Medical decision making among cancer patients.

The purpose of this study is to assess the decisional processes used by patients undergoing cancer treatment. Results demonstrated that patients used 4 discrete strategies to make medical decisions: information seeking, information processing, advice following, and ruminating. Patients' decisional style predicted their scores on measures of coping. Patients who used the cognitively effortful information-seeking and information-processing decisional strategies reported using more coping strategies and more of the strategies that prior research has shown to be more effective for coping with life-threatening illness than did patients who used the advice-following decisional strategy (all ps?     

Physician-patient relations--participation of patients with ureteral calculi in clinical decision making and level of anxiety

In a study examining the relationship between patient participation in clinical decision making and levels of anxiety, patients were offered a choice of treatment for ureteral calculus. 42 received information about 2 treatment options, ultrasound fragmentation of the stone through a ureteroscope and extracorporeal shock wave lithotripsy (ESWL), and were asked to choose the method that they preferred. 54 received treatment decided on by the physician without their participation in the decision making process. Anxiety was measured before meeting with the physician, immediately after the meeting and on hospitalization for treatment. The contribution of the patient's perception of participation in the decision-making process and level of education was also examined. There was a decrease in level of anxiety after meeting with the physician only among those who did not actually participate in the decision-making process (p < 0.05). There was no change in the level of anxiety among those offered choice of treatment. However, a decrease in anxiety was evident among patients who perceived that they had received information about their illness and its treatment (p < 0.01). This was not the case for patients who perceived themselves as participants in decision making unless they had a relatively high-level of education (p = 0.05).     

Observer variation and clinical decision making

The effects of nutritional regime on the colonic absorption of electrolytes, water, and short-chain fatty acids (SCFA) were studied in three rodent species (voles, spiny mice, and laboratory mice) differing in their ecological background. The effects of different levels of SCFA, induced by restriction of food intake, on the capacity of the in situ perfused colon to absorb water and electrolytes was studied. In addition, in vitro experiments were carried out to assess the mechanisms related to electrolyte transport in the proximal and distal colon. Water and solutes absorption from the perfused colon in the food restricted voles were significantly lower compared to voles fed ad libitum. No such effect was recorded in the two murid species. In vitro studies, employing Ussing chambers, were conducted to characterize the sodium and chloride transport mechanisms. In the colon of the voles and spiny mice as well as in the distal colon of the laboratory mice, net Na+ flux was not significantly different from that of Cl-, and both were higher than the measured equivalent short circuit current. The results suggest an electroneutral sodium transport mechanism in all three species. A high capacity to adjust the rate of water absorption to the amount of fermentable substance in the intestine was demonstrated only in the vole.     

Neuropsychological correlates of decision making in patients with bulimia nervosa.

In addition to the core psychopathology of bulimia nervosa (BN), patients with BN often show impulsive behavior that has been related to decision making deficits in other patient groups, such as individuals with anorexia nervosa and pathological gamblers. However, it remains unclear whether BN patients also show difficulties in decision making. In this study, 14 patients with BN and 14 healthy comparison subjects, matched for age, gender, education, body mass index, and intelligence, were examined with the Game of Dice Task (M. Brand, E. Fujiwara, et al., 2005), a gambling task that has fixed winning probabilities and explicit rules for gains and losses, as well as with a neuropsychological test battery and personality questionnaires. On the task, the patients with BN chose the disadvantageous alternatives more frequently than did the comparison subjects. Performance on the Game of Dice Task was related to executive functioning but not to other neuropsychological functions, personality, or disease-specific variables in the BN group. Thus, in patients with BN, decision making abnormalities and executive reductions can be demonstrated and might be neuropsychological correlates of the patients' dysfunctional everyday-life decision making behavior. Neurocognitive functions should be considered in the treatment of BN. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immediate implants: indications and clinical decision making

This paper is intended to describe the current concepts in timing of implant placement, and to address some of the controversies surrounding implants and bone grafting.     

Ethical hazards of the substituted judgement test in decision making concerning the end of life of dementia patients

Previously we reported that the South American gray short-tailed opossum, Monodelphis domestica, had an MHC class-I locus similar to that of eutherian species. In addition to the detection of lymphocyte antigens by cytotoxic antisera, we concluded that this marsupial rejected allogeneic skin grafts, as would be expected of animals with MHC class-I polymorphism. However, this conclusion was based on a limited number of skin transplants that were assayed for only a short period. Here we report the results of 22 reciprocal skin grafts made between individuals of known genetic relationships. On the basis of gross inspection of the grafts and histologic examination, we found that the average time of the onset of graft rejection was about 19 days and that the average time for complete graft rejection was about 31 days. In general, it took longer for the onset of graft rejection among pairs of genetically related animals than among less related animals. These results indicate unequivocally that this marsupial species has a high degree of class-I polymorphism and rejects allogeneic skin transplants in a manner similar to but more slowly than eutherian mammals.     

Relationship of life stress and body consciousness to hypervigilant decision making.

I. L. Janis and L. Mann's (1977) model was used to study the relationship of naturally occurring life stress and private body consciousness (PBC; L. Miller et al, 1981) to decision making. Students (N?=?61) performed an analogies task developed by G. Keinan (1987). Hierarchical regression analyses indicated that performance quality could be explained by aversive life event stress, PBC, state anxiety, and their interaction. The greater the state anxiety, the poorer the performance. For low PBC individuals there was little relationship between life stress and decision quality or strategies. For high PBC individuals, increasing life stress was associated with poorer performance and the use of hypervigilant strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of clinical decision making in primary care: opinion of physicians

The in vivo genotoxic activities in mouse skin of the dimethyl sulphoxide (DMSO) extracts of a range of oil products [residual aromatic extract; untreated heavy paraffinic distillate aromatic extract; mildly refined light naphthenic base oil; bitumen (vacuum residue); high viscosity index base oil obtained by catalytic hydrogenation] were evaluated by 32P-postlabelling DNA analysis. The results of quantitative 32P-postlabelling analyses of epidermal DNA from mice treated with the DMSO extracts showed linear relationships with the total polycyclic aromatic compound (PAC) contents, determined by the Institute of Petroleum method IP 346 and also the 3-6 ring PAC contents, measured by on-line liquid-liquid extraction using flow injection analysis. The 32P-postlabelling data also showed a linear relationship with the mutagenicity indices of these oil products determined in S. typhimurium TA98 using the modified Ames Salmonella microsome test. The in vivo genotoxicity of the DMSO extracts from the oil products was low, judged by 32P-postlabelling analysis of DNA adducts measured in epidermal DNA of treated mouse skin, and ranging from 2 to 723 attomole/microg DNA per mg oil product. The in vivo 32P-postlabelling data from this study are consistent with these materials expressing low genotoxicity in mouse skin in vivo. The DMSO extraction procedure coupled with 32P-postlabelling DNA analysis is useful for ranking the relative genotoxic potency in vivo of a wide range of oil products. In general the trend observed is similar to rankings based on physicochemical measurements of total PAC contents or 3 6 ring PAC contents of the oil products.     

Outpatient psychotherapy with dangerous clients: A model for clinical decision making.

The precedent-setting 1976 judicial decision of Tarasoff v. Regents of the University of California established a duty to protect whereby psychotherapists are expected to exercise reasonable care to protect the potential victims of their clients' violent behavior. However, no standard of care for dangerous clients has been established. In this article, the authors present a model for clinical decision making to determine the best interventions for dealing with dangerous outpatient clients. The model takes into account the degree of violence risk and the strength of the therapeutic alliance. Four cases are presented to illustrate the application of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying artificial neural network models to clinical decision making.

Because psychological assessment typically lacks biological gold standards, it traditionally has relied on clinicians' expert knowledge. A more empirically based approach frequently has applied linear models to data to derive meaningful constructs and appropriate measures. Statistical inferences are then used to assess the generality of the findings. This article introduces artificial neural networks (ANNs), flexible nonlinear modeling techniques that test a model's generality by applying its estimates against "future" data. ANNs have potential for overcoming some shortcomings of linear models. The basics of ANNs and their applications to psychological assessment are reviewed. Two examples of clinical decision making are described in which an ANN is compared with linear models, and the complexity of the network performance is examined. Issues salient to psychological assessment are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life in patients with chronic obstructive pulmonary disease and bronchial asthma

Review of data in the literature on the quality of life and its assessment in chronic obstructive lung disease and in bronchial asthma. The authors mention the most frequently used types of questionnaires and results achieved when using them. General questionnaires include the Sickness Impact Profile or the short version of a very detailed questionnaire which has 36 questions with sub-questions (SF-36 = Short Form-36). Specific questionnaires are focused on certain questions concerning different diseases. These questionnaires include SGRQ (St. George's Respiratory Questionnaire) which is used mainly in chronic obstructive lung disease. For this disease also the CRQ was developed (Chronic Respiratory Questionnaire) but its section on dyspnoea is not standardized. For evaluation of the quality of life of asthmatic patients several questionnaires exist, in particular for children. Several questions call for further standardization. The value of questionnaires is, however, beyond dount. They elucidate the situation which does not ensue even from detailed functional examination of the lungs or immunological examination. It appraises bodily and mental functions of man, restriction of his activity, the sensation of comfort and general evaluation of his health. Thus "classical" evaluation methods are extended by now non-traditional ways of appraisal of diseases which have a high prevalence and thus also great impact in the population.     

Pregnancy decision making as a significant life event: A commitment approach.

A value-laden basis for commitment to goals and the behavioral and affective sequelae of commitment were examined in the context of a stressful life event. Fifty-seven women who were interviewed during a clinic visit for a pregnancy test (Time 1 [T1] ) subsequently received positive test results and were then interviewed 2 days later (Time 2 [T2]) and a month later (Time 3 [T3]). The intentionality and the meaning of the pregnancy were associated with self-reported commitment to the pregnancy at T1. In turn, commitment predicted affective states both prior to (T1) and shortly after (T2) receiving test results. Initial commitment also predicted decisions to continue versus to terminate the pregnancy. The decision to continue the pregnancy appeared to bolster self-reported commitment. Relatedly, those continuing the pregnancy reported smoking fewer cigarettes at T3 than at T1. For those aborting the pregnancy, commitment at T1 was negatively related to adjustment at T3. Initial commitment predicted subsequent depression, guilt, and hostility among those who aborted, whereas commitment predicted anxiety among those who continued the pregnancy. Other correlates of commitment (pregnancy concerns, religion, abortion history, and other lifegoals) were explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing life expectancies of older nursing home residents

OBJECTIVE: Care of nursing home (NH) residents is often based on the usual survival of the home's residents. In order to improve our understanding of this population, and, thus, ultimately facilitate individualization of their care, we developed a mathematical model that predicts their survival. SETTING: The Jewish Home and Hospital (JHH), a nursing home. PARTICIPANTS: 1145 older residents who were at the JHH from January 1, 1986, through July 1, 1986. MEASUREMENTS: Information abstracted from medical records and JHH computerized data: clinical, demographic, and dependencies in activities of daily living (ADLs). Main outcome measure: survival from July 1, 1986. DESIGN: Retrospective cohort study via medical chart review. The study period covered admission to JHH through January 17, 1996. Accelerated failure time (AFT) models generated the life expectancy model derived from 50% of the study group and were validated on the remaining sample. We computed predicted AFT and proportional hazards (PH) life expectancies. RESULTS: Significant, independent predictors of decreased survival were male gender, increased age, increase in summary ADL index, and impairment of cardiac, respiratory, neurological, and endocrine/metabolic systems. The interaction between gender and respiratory system impairment was significant. The Spearman correlation coefficients between the observed survivals and those predicted by the Phase I model are 0.49 for Phase I residents and 0.42 for Phase II residents. Our sample life table includes NH residents with different risk profiles and their associated survival estimates as well as interquartile ranges. AFT and PH survivals were similar. CONCLUSION: This first comprehensive model that predicts survival of NH residents can help formulate public health policies and identify appropriate NH residents for clinical trials. The model is a promising step toward improving the health care of NH residents.     

Linear models in decision making.

A review of the literature indicates that linear models are frequently used in situations in which decisions are made on the basis of multiple codable inputs. These models are sometimes used (a) normatively to aid the decision maker, (b) as a contrast with the decision maker in the clinical vs statistical controversy, (c) to represent the decision maker "paramorphically" and (d) to "bootstrap" the decision maker by replacing him with his representation. Examination of the contexts in which linear models have been successfully employed indicates that the contexts have the following structural characteristics in common: each input variable has a conditionally monotone relationship with the output; there is error of measurement; and deviations from optimal weighting do not make much practical difference. These characteristics ensure the success of linear models, which are so appropriate in such contexts that random linear models (i.e., models whose weights are randomly chosen except for sign) may perform quite well. 4 examples involving the prediction of such codable output variables as GPA and psychiatric diagnosis are analyzed in detail. In all 4 examples, random linear models yield predictions that are superior to those of human judges. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal horizons in decision making.

The perception of duration is crucial when we make choices between immediate and delayed rewards. Immediate rewards are valued more than the same rewards if they are delayed. Preferences for earlier rewards become even stronger when the reward can be received within a subjectively proximate time frame. A “rational” decision to wait for a delayed reward may be overruled by an “impulsive” choice when the option for the closer reward falls within this proximate time range. Based on findings on circadian and circannual physiological rhythms, we suggest that there are 2 time units that are both biologically and culturally determined and have an impact on human experience and behavior: the day and the year. We highlight results of a neuroimaging study showing that rewards with delays up to 1 year are discounted differently than reward delays longer than 1 year. This duration-dependent discounting is associated with specific brain activation in the striatum. We present various conceptualizations of subjective time incorporated in parametric models of intertemporal decisions that may lead to a better understanding of human choice behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness

Phosphopeptides are a useful tool for the investigation of phosphorylation as a reversible posttranslational modification. There is a growing interest in using mimics of phosphoamino acids involved in phosphorylation in order to study the enzymes concerned in these processes. These mimics should contain a non-hydrolysable or isoelectrically modified phosphate moiety to be used as a specific inhibitor of phosphatases and kinases. We introduce sold-phase synthesis of H- and methylphosphonopeptides as a new class of mimics of phosphotyrosyl peptides. The peptides were synthesized on solid phase using the standard fluorenyl-methyloxycarbonyl (Fmoc) strategy. Tyrosine residues were incorporated as allyl-protected derivatives, which were selectively deprotected on the resin by treatment with Pd(PPh3)4. The peptide resin carrying the side-chain unprotected tyrosine of the model peptide Gly-Gly-Tyr-Ala was phosphonylated with di-tert-butyl-N,N-diethyl-phosphoramidite in the presence of 1H-tetrazole, yielding H-phosphonopeptides after trifluoroacetic acid (TFA) cleavage. Alternatively, phosphonylation of the unprotected tyrosine with O-tert-butyl-N,N-diethyl-P-methylphosphonamidite catalysed by 1H-tetrazole and followed by oxidation led to the methyphosphonopeptides after TFA cleavage. We obtained both the H-phosphonopeptides and the methylphosphonopeptides of the tetrapeptide in high yields and purities above 90%, according to reversed-phase high-performance liquid chromatography (RP-HPLC). To investigate the general applicability of our new methodology, we synthesized phosphonopeptides up to 13 amino acids long, corresponding to recognition sequences of tyrosine kinases. After cleavage and deprotection, all phosphonopeptides were obtained in high yields and purities of about 90%, as shown by mass spectrometry. The only by-product found was the unmodified peptide.     

Clinical trials: are they really useful for clinical decision making?

For the first time salvarsan treatment in Cracow was successfully held in Opthalmology Clinic of Jagiellonian University by Prof. Boles?aw Wicherkiewicz, who used preparation 606 in three cases at ophthalmic complications caused by syphilis infection. He received this preparation directly from P. Ehrlich.     

What role do patients wish to play in treatment decision making?

BACKGROUND: Although current ideology suggests patients should be active participants in decision making about their care, the literature suggests that patients wish to be informed but not involved. OBJECTIVE: To test the hypothesis that most patients want their physicians to take the responsibility for problem solving (PS, identifying the one right answer), but that many want to be involved in decision-making (DM, selecting the most desired bundle of outcomes) tasks. METHODS: Survey responses from 300 patients undergoing angiogram at a Toronto, Ontario, hospital were analyzed (response rate, 72%). Survey items included scales to measure desire for information and participation, including Autonomy Preference Index, the Krantz Health Opinion Survey, and the Deber-Kraetschmer Problem-Solving Decision-Making Scale measured on a scale from, 1 (doctor only) to 5 (patient only). RESULTS: Patients had a relatively high desire for information. On the Problem-Solving Decision-Making Scale, they overwhelmingly wished the PS tasks to be performed by or shared with the physician (98.4% of the 12 PS scores are between 1 and 3), but wanted to be involved in DM (78% of the 6 DM scores are between 3 and 5). Preference for handing over control to the physician was significantly greater for the vignette involving potential mortality (chest pain) than for the vignettes involving mainly morbidity (urinary problems) or quality of life (fertility). CONCLUSIONS: Although patients do not wish to be involved in PS tasks, few wish to hand over DM control to their physician. These findings suggest 2 major roles for clinicians--assisting patients in PS to structure choices and supporting them in making often difficult decisions.     

Patho-flow diagramming: a strategy for critical thinking and clinical decision making

Developing and implementing alternative strategies to assist nursing students to gain critical thinking and clinical decision-making skills are paramount for today's nurse educator. Patho-flow diagramming is offered as a strategy that merges nursing process and pathophysiology with approaches used effectively in general education to develop thinking skills.