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Results for “Decision Making--determinants”

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At least 19 recordsLinked to original sources

PubMed2001

Women's decision-making determinants in choosing uterine artery embolization for symptomatic fibroids.

OBJECTIVE: To determine what symptoms of leiomyomata uteri prompted women to seek uterine artery embolization (UAE) and what factors were most frequently cited in the decision making leading to choosing UAE over other treatments. STUDY DESIGN: Eighty-four consecutive women with symptomatic leiomyoma presenting for UAE completed a questionnaire that inquired about their pelvic symptoms and the issues that were important in their decision to request UAE. All subjects previously had been told that they were surgical candidates. RESULTS: Pelvic symptoms that the 84 women most frequently noted were bleeding (n = 61), anemia (41), pelvic pain (29), frequent urination (24) and pelvic pressure (21). The majority of women (78) reported significant worry about their health from the fibroids, and (72) reported that the symptoms caused daily discomfort. Although the majority of women wanted a treatment that would give permanent relief of symptoms and thought UAE would do this, other factors frequently cited in the decision making included quality-of-life reasons, such as the desire to avoid adverse effects of other treatments (76), anticipated prolonged postoperative recovery from surgery (70) and avoiding surgery (66). Many women considered the uterus an important female organ, believed that the uterus was a source of femininity (33), stated that the uterus was necessary to maintain self-image (49) and reported that the uterus was necessary to maintain sexual image (49). CONCLUSION: In this cohort of women with symptomatic leiomyomas, treatment preferences did not interfere with the current lifestyle. In addition, the uterus was considered a source of femininity and sexuality. It is not clear whether women requesting UAE differ from women requesting surgical intervention in terms of how they assess the importance of the uterus, but these data suggest that many women still consider the uterus an important aspect of their femininity and that those seeking nonsurgical options should be thoroughly counseled about uterine function and how it relates to sexuality.

Adult↗

PubMed1997

Transesophageal echocardiography and the perioperative management of valvular heart disease.

Transesophageal echocardiography (TEE) is an integral part of decision-making and monitoring in the perioperative period for patients undergoing valvular heart surgery. Multiplanar probes with improved pre- and intraoperative evaluation, eg, improved accuracy of estimation of mitral regurgitation jet size, have led to a more precise surgical approach. In the intensive care unit, TEE is proving invaluable in diagnosing occult causes of clinical instability that are usually surgically correctable. Advances in imaging technology with three- and four-dimensional TEE will facilitate preoperative decision-making, determine intraoperative approaches to valvular surgery, and provide earlier recognition of complications in the intensive care unit.

Aortic Valve↗

PubMed1997

Decreased ankle/brachial indices in relation to morbidity and mortality in patients with peripheral arterial disease.

To determine the relationship between ankle/brachial indices (ABIs) and morbidity and mortality in patients with peripheral arterial disease (PAD), a historical cohort study was performed. A total of 154 patients who had undergone noninvasive arterial assessment of the lower extremities in 1989 and 1990 were selected for this purpose. Selection criteria were age > 40 years at the time of investigation, a resting ABI < 0.90 and the availability of an ABI after exercise or arterial occlusion. Mortality and vascular events were recorded after an average follow-up period of 6 years. A vascular event was defined as an intervention because of PAD, the occurrence of a nonfatal myocardial infarction or stroke, a transient ischaemic attack or a coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA) procedure. During the period studied, 44 patients died and 111 patients suffered a vascular event. The relative risk for mortality was 3.1 per 0.50 decrease of the ABI at rest (95% confidence interval (CI) 1.1-8.7, p = 0.03) and 2.4 per 0.50 decrease of the ABI after exercise or arterial occlusion (95% CI 0.9-6.4, p = 0.08). The relative risk for mortality or the occurrence of a vascular event was 3.3 per 0.50 decrease of the resting ABI (95% CI 1.7-6.3, p < 0.001) and 2.5 per 0.50 decrease of the ABI after exercise or occlusion (95% CI 1.5-4.4, p < 0.001). After standardization, the prognostic power of the two types of ABIs was equivalent. The cumulative survival after 5 years was 63% for patients with resting ABIs < 0.50, 71% for patients with ABIs 0.50-0.69 and 91% for those with ABIs of 0.70-0.89. There were obvious differences between the mean initial ABIs of patients who suffered a vascular event and/or died and those of survivors, who did not suffer an event. A relatively simple measurement like the determination of the resting ABI can give valuable information about the prognosis for vascular related morbidity and mortality. This can be of help in the approach of patients with PAD and assist in therapeutical decision making. Determination of the ABI after exercise or occlusion has no additional value for this purpose.

Adult↗

PubMed1990

Case management: planning and coordinating strategies.

In summary, planning a case management system involves moving through sequenced stages; namely, (1) a developmental stage; (2) a phase-in stage; and (3) an operational stage. During the developmental stage, before processes have been formalized, attention is given to the political realities, the formation of a representative planning group, formulating goals and objectives, obtaining administrative support, information gathering, assessment of needs, resource procurement, program structure and design, selection of a case management model, participatory decision making, determining organizational fit, and beginning networking. During the phase-in or early implementation state, the formal stage of system introduction, attention is given to the establishment of interorganizational relationships, contracting for services, job descriptions, work assignments, training, problem solving, and conflict resolution. During the operational or full implementation stage, a period when the system should become more stabilized, attention needs to be given to managing movement of the client through the system, the flow of information, program updating, quality assurance, recordkeeping, resource management, evaluating, and system refurbishing. In practice, these stages will interact and overlap. Closure, if the system is to remain viable and open to change, should never occur.

Aged↗

PubMed2000

[Adaptations in reproduction and behavior of captive chimpanzees-- zoobiological and veterinary managements].

Monitoring of renal LH-excretion, changes in genital tumescence and menses assesses reproductive status in zookept female chimpanzees. Temporary detumescence of female sex skin in estrus is a reliable indicator for stress. Assessment of female chimpanzee reproductive status relates to local and individual variation of cycle length and temporal correlation of investigated parameters. Monitoring of neonate chimpanzee behavioural ontogeny is an essential tool of evaluating applied rearing methods since individuals were to be integrated into the adult group during adolescence. Slow and continuous transition periods between consecutive rearing phases avoid irreversible disturbed behaviour. Care by one person up to the age of 12 months, followed by a 3 year stay in a peer group guarantee normal development in zookept infant chimpanzees. 4-5 years old chimpanzees with infantile attributes and abilities to submit and appease can be integrated to adults with low risk. In female gorillas sexual cyclicity was monitored by renal excretion of LH, length of menses, sexual behaviour and--in tame females--by basal body temperature and variation of length of the urogenital cleft. Intraspecific variation of cyclicity allowed individual fertility assessment after comparison of several cycles. Analyses of behaviour gave hints to overcharged adaptability and reduced infertility under inadequate maintenance. Data on semen and testicular biopsy improve fertility evaluation in gorilla males and point to degree and time of tissue alteration and etiology. Body hygiene analogous to the human, tool use and interspecific play with chimpanzees and humans behind window screens were observed in inadequately kept gorillas. Homosexual behaviour among females was reversible with environmental and social changes. Coalitions among nonrelated females were an effective social strategy against an aggressive male. Cyclicity was disturbed drastically by social events such as physical lesions made by a male but normalized with improved social situation. Disturbed cyclicity featured prolongation of interestrus intervals and complete detumescence, oligomenorrhea and amenorrhea. Nulliparous females in their third decennium needed more than 1.5 years of social contact to a fertile male to become fullterm pregnant. During the first two months of pregnancy stillbirths and embryonic resorptions were detected. Handreared and inexperienced primiparous gorilla females accepted their infants and reared them normally after witnessing motherrearing in neighbored chimpanzee females for several years. Opportunities of free choice and decision making determine zookept pongid behaviour, that cannot be compared with prisoners' ethology. Adaptations of ontogenetic behaviour and reproduction, teleonomic patterns and zoomorphism are of zoobiological relevance. Adaptations develope during prolonged periods of time and thus results of corresponding management issues are to be assessed a posteriori.

Adaptation, Physiological↗

PubMedDate not supplied

Health care provider choice: the North West Province of Cameroon.

Health care is provided in many developing countries free of any charge at the point of delivery. This is attributed to the fact that health care is one of the basic human rights. While modern health care in public health units is free, patients in rural areas continue to use either self-care, traditional healers or both. In Cameroon, the idea of integrating traditional and modern medical practices is discussed by both traditional and medical practitioners. However, it is not very clear what influences the household's choice of one or the other. Within a health district, where there are many providers, the question as to whether or not there is a possibility of choice open to all is posed. This article reports on a study undertaken in a rural health district that shows that there are many factors that influence the choice of health care. Among these factors is quality of care which is the most important factor influencing the choice of health care provider. As quality of care increases in governmental health centres, their choice probability also increases. Other factors include: the time spent seeking treatment; household income and size; distance; and, cost of health care. Those with higher incomes tend to choose private health units and those with larger families tend to choose government health units. Other socio-cultural factors, difficult to model, appear to also influence the choice of providers. It is concluded that since household income influences the choice of private health units, policies targeting poverty alleviation should be instituted in the rural areas to provide households with income. This will enable them widened access to private health care and enable government to redeploy its scarce resources to maintain and extend services to needy areas.

Cameroon↗

PubMed2000

Women, men, and contraceptive sterilization.

OBJECTIVE: To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices. DESIGN: Multinomial logit regression of sterilization. PATIENT(S): Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Tubal sterilization and vasectomy. RESULT(S): Surprisingly high proportions of recent tubal sterilizations were performed on unmarried women: 1 in 3 overall, 1 in 5 among white non-Hispanic women, and 2 in 3 among black women. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilizations to vasectomies is extremely low in the Western region of the United States. CONCLUSION(S): Analysis of sterilization decisions must be based on time since the completion of childbearing. The findings call attention to the need for measuring variables that mediate observed associations with sterilization outcomes.

Adolescent↗

PubMed1991

Tubal sterilization or vasectomy: how do married couples make the choice?

OBJECTIVE: To examine the relative importance of husband, wife, and couple factors as determinants of sterilization method choice. DESIGN: Married couples seeking sterilization interviewed before surgery and again 1 year later. SETTING: Kaiser Permanente Medical Care Program subscribers seeking care at the Kaiser Foundation Hospital, Santa Clara, California. PARTICIPANTS: Two hundred married women seeking a tubal sterilization and their husbands and 200 married men seeking a vasectomy and their wives. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sterilization method chosen. RESULTS: In a logistic regression model, nine predictor variables correctly classified 94.9% of 395 couples (P less than 0.000). CONCLUSIONS: The choice of a sterilization method is achieved primarily through processes that involve both spouses. The motivations of both husband and wife, their mutual influence and communication, their present pattern of contraceptive use, and what they know about the satisfactions or dissatisfactions of other people who have had sterilizations are all factors that should be taken into account when the clinician helps a patient make the method-choice decision.

Choice Behavior↗

PubMed1992

Predictors of adolescent female decision making regarding contraceptive usage.

The relationship of cognitive capacity, cognitive egocentrism, and experience factors to decision making in a contraceptive usage problem was examined. Fifty sexually active, unmarried females, ages 14-19, served as subjects. Using correlational, regression, and canonical correlational analyses, cognitive capacity and cognitive egocentrism variables, not experience with contraceptives, were found to be significantly related to, and predictive of, five of seven decision-making variables. Forty-one percent of the variance was accounted for in predicting the canonical decision-making variable. The implications of these results for future research are discussed.

Adolescent↗

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↗

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↗