to aid in decision making and risk stratification in postinfarction patients.

Knowledge of the clinical and electrophysiological features of certain cardiovascular risk groups, the adaptation and specialization of clinical protocols, the availability of tools to make determinations for use in patient follow-up and to assess the efficacy of the treatments applied, and the proper processing of different parameters can aid in decision making, leading to the application of a given therapeutic approach, and can facilitate the performance of group and multicenter studies. To address these needs, a simple, low-cost, portable ECG processing system has been designed that complements the current techniques for managing patients with ischemic heart disease and nonmalignant ventricular arrhythmias. This system, consisting of an electrocardiograph and a laptop PC, determines the following parameters on the basis of the ECG: incidence of arrhythmia, heart rate variability, QT dispersion, ECG criteria for ventricular hypertrophy and late potentials. Left ventricular ejection fraction and diastolic function (according to Doppler ultrasound) and other basic epidemiological parameters are typed in. Moreover, the system integrates these parameters, which have usually been considered separately, to arrive at second-level indicators with a greater predictive capacity during the long-term follow-up of patients with ischemic heart disease and ventricular arrhythmias, thus providing an idea of the risk of mortality and the onset of arrhythmic events and allowing risk stratification in this patient population. Finally, the system includes a database of all the patients analyzed, with tools that make it possible to follow the course of their disease and to assess the efficacy of the treatments applied.

Arrhythmias, Cardiac↗

PubMed1998

Concussions in athletics: guidelines for return to sport.

Physicians are required to make determinations that affect the health and well-being of their patients on a daily basis. None of these judgements may have as profound an impact as the decisions rendered for athletes who have suffered a concussion. Concussions occur with regularity in sports and vary in severity and appropriate management. Guidelines should be followed and used as a tool to allow safe return to competitive endeavors in the athletic arena. Following guidelines will decrease the likelihood of worsening the condition with potentially fatal consequences.

Athletic Injuries↗

PubMed2001

Technologic advances for evaluation of cervical cytology: is newer better?

Among those women who have cervical cancer and have been screened, 14% to 33% of the cases represent failure to detect abnormalities that existed at the time of screening. New technologies intended to improve detection of cytologic abnormalities include liquid-based, thin-layer cytology (ThinPrep, AutoCyte), computerized rescreening (PAPNET), and algorithm-based computer rescreening (AutoPap). This report combines evidence reviews conducted for the U.S. Preventive Services Task Force and the Agency for Healthcare Research and Quality, in which we systematically identified articles on cervical neoplasia, cervical dysplasia, and screening published between January 1966 and March 2001. We note the challenges for improving screening methods, providing an overview of methods for collecting and evaluating cytologic samples, and examining the evidence about the diagnostic performance of new technologies for detecting cervical lesions. Using standard criteria for evaluation of the diagnostic tests, we determined that knowledge about the sensitivity, specificity, and predictive values of new technologies is meager. Only one study of liquid-based cytology used a reference standard of colposcopy, with histology as indicated, to assess participants with normal screening results. Lack of an adequate reference standard is the overwhelming reason that test characteristics cannot be properly assessed or compared. Most publications compare results of screening using the new technology with expert panel review of the cytologic specimen. In that case, the tests are not independent measures and do nothing to relate the screening test findings to the true status of the cervix, making determination of false-negatives, and thus sensitivity, specificity, and negative predictive value, impossible. We did not identify any literature about health outcomes or cost effectiveness of using these tools in a system of screening. For the purposes of guiding decision making about choice of screening tools, the current evidence is inadequate to gauge whether new technologies are "better" than conventional cytology..

Colposcopy↗

PubMed1994

The case against using the APACHE system to predict intensive care unit outcome in trauma patients.

The use of outcome indices as a means of evaluating institutional performance for delivery of medical care is at the forefront of federal health policy reforms. Because an enormous number of clinical and financial data are generated by ICU patients, it is inevitable that integrated bedside computers will be necessary to supply the type of information that is being sought by governmental and private insurance agencies involved in assessment of hospital performance. The Health Care Financing Administration already has adopted the APACHE data collection protocols and predictive models for the severity of illness adjustments that were used in assessing the 1986 hospital-specific death rate for acute myocardial infarction, congestive heart failure, stroke, and pneumonia. In our opinion, however, it is unlikely that any single system will be developed that can accurately estimate more than 50% of ICU deaths. The intention of the APACHE III system to include 78 diagnostic categories seems unrealistic. Furthermore, the number of data needed to document outcomes for both low- and high-risk admissions is impractical. We are evaluating APACHE III to determine whether the revisions to the definition for head trauma will represent a significant improvement in predicting outcomes for trauma patients. In the interim, the financial investment in the APACHE III automated bedside data collection system cannot be justified for trauma patients. Neither should it be used in ICUs that admit a large number of trauma patients as a tool for monitoring unit efficiency, guiding triage decisions, allocating staff and ICU beds, identifying risks of iatrogenic or other potential complications, or assessing quality of life, in spite of marketing efforts by the APACHE Corporation. We believe that using any of the APACHE systems for these purposes, at best, is premature, and potentially misrepresents the trauma patient population. Standards for patient classification already are in place for use in making determinations for institutional reimbursement from governmental and insurance agencies. The inequities for certain subgroups of patients, including trauma patients, could create situations in which care is rationed rather than allocated according to a plan that distributes resources efficiently. The APACHE system has several shortcomings and adds little, if anything, to the potential solutions for trauma quality assurance and resource allocation. Nor has the APACHE system established procedures for documenting institutional review of unexpected trauma deaths that would be equivalent, for example, to the type of audit filters applied by the American College of Surgeons in conjunction with the TRISS methodology.(ABSTRACT TRUNCATED AT 400 WORDS)

Bias↗

PubMed1993

Delegations of authority to the Commissioner of Food and Drugs--FDA. Final rule.

The Food and Drug Administration (FDA) is amending the regulations for delegations of authority to redelegate the authority of the Assistant Director for Health to make determinations to close advisory committee meetings to the public to the Commissioner of Food and Drugs (the Commissioner) and other agency heads. FDA is further redelegating this authority from the Commissioner to the Deputy Commissioner for Operations.

Community Participation↗

PubMedDate not supplied

Successfully weaning the intra-aortic balloon pump patient: an algorithm.

Guiding a patient safely through the process of weaning from an intra-aortic balloon pump (IABP) requires knowledge that goes beyond understanding the device's purpose and mechanisms. Critical care nurses are responsible for coordinating multidisciplinary care throughout the patient's IABP therapy, assessing and supporting the patient throughout the weaning process, and making determinations about the rate of--and the patient's response to--weaning. This article presents an algorithm for critical care nurses who must make decisions before and during the weaning process.

Algorithms↗

PubMed1985

Alcohol-induced impairment of central nervous system function: behavioral skills involved in driving.

Several points emerge from the large body of data on the effects of alcohol on CNS function. First, the degree of impairment is dose related, but not identical or strictly linear for all behaviors. Alcohol-related impairment of behavioral skills involved in driving is greatest for those tasks that require cognitive functioning; simple perception alone is least affected. Impairment of cognitive functioning, which includes information processing and decision making under conditions of divided attention, is evident at BALs above 50 mg/dl and is markedly affected above 100 mg/dl. Above a BAL of 100 mg/dl, almost all behavioral skills are impaired by alcohol. Most studies have employed only one or at most two doses of alcohol in testing for impairment. The limited range of BALs studied makes determination of the overall shape of the dose-response curve difficult. Second, alcohol-related impairment of CNS functions cannot be demonstrated at low BALs. There is no consistent evidence that BALs below 50 mg/dl impair any behavior in most individuals. Youth and the elderly, groups not typically studied in the laboratory, may represent exceptions to this general observation. Nonetheless, these findings are more consistent with a threshold effect for impairment than for impairment at all levels of BAL. Third, for most behavioral skills, the decrement in performance after alcohol is slight, rarely exceeding 35-50% of the control period. In many studies, changes of only 8-10% are reported to be statistically significant. Whether these small statistically significant decrements in performance are an explanation for increased crash risk remains uncertain.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗