scholarly journals The Impact of Clinical Factors in Physician and ATC Decision Making for Concussion Return to Play: Insight froma Policy Capturing Study

2019 ◽  
Vol 51 (Supplement) ◽  
pp. 590
Author(s):  
Darwin McKnight ◽  
Vicki Nelson ◽  
Franklin Sease ◽  
R G Gilliland
Keyword(s):  
Decision Making ◽  
Return To Play ◽  
Policy Capturing ◽  
Clinical Factors ◽  
The Impact

scholarly journals Understanding Surgical Decision Making in Early Hepatocellular Carcinoma

2011 ◽  
Vol 29 (6) ◽  
pp. 619-625 ◽  
Author(s):  
Hari Nathan ◽  
John F.P. Bridges ◽  
Richard D. Schulick ◽  
Andrew M. Cameron ◽  
Kenzo Hirose ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Decision Making ◽  
Independent Effect ◽  
Clinical Factors ◽  
Surgical Decision ◽  
Early Hepatocellular Carcinoma ◽  
Early Hcc ◽  
The Impact ◽  
Surgical Decision Making ◽  
Choice Of Therapy

Purpose The choice between liver transplantation (LT), liver resection (LR), and radiofrequency ablation (RFA) as initial therapy for early hepatocellular carcinoma (HCC) is controversial, yet little is known about how surgeons choose therapy for individual patients. We sought to quantify the impact of both clinical factors and surgeon specialty on surgical decision making in early HCC by using conjoint analysis. Methods Surgeons with an interest in liver surgery were invited to complete a Web-based survey including 10 case scenarios. Choice of therapy was then analyzed by using regression models that included both clinical factors and surgeon specialty (non-LT v LT). Results When assessing early HCC occurrences, non-LT surgeons (50% LR; 41% LT; 9% RFA) made significantly different recommendations compared with LT surgeons (63% LT; 31% LR; 6% RFA; P < .001). Clinical factors, including tumor number and size, type of resection required, and platelet count, had significant effects on the choice between LR, LT, and RFA. After adjusting for clinical factors, non-LT surgeons remained more likely than LT surgeons to choose LR compared with LT (relative risk ratio [RRR], 2.67). When the weight of each clinical factor was allowed to vary by surgeon specialty, the residual independent effect of surgeon specialty on the decision between LR and LT was negligible (RRR, 0.93). Conclusion The impact of surgeon specialty on choice of therapy for early HCC is stronger than that of some clinical factors. However, the influence of surgeon specialty does not merely reflect an across-the-board preference for one therapy over another. Rather, certain clinical factors are weighed differently by surgeons in different specialties.

scholarly journals Factors influencing general practitioners decisions to refer Paediatric patients to the emergency department: a systematic review and narrative synthesis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ciara Conlon ◽  
Emma Nicholson ◽  
Beatriz Rodríguez-Martin ◽  
Roisin O’Donovan ◽  
Aoife De Brún ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Emergency Department ◽  
Paediatric Patient ◽  
General Practitioners ◽  
Clinical Decision Making ◽  
System Level ◽  
Clinical Factors ◽  
Paediatric Patients ◽  
The Impact

Abstract Background Clinical guidelines are integral to a general practitioner’s decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED). Methods A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs’ decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach. Results Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child’s illness, parent’s request for onward referral and GPs’ appraisal of parents’ ability to cope. Socio-economic status, GPs’ aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions. Conclusions A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.

Policy Capturing and Fuzzy Logic: A Better Approach to Representing Judgment Data?

2002 ◽  
Vol 46 (3) ◽  
pp. 541-545
Author(s):  
Amy E. Bolton ◽  
Randolph S. Astwood ◽  
Gwendolyn E. Campbell
Keyword(s):  
Decision Making ◽  
Fuzzy Logic ◽  
Traditional Approach ◽  
Value Added ◽  
Policy Capturing ◽  
Empirical Assessment ◽  
Alternative Approach ◽  
Modeling Techniques ◽  
The Impact ◽  
Judgment Data

At the 45th annual meeting of HFES, we conducted an alternative format session in which fuzzy logic was introduced as an alternative approach to analyzing judgment data and representing decision-making policies (see Buff et al., 2001). During the alternative format session, usability judgments were collected on-site for Advanced Distance Learning (ADL) applications. These data provided the basis for an empirical assessment of the value added of one modeling technique, fuzzy logic, over the more traditional approach to analyzing policy capturing data, multiple linear regression. This paper describes the results of an empirical assessment of the two modeling techniques. For a discussion of the empirical results of the impact of the different usability dimensions on the learning effectiveness of ADL applications, see Holness, Pharmer, and Buff (2002).

scholarly journals Neuroimaging findings in pediatric sports-related concussion

2015 ◽  
Vol 16 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Michael J. Ellis ◽  
Jeff Leiter ◽  
Thomas Hall ◽  
Patrick J. McDonald ◽  
Scott Sawyer ◽  
...  
Keyword(s):  
Decision Making ◽  
Arachnoid Cyst ◽  
Clinical Decision Making ◽  
Demyelinating Disease ◽  
Skull Fracture ◽  
Clinical Decision ◽  
Return To Play ◽  
Mri Findings ◽  
Imaging Results ◽  
The Impact

OBJECT The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age ≤ 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.

scholarly journals The Effect of Pretest Exercise on Baseline Computerized Neurocognitive Test Scores

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773449 ◽  
Author(s):  
Alec Pawlukiewicz ◽  
Aaron M. Yengo-Kahn ◽  
Gary Solomon
Keyword(s):  
Decision Making ◽  
Test Scores ◽  
Adolescent And Young Adult ◽  
Return To Play ◽  
Strenuous Exercise ◽  
History Of ◽  
Baseline Testing ◽  
Baseline Test ◽  
Composite Scores ◽  
The Impact

Background: Baseline neurocognitive assessment plays a critical role in return-to-play decision making following sport-related concussions. Prior studies have assessed the effect of a variety of modifying factors on neurocognitive baseline test scores. However, relatively little investigation has been conducted regarding the effect of pretest exercise on baseline testing. Purpose/Hypothesis: The aim of our investigation was to determine the effect of pretest exercise on baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores in adolescent and young adult athletes. We hypothesized that athletes undergoing self-reported strenuous exercise within 3 hours of baseline testing would perform more poorly on neurocognitive metrics and would report a greater number of symptoms than those who had not completed such exercise. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The ImPACT records of 18,245 adolescent and young adult athletes were retrospectively analyzed. After application of inclusion and exclusion criteria, participants were dichotomized into groups based on a positive (n = 664) or negative (n = 6609) self-reported history of strenuous exercise within 3 hours of the baseline test. Participants with a positive history of exercise were then randomly matched, based on age, sex, education level, concussion history, and hours of sleep prior to testing, on a 1:2 basis with individuals who had reported no pretest exercise. The baseline ImPACT composite scores of the 2 groups were then compared. Results: Significant differences were observed for the ImPACT composite scores of verbal memory, visual memory, reaction time, and impulse control as well as for the total symptom score. No significant between-group difference was detected for the visual motor composite score. Furthermore, pretest exercise was associated with a significant increase in the overall frequency of invalid test results. Conclusion: Our results suggest a statistically significant difference in ImPACT composite scores between individuals who report strenuous exercise prior to baseline testing compared with those who do not. Since return-to-play decision making often involves documentation of return to neurocognitive baseline, the baseline test scores must be valid and accurate. As a result, we recommend standardization of baseline testing such that no strenuous exercise takes place 3 hours prior to test administration.

PP10  How senior paramedics determine a futile resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study

2020 ◽  
Vol 37 (10) ◽  
pp. e6.1-e6
Author(s):  
Ali Coppola ◽  
Sarah Black ◽  
Ruth Endacott
Keyword(s):  
Decision Making ◽  
Cardiac Arrest ◽  
Electrical Activity ◽  
Pulseless Electrical Activity ◽  
Ambulance Service ◽  
Clinical Factors ◽  
Patient Demographics ◽  
System Factors ◽  
The Impact ◽  
Hospital Cardiac Arrest

BackgroundPulseless electrical activity, a non-shockable cardiac arrest, is treated using advanced life support resuscitation. When resuscitation fails, evidenced-based guidelines are limited on when to stop resuscitation. This led to one UK Ambulance Service developing a local guideline for senior paramedics to cease resuscitation when considered futile. The aim of this study was to examine clinical, patient and system factors of a futile resuscitation for pulseless electrical activity and how senior paramedics apply these factors to the decision-making process.Design and MethodsAn explanatory sequential mixed method design conducted in a single UK Ambulance Service. Cessation of resuscitation data was retrieved for all adult patients suffering an Out of Hospital Cardiac Arrest from 1st December 2015 to 31st December 2018. Cases subject to a coronial or police investigation were excluded. Senior paramedics made decisions to cease resuscitation for 50 patients at the scene and these were reviewed in detail. Interviews were conducted with six senior paramedics, who provide telephone clinical support to on-scene paramedics.ResultsThe mean patient age was 78 years, the majority were male (n=30, 60%) had a witnessed collapse (n=37, 74%) and had a PEA rate below 50 (n=46, 92%). There were no significant associations between patient demographics and clinical or system factors. Themes arising from paramedic interviews included concepts that defined futility, the impact of decision-making, conflicting views and supportive clinical decision tools.ConclusionWhilst there were no significant associations between variables, senior paramedics balanced patient survival with resuscitation futility by interpreting key factors, such as patient demographics and clinical factors. This multifactorial approach questions termination of resuscitation based on clinical factors alone. It identifies a group of PEA patients, when resuscitation is not successful, may be considered for termination of resuscitation. Research using a larger sample is warranted to explore the validity of these criteria.AcknowledgementsThe authors would like to thank Professor Jonathan Benger for his valuable input and guidance as the educational supervisor for this study. J. Lynde and H. Trebilcock for quantitative data extraction. L. Tremayne and E. Freeman, qualitative data coding. Thank you to all the paramedics who participated.

Quota Women Are Threatening to Men

2017 ◽  
Vol 76 (3) ◽  
pp. 107-116 ◽  
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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