The impact of Computer-assisted Test Interpretation on Physician Decision Making

Abstract Background Physicians’ decision-making for seriously ill patients with advanced dementia is of high importance, especially as the prevalence of dementia is rising rapidly, and includes many challenging ethical, medical and juridical aspects. We assessed the change in this decision-making over 16 years (from 1999 to 2015) and several background factors influencing physicians’ decision. Methods A postal survey including a hypothetical patient-scenario representing a patient with an advanced dementia and a life-threatening gastrointestinal bleeding was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. The target groups were general practitioners (GPs), surgeons, internists and oncologists. The respondents were asked to choose between several life-prolonging and palliative care approaches. The influence of physicians’ background factors and attitudes on their decision were assessed. Results The response rate was 56%. A palliative care approach was chosen by 57 and 50% of the physicians in 1999 and 2015, respectively (p = 0.01). This change was statistically significant among GPs (50 vs 40%, p = 0.018) and oncologists (77 vs 56%, p = 0.011). GPs chose a palliative care approach less often than other responders in both years (50 vs. 63% in 1999 and 40 vs. 56% in 2015, p < 0.001). In logistic regression analysis, responding in 2015 and being a GP remained explanatory factors for a lower tendency to choose palliative care. The impact of family’s benefit on the decision-making decreased, whereas the influence of the patient’s benefit and ethical values as well as the patient’s or physician’s legal protection increased from 1999 to 2015. Conclusions Physicians chose a palliative care approach for a patient with advanced dementia and life-threatening bleeding less often in 2015 than in 1999. Specialty, attitudes and other background factors influenced significantly physician decision-making. Education on the identification and palliative care of the patients with late-stage dementia are needed to make these decisions more consistent.

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The Click-On gamma probe, a second-generation tethered robotic gamma probe that improves dexterity and surgical decision-making

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-021-05387-z ◽

2021 ◽

Author(s):

Samaneh Azargoshasb ◽

Simon van Alphen ◽

Leon J. Slof ◽

Giuseppe Rosiello ◽

Stefano Puliatti ◽

...

Keyword(s):

Decision Making ◽

Invasive Surgery ◽

Gamma Probe ◽

Minimal Invasive ◽

Task Completion ◽

Computer Assisted ◽

Surgical Decision ◽

Press Fit ◽

The Impact ◽

Surgical Decision Making

Abstract Purpose Decision-making and dexterity, features that become increasingly relevant in (robot-assisted) minimally invasive surgery, are considered key components in improving the surgical accuracy. Recently, DROP-IN gamma probes were introduced to facilitate radioguided robotic surgery. We now studied if robotic DROP-IN radioguidance can be further improved using tethered Click-On designs that integrate gamma detection onto the robotic instruments themselves. Methods Using computer-assisted drawing software, 3D printing and precision machining, we created a Click-On probe containing two press-fit connections and an additional grasping moiety for a ProGrasp instrument combined with fiducials that could be video tracked using the Firefly laparoscope. Using a dexterity phantom, the duration of the specific tasks and the path traveled could be compared between use of the Click-On or DROP-IN probe. To study the impact on surgical decision-making, we performed a blinded study, in porcine models, wherein surgeons had to identify a hidden 57Co-source using either palpation or Click-On radioguidance. Results When assembled onto a ProGrasp instrument, while preserving grasping function and rotational freedom, the fully functional prototype could be inserted through a 12-mm trocar. In dexterity assessments, the Click-On provided a 40% reduction in movements compared to the DROP-IN, which converted into a reduction in time, path length, and increase in straightness index. Radioguidance also improved decision-making; task-completion rate increased by 60%, procedural time was reduced, and movements became more focused. Conclusion The Click-On gamma probe provides a step toward full integration of radioguidance in minimal invasive surgery. The value of this concept was underlined by its impact on surgical dexterity and decision-making.

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Evaluation of a genomic-based prognostic test for metastasis in high-risk post-prostatectomy patients: Does it impact physician decision making?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.196 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 196-196

Author(s):

Ketan K. Badani ◽

Darby J. S. Thompson ◽

Anirban Pradip Mitra ◽

Mercedeh Ghadessi ◽

Christine Buerki ◽

...

Keyword(s):

Decision Making ◽

High Risk ◽

Treatment Recommendations ◽

Additional Treatment ◽

Treatment Recommendation ◽

Test Results ◽

Clinical Implementation ◽

Clinical Predictors ◽

Physician Decision Making ◽

The Impact

196 Background: Currently, identification of individual patients who are truly at risk of developing lethal prostate cancer after radical prostatectomy (RP) is based on clinical nomograms. A prospectively validated genomic classifier (Decipher) has been shown to more accurately predict metastatic disease post RP than established clinical predictors and can identify patients with adverse pathology who may be cured by RP alone and may therefore not require additional treatment. Methods: An IRB-approved study assessed the impact of a genomic classifier (GC) test in 240 pathologically high-risk post RP case reviews. Twenty (20) urologic oncologists from 18 institutions reviewed 12 cases presented in a randomized, de-identified fashion via a secure online platform to provide treatment recommendations pre- and post- patient GC test results. Possible recommendations included referral to radiation oncologist and/or initiation of adjuvant hormones, close observation, or other. The primary endpoint was any change in treatment recommendation after unblinding of GC test results. Confidence in treatment recommendations was assessed using a 5-point Likert scale. Results: Following unblinding of GC test results, treatment recommendations changed in 43% (95% CI: 37-49) of all cases. Specifically, among cases with a pre-GC recommendation involving treatment, 31% (95% CI: 23-41) of respondents changed their recommendation to observation post-GC.Respondents considered the GC result to have influenced their recommendation in 63% (95% CI: 56-68) of cases. The addition of information provided by the GC result increased decision making confidence in 39% (95% CI: 30-49) of cases where a change of treatment recommendation was made. Following unblinding, physicians reported that the GC result was clinically relevant in 84% (95% CI: 79-84) of cases. Conclusions: GC appears to influence treatment recommendations and decision making confidence for high-risk prostatectomy patients. This study suggests that clinical implementation of GC may potentially impact treatment recommendations.

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Poster 385 The Impact of MRI on Physician Decision Making Prior to Initial Lumbar Spinal Intervention

PM&R ◽

10.1016/j.pmrj.2012.09.996 ◽

2012 ◽

Vol 4 ◽

pp. S322-S322

Author(s):

Jaspal R. Singh ◽

Venu Akuthota ◽

Elizabeth Knight ◽

Scott Laker ◽

William J. Sullivan

Keyword(s):

Decision Making ◽

Physician Decision Making ◽

Lumbar Spinal ◽

The Impact

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Changes in Interventional Pain Physician Decision-Making, Practice Patterns, and Mental Health During the Early Phase of the SARS-CoV-2 Global Pandemic

Pain Medicine ◽

10.1093/pm/pnaa294 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3585-3595 ◽

Cited By ~ 1

Author(s):

Andrew A Joyce ◽

Aaron Conger ◽

Zachary L McCormick ◽

Richard W Kendall ◽

Graham Wagner ◽

...

Keyword(s):

Mental Health ◽

Decision Making ◽

Early Phase ◽

Practice Patterns ◽

Prescribing Patterns ◽

The Novel ◽

Physician Decision Making ◽

Spine Intervention ◽

Novel Coronavirus ◽

The Impact

Abstract Background and Objectives The novel coronavirus outbreak (SARS-CoV-2) began in late 2019 and dramatically impacted health care systems. This study aimed to describe the impact of the early phase of the pandemic on physician decision-making, practice patterns, and mental health. Methods An anonymous survey was distributed to physician members of the Spine Intervention Society (SIS) on March 24 and April 7, 2020. Respondents provided information regarding changes in clinical volume, treatment, and mental health (Patient Health Questionnaire [PHQ-4]) before April 10, 2020. Results Of the 1,430 individuals who opened the survey, 260 completed it (18.2%). Overall clinical and procedural volume decreased to 69.6% and 13.0% of prepandemic volume, respectively. Mean in-person clinic visits were reduced to 17.7% of total prepandemic clinic volume. Ongoing clinical visits were predominantly completed via telemedicine (video) or telephone (74.5%), rather than in-person (25.5%). Telemedicine and telephone visits represented 24.6% and 27.3% of prepandemic clinical volume, respectively. Respondents decreased in-person visits of select groups of high-risk patients by 85.8–94.6%. Significantly more providers reported increasing rather than decreasing prescriptions of the following medications: opioids (28.8% vs 6.2% of providers, P < 0.001), muscle relaxants (22.3% vs 5.4%, P < 0.001), neuropathic pain medications (29.6% vs 3.8%, P < 0.001), and acetaminophen (26.2% vs 4.2%, P < 0.001). Respondents’ mean PHQ-4 score was 3.1, with 19% reporting moderate or severe psychological distress. Several demographic factors were significantly associated with practice changes. Conclusions The novel coronavirus pandemic dramatically altered the practice and prescribing patterns of interventional pain physicians.

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Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod18.1.31 ◽

2008 ◽

Vol 18 (1) ◽

pp. 31-40 ◽

Cited By ~ 2

Author(s):

David J. Zajac

Keyword(s):

Clinical Practice ◽

Speech Intelligibility ◽

Current Practice ◽

Computer Assisted ◽

Behavioral Management ◽

Single Word ◽

Future Directions ◽

Speech Science ◽

The Impact ◽

Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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Quota Women Are Threatening to Men

Swiss Journal of Psychology ◽

10.1024/1421-0185/a000195 ◽

2017 ◽

Vol 76 (3) ◽

pp. 107-116 ◽

Cited By ~ 4

Author(s):

Klea Faniko ◽

Till Burckhardt ◽

Oriane Sarrasin ◽

Fabio Lorenzi-Cioldi ◽

Siri Øyslebø Sørensen ◽

...

Keyword(s):

Decision Making ◽

Organizational Performance ◽

Gender Stereotypes ◽

Perceived Threat ◽

Preferential Treatment ◽

Public Sector Employees ◽

Different Types ◽

Low Levels ◽

Women In Decision Making ◽

The Impact

Abstract. Two studies carried out among Albanian public-sector employees examined the impact of different types of affirmative action policies (AAPs) on (counter)stereotypical perceptions of women in decision-making positions. Study 1 (N = 178) revealed that participants – especially women – perceived women in decision-making positions as more masculine (i.e., agentic) than feminine (i.e., communal). Study 2 (N = 239) showed that different types of AA had different effects on the attribution of gender stereotypes to AAP beneficiaries: Women benefiting from a quota policy were perceived as being more communal than agentic, while those benefiting from weak preferential treatment were perceived as being more agentic than communal. Furthermore, we examined how the belief that AAPs threaten men’s access to decision-making positions influenced the attribution of these traits to AAP beneficiaries. The results showed that men who reported high levels of perceived threat, as compared to men who reported low levels of perceived threat, attributed more communal than agentic traits to the beneficiaries of quotas. These findings suggest that AAPs may have created a backlash against its beneficiaries by emphasizing gender-stereotypical or counterstereotypical traits. Thus, the framing of AAPs, for instance, as a matter of enhancing organizational performance, in the process of policy making and implementation, may be a crucial tool to countering potential backlash.

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