Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?

Background: Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field. Hypothesis: It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons. In addition, it was hypothesized that youth sports medicine professionals who were parents of a child with a previous major sports injury or concussion would be less likely to allow their child to play American tackle football or return to football after a concussion. Study Design: Cross-sectional study. Methods: An online survey was provided to the active members of the Pediatric Research in Sports Medicine Society. We used both professional background information and responses to questions related to personal experiences with youth sports injuries to determine potential factors associated with underlying biases. Survey responses among subgroups were compared using the Fisher exact test. The Pearson correlation coefficient was used to evaluate years in practice versus opioid use. Results: Of the survey participants, 62.5% were pediatric surgeons, and 37.5% represented different nonsurgical youth sports medicine professions. Surgeons were less likely than nonsurgeons to agree to allow their child to return to football after sustaining a concussion and completing a concussion protocol (48% vs 76%, P = .013). Surgeons were more likely than nonsurgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%, P = .003 and 52% vs 23%, P = .013, respectively). Those who reported having a child with a concussion history were more likely to support him or her returning to football after a concussion (65% vs 33%, P = .026). Conclusion: Surgeons were more likely to favor elective shoulder-stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of nonoperative management. Personal experience of having a child who sustained a major sports injury or concussion did not demonstrate a bias against participation in football or return to football after a concussion.

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Sports Medicine in the Pediatric Office

10.1542/9781581104240 ◽

2007 ◽

Keyword(s):

Sports Medicine ◽

Practical Skills ◽

Video Clips ◽

Pediatric Sports Medicine ◽

First Time ◽

Motion Video

Now--for the first time anywhere--a single pediatric sports medicine resource teams a practical skills-focused text with full-motion video clips that show you exactly how it's done.

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MANAGEMENT OF FIRST-TIME PATELLAR DISLOCATION: A SURVEY OF PRISM MEMBERS (201)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00310 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0031

Author(s):

Shital Parikh ◽

Matthew Veerkamp ◽

Keyword(s):

Decision Making ◽

Sports Medicine ◽

Patellar Dislocation ◽

Decision Making Process ◽

Free Text ◽

Guided Growth ◽

Osteochondral Fracture ◽

Orthopedic Surgeons ◽

Several Variables ◽

First Time

Objectives: There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. The objective of this study was to develop consensus-based guidelines for management of first-time dislocation in adolescents. Methods: A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed. Results: 81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses (Table 1).There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process. Conclusions: There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes. *PF RIG members: Matthew Ellington, MD, Craig J Finlayson, MD, Joseph Molony, Jr., PT, MS, SCS, CSCS, Nicole Friel, MD MS, Daniel W Green, MD, Jeffery L Mikutis, DO, Todd A Milbrandt, MD, James L Pace, MD, Albert M Pendleton, MD, Lauren H Redler, MD, Jason Rhodes, MD, Shannon D Safier, MD, John A Schlechter, MD, Beth E Shubin Stein, MD, Curtis Vandenberg, MD, Jeffrey M Vaughn, DO, Eric J Wall, MD, Drew E Warnick, MD, Moshe Yaniv, MD, Shital N Parikh, MD.

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MANAGEMENT OF FIRST-TIME PATELLAR DISLOCATION: A SURVEY OF PRISM MEMBERS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00133 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0013

Author(s):

Shital N Parikh ◽

Matthew Veerkamp ◽

Matthew Ellington ◽

Craig J Finlayson ◽

Joseph Molony ◽

...

Keyword(s):

Decision Making ◽

Sports Medicine ◽

Patellar Dislocation ◽

Decision Making Process ◽

Free Text ◽

Guided Growth ◽

Osteochondral Fracture ◽

Orthopedic Surgeons ◽

Several Variables ◽

First Time

Background: There are no current guidelines for optimal management of first-time patellar dislocation in children and adolescents. Purpose: To develop consensus-based guidelines for management of first-time dislocation in adolescents. Methods: A 29-question, case-based, multiple-choice survey was developed after 2-rounds of iterations by 20 members of the Patellofemoral RIG. The survey contained two case scenarios of first-time patellar dislocation in adolescents - one with and one without an osteochondral fracture. The survey was administered to primary sports medicine and orthopedic surgeons of the PRISM Society in April 2020 and the responses were analyzed. Consensus-based guidelines were generated when at least 66% of the respondents agreed Results: 81/276 (29%) members responded to the survey and 6 consensus-based guidelines were generated from those responses. [Table: see text] There was no consensus between conservative (60%) and operative (40%) treatment of contralateral patellar dislocation. Free-text analysis revealed several variables that influence the decision-making process. Conclusion: There are changes in trends related to management of first-time dislocation in adolescents. MRI, though not recommended for all patients with first-time dislocation, was obtained by 51% of respondents. The survey provides details of conservative treatment, including the role and duration of bracing and physical therapy. For first-time dislocation with an osteochondral fracture, concomitant patellar stabilization is preferred over isolated fixation. Simultaneous guided-growth for genu valgum correction is recommended. There were several variables that influenced the decision-making process and there were several areas of discordance. Further research studies on these parameters could potentially improve outcomes.

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Book Review: A Guide to Decision Making in Student Affairs: A Case Study Approach

NASPA Journal ◽

10.2202/0027-6014.1123 ◽

2000 ◽

Vol 38 (1) ◽

Author(s):

Tracy Davis

Keyword(s):

Decision Making ◽

Student Affairs ◽

Student Affairs Professionals ◽

Expert Advice ◽

Background Information ◽

Case Study Approach ◽

New Professionals ◽

Study Approach

Stanley Levy and Charles Kozoll capture much of the complexity of decisionmaking and offer an important contribution to our understanding of this perplexing topic. The publication of A Guide to Decision Making in Student Affairs: A Case Study Approach, furthermore, is timely due to what Stage (1993) recognizes as an increasing expectation that "new professionals, even at the lowest levels, have the ability to work independently and solve complex issues knowledgeably and with skill and integrity" (p. iii). The case study approach combined with the expert advice of 15 seasoned student affairs deans (called informants) provides a valuable resource for learning about a central task in our profession. The book offers students as well as experienced professionals background information critical to decisionmaking in higher education, exploration of fundamental issues that influence the process, carefully constructed and relevant case studies, and a reservoir of advice from some of the most well respected senior-level practitioners in our field. This book is particularly valuable to faculty members facilitating learning with new professionals, but it is a resource most student affairs professionals would find well worth owning.

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Using Telemedicine to Pre-Screen Sports Medicine Patients in the Ambulatory Setting Reduces Wait Times and Maximizes Provider-Patient Interaction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00417 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0041

Author(s):

Alfred Atanda ◽

Kathryn Leyden ◽

Medical Student

Keyword(s):

Patient Satisfaction ◽

Knee Pain ◽

Sports Medicine ◽

Clinic Visit ◽

Background Information ◽

Full Time ◽

Visit Time ◽

Medicine Clinic ◽

Exam Room ◽

Room Time

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

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Towards enhanced risk management: planning, decision making and monitoring of US wildfire response

International Journal of Wildland Fire ◽

10.1071/wf17089 ◽

2017 ◽

Vol 26 (7) ◽

pp. 551 ◽

Cited By ~ 16

Author(s):

Christopher J. Dunn ◽

David E. Calkin ◽

Matthew P. Thompson

Keyword(s):

Decision Making ◽

Risk Management ◽

Fire Management ◽

The United States ◽

Management Decision ◽

Current Response ◽

Ongoing Research ◽

Response Strategies ◽

Management Decision Making ◽

Response Decisions

Wildfire’s economic, ecological and social impacts are on the rise, fostering the realisation that business-as-usual fire management in the United States is not sustainable. Current response strategies may be inefficient and contributing to unnecessary responder exposure to hazardous conditions, but significant knowledge gaps constrain clear and comprehensive descriptions of how changes in response strategies and tactics may improve outcomes. As such, we convened a special session at an international wildfire conference to synthesise ongoing research focused on obtaining a better understanding of wildfire response decisions and actions. This special issue provides a collection of research that builds on those discussions. Four papers focus on strategic planning and decision making, three papers on use and effectiveness of suppression resources and two papers on allocation and movement of suppression resources. Here we summarise some of the key findings from these papers in the context of risk-informed decision making. This collection illustrates the value of a risk management framework for improving wildfire response safety and effectiveness, for enhancing fire management decision making and for ushering in a new fire management paradigm.

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The Police Use of Background Information Related to Alleged Victims in Mock Evaluations of Child Sexual Abuse

Journal of Police and Criminal Psychology ◽

10.1007/s11896-019-9312-6 ◽

2019 ◽

Vol 35 (4) ◽

pp. 414-421 ◽

Cited By ~ 1

Author(s):

Alessandro Tadei ◽

Pekka Santtila ◽

Jan Antfolk

Keyword(s):

Decision Making ◽

Sexual Abuse ◽

Child Sexual Abuse ◽

Police Officers ◽

Background Information ◽

Support Tools ◽

Low Probability ◽

Individual Variables ◽

Subject Performance ◽

Decision Making Support

Abstract When statistically related to child sexual abuse (CSA), background information can assist decision-making in investigations of CSA allegations. Here, we studied the use of such background information among Finnish police officers. We analyzed their ability to identify and interpret CSA-related and CSA-unrelated background information both when placed in mock scenarios and when presented as separate, individual variables. We also measured the ability to correctly estimate the probability of CSA based on such background information. In the context of mock scenarios, officers were better in discarding CSA-unrelated variables than in identifying CSA-related ones. Within-subject performance across different scenarios was, however, not consistent. When information was presented as separate variables, officers tended to incorrectly consider many CSA-unrelated variables as CSA-related. Officers performed better in recognizing whether actual CSA-related variables increase or decrease the probability of CSA. Finally, officers were inaccurate in identifying variables that are CSA-related only for boys or only for girls. When asked to estimate the CSA probability of mock scenarios, participants were accurate only in assessing low-probability cases, and this was not associated with the ability to identify CSA-related and CSA-unrelated variables. We conclude that police officers would benefit from more training in using background information and from using available decision-making support tools in the context of investigating CSA allegations.

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Deterministic policies based on maximum regrets in MDPs with imprecise rewards

AI Communications ◽

10.3233/aic-190632 ◽

2021 ◽

pp. 1-16

Author(s):

Pegah Alizadeh ◽

Emiliano Traversi ◽

Aomar Osmani

Keyword(s):

Decision Making ◽

Decision Process ◽

Process Models ◽

Sequential Decision Making ◽

Sequential Decision ◽

Exact Procedure ◽

Markov Decision ◽

Intuitive Idea ◽

First Time ◽

Maximum Regret

Markov Decision Process Models (MDPs) are a powerful tool for planning tasks and sequential decision-making issues. In this work we deal with MDPs with imprecise rewards, often used when dealing with situations where the data is uncertain. In this context, we provide algorithms for finding the policy that minimizes the maximum regret. To the best of our knowledge, all the regret-based methods proposed in the literature focus on providing an optimal stochastic policy. We introduce for the first time a method to calculate an optimal deterministic policy using optimization approaches. Deterministic policies are easily interpretable for users because for a given state they provide a unique choice. To better motivate the use of an exact procedure for finding a deterministic policy, we show some (theoretical and experimental) cases where the intuitive idea of using a deterministic policy obtained after “determinizing” the optimal stochastic policy leads to a policy far from the exact deterministic policy.

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Timing of Vaccine Decision-Making Among First-Time Parents

Academic Pediatrics ◽

10.1016/j.acap.2021.10.004 ◽

2021 ◽

Author(s):

J. Nathan Yarnall ◽

Carl Seashore ◽

Carrie A. Phillipi ◽

Joseph E. Hatch ◽

Beth King ◽

...

Keyword(s):

Decision Making ◽

Vaccine Decision Making ◽

First Time

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A consumer perspective of advertising by attorneys

SA Journal of Industrial Psychology ◽

10.4102/sajip.v17i1.520 ◽

1991 ◽

Vol 17 (1) ◽

Author(s):

C. Boshoff

Keyword(s):

South Africa ◽

Decision Making ◽

Information Needs ◽

Communication Strategies ◽

Legal Services ◽

Marketing Communication ◽

Advertising Agencies ◽

The Public ◽

Consumer Perspective ◽

First Time

Attorneys in South Africa may soon be permitted to advertise their services for the first time. This recommendation put forward by the Association of Law Societies, though still to be ratified by the four provincial law societies, has come amid increasing competition between attorneys and non- professionals. The marketing fraternity is, however, uncertain as to how members of the public are likely to react to legal services advertising. This study attempts to provide some tentative guidelines for decision-making on advertising by attorneys. Interested parties like attorneys, marketing consultants, and advertising agencies could use the researched information to structure marketing communication strategies which will not transgress the ethical code of the attorneys' profession, but which will satisfy the information needs of consumers. The study reports the findings of a survey conducted among 1 000 members of the public. Indications are that consumers not only think that advertising should be permitted, but also that it will benefit both themselves and the legal profession. Opsomming Prokureurs mag moontlik binnekort toegelaat word om hul dienste te adverteer. Die aanbeveling van die Vereniging van Prokureursordes, wat nog deur die vier provinsiale wetsgenootskappe bekragtig moet word, is geneem as gevolg van toenemende mededinging tussen prokureurs en nie-professionele praktisyns. Bemarkingsdeskundiges is egter onseker oor wat die publiek se reaksie sal wees. Die studie poog om enkele tentatiewe riglyne voor te stel vir bemarkingskommunikasiestrategieë wat nie die regsprofessie se etiese kode sal oortree nie, maar tog voldoende inligting aan verbruikers sal beskikbaar stel. Die bevindinge van 'n opname onder 1 000 lede van die publiek dui daarop dat reklame nie alleen verwelkom sal word nie, maar dat dit moontlik tot voordeel van sowel die publiek as die regsprofessie sal strek.

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