scholarly journals Development of a Critical Skills Assessment for Military Medical Field Settings

2017 ◽  
Vol 1 (4) ◽  
pp. 1-8
Author(s):  
Denise A. Smart ◽  
Tamara Odom-Maryon ◽  
Lois James ◽  
Stephanie Rowan ◽  
Amanda Roby
Keyword(s):  
Decision Making ◽  
Sleep Deprivation ◽  
Life Support ◽  
Standardized Test ◽  
Response Times ◽  
Medical Decision ◽  
Critical Skills ◽  
The Impact ◽  
Field Setting ◽  
Medication Calculation

Objectives: To develop a method of measuring medical decision making in a military field setting that would allow an evaluation of the impact of sleep deprivation, fatigue, and other stressors on critical skills deterioration. Methods: Thirty-seven students who were enrolled in a Doctor of Nursing Practice (DNP) program or a Bachelor of Science in Nursing (BSN) program participated in this study. Over the course of three days, student participants were sent five questions in the morning and five questions in the evening. On the fourth day, students were sent 10 questions in the morning and 10 questions in the evening. DNP students received medication calculation questions and BSN students received Basic Life Support (BLS) questions. All questions were drawn from standardized test bank sources, were multiple choice, and were thoroughly reviewed by the research team for relevant content prior to study testing. Results: Twenty-five (50%) and twenty-eight (56%) of the 50 BLS and medication calculation questions met the selection criteria of average response times between 10 and 50 seconds and accuracy of at least 80%. From these, 16 questions were selected from both sets with smaller standard deviations, minimum response times of at least 5 seconds and maximum response times less than 90 seconds. Implications: In order to test the impact of sleep deprivation, fatigue, or any other stressors on critical decision making skills of military medical personnel during field training operations it was necessary to develop a test battery of questions that are sensitive enough to detect variation due to human factors. Our study accomplished this objective, and the resulting medication calculation and BLS questions can be used to readily assess deterioration in critical decision making skills within a field setting. Key Words: Critical Skills, Disaster Training, Sleep and Fatigue

scholarly journals Dissecting the impact of depression on decision-making

2019 ◽  
Vol 50 (10) ◽  
pp. 1613-1622 ◽  
Author(s):  
Victoria M. Lawlor ◽  
Christian A. Webb ◽  
Thomas V. Wiecki ◽  
Michael J. Frank ◽  
Madhukar Trivedi ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Deficits ◽  
Response Times ◽  
Major Depressive ◽  
Evidence Accumulation ◽  
Two Samples ◽  
Sensorimotor Deficit ◽  
The Impact ◽  
To Receive ◽  
Trial Participants

AbstractBackgroundCognitive deficits in depressed adults may reflect impaired decision-making. To investigate this possibility, we analyzed data from unmedicated adults with Major Depressive Disorder (MDD) and healthy controls as they performed a probabilistic reward task. The Hierarchical Drift Diffusion Model (HDDM) was used to quantify decision-making mechanisms recruited by the task, to determine if any such mechanism was disrupted by depression.MethodsData came from two samples (Study 1: 258 MDD, 36 controls; Study 2: 23 MDD, 25 controls). On each trial, participants indicated which of two similar stimuli was presented; correct identifications were rewarded. Quantile-probability plots and the HDDM quantified the impact of MDD on response times (RT), speed of evidence accumulation (drift rate), and the width of decision thresholds, among other parameters.ResultsRTs were more positively skewed in depressed v. healthy adults, and the HDDM revealed that drift rates were reduced—and decision thresholds were wider—in the MDD groups. This pattern suggests that depressed adults accumulated the evidence needed to make decisions more slowly than controls did.ConclusionsDepressed adults responded slower than controls in both studies, and poorer performance led the MDD group to receive fewer rewards than controls in Study 1. These results did not reflect a sensorimotor deficit but were instead due to sluggish evidence accumulation. Thus, slowed decision-making—not slowed perception or response execution—caused the performance deficit in MDD. If these results generalize to other tasks, they may help explain the broad cognitive deficits seen in depression.

scholarly journals Estimating and Comparing Response Times in Traditional and Connected Environments

2019 ◽  
Vol 2673 (4) ◽  
pp. 674-684 ◽  
Author(s):  
Anshuman Sharma ◽  
Zuduo Zheng ◽  
Jiwon Kim ◽  
Ashish Bhaskar ◽  
Md. Mazharul Haque
Keyword(s):  
Decision Making ◽  
Traffic Safety ◽  
Driving Simulator ◽  
Response Times ◽  
Flow Characteristics ◽  
Trajectory Data ◽  
Stimulus Response ◽  
Wide Range ◽  
The Mean ◽  
The Impact

Response time (RT) is a critical human factor that influences traffic flow characteristics and traffic safety, and is governed by drivers’ decision-making behavior. Unlike the traditional environment (TE), the connected environment (CE) provides information assistance to drivers. This in-vehicle informed environment can influence drivers’ decision-making and thereby their RTs. Therefore, to ascertain the impact of CE on RT, this study develops RT estimation methodologies for TE (RTEM-TE) and CE (RTEM-CE), using vehicle trajectory data. Because of the intra-lingual inconsistency among traffic engineers, modelers, and psychologists in the usage of the term RT, this study also provides a ubiquitous definition of RT that can be used in a wide range of applications. Both RTEM-TE and RTEM-CE are built on the fundamental stimulus–response relationship, and they utilize the wavelet-based energy distribution of time series of speeds to detect the stimulus–response points. These methodologies are rigorously examined for their efficiency and accuracy using noise-free and noisy synthetic data, and driving simulator data. Analysis results demonstrate the excellent performance of both the methodologies. Moreover, the analysis shows that the mean RT in CE is longer than the mean RT in TE.

Bias: a normal operating characteristic of the diagnosing brain

Diagnosis ◽  
2014 ◽  
Vol 1 (1) ◽  
pp. 23-27 ◽  
Author(s):  
Pat Croskerry
Keyword(s):  
Decision Making ◽  
Process Model ◽  
Clinical Decision Making ◽  
Conventional Medicine ◽  
Clinical Decision ◽  
Blind Spot ◽  
Research Area ◽  
Dual Process ◽  
Medical Decision ◽  
The Impact

AbstractPeople diagnose themselves or receive advice about their illnesses from a variety of sources ranging from their family or friends, alternate medicine, or through conventional medicine. In all cases, the diagnosing mechanism is the human brain which normally operates under the influence of a variety of biases. Most, but not all biases, reside in intuitive decision making, and no individual or group is immune from them. Two biases in particular, bias blind spot and myside bias, have presented obstacles to accepting the impact of bias on medical decision making. Nevertheless, there is now a widespread appreciation of the important role of bias in the majority of medical disciplines. The dual process model of decision making now seems well accepted, although a polarization of opinions has arisen with some arguing the merits of intuitive approaches over analytical ones and vice versa. We should instead accept that it is not one mode or the other that enables well-calibrated thinking but the discriminating use of both. A pivotal role for analytical thinking lies in its ability to allow decision makers the means to detach from the intuitive mode to mitigate bias; it is the gatekeeper for the final diagnostic decision. Exploring and cultivating such debiasing initiatives should be seen as the next major research area in clinical decision making. Awareness of bias and strategies for debiasing are important aspects of the critical thinker’s armamentarium. Promoting critical thinking in undergraduate, postgraduate and continuing medical education will lead to better calibrated diagnosticians.

The impact of “significant others” on breast cancer patients’ treatment decision making.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 20-20
Author(s):  
Suepattra G. May ◽  
Katharine Rendle ◽  
Meghan Halley ◽  
Nicole Ventre ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Treatment Decision ◽  
Significant Others ◽  
Medical Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
The Impact

20 Background: Shared medical decision making (SDM) has been lauded by advocates for its potential to democratize the patient-physician relationship. However, the practice of SDM is still conceived of as largely a dyadic moment that exists between the patient and the physician. Few studies have looked at the role of significant others (spouses, partners, family members and friends) in decision making or considered how discussions and actions outside the consultation room affect a patient’s medical decisions. This prospective study investigated the impact of significant others on the decision making deliberations of newly diagnosed breast cancer patients. Methods: Forty-one newly diagnosed breast cancer patients were interviewed at four critical time points throughout treatment to explore how they deliberated decisions with both care providers and significant others. Surveys assessing HRQOL, role preferences and treatment satisfaction along with EHR abstraction augmented interview data. Grounded theory analysis was used to identify recurrent themes in the qualitative data, and survey data were analyzed using IBM SPSS Statistics 20. Results: Emergent themes from our analysis identified several factors that patients consider when faced with cancer treatment decisions, including 1) presentation of treatment options 2) patient or significant other conflict/concordance with care team recommendations 3) perceived risk of recurrence and 4) short and long term impact of treatment on daily life. Participants stressed the need for clinicians to view patients beyond diagnosis and recognize their larger care network as influential factors in their decision making. Conclusions: Our interviews highlight how the current healthcare delivery structure rarely acknowledges the circles of care that can exert influence on decision making. Lack of attention to non-clinical others can lead to sub-optimal medical decision making because these influences are not adequately understood by clinicians. Findings from this study suggest the need to enhance clinicians’ and researchers’ understanding of the influence of others in patients’ treatment decision making, enabling them to intervene in these practices.

Abstract 19131: The Advanced Life Support Termination of Resuscitation Rule: A Local Evaluation of the Impact on Termination Rates

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joris Nas ◽  
Judith L Bonnes ◽  
Dominique V Verhaert ◽  
Wessel Keuper ◽  
Pierre van Grunsven ◽  
...  
Keyword(s):  
Life Support ◽  
Response Times ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Shock Delivery ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Initial Rhythm ◽  
Bystander Cpr ◽  
The Impact ◽  
Termination Decisions

Introduction: Termination of Resuscitation (TOR) rules have been designed to guide in-field termination decisions and reduce futile hospital transportations. The impact of such a rule may depend on regional infrastructure, arrest characteristics and pre-existent termination rates. Our region is characterized by high rates of bystander cardiopulmonary resuscitation (CPR), and Advanced Life Support (ALS) trained rescuers authorized to make termination decisions. We aim to investigate the actual in-field termination rates and the termination rates as recommended by the ALS-TOR rule. Furthermore, we studied factors associated with the actual termination decisions. Methods: Cohort of out-of-hospital cardiac arrest patients who were resuscitated in the Nijmegen area, the Netherlands (2008-2011). The ALS-TOR rule recommends termination in case all following criteria are met: unwitnessed arrest, no bystander CPR, no shock delivery, no return of spontaneous circulation (ROSC). Results: The observed percentage of in-field termination was 46% (275/598), while the ALS-TOR rule recommended termination in only 6% (35/588), owing to high percentages of witnessed arrests (73%) and bystander CPR (54%) in our region. Factors independently associated with the actual decisions to terminate resuscitation were absence of ROSC [aOR 35.6 (95% CI 18.3-69.3)], non-shockable initial rhythm [aOR 6.0 (95% CI 3.2-11.0)], unwitnessed arrest [aOR 2.7 (95% CI 1.4-5.2)], non-public arrest [aOR 2.5 (95% CI 1.2-5.0)] and longer EMS-response times [aOR 1.1 per minute increase (95% CI 1.0-1.2)]. Conclusions: Contrary to previous studies, implementation of the ALS-TOR rule in our region would have decreased termination rates from almost half to less than 10% due to the favourable arrest characteristics. In light of the prognosis after OHCA, this finding suggests that adherence to this set of criteria does not contribute to efficient triage in our population. Therefore it seems prudent to locally evaluate the utility of the ALS-TOR rule prior to implementation.

scholarly journals The Impact of Pet Care Needs on Medical Decision-Making among Hospitalized Patients: A Cross-Sectional Analysis of Patient Experience

2021 ◽  
Vol 8 ◽  
pp. 237437352110460
Author(s):  
Carri S. Polick ◽  
Jennifer W. Applebaum ◽  
Caitlin Hanna ◽  
Darnysus Jackson ◽  
Sophia Tsaras-Schumacher ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Negative Impact ◽  
Care Center ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Medical Decision ◽  
Care Needs ◽  
Cross Sectional ◽  
The Impact

Hospital-based protocols to support pet care needs for hospitalized patients may have potential to benefit patient health and wellbeing, but must be informed by experiences of hospitalized pet owners. The aim of this study was to determine the scope and need for pet care services among hospitalized patients. A panel of prior inpatients and their family members at a tertiary care center were surveyed about preferences, experiences, and need for assistance with pet care during hospitalization. Respondents (n = 113) expressed interest in a low/no-cost pet-boarding or foster program for adult patients struggling to find pet care assistance. The majority of respondents (n = 71; 63%) reported challenges securing pet care during a prior hospitalization, and/or knew someone who encountered similar challenges. Respondents also indicated that these challenges had a negative impact on health, recovery, or their own decision to receive medical care. Pet care challenges during hospitalization are likely common and have the potential to hamper medical decision-making and health outcomes of inpatients.

scholarly journals Patient-reported outcomes in RA care improve patient communication, decision-making, satisfaction and confidence: qualitative results

Rheumatology ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 1662-1670 ◽  
Author(s):  
Susan J Bartlett ◽  
Elaine De Leon ◽  
Ana-Maria Orbai ◽  
Uzma J Haque ◽  
Rebecca L Manno ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Patient Reported Outcomes ◽  
Medical Decision ◽  
Measurement Information ◽  
Shared Decision ◽  
Clinic Staff ◽  
Patient Reported ◽  
The Impact

Abstract Objective To evaluate the impact of integrating patient-reported outcomes (PROs) into routine clinics, from the perspective of patients with RA, clinicians and other staff. Methods We conducted a prospective cohort study using a mixed methods sequential explanatory design at an academic arthritis clinic. RA patients completed selected Patient-Reported Outcomes Measurement Information System measures on tablets in the waiting room. Results were immediately available to discuss during the visit. Post-visit surveys with patients and physicians evaluated topics discussed and their impact on decision making; patients rated confidence in treatment. Focus groups or interviews with patients, treating rheumatologists and clinic staff were conducted to understand perspectives and experiences. Results Some 196 patients and 20 rheumatologists completed post-visit surveys at 816 and 806 visits, respectively. Focus groups were conducted with 24 patients, 10 rheumatologists and 4 research/clinic staff. PROs influenced medical decision-making and RA treatment changes (38 and 18% of visits, respectively). Patients reported very high satisfaction and treatment confidence. Impact on clinical workflow was minimal after a period of initial adjustment. PROs were valued by patients and physicians, and provided new insight into how patients felt and functioned over time. Reviewing results together improved communication, and facilitated patient-centred care, shared decision making, and the identification of new symptoms and contributing psychosocial/behavioural factors. Conclusion PRO use at RA visits was feasible, increased understanding of how disease affects how patients feel and function, facilitated shared decision-making, and was associated with high patient satisfaction and treatment confidence.

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