Using trained "developmental" discussion leaders to improve further the quality of group decisions.

To test the value of a group discussion technique, 22 students, each leading in discussions 2 groups of 3 persons each, were classified as untrained developmental leaders, trained leaders without prior experience with the case, and trained leaders who had the case previously. Recommendations about the case were given first from the point of view of the company and then from the point of view of the individual under discussion after decisions had been reached. These were compared with the E's preferred answer to the problem. "The results of the study provide strong evidence for the power of the developmental discussion technique for producing decisions of high quality." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using cluster analysis for medical resource decision making

Escalating costs of health care delivery have in the recent past often made the health care industry investigate, adapt, and apply those management techniques relating to budgeting, resource control, and forecasting that have long been used in the manufacturing sector. A strategy that has contributed much in this direction is the definition and classification of a hospital's output into "products" or groups of patients that impose similar resource or cost demands on the hospital. Existing classification schemes have frequently employed cluster analysis in generating these groupings. Unfortunately, the myriad articles and books on clustering and classification contain few formalized selection methodologies for choosing a technique for solving a particular problem, hence they often leave the novice investigator at a loss. This paper reviews the literature on clustering, particularly as it has been applied in the medical resource-utilization domain, addresses the critical choices facing an investigator in the medical field using cluster analysis, and offers suggestions (using the example of clustering low-vision patients) for how such choices can be made.     

Using conflict to improve effectiveness of nurse teams

As nurses increasingly turn to teamwork as a viable option for accomplishing a myriad of duties and responsibilities, they are discovering that teamwork can also be a source of conflict. This article suggests that conflict is both inevitable and necessary within a team. A model is presented that aims not at reducing conflict but at making it more effective. The author traces the influence of preconflict conditions and perspective-taking on conflict and ultimately team effectiveness. Finally, to aid in applying the model to practice, two examples are presented, demonstrating both an ineffective and an effective use of conflict.     

Patient-oriented interventions to improve communication in a medical office visit.

Examined an intervention to improve the patient's contribution to communication in a medical office visit. In Study 1, 53 women awaiting a medical appointment were assigned either to a group that was asked to list 3 questions to ask their physician or to a control group. Ss who listed questions asked more questions in the visit and reported being less anxious. In Study 2, with 49 women, a 3rd group received a message from their physician encouraging question asking. Both experimental groups asked more of the questions they had wished to, had greater feelings of control, and were more satisfied with the visit and with the information they received. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Projection in surrogate decisions about life-sustaining medical treatments.

To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using health care outcomes to improve patient care in the NICU

The authors describe their use of outcomes research in improving the care of infants in a ten-hospital network of neonatal intensive care units. Improvements in the processes of care for infants born with very low birth weights, and those suffering from chronic lung disease and nosocomial infections, are among the issues discussed.     

Determinants of decisions to seek medical treatment by patients with acute myocardial infarction symptoms.

Among 43 myocardial infarction patients (mean age 53.4 yrs), Ss who delayed between noting initial symptoms and deciding they were ill were those who reported that they characteristically exhibited some Type A behaviors, experienced little initial pain at a time when work was quite demanding, responded to their symptoms with depression and fatigue, and were currently quite pessimistic about their health. Those who delayed between deciding they were ill and seeking treatment were those who were assessed as Type B on the structured interview and who talked to others to assess the meaning of their symptoms. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of screening decisions in a medical school admission process

To study and predict a set of screening decisions in a medical school admission process, a stratified sample (n = 864) was drawn to represent the range of applicants to the Yale University School of Medicine during a single year. A smaller sample from the following year's applicants was drawn in a similar fashion for purposes of cross-validation. Prior to the prediction of screening decisions, a set of independent variables was selected by a factor analytic procedure from credentials in an applicant's admission folder. These folder variables ranged in nature from quantitative measures of academic performance to demographic information and types of extracurricular activity. Two multivariate statistical procedures, Sonquist's Automatic Interaction Detection (AID) and linear discriminant analysis (LDA), were used to predict screening decisions. Measures of academic performance and ability proved to be the most effective predictors of screening decision, as evidenced in the final AID tree and the discriminant function.     

Using memory strategies to improve 24-hour dietary recalls among older adults

Dietitians commonly use 24-hour recall to obtain estimates of the typical food intakes for a population. This study was designed to determine whether using an encoding strategy or support at the time of retrieval improves older adults' 24-hour recall of food items and amounts consumed. The study included 17 older adults ranging from 74 to 91 years of age. Lunch was served to these individuals, and 24-hour dietary recall and recognition of food items consumed at the meal were conducted the following day. Portion sizes for five food items served at the meal, as well as memory tests for recall and recognition and a visual perceptual test, were also administered. Among older adults, use of an encoding strategy did not enhance memory of food items and amounts consumed. However, when the adults were provided support with a visual recognition aid at the time of food item recall, individuals remembered more food items but not amounts consumed. Performance on the Wechsler Memory Scale I and II, Verbal Paired Associates, was found to be a predictor of subjects' performance on 24-hour recall.     

A systems analysis approach to medical error

Using decerebrate frogs (Rana catesbeiana), we investigated the role of vagal and laryngeal sensory feedback in controlling motor activation of the larynx. Vagal and laryngeal nerve afferents were activated by electrical stimulation of the intact vagal and laryngeal nerves. Pulmonary afferents were activated by lung inflation. Reflex responses were recorded by measuring efferent activity in the laryngeal branch of the vagus (Xl) and changes in glottal aperture. Two glottic closure reflexes were identified, one evoked by lung inflation or electrical stimulation of the main branch of the vagus (Xm), and the other by electrical stimulation of Xl. Lung inflation evoked a decrementing burst of Xl efferent activity and electrical stimulation of Xm resulted in a brief burst of Xl action potentials. Electrical stimulation of Xl evoked a triphasic mechanical response, an abrupt glottal constriction followed by glottal dilatation followed by a long-lasting glottal constriction. The first phase was inferred to be a direct (nonreflex) response to the stimulus, whereas the second and third represent reflex responses to the activation of laryngeal afferents. Intracellular recordings of membrane potential of vagal motoneurons of lung and nonlung types revealed EPSPs in both types of neurons evoked by stimulation of Xm or Xl, indicating activation of glottal dilator and constrictor motoneurons. In summary, we have identified two novel reflexes producing glottic closure, one stimulated by activation of pulmonary receptors and the other by laryngeal receptors. The former may be part of an inspiratory terminating reflex and the latter may represent an airway protective reflex.     

Tacit components of medical ethics: making decisions in the clinic

When a patient visits his doctor there is, as well as a spoken dialogue, also an unspoken, or tacit, dialogue between them. This may not be evident unless that dialogue breaks down when the psychological or moral terms of reference of each are seen to be different. The author of this paper tries to elucidate the framework in which physician and patient think, and in so doing allow an understanding of why the physician may appear to be rigid and authoritarian in his dealing with his patients and the patient uncooperative.     

Explanations for side effect aversion in preventive medical treatment decisions.

Objective: Many laypeople demonstrate excessive sensitivity to negative side effects of medical treatments, which may lead them to refuse beneficial therapies. This Internet-based experiment investigated three possible explanations for such “side effect aversion.” One was derived from mental accounting, one examined the mere presence of a side effect, and one focused on computational difficulties. Design: Participants (N = 5,379) were presented with a hypothetical cancer preventive treatment situation that was or was not accompanied by one or two small side effects. The side effects were either beneficial or harmful. In all conditions, the net absolute risk reduction associated with the treatment was 15%. Main Outcome Measures: Participants indicated their willingness to accept treatment and their perceptions of the treatment's effects on their overall cancer risk. Results: Data were consistent only with the “mere presence” explanation of side effect aversion, the idea that side effects act as a strong negative cue that directly affects treatment appraisal. The number of negative side effects did not influence treatment willingness. Conclusion: Side effect aversion is a challenge to informed decision making. Specific mechanisms that produce side effect aversion should be identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)