The decision-making process for the treatment of abnormal uterine bleeding

This pilot study was conducted to investigate the treatment decision-making process of patients and physicians for abnormal uterine bleeding (AUB). Frequently, women with AUB are referred for hysterectomy without diagnostic workup, alternative therapeutic management, or patient input (i.e., patient treatment preferences). Variations in treatment strategies used for patients may be related to a number of factors external to the patient's underlying disease. However, little is known about which factors are most influential or about the extent to which they influence physicians' and patients' decisions. We prospectively followed the management and treatment of 52 women with complaints of AUB and examined differences in treatment among these patients. Extensive previsit interviews were conducted with these women to identify each patient's symptoms, health status, functional status, and preferences for and expectations of treatment. We then conducted telephone interviews within a week of the visit and again 9-12 months later to determine the treatment plan, patient level of participation in and satisfaction with the treatment, symptoms, and functional status. Overall, our findings suggest that patients want to be involved in making treatment decisions and that when women were presented with alternatives to hysterectomy, many chose alternative medical therapy or other surgical procedures. In addition, women reported that these alternative treatments produced significant improvement in symptom intensity and functioning. Increased patient participation in decision making enhanced patient satisfaction. These findings suggest that hysterectomy rates may be decreased by offering women alternative treatments and by finding ways to increase women's participation in their treatment decisions.     

How the patient's sense of danger and safety influence the analytic process.

Discusses J. Weiss's (see record 1990-17877-001) proposition that a person may exercise unconscious control over repressions based on unconscious appraisals of danger and safety. This hypothesis derives from Freud's (1926) theory that repression is instituted due to anticipation that certain inner feelings or intentions would bring about a dangerous situation. Anticipation of danger evokes anxiety and leads to defense. The hypothesis implies that anticipation of danger (along with underlying pathogenic belief) is the linchpin that holds pathological formations in place. Clinical observations show that a patient's unconscious appraisals of danger and safety regulate analytic progress. These observations also change intuitions about how powerful unconscious contents may become conscious during analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medication compliance: the patient's perspective

There has been increasing interest in using outcomes-based research to evaluate quality of care. Compliance with prescribed regimens is an intermediate outcome measure that presumes that a positive health outcome will follow, which is why clinicians and researchers are interested in compliance. Patients, however, use a variety of criteria to determine the value of medication. They may place equal or greater value on personal and often competing nonclinical outcomes. A small but growing literature explores the influence of physical, economic, psychological, and social factors that influence medication use behavior. This literature supports the notion that patients evaluate medication based not only on its clinical effectiveness, but also how it affects all aspects of their lives. Outcomes research on compliance with prescribed medicine should recognize the outcomes valued from the patient's perspective.     

Vocationally mature coping strategies and progress in the decision-making process: A canonical analysis.

It has been suggested that variation in the extent to which individuals possess vocationally mature coping strategies will differentially influence their progress in the process of completing specific decision-making tasks. Measures of vocationally mature coping strategies and progress on decision-making tasks were administered to 174 undergraduates. A canonical analysis was employed to identify the primary independent dimensions that relate the 2 sets of variables measured. Two significant canonical roots were extracted from this analysis. Results suggest that (a) the extent to which an S employed a planning orientation appeared to hinder or facilitate movement beyond the exploratory phase of making a decision about an occupation and (b) Ss who engaged in making decisions about college major or occupation and who did so without the benefit of decision-making skills and available resources were likely to devote excess effort in the prechoice portion of the decision-making process. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A neurocognitive model of the ethical decision-making process: Implications for study and practice.

The field of business ethics is entrenched in a cognitive approach that portrays the ethical decision-making process as a completely deliberate and reasoned exercise. In light of growing concerns about the veracity of this approach, I build upon current knowledge of how the brain functions to present a neurocognitive model of ethical decision making. The model suggests that ethical decision making involves 2 interrelated yet functionally distinct cycles, a reflexive pattern matching cycle and a higher order conscious reasoning cycle, and thereby describes not only reasoned analysis, but also the intuitive and retrospective aspects of ethical decision making. The model sparks research in new areas, holds significant implications for the study of ethical decision making, and provides suggestions for improving ethical behavior in organizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The physician decision-making process in transferring nursing home patients to the hospital

BACKGROUND: Each year more than 25% of nursing home patients are transferred to the emergency department or hospital for evaluation and treatment of infection. These transfers may have an adverse impact on the quality and cost of patient care. This study examined physician assessment and management of acute infections in the nursing home. METHODS: A cross-sectional study was conducted of all acute urinary tract infections and lower respiratory tract infections occurring from February through June 1991 in eight randomly selected urban nursing homes. The numbers of transfers to the emergency department of hospital were recorded along with identification of the clinical, psychosocial, and institutional factors that influenced the physician's decision to transfer. RESULTS: Three hundred fifty-nine patients had 258 urinary tract infections and 219 respiratory tract infections. Eighty-one (17%) of these events resulted in transfer to a hospital for evaluation (16/81) and/or admission (65/81). Less than one third (30.4%) of the events caused the patient to be examined in the nursing home by a physician before the decision to transfer to the hospital. The mean time between the staff notification of an acute event and physician response by telephone was 5.12 hours. Independent mobility (P < or = .05), a transfer to the hospital during the previous 6 months (P < or = .01), and fewer nursing home laboratory tests and treatments (P < or = .01) were all associated with hospital transfer. CONCLUSIONS: In this sample of acutely ill nursing home patients, physicians collected limited clinical data before the decision to transfer. Although some transfers may be appropriate, a reduction in the transfer rate may reduce health care costs and limit the risk of iatrogenesis, thus improving the outcome of acute illnesses occurring in the nursing home.     

Anti-phospholipid syndrome: from patient's bedside to experimental animal models and back to the patient's bedside

The availability of animal models of the APS has provided a lot of experimental data which might be considered in trying to unravel several questions concerning this complicated disease. The main clinical manifestations associated with this disorder are repeated pregnancy loss, thrombocytopenia and thrombotic events. Other manifestations have been reported in relation to APS. However, the association with anti-phospholipid antibodies (aPL) are still uncertain. In the APS murine models presented here, both the Lupus-prone mice and the naive mice with induced APS, fetal resorption (parallels to embryo loss) and reduced fecundity rate were prominent features strongly associated with pathogenic aCL antibodies, making these models appropriate for investigating the human disease. Utilizing these models for APS have enabled to show the pathogenicity of aPL in pregnancy loss, neurological and behavioral changes, renal involvement and thrombus formation. Antiphospholipid antibodies from patients with APS, as well as natural aCL antibodies exerted pathogenic effects in naive mice, and in an in vivo thrombosis model. Several therapeutic modalities were found promising for application in the clinics. These include the antithrombotic and anticoagulant treatments using aspirin or LMWH, IL-3, or immunomodulation by high dose IVIG, specific anti-idiotypic or anti-CD4 antibodies, cyprofloxacin or bromocriptin administration.     

韶关冶炼厂提高ISP工艺处理混合矿能力的实践

分析了混合矿对ISP生产工艺的影响,通过改进烧结配料、厚料层烧结方面的研究与应用,使混合矿的处理量达到较高水平,取得良好的经济效益.     

论提高领导科学发展的能力——探析完善领导决策体制的基本途径

从四个方面论述了现阶段我国决策体制存在的一些问题,并相应提出了完善领导决策体制的基本途径,即完善决策权力配置机制、实现决策过程的民主化、健全信息收集处理机制、完善领导决策评估标准.     

Counselors' judgments of the quality of the prescreening stage of the career decision-making process.

The first stage of the career decision-making process is prescreening, which aims at locating promising alternatives deserving further exploration. J. L. Holland's (1997) concepts of differentiation, consistency, and coherence were adapted to cases in which an individual's career-related preferences, which serve as guidelines for locating such promising alternatives, are expressed in many work aspects (e.g., length of training, income, work environment) and not merely in terms of vocational interests. The assumption was that, as for interests, the optimal starting point is crystallized preferences. Judgments of 29 career counseling psychologists and 48 counseling graduate students who were presented with information about the career-related preferences of 18 hypothetical clients supported the hypotheses that crystallized preferences are differentiated, that they are consistent, and that they are coherent. The judgments of these experts on 9 lists of occupations supported the hypothesis that the desirable outcome of the prescreening stage is a concise and homogeneous list of promising alternatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bystander response to arterial bleeding: Helping skills, the decision-making process, and differentiating the helping response.

Explored the impact of variables on 2 different decisions in the decision-making process leading to help, using a mock injury involving arterial bleeding and 163 university students (100 females and 63 males). Expertise (Red Cross training), ambiguity, and number of bystanders were manipulated in a 2?×?2?×?2 design. The following responses were observed: nonhelp, ineffective direct help, indirect help, and direct help. The decision to help or not was affected by ambiguity, sex, and the presence or absence of other bystanders. Greater ambiguity led to less help; women helped less than men; fewer people helped when other bystanders were present. Expertise affected the decision leading to the type of help used but not the decision to help. Although training did not raise the intervention rate, it did dramatically change the effectiveness of the help used and could yield as many as 28 more saved lives out of 80 such incidents. Ineffective direct help occurred most frequently when the bystander was alone. The presence of other bystanders affected the type of indirect help that was used. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Indecisiveness and high school students' career decision-making process: Longitudinal associations and the mediational role of anxiety.

This study examined how indecisiveness relates to adolescents' process of choosing a study in higher education, using a longitudinal design. A sample of 281 students participated at the beginning, middle, and end of Grade 12. Findings show that indecisiveness was a risk factor for future levels of coping with the career decisional tasks of broad and in-depth environmental exploration (amount of information and exploratory behavior), amount of self-information, decisional status, and commitment. However, indecisiveness did not relate to the degree of change in decisional tasks during Grade 12. Moreover, results suggest that the linkage of indecisiveness with the amount of in-depth environmental information, the amount of self-information, decisional status, and commitment was mediated by adolescents' career choice anxiety. Finally, stability data provided support for the conceptualization of indecisiveness as a trait. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Competency and common law: Why and how decision-making capacity criteria should be drawn from the capacity-determination process.

Determining competence to request physician-assisted suicide should be no more difficult than determining competence to refuse life-prolonging treatment. In both cases, criteria and procedures should be developed out of the process of actually making capacity determinations; they should not be promulgated a priori. Because patient demeanor plays a critical role in capacity determinations, it should be made part of the record of such determinations through greater use of video- and audiotapes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On receiving the patient's transference: the symbolizing and desymbolizing countertransference

This is an empirical study of the therapist's experience of the patient delineating the boundaries between empathy and constructive and destructive forms of countertransference. The unique step was taken of focusing a video camera on the therapist in order to trace the therapist's nonverbal behavior during listening. The same therapist was observed first in a "not-so-difficult" and then a "difficult" session; the sessions could then be distinguished along dimensions of rhythmicity or arrhythmicity of nonverbal behavior. These observations suggested three modes of experiencing the patient: empathy marked by rhythmicity, a symbolizing countertransference marked by a transitory arrhythmicity, and a desymbolizing countertransference marked by continuous arrhythmicity. The congruence of these formulations based on direct observation of therapist behavior and ones derived from retrospective reconstructions of analysts in sessions (Schwaber, Jacobs, and Laskey) was explored and was found to enhance the validity of the proposed formulations.     

Cushing's syndrome from the patient's perspective

Forty-one patients with Cushing's syndrome described the physical, mental, and emotional effects of the disease, and the effects that the disease has on their families and performance at work or school. The majority of patients reported that Cushing's syndrome greatly affected everyday life. Areas in which physicians and nurses can provide critical assistance and support are described.