WorldWideScience

Sample records for clinical decision making

  1. Shared clinical decision making

    Science.gov (United States)

    AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

    2015-01-01

    Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

  2. Treatment process - Clinical decision making

    International Nuclear Information System (INIS)

    Full text: Although many aspects of cancer treatment, especially the technical aspects of radiotherapy, are subject to rigorous quality assurance, the quality of actual clinical decision making is rarely scrutinized. There are several developments over the past 10 to 15 years that have driven forward attempts in the UK National Health Service (NHS) to bring such quality assurance into the clinic. This goes back to the work of Dr. Archie Cochrane in the 1970s and his views that clinical practice should be underpinned by research evidence and only treatments that have been shown to be effective should be used. The term clinical effectiveness is now widely used. It refers to the amount by which any treatment actually affects outcomes for patients. For cancer patients this may mean 'cure', improving survival, local control, or symptoms, or minimizing toxicity - or indeed a combination of all of them. But how do we know what is the most effective treatment for a particular patient? How do we assure the quality of the clinical decision? By going to the research evidence and asking questions about whether there is clear evidence which treatment is likely to give the best outcome for this patient. This is 'evidence-based medicine': the application of the best available evidence from clinical care research to the management of individual patients. However this is not just a blind application of this evidence and is not 'cookbook medicine'. Other things need to be considered as well as the evidence, a clinical judgement about the applicability of any treatment to an individual patient and patient preference. When confronted by a patient with a clinical problem, how do we find the 'best' evidence? 1. Refine the clinical question into a standard format: patient, intervention, comparison, and outcomes (PICO) 2. Search for relevant publications in electronic databases, such as Pubmed and Medline, and retrieve them 3. Critically read and appraise them: Are they relevant to this

  3. Integrating clinical research into clinical decision making

    Directory of Open Access Journals (Sweden)

    Mark R Tonelli

    2011-01-01

    Full Text Available Evidence-based medicine has placed a general priority on knowledge gained from clinical research for clinical decision making. However, knowledge derived from empiric, population-based research, while valued for its ability to limit bias, is not directly applicable to the care of individual patients. The gap between clinical research and individual patient care centers on the fact that empiric research is not generally designed to answer questions of direct relevance to individual patients. Clinicians must utilize other forms of medical knowledge, including pathophysiologic rationale and clinical experience, in order to arrive at the best medical decision for a particular patient. In addition, clinicians must also elucidate and account for the goals and values of individual patients as well as barriers and facilitators of care inherent in the system in which they practice. Evidence-based guidelines and protocols, then, can never be prescriptive. Clinicians must continue to rely on clinical judgment, negotiating potentially conflicting warrants for action, in an effort to arrive at the best decision for a particular patient.

  4. Clinical Decision Making of Rural Novice Nurses

    Science.gov (United States)

    Seright, Teresa J.

    2010-01-01

    The purpose of this study was to develop substantive theory regarding decision making by the novice nurse in a rural hospital setting. Interviews were guided by the following research questions: What cues were used by novice rural registered nurses in order to make clinical decisions? What were the sources of feedback which influenced subsequent…

  5. Legal Considerations in Clinical Decision Making.

    Science.gov (United States)

    Ursu, Samuel C.

    1992-01-01

    Discussion of legal issues in dental clinical decision making looks at the nature and elements of applicable law, especially malpractice, locus of responsibility, and standards of care. Greater use of formal decision analysis in clinical dentistry and better research on diagnosis and treatment are recommended, particularly in light of increasing…

  6. Clinical decision making in veterinary practice

    OpenAIRE

    Everitt, Sally

    2011-01-01

    Aim The aim of this study is to develop an understanding of the factors which influence veterinary surgeons’ clinical decision making during routine consultations. Methods The research takes a qualitative approach using video-cued interviews, in which one of the veterinary surgeon’s own consultations is used as the basis of a semi-structured interview exploring decision making in real cases. The research focuses primarily on small animal consultations in first opinion practice, how...

  7. Entrustment Decision Making in Clinical Training.

    Science.gov (United States)

    Ten Cate, Olle; Hart, Danielle; Ankel, Felix; Busari, Jamiu; Englander, Robert; Glasgow, Nicholas; Holmboe, Eric; Iobst, William; Lovell, Elise; Snell, Linda S; Touchie, Claire; Van Melle, Elaine; Wycliffe-Jones, Keith

    2016-02-01

    The decision to trust a medical trainee with the critical responsibility to care for a patient is fundamental to clinical training. When carefully and deliberately made, such decisions can serve as significant stimuli for learning and also shape the assessment of trainees. Holding back entrustment decisions too much may hamper the trainee's development toward unsupervised practice. When carelessly made, however, they jeopardize patient safety. Entrustment decision-making processes, therefore, deserve careful analysis.Members (including the authors) of the International Competency-Based Medical Education Collaborative conducted a content analysis of the entrustment decision-making process in health care training during a two-day summit in September 2013 and subsequently reviewed the pertinent literature to arrive at a description of the critical features of this process, which informs this article.The authors discuss theoretical backgrounds and terminology of trust and entrustment in the clinical workplace. The competency-based movement and the introduction of entrustable professional activities force educators to rethink the grounds for assessment in the workplace. Anticipating a decision to grant autonomy at a designated level of supervision appears to align better with health care practice than do most current assessment practices. The authors distinguish different modes of trust and entrustment decisions and elaborate five categories, each with related factors, that determine when decisions to trust trainees are made: the trainee, supervisor, situation, task, and the relationship between trainee and supervisor. The authors' aim in this article is to lay a theoretical foundation for a new approach to workplace training and assessment. PMID:26630606

  8. Economic aspects of clinical decision making: applications of clinical decision analysis.

    Science.gov (United States)

    Crane, V S

    1988-03-01

    Clinical decision analysis as a basic tool for decision making is described, and potential applications of decision analysis in six areas of clinical practice are identified. Clinical decision analysis is a systematic method of describing clinical problems in a quantitative fashion, identifying possible courses of action, assessing the probability and value of outcomes, and then making a calculation to select the ultimate course of action. Clinical decision analysis provides a structure for clinical decision problems, helps clarify medical controversies, and encourages decision makers to speak a common language. Applications of clinical decision analysis in the areas of diagnostic testing, patient management, product and program selection, research and education, patient preferences, and health-care-policy evaluation are described. Decision analysis offers health professionals a tool for making quantifiable, cost-effective clinical decisions, especially in terms of clinical outcomes. PMID:3285672

  9. Clinical decision-making: physicians' preferences and experiences

    OpenAIRE

    White Martha; Pollack Lance; Murray Elizabeth; Lo Bernard

    2007-01-01

    Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence b...

  10. Clinical Decision Making of Nurses Working in Hospital Settings

    OpenAIRE

    Ida Torunn Bjørk; Hamilton, Glenys A.

    2011-01-01

    This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with d...

  11. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  12. Better clinical decision making and reducing diagnostic error.

    Science.gov (United States)

    Croskerry, P; Nimmo, G R

    2011-06-01

    A major amount of our time working in clinical practice involves thinking and decision making. Perhaps it is because decision making is such a commonplace activity that it is assumed we can all make effective decisions. However, this is not the case and the example of diagnostic error supports this assertion. Until quite recently there has been a general nihilism about the ability to change the way that we think, but it is now becoming accepted that if we can think about, and understand, our thinking processes we can improve our decision making, including diagnosis. In this paper we review the dual process model of decision making and highlight ways in which decision making can be improved through the application of this model to our day-to-day practice and by the adoption of de-biasing strategies and critical thinking. PMID:21677922

  13. Risk perception and clinical decision making in primary care

    DEFF Research Database (Denmark)

    Barfoed, Benedicte Marie Lind

    2015-01-01

    Objectives We aim to present new knowledge about different perspectives of health care professionals’ risk perceptions and clinical decision making. Furthermore, we intend to discuss differences between professional and personal risk perceptions and the impact on decisions in terms of both short...... considerations and the specific context. Most research has been focused on understanding of the concepts of risk. However healthcare professionals’ risk perception and personal attitudes also affect their clinical decision-making and risk communication. The differences between health care professionals’ personal...... and professional risk perception and attitudes and the subsequent impact on patients’ decision making have not previously been discussed. Content 1. Peder Halvorsen, MD, Professor, General Practice, Department of Community Medicine, The Arctic University of Norway: Making good decisions: Intuition or...

  14. Clinical Decision Making in Renal Pain Management

    OpenAIRE

    Aganovic, Damir; Prcic, Alen; Kulovac, Benjamin; Hadziosmanovic, Osman

    2012-01-01

    Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., whi...

  15. Clinical Decision Making among Dental Students and General Practitioners.

    Science.gov (United States)

    Grembowski, David; And Others

    1989-01-01

    Senior dental students and family dental practitioners were surveyed concerning their choice of pairs of alternative treatments and the technical and patient factors influencing their decisions. Greater agreement in clinical decision-making was found among dentists than among students for all four pairs of alternative services. (MSE)

  16. Syncope: risk stratification and clinical decision making.

    Science.gov (United States)

    Peeters, Suzanne Y G; Hoek, Amber E; Mollink, Susan M; Huff, J Stephen

    2014-04-01

    Syncope is a common occurrence in the emergency department, accounting for approximately 1% to 3% of presentations. Syncope is best defined as a brief loss of consciousness and postural tone followed by spontaneous and complete recovery. The spectrum of etiologies ranges from benign to life threatening, and a structured approach to evaluating these patients is key to providing care that is thorough, yet cost-effective. This issue reviews the most relevant evidence for managing and risk stratifying the syncope patient, beginning with a focused history, physical examination, electrocardiogram, and tailored diagnostic testing. Several risk stratification decision rules are compared for performance in various scenarios, including how age and associated comorbidities may predict short-term and long-term adverse events. An algorithm for structured, evidence-based care of the syncope patient is included to ensure that patients requiring hospitalization are managed appropriately and those with benign causes are discharged safely. PMID:25105200

  17. The thinking doctor: clinical decision making in contemporary medicine.

    Science.gov (United States)

    Trimble, Michael; Hamilton, Paul

    2016-08-01

    Diagnostic errors are responsible for a significant number of adverse events. Logical reasoning and good decision-making skills are key factors in reducing such errors, but little emphasis has traditionally been placed on how these thought processes occur, and how errors could be minimised. In this article, we explore key cognitive ideas that underpin clinical decision making and suggest that by employing some simple strategies, physicians might be better able to understand how they make decisions and how the process might be optimised. PMID:27481378

  18. The role of emotions in clinical reasoning and decision making.

    Science.gov (United States)

    Marcum, James A

    2013-10-01

    What role, if any, should emotions play in clinical reasoning and decision making? Traditionally, emotions have been excluded from clinical reasoning and decision making, but with recent advances in cognitive neuropsychology they are now considered an important component of them. Today, cognition is thought to be a set of complex processes relying on multiple types of intelligences. The role of mathematical logic (hypothetico-deductive thinking) or verbal linguistic intelligence in cognition, for example, is well documented and accepted; however, the role of emotional intelligence has received less attention-especially because its nature and function are not well understood. In this paper, I argue for the inclusion of emotions in clinical reasoning and decision making. To that end, developments in contemporary cognitive neuropsychology are initially examined and analyzed, followed by a review of the medical literature discussing the role of emotions in clinical practice. Next, a published clinical case is reconstructed and used to illustrate the recognition and regulation of emotions played during a series of clinical consultations, which resulted in a positive medical outcome. The paper's main thesis is that emotions, particularly in terms of emotional intelligence as a practical form of intelligence, afford clinical practitioners a robust cognitive resource for providing quality medical care. PMID:23975905

  19. Medical Device Data and Modeling for Clinical Decision Making

    CERN Document Server

    Zaleski, John R

    2010-01-01

    This cutting-edge volume is the first book that provides you with practical guidance on the use of medical device data for bioinformatics modeling purposes. You learn how to develop original methods for communicating with medical devices within healthcare enterprises and assisting with bedside clinical decision making. The book guides in the implementation and use of clinical decision support methods within the context of electronic health records in the hospital environment.This highly valuable reference also teaches budding biomedical engineers and bioinformaticists the practical benefits of

  20. Clinical Decision Making of Nurses Working in Hospital Settings

    Directory of Open Access Journals (Sweden)

    Ida Torunn Bjørk

    2011-01-01

    Full Text Available This study analyzed nurses' perceptions of clinical decision making (CDM in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.

  1. Priority oral health research identification for clinical decision-making.

    Science.gov (United States)

    Worthington, Helen; Clarkson, Jan; Weldon, Jo

    2015-09-01

    The Cochrane Library is a core resource for clinical decision-making globally, by clinicians, guideline developers, healthcare providers and patients.The publication of Cochrane Library systematic reviews concerning oral health conditions has grown exponentially to over 215 individual titles (as of 20 June 2015) during the past 20 years.Consequently, maintaining updates of the most clinically important reviews to provide up-to-date and accurate sources of evidence for decision-making has become a pressing concern for the editorial group behind their production, Cochrane Oral Health Group.To identify priority research required by oral health decision-makers, the Cochrane OHG embarked on a consultation process across eight defined areas of dentistry (periodontology, operative (including endodontics) and prosthodontics, paediatric dentistry, dental public health, oral and maxillofacial surgery, oral medicine, orthodontics, cleft lip and/or palate) with existing authors (by email), with members of the public (by online survey), and established internationally clinically expert panels for each area of defined area of dentistry to discuss and ratify (by teleconference) a core portfolio of priority evidence to be produced and maintained on the Cochrane Library.The resulting portfolio of priority research encompasses 81 existing titles to be maintained, and an additional 15 new systematic reviews to be developed by the Cochrane OHG in due course.The Cochrane OHG has actively responded to the outcomes of this prioritisation process by allocating resources to primarily supporting the maintenance of identified priority evidence for the Cochrane Library. PMID:26492797

  2. A review of clinical decision-making: Models and current research

    OpenAIRE

    Banning, M

    2007-01-01

    Aims and objectives: The aim of this paper was to review the current literature with respect to clinical decision-making models and the educational application of models to clinical practice. This was achieved by exploring the function and related research of the three available models of clinical decision making: information processing model, the intuitive-humanist model and the clinical decision making model. Background: Clinical decision-making is a unique process that involves the inte...

  3. Nurses' Clinical Decision Making on Adopting a Wound Clinical Decision Support System.

    Science.gov (United States)

    Khong, Peck Chui Betty; Hoi, Shu Yin; Holroyd, Eleanor; Wang, Wenru

    2015-07-01

    Healthcare information technology systems are considered the ideal tool to inculcate evidence-based nursing practices. The wound clinical decision support system was built locally to support nurses to manage pressure ulcer wounds in their daily practice. However, its adoption rate is not optimal. The study's objective was to discover the concepts that informed the RNs' decisions to adopt the wound clinical decision support system as an evidence-based technology in their nursing practice. This was an exploratory, descriptive, and qualitative design using face-to-face interviews, individual interviews, and active participatory observation. A purposive, theoretical sample of 14 RNs was recruited from one of the largest public tertiary hospitals in Singapore after obtaining ethics approval. After consenting, the nurses were interviewed and observed separately. Recruitment stopped when data saturation was reached. All transcribed interview data underwent a concurrent thematic analysis, whereas observational data were content analyzed independently and subsequently triangulated with the interview data. Eight emerging themes were identified, namely, use of the wound clinical decision support system, beliefs in the wound clinical decision support system, influences of the workplace culture, extent of the benefits, professional control over nursing practices, use of knowledge, gut feelings, and emotions (fear, doubt, and frustration). These themes represented the nurses' mental outlook as they made decisions on adopting the wound clinical decision support system in light of the complexities of their roles and workloads. This research has provided insight on the nurses' thoughts regarding their decision to interact with the computer environment in a Singapore context. It captured the nurses' complex thoughts when deciding whether to adopt or reject information technology as they practice in a clinical setting. PMID:26066306

  4. Endodontic retreatment. Aspects of decision making and clinical outcome.

    Science.gov (United States)

    Kvist, T

    2001-01-01

    regardless of assessment method. Compared with Standard gamble Visual Analogue Scale systematically produced lower ratings. U-values were found to change considerably in both the short and long-term. Any significant correlation between endodontists' U-values and retreatment prescriptions could not be demonstrated. Surgical and nonsurgical retreatment were randomly assigned to 95 "failed" root filled teeth in 92 patients. Cases were followed clinically and radiographically for four years postoperatively. At the 12-month recall a statistically significant higher healing rate was observed for teeth retreated surgically. At the final 48-month recall no systematic difference was detected. Patients were found to be more subject to postoperative discomfort when teeth were retreated surgically compared with nonsurgically. Consequently, surgical retreatment tended to be associated with higher indirect costs than a nonsurgically approach. In the final part of the thesis it is argued that retreatment decision making in everyday clinical practice normally should be based on simple principles. It is suggested that in order to achieve the best overall consequence a periapical lesion in a root filled tooth that is not expected to heal should be retreated. Arguments to withhold retreatment should be based on (i) respect for patient autonomy, (ii) retreatment risks or (iii) retreatment costs. PMID:11288682

  5. Clinical implementation of RNA signatures for pharmacogenomic decision-making

    Directory of Open Access Journals (Sweden)

    Tang W

    2011-09-01

    Full Text Available Weihua Tang1, Zhiyuan Hu2, Hind Muallem1, Margaret L Gulley1,21Department of Pathology and Laboratory Medicine, 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, NC, USAAbstract: RNA profiling is increasingly used to predict drug response, dose, or toxicity based on analysis of drug pharmacokinetic or pharmacodynamic pathways. Before implementing multiplexed RNA arrays in clinical practice, validation studies are carried out to demonstrate sufficient evidence of analytic and clinical performance, and to establish an assay protocol with quality assurance measures. Pathologists assure quality by selecting input tissue and by interpreting results in the context of the input tissue as well as the technologies that were used and the clinical setting in which the test was ordered. A strength of RNA profiling is the array-based measurement of tens to thousands of RNAs at once, including redundant tests for critical analytes or pathways to promote confidence in test results. Instrument and reagent manufacturers are crucial for supplying reliable components of the test system. Strategies for quality assurance include careful attention to RNA preservation and quality checks at pertinent steps in the assay protocol, beginning with specimen collection and proceeding through the various phases of transport, processing, storage, analysis, interpretation, and reporting. Specimen quality is checked by probing housekeeping transcripts, while spiked and exogenous controls serve as a check on analytic performance of the test system. Software is required to manipulate abundant array data and present it for interpretation by a laboratory physician who reports results in a manner facilitating therapeutic decision-making. Maintenance of the assay requires periodic documentation of personnel competency and laboratory proficiency. These strategies are shepherding genomic arrays into clinical settings to provide added

  6. Mental Workload as a Key Factor in Clinical Decision Making

    Science.gov (United States)

    Byrne, Aidan

    2013-01-01

    The decision making process is central to the practice of a clinician and has traditionally been described in terms of the hypothetico-deductive model. More recently, models adapted from cognitive psychology, such as the dual process and script theories have proved useful in explaining patterns of practice not consistent with purely cognitive…

  7. Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription.

    Science.gov (United States)

    Zadik, Yehuda; Levin, Liran

    2008-01-01

    The purpose of this study was to evaluate the influence of geographic location of graduation (Israel, Eastern Europe, Latin America) on decision making regarding management of dental caries, periapical lesions, and antibiotic prescribing routines. A questionnaire was given to ninety-eight general practitioners regarding demographic and work habits. Photographs of lesions were shown on a screen. Participants reported recommended treatment and whether they would routinely prescribe antibiotics following regular endodontic treatment, retreatment, and impacted third molar surgical extraction in healthy patients. There was a 94 percent (n=92) response rate, of which eighty-five responses were used in the data analysis. Surgical treatment of asymptomatic enamel caries lesions was not recommended by most of the subjects, and surgery was recommended for DEJ caries lesions in low or moderate caries risk patients, both without significant differences between geographic regions of dental school graduation. Israelis had a lower frequency of retreatment in asymptomatic teeth that demonstrated periapical radiolucency with post restoration (without crown) compared to Latin Americans and East Europeans. Most of the participants would not retreat asymptomatic teeth that demonstrated periapical radiolucency with post and crown. After third molar surgery, 46 percent of participants routinely prescribed antibiotics. Significantly more Latin American graduates prescribed antibiotics following endodontic treatment, retreatment, and third molar extractions (p<0.05). Overmedication (antibiotics) and overtreatment (caries) among young practitioners reflect failure of undergraduate education in proper use of antibiotics and management of the carious lesions according to the patient's clinical presentation and caries risk assessment rather than routinely undertaking surgical caries treatment. PMID:18172239

  8. Forms of Knowledge Incorporated in Clinical Decision-making among Newly-Graduated Nurses: A Metasynthesis

    DEFF Research Database (Denmark)

    Voldbjerg, Siri; Elgaard Sørensen, Erik; Grønkjær, Mette;

    2013-01-01

    Clinical-decision-making is of decisive importance to how evidence-based practice is put into practice. Schools of Nursing have a responsibility to teach and train nursing students to make clinical decisions within a frame of evidence-based practice. Clinical decision-making among nurses has been...... knowledge that informs clinical decision-making among newly-graduated nurses. Qualitative studies were retrieved from CINAHL, PubMed, SCOPE, ERIC and GOOGLE-Scholar and subsequently selected by pre-defined inclusion criteria and critically appraised using CASP. Metaphors identified in the analytical process...... will contribute to theory development and have implications for clinical and educational practice regarding the professional development of clinical decision making within a frame of evidence-based practice. The presentation highlights the main findings from the metasynthesis and provides perspectives...

  9. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction. PMID:23304284

  10. Detecting fast, online reasoning processes in clinical decision making.

    Science.gov (United States)

    Flores, Amanda; Cobos, Pedro L; López, Francisco J; Godoy, Antonio

    2014-06-01

    In an experiment that used the inconsistency paradigm, experienced clinical psychologists and psychology students performed a reading task using clinical reports and a diagnostic judgment task. The clinical reports provided information about the symptoms of hypothetical clients who had been previously diagnosed with a specific mental disorder. Reading times of inconsistent target sentences were slower than those of control sentences, demonstrating an inconsistency effect. The results also showed that experienced clinicians gave different weights to different symptoms according to their relevance when fluently reading the clinical reports provided, despite the fact that all the symptoms were of equal diagnostic value according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The diagnostic judgment task yielded a similar pattern of results. In contrast to previous findings, the results of the reading task may be taken as direct evidence of the intervention of reasoning processes that occur very early, rapidly, and online. We suggest that these processes are based on the representation of mental disorders and that these representations are particularly suited to fast retrieval from memory and to making inferences. They may also be related to the clinicians' causal reasoning. The implications of these results for clinician training are also discussed. PMID:24274045

  11. Disciplined Decision Making in an Interdisciplinary Environment: Some Implications for Clinical Applications of Statistical Process Control.

    Science.gov (United States)

    Hantula, Donald A.

    1995-01-01

    Clinical applications of statistical process control (SPC) in human service organizations are considered. SPC is seen as providing a standard set of criteria that serves as a common interface for data-based decision making, which may bring decision making under the control of established contingencies rather than the immediate contingencies of…

  12. The effect of concept mapping on clinical decision making skills of ICU nurses

    OpenAIRE

    Fakhri Dokht Akbari; Malahat Nikravan Mofrad; Azam Dabirian

    2014-01-01

    Introduction: Concept mapping is an innovative tool that would help hospital educators and nurses to promote their knowledge and clinical decision making skills. The aim of this study was to investigate the effect of concept mapping on clinical decision making skills of nurses working in the intensive care unit (ICU). Methods: The quasi-experimental, non-equivalent control group, pretest-posttest design was conducted among baccalaureate nurses working in an intensive care unit. Forty two nur...

  13. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    Science.gov (United States)

    Holmes-Rovner, Margaret; Nelson, Wendy L; Pignone, Michael; Elwyn, Glyn; Rovner, David R; O'Connor, Annette M; Coulter, Angela; Correa-de-Araujo, Rosaly

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against. PMID:17873257

  14. Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice.

    Science.gov (United States)

    Hajjaj, F M; Salek, M S; Basra, M K A; Finlay, A Y

    2010-05-01

    This article reviews an aspect of daily clinical practice which is of critical importance in virtually every clinical consultation, but which is seldom formally considered. Non-clinical influences on clinical decision-making profoundly affect medical decisions. These influences include patient-related factors such as socioeconomic status, quality of life and patient's expectations and wishes, physician-related factors such as personal characteristics and interaction with their professional community, and features of clinical practice such as private versus public practice as well as local management policies. This review brings together the different strands of knowledge concerning non-clinical influences on clinical decision-making. This aspect of decision-making may be the biggest obstacle to the reality of practising evidence-based medicine. It needs to be understood in order to develop clinical strategies that will facilitate the practice of evidence-based medicine. PMID:20436026

  15. [Locator or ball attachment: a guide for clinical decision making].

    Science.gov (United States)

    Büttel, Adrian E; Bühler, Nico M; Marinello, Carlo P

    2009-01-01

    Various attachments are available to retain overdentures on natural roots or implants. Technical aspects, the clinical handling, the capability to adapt or repair and the costs are parameters to be considered when choosing the appropriate attachment. Ball attachments and bars are clinically established and well documented. Ball attachments as prefabricated, unsplinted units are easily replaceable and show hygienic advantages, while bars show favorable stability. The Locator is a newer, popular clinical alternative to these established attachments. The ball attachment and the Locator are compared from a technical and clinical point of view. PMID:19852208

  16. Adolescent Depression: An Update and Guide to Clinical Decision Making

    OpenAIRE

    Cook, Mary N.; Peterson, John; Sheldon, Christopher

    2009-01-01

    Depression in adolescence and adulthood is common, afflicting up to 20 percent of these populations. It represents a significant public health concern and is associated with considerable suffering and functional impairment. Adolescent-onset depression tends to be a particularly malignant and recalcitrant condition, increasing the likelihood of recurrence and chronicity in adulthood. Clinical presentations for various medical and psychiatric conditions, as well as reactions to psychosocial str...

  17. Clinical implementation of RNA signatures for pharmacogenomic decision-making

    OpenAIRE

    Tang W; Hu Z.; Muallem H; Gulley ML

    2011-01-01

    Weihua Tang1, Zhiyuan Hu2, Hind Muallem1, Margaret L Gulley1,21Department of Pathology and Laboratory Medicine, 2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, NC, USAAbstract: RNA profiling is increasingly used to predict drug response, dose, or toxicity based on analysis of drug pharmacokinetic or pharmacodynamic pathways. Before implementing multiplexed RNA arrays in clinical practice, validation studies are carried out to demonstrate s...

  18. Clinical decision making in seizures and status epilepticus.

    Science.gov (United States)

    Teran, Felipe; Harper-Kirksey, Katrina; Jagoda, Andy

    2015-01-01

    Seizures and status epilepticus are frequent neurologic emergencies in the emergency department, accounting for 1% of all emergency department visits. The management of this time-sensitive and potentially life-threatening condition is challenging for both prehospital providers and emergency clinicians. The approach to seizing patients begins with differentiating seizure activity from mimics and follows with identifying potential secondary etiologies, such as alcohol-related seizures. The approach to the patient in status epilepticus and the patient with nonconvulsive status epilepticus constitutes a special clinical challenge. This review summarizes the best available evidence and recommendations regarding diagnosis and resuscitation of the seizing patient in the emergency setting. PMID:25902572

  19. Clinical decision-making and therapeutic approaches in osteopathy - a qualitative grounded theory study.

    Science.gov (United States)

    Thomson, Oliver P; Petty, Nicola J; Moore, Ann P

    2014-02-01

    There is limited understanding of how osteopaths make decisions in relation to clinical practice. The aim of this research was to construct an explanatory theory of the clinical decision-making and therapeutic approaches of experienced osteopaths in the UK. Twelve UK registered osteopaths participated in this constructivist grounded theory qualitative study. Purposive and theoretical sampling was used to select participants. Data was collected using semi-structured interviews which were audio-recorded and transcribed. As the study approached theoretical sufficiency, participants were observed and video-recorded during a patient appointment, which was followed by a video-prompted interview. Constant comparative analysis was used to analyse and code data. Data analysis resulted in the construction of three qualitatively different therapeutic approaches which characterised participants and their clinical practice, termed; Treater, Communicator and Educator. Participants' therapeutic approach influenced their approach to clinical decision-making, the level of patient involvement, their interaction with patients, and therapeutic goals. Participants' overall conception of practice lay on a continuum ranging from technical rationality to professional artistry, and contributed to their therapeutic approach. A range of factors were identified which influenced participants' conception of practice. The findings indicate that there is variation in osteopaths' therapeutic approaches to practice and clinical decision-making, which are influenced by their overall conception of practice. This study provides the first explanatory theory of the clinical decision-making and therapeutic approaches of osteopaths. PMID:23932101

  20. Quantitative ultrasound texture analysis for clinical decision making support

    Science.gov (United States)

    Wu, Jie Ying; Beland, Michael; Konrad, Joseph; Tuomi, Adam; Glidden, David; Grand, David; Merck, Derek

    2015-03-01

    We propose a general ultrasound (US) texture-analysis and machine-learning framework for detecting the presence of disease that is suitable for clinical application across clinicians, disease types, devices, and operators. Its stages are image selection, image filtering, ROI selection, feature parameterization, and classification. Each stage is modular and can be replaced with alternate methods. Thus, this framework is adaptable to a wide range of tasks. Our two preliminary clinical targets are hepatic steatosis and adenomyosis diagnosis. For steatosis, we collected US images from 288 patients and their pathology-determined values of steatosis (%) from biopsies. Two radiologists independently reviewed all images and identified the region of interest (ROI) most representative of the hepatic echotexture for each patient. To parameterize the images into comparable quantities, we filter the US images at multiple scales for various texture responses. For each response, we collect a histogram of pixel features within the ROI, and parameterize it as a Gaussian function using its mean, standard deviation, kurtosis, and skew to create a 36-feature vector. Our algorithm uses a support vector machine (SVM) for classification. Using a threshold of 10%, we achieved 72.81% overall accuracy, 76.18% sensitivity, and 65.96% specificity in identifying steatosis with leave-ten-out cross-validation (padenomyosis, we identified 38 patients with MR-confirmed findings of adenomyosis and previous US studies and 50 controls. A single rater picked the best US-image and ROI for each case. Using the same processing pipeline, we obtained 76.14% accuracy, 86.00% sensitivity, and 63.16% specificity with leave-one-out cross-validation (p<0.0001).

  1. Clinical decision making on the use of physical restraint in intensive care units

    Directory of Open Access Journals (Sweden)

    Xinqian Li

    2014-12-01

    Full Text Available Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients' safety and to prevent unexpected accidents. However, existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales, the negative physical and emotional effects on patients, but the lack of perceived alternatives. This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses. By reviewing the literature, intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases. However, it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint. Besides that, such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated. Therefore, despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint, it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

  2. Students' Stereotypes of Patients as Barriers to Clinical Decision-Making.

    Science.gov (United States)

    Johnson, Shirley M.; And Others

    1986-01-01

    At the Michigan State University College of Osteopathic Medicine, a study was designed that graphically illustrated to beginning students that unconscious sociocultural stereotypes may influence clinical decision-making. Students were shown a videotape depicting five simulated patients, each with the same physical complaint. (Author/MLW)

  3. Costs, Quality and Value in Cardiovascular Interventions: Implications for clinical decision-making and policy development

    OpenAIRE

    Osnabrugge, Ruben

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis is to study the clinical, economic and quality-of-life considerations for clinical decision-making and policy development in cardiovascular interventions. More specifi cally the goals are: 1. To investigate the disease prevalence, adoption trends, quality of life, and economic aspects associated with therapies of aortic stenosis. 2. To explore the economic and policy aspects of alternative revascularization therapies for coronary artery dise...

  4. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'

    Directory of Open Access Journals (Sweden)

    Amorin-Woods Lyndon G

    2012-03-01

    Full Text Available Abstract Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  5. THE IMPACT OF RACISM ON CLINICIAN COGNITION, BEHAVIOR, AND CLINICAL DECISION MAKING

    Science.gov (United States)

    van Ryn, Michelle; Burgess, Diana J.; Dovidio, John F.; Phelan, Sean M.; Saha, Somnath; Malat, Jennifer; Griffin, Joan M.; Fu, Steven S.; Perry, Sylvia

    2014-01-01

    Over the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians’ behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians’ behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations. PMID:24761152

  6. Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

    Science.gov (United States)

    Pacheco, José Márcio da Cunha; Gomes, Romeu

    2016-08-01

    This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice. PMID:27557021

  7. Decision Making and Cancer

    OpenAIRE

    Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P

    2015-01-01

    We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cogni...

  8. How Qualitative Research Informs Clinical and Policy Decision Making in Transplantation: A Review.

    Science.gov (United States)

    Tong, Allison; Morton, Rachael L; Webster, Angela C

    2016-09-01

    Patient-centered care is no longer just a buzzword. It is now widely touted as a cornerstone in delivering quality care across all fields of medicine. However, patient-centered strategies and interventions necessitate evidence about patients' decision-making processes, values, priorities, and needs. Qualitative research is particularly well suited to understanding the experience and perspective of patients, donors, clinicians, and policy makers on a wide range of transplantation-related topics including organ donation and allocation, adherence to prescribed therapy, pretransplant and posttransplant care, implementation of clinical guidelines, and doctor-patient communication. In transplantation, evidence derived from qualitative research has been integrated into strategies for shared decision-making, patient educational resources, process evaluations of trials, clinical guidelines, and policies. The aim of this article is to outline key concepts and methods used in qualitative research, guide the appraisal of qualitative studies, and assist clinicians to understand how qualitative research may inform their practice and policy. PMID:27479165

  9. The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Sarah Brien

    2011-01-01

    Full Text Available While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM. The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its’ manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i to enhance the practitioner-patient relationship, these were generally trusted; and (ii intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths’ sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e., time limited settings.

  10. The effect of concept mapping on clinical decision making skills of ICU nurses

    Directory of Open Access Journals (Sweden)

    Fakhri Dokht Akbari

    2014-10-01

    Full Text Available Introduction: Concept mapping is an innovative tool that would help hospital educators and nurses to promote their knowledge and clinical decision making skills. The aim of this study was to investigate the effect of concept mapping on clinical decision making skills of nurses working in the intensive care unit (ICU. Methods: The quasi-experimental, non-equivalent control group, pretest-posttest design was conducted among baccalaureate nurses working in an intensive care unit. Forty two nurses were recruited and data gathering was performed through a self-administered questionnaire. Statistical analysis was conducted by SPSS software package version 16.0. Results: Despite the significant difference between the mean pre-, post- and retention test scores (P<0.001, there was no significant correlation between these results and the nurses’ gender. A negative significant association was found between age and improved post test scores (P=0.02. Work experience had a significant positive effect on post test score improvement (P<0.001. Conclusion: This study revealed that the concept mapping strategy had a significant effect on the clinical decision making skills of nurses. However, further research on a larger sample size is recommended to confirm the results.

  11. A collaborative teaching strategy for enhancing learning of evidence-based clinical decision-making.

    Science.gov (United States)

    Scott, P J; Altenburger, P A; Kean, J

    2011-01-01

    The educational literature cites a lack of student motivation to learn how to use research evidence in clinical decision-making because the students do not observe clinicians using evidence. This lack of motivation presents a challenge to educators as they seek to instill the value of evidence-based clinical decision-making (EBCD) in students. One problem is that students in entry-level programs do not have the experience needed to know what to look for, and secondly, clinical decision-making is contextually based in a patient problem. Our approach offers one solution to bridging the gap between classroom teaching and real-world implementation of EBCD through a three-phase collaborative approach. Occupational and physical therapy students are partnered with clinicians to find and appraise evidence to answer the real-world questions posed by these therapists. This paper describes the implementation of the partnership, teaching/learning outcomes, logistics, and implications for clinicians. We found this approach increased student motivation and greatly enhanced the learning experience. Future directions include implementing a framework which allows for the assessment of the strategy on the facility and creates opportunities to integrate the use of EBCD in all aspects of facility practice. PMID:21927777

  12. Responsive Decision-Making

    DEFF Research Database (Denmark)

    Pedersen, Carsten Lund; Andersen, Torben Juul

    environmental developments and feeding that information into strategic decisions will enable higher quality outcomes and better adaptive responses for persistent performance. Thus we review relevant parts of the strategic decision making literature to conceptualize the responsive decision making model and...

  13. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  14. Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India.

    Science.gov (United States)

    Tanderup, Malene; Reddy, Sunita; Patel, Tulsi; Nielsen, Birgitte Bruun

    2015-09-01

    As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents' demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. PMID:26133889

  15. Radiographer's impact on improving clinical decision-making, patient care and patient diagnosis: a pilot study

    International Nuclear Information System (INIS)

    This pilot study attempts to quantify the benefits of a documented radiographic clinical history through the use of the clinical history template form designed by Egan and Baird. Six radiographers completed the clinical history template for 40 patients and four radiologists included the recorded information as part of their reporting process. A focus discussion group was held between the radiographers to ascertain the level of satisfaction and benefits encountered with the use of the template form. A questionnaire was designed for the radiologists to complete regarding the usefulness of the template form with respect to the radiological reporting process. Results/Discussion: 15 cases for which the form was used demonstrated a direct benefit in respect to improved radiographic clinical decision-making. Radiographers agreed the template form aided the establishment of a stronger radiographer-patient relationship during the radiographic examination. Two radiologists agreed the form aided in establishing a radiological diagnosis and suggested the form be implemented as part of the standard departmental protocol. Despite the small sample size, there is evidence the form aided radiographic decision-making and assisted in the establishment of an accurate radiological diagnosis. The overall consensus amongst radiographers was that it enhanced radiographer-patient communication and improved the level of patient care. Copyright (2004) Australian Institute of Radiography

  16. Students' stereotypes of patients as barriers to clinical decision-making.

    Science.gov (United States)

    Johnson, S M; Kurtz, M E; Tomlinson, T; Howe, K R

    1986-09-01

    The ability to formulate quick, accurate clinical judgments is stressed in medical training. Speed is usually an asset when a physician sorts through his biomedical knowledge, but it is often a liability when the physician assesses the sociocultural context of a clinical encounter. At the Michigan State University College of Osteopathic Medicine, a study was designed which graphically illustrated to beginning students that unconscious sociocultural stereotypes may influence clinical decision-making. Three entering classes of students were shown a videotape depicting five simulated patients (attractive black woman, attractive white woman, professional man, middle-aged housewife, and elderly man), each presenting with the same physical complaint. Elements of positive and negative stereotypes were incorporated into each of the portrayals, and the students rated these patients on positive and negative characteristics. The results suggested that the students attributed both positive and negative characteristics to patients on the basis of irrelevant characteristics, such as attractiveness, and with little further justification for their attributions. Such stereotypic generalizations held by students may become barriers to the students' objective clinical decision-making. PMID:3755759

  17. Patient exposure in the basic science classroom enhances differential diagnosis formation and clinical decision-making

    Directory of Open Access Journals (Sweden)

    Justin G. Peacock

    2015-02-01

    Full Text Available Purpose. The authors proposed that introducing real patients into a pathology classroom early in medical education would help integrate fundamental principles and disease pathology with clinical presentation and medical history. Methods. Three patients with different pathologies described their history and presentation without revealing their diagnosis. Students were required to submit a differential diagnosis in writing, and then were able to ask questions to arrive at the correct diagnosis. Students were surveyed on the efficacy of patient-based learning. Results. Average student scores on the differential diagnosis assignments significantly improved 32% during the course. From the survey, 72% of students felt that patient encounters should be included in the pathology course next year. Seventy-four percent felt that the differential diagnosis assignments helped them develop clinical decision-making skills. Seventy-three percent felt that the experience helped them know what questions to ask patients. Eighty-six percent felt that they obtained a better understanding of patients’ social and emotional challenges. Discussion. Having students work through the process of differential diagnosis formulation when encountering a real patient and their clinical presentation improved clinical decision-making skills and integrated fundamental concepts with disease pathology during a basic science pathology course.

  18. Categorization = Decision Making + Generalization

    OpenAIRE

    Seger, Carol A; Peterson, Erik J.

    2013-01-01

    We rarely, if ever, repeatedly encounter exactly the same situation. This makes generalization crucial for real world decision making. We argue that categorization, the study of generalizable representations, is a type of decision making, and that categorization learning research would benefit from approaches developed to study the neuroscience of decision making. Similarly, methods developed to examine generalization and learning within the field of categorization may enhance decision making...

  19. Decision Making in the PICU: An Examination of Factors Influencing Participation Decisions in Phase III Randomized Clinical Trials

    OpenAIRE

    Slosky, Laura E; Marilyn Stern; Burke, Natasha L.; Siminoff, Laura A.

    2014-01-01

    Background. In stressful situations, decision making processes related to informed consent may be compromised. Given the profound levels of distress that surrogates of children in pediatric intensive care units (PICU) experience, it is important to understand what factors may be influencing the decision making process beyond the informed consent. The purpose of this study was to evaluate the role of clinician influence and other factors on decision making regarding participation in a randomiz...

  20. Reproductive Ethics in Commercial Surrogacy: Decision-Making in IVF Clinics in New Delhi, India

    DEFF Research Database (Denmark)

    Tanderup, Malene; Reddy, Sunita; Patel, Tulsi;

    2015-01-01

    As a neo-liberal economy, India has become one of the new health tourism destinations, with Commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology (ART) Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical...... Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in New Delhi, the capital of India, from...... success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of Commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the...

  1. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    NARCIS (Netherlands)

    Holmes-Rovner, M.; Nelson, W.L.; Pignone, M.; Elwyn, G.; Rovner, D.; O'Connor, A.M.; Coulter, A.; Correa-de-Araujo, R.

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clin

  2. Healthcare decision-making in end stage renal disease-patient preferences and clinical correlates

    OpenAIRE

    Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul,; Mitra, Sandip; ,

    2015-01-01

    Background Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. Methods 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluat...

  3. Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

    DEFF Research Database (Denmark)

    Puschner, B; Becker, T; Mayer, B;

    2016-01-01

    course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also...... controlled for nesting of patients within staff. Results. Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by......Aims. Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and...

  4. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E; Houdayer, Claude; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A

    2016-06-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  5. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making.

    Directory of Open Access Journals (Sweden)

    Pierre Thouvenot

    2016-06-01

    Full Text Available Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening.

  6. Functional Assessment of Genetic Variants with Outcomes Adapted to Clinical Decision-Making

    Science.gov (United States)

    Thouvenot, Pierre; Ben Yamin, Barbara; Fourrière, Lou; Lescure, Aurianne; Boudier, Thomas; Del Nery, Elaine; Chauchereau, Anne; Goldgar, David E.; Stoppa-Lyonnet, Dominique; Nicolas, Alain; Millot, Gaël A.

    2016-01-01

    Understanding the medical effect of an ever-growing number of human variants detected is a long term challenge in genetic counseling. Functional assays, based on in vitro or in vivo evaluations of the variant effects, provide essential information, but they require robust statistical validation, as well as adapted outputs, to be implemented in the clinical decision-making process. Here, we assessed 25 pathogenic and 15 neutral missense variants of the BRCA1 breast/ovarian cancer susceptibility gene in four BRCA1 functional assays. Next, we developed a novel approach that refines the variant ranking in these functional assays. Lastly, we developed a computational system that provides a probabilistic classification of variants, adapted to clinical interpretation. Using this system, the best functional assay exhibits a variant classification accuracy estimated at 93%. Additional theoretical simulations highlight the benefit of this ready-to-use system in the classification of variants after functional assessment, which should facilitate the consideration of functional evidences in the decision-making process after genetic testing. Finally, we demonstrate the versatility of the system with the classification of siRNAs tested for human cell growth inhibition in high throughput screening. PMID:27272900

  7. Ethics of Clinical Decision-Making for Older Drivers: Reporting Health-Related Driving Risk.

    Science.gov (United States)

    Mazer, Barbara; Laliberté, Maude; Hunt, Matthew; Lemoignan, Josée; Gélinas, Isabelle; Vrkljan, Brenda; Naglie, Gary; Marshall, Shawn

    2016-06-01

    The number of older drivers will continue to increase as the population ages. Health care professionals have the responsibility of providing care and maintaining confidentiality for their patients while ensuring public safety. This article discusses the ethics of clinical decision-making pertaining to reporting health-related driving risk of older drivers to licensing authorities. Ethical considerations inherent in reporting driving risk, including autonomy, confidentiality, therapeutic relationships, and the uncertainty about determining individual driving safety and risk, are discussed. We also address the moral agency of reporting health-related driving risk and raise the question of whose responsibility it is to report. Issues of uncertainty surrounding clinical reasoning and concepts related to risk assessment are also discussed. Finally, we present two case studies to illustrate some of the issues and challenges faced by health care professionals as they seek to balance their responsibilities for their patients while ensuring road safety for all citizens. PMID:27117942

  8. Exploring a Laboratory Model of Pharmacogenetics as Applied to Clinical Decision Making

    Directory of Open Access Journals (Sweden)

    Angela Smith, PharmD Candidate

    2013-01-01

    Full Text Available Objective: To evaluate a pilot of a laboratory model for relating pharmacogenetics to clinical decision making. Case Study: This pilot was undertaken and evaluated to help determine if a pharmacogenetics laboratory should be included in the core Doctor of Pharmacy curriculum. The placement of the laboratory exercise in the curriculum was determined by identifying the point in the curriculum where the students had been introduced to the chemistry of deoxyribonucleic acid (DNA as well as instructed on the chemistry of genetic variation. The laboratory included cytochrome P450 2C19 genotyping relative to the *2 variant. Twenty-four students served as the pilot group. Students provided buccal swabs as the source of DNA. Students stabilized the samples and were then provided instructions related to sample preparation, polymerase chain reaction, and gel electrophoresis. The results were reported as images of gels. Students used a reference gel image to compare their results to. Students then applied a dosing algorithm to make a “clinical decision” relative to clopidogrel use. Students were offered a post laboratory survey regarding attitudes toward the laboratory. Twenty-four students completed the laboratory with genotyping results being provided for 22 students (91.7%. Sixteen students were wild-type (*1/*1, while six students were heterozygous (*1/*2. Twenty-three students (96% completed the post laboratory survey. All 23 agreed (6, 26.1% or strongly agreed (17, 73.9% that the laboratory “had relevance and value in the pharmacy curriculum”. Conclusion: The post pilot study survey exploring a laboratory model for pharmacogenetics related to clinical decision making indicated that such a laboratory would be viewed positively by students. This model may be adopted by colleges to expand pharmacogenetics education.

  9. Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

    OpenAIRE

    Ambigapathy, Ranjini; Chia, Yook Chin; Ng, Chirk Jenn

    2016-01-01

    Objective Shared decision-making has been advocated as a useful model for patient management. In developing Asian countries such as Malaysia, there is a common belief that patients prefer a passive role in clinical consultation. As such, the objective of this study was to determine Malaysian patients’ role preference in decision-making and the associated factors. Design A cross-sectional study. Setting Study was conducted at an urban primary care clinic in Malaysia in 2012. Participants Patie...

  10. Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

    OpenAIRE

    Puschner, B; Becker, T.; Mayer, B; Jordan, H.; Maj, M.; Fiorillo, A; Égerházi, A.; Ivánka, T.; Munk-Jørgensen, P; Krogsgaard Bording, M.; Rössler, W.; Kawohl, W; Slade, Mike

    2016-01-01

    Aims. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome. Methods. CEDAR (ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. 588 adults with severe mental illnes...

  11. Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment

    Directory of Open Access Journals (Sweden)

    Thomason J Mark

    2009-01-01

    Full Text Available Abstract Background The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments – such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. Methods/Design Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs in three Primary Care Trust areas (n = 300 to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs and 3 (patients use qualitative focused one to one interviews with a sample of these practitioners (up to 30 and their patients (up to 60 to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. Discussion Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an

  12. Business making decisions

    Directory of Open Access Journals (Sweden)

    Enrique Benjamín Franklin Fincowsky

    2011-06-01

    Full Text Available People and organizations make better or get wrong as consequence of making decisions. Sometimes making decisions is just a trial and error process. Some others, decisions are good and the results profitable with a few of mistakes, most of the time because it’s considered the experience and the control of a specific field or the good intention of who makes them. Actually, all kinds of decisions bring learning. What is important is the intention, the attitude and the values considered in this process. People from different scenes face many facts and circumstances—almost always out of control—that affect the making decisions process. There is not a unique way to make decisions for all companies in many settings. The person who makes a decision should identify the problem, to solve it later using alternatives and solutions. Even though, follow all the steps it’s not easy as it seems. Looking back the conditions related to the decisions, we can mention the followings: uncertainty, risk and certainty. When people identify circumstances and facts, as well as its effects in a possible situation, they will make decisions with certainty. As long as the information decreases and it becomes ambiguous the risk becomes an important factor in the making decisions process because they are connected to probable objectives (clear or subjective (opinion judgment or intuition. To finish, uncertainty, involves people that make a decision with no or little information about circumstances or criteria with basis

  13. Which factors play a role in clinical decision-making in subfertility?

    Science.gov (United States)

    van der Steeg, Jan W; Steures, Pieternel; Eijkemans, Marinus J C; Habbema, J Dik F; Bossuyt, Patrick M M; Hompes, Peter G A; van der Veen, Fulco; Mol, Ben W J

    2006-04-01

    Sixteen vignettes of subfertile couples were constructed by varying fertility history, post-coital test, sperm motility, FSH concentration and Chlamydia antibody titre (CAT). Thirty-five gynaecologists estimated probabilities of treatment-independent pregnancy, intrauterine insemination (IUI) and IVF. Thereafter, they chose IUI, IVF or no treatment. The relative contribution of each factor to probability estimates and to subsequent treatment decisions was calculated. Duration of subfertility and maternal age were the most important contributors for gynaecologists' estimates of treatment-independent pregnancy [relative contribution (RC) 41, 26%]. Maternal age and FSH concentration were the most important contributors in the estimates for IUI (RC: 51, 25%) and for IVF (RC: 64, 31%). The decision to start IVF was mainly determined by maternal age, duration of subfertility, FSH concentration and CAT. The relative contribution of maternal age and duration of subfertility was in concordance with existing prediction models, whereas previous pregnancy and FSH concentration were under- and overestimated respectively. In conclusion, maternal age, duration of subfertility and FSH concentration are the main factors in clinical decision-making in subfertility. Gynaecologists overestimate the importance of FSH concentration, but underestimate that of a previous pregnancy, as compared with their importance reported in prediction models and guidelines. PMID:16740221

  14. Shared decision making

    Science.gov (United States)

    When facing a decision, your provider will fully explain your options. You can bring friends or family members to your visits to help in the shared decision making process. You will learn about the risks and ...

  15. Managerial Decision Making

    OpenAIRE

    Langhammerová, Andrea

    2013-01-01

    In this thesis the attention is not concentrated only on the manager, his knowledge and skills, functions etc., but mainly on one of the basic management activities, which is the decision making. Decision-making includes additional terms related to this very important managerial function. The first part of this thesis is the literature review. The aim is the explanation of the theoretical knowledge and explanation of basic terminology in the area of managerial decision-making. It shows a numb...

  16. An Investigation of Factors Influencing Nurses' Clinical Decision-Making Skills.

    Science.gov (United States)

    Wu, Min; Yang, Jinqiu; Liu, Lingying; Ye, Benlan

    2016-08-01

    This study aims to investigate the influencing factors on nurses' clinical decision-making (CDM) skills. A cross-sectional nonexperimental research design was conducted in the medical, surgical, and emergency departments of two university hospitals, between May and June 2014. We used a quantile regression method to identify the influencing factors across different quantiles of the CDM skills distribution and compared the results with the corresponding ordinary least squares (OLS) estimates. Our findings revealed that nurses were best at the skills of managing oneself. Educational level, experience, and the total structural empowerment had significant positive impacts on nurses' CDM skills, while the nurse-patient relationship, patient care and interaction, formal empowerment, and information empowerment were negatively correlated with nurses' CDM skills. These variables explained no more than 30% of the variance in nurses' CDM skills and mainly explained the lower quantiles of nurses' CDM skills distribution. PMID:26906246

  17. Quantitative Imaging Biomarkers: The Application of Advanced Image Processing and Analysis to Clinical and Preclinical Decision Making

    OpenAIRE

    Prescott, Jeffrey William

    2012-01-01

    The importance of medical imaging for clinical decision making has been steadily increasing over the last four decades. Recently, there has also been an emphasis on medical imaging for preclinical decision making, i.e., for use in pharamaceutical and medical device development. There is also a drive towards quantification of imaging findings by using quantitative imaging biomarkers, which can improve sensitivity, specificity, accuracy and reproducibility of imaged characteristics used for dia...

  18. Shared decision making

    Science.gov (United States)

    ... features on this page, please enable JavaScript. Shared decision making is when health care providers and patients work together to decide ... There many test and treatment options for most health conditions. So your condition may be ... decision making helps you and your provider choose a treatment ...

  19. Helping patients make better decisions: how to apply behavioral economics in clinical practice

    Directory of Open Access Journals (Sweden)

    Courtney MR

    2014-10-01

    Full Text Available Maureen Reni Courtney,1 Christy Spivey,2 Kathy M Daniel1 1College of Nursing, 2College of Business, University of Texas at Arlington, Arlington, TX, USA  Abstract: Clinicians are committed to effectively educating patients and helping them to make sound decisions concerning their own health care. However, how do clinicians determine what is effective education? How do they present information clearly and in a manner that patients understand and can use to make informed decisions? Behavioral economics (BE is a subfield of economics that can assist clinicians to better understand how individuals actually make decisions. BE research can help guide interactions with patients so that information is presented and discussed in a more deliberate and impactful way. We can be more effective providers of care when we understand the factors that influence how our patients make decisions, factors of which we may have been largely unaware. BE research that focuses on health care and medical decision making is becoming more widely known, and what has been reported suggests that BE interventions can be effective in the medical realm. The purpose of this article is to provide clinicians with an overview of BE decision science and derived practice strategies to promote more effective behavior change in patients.Keywords: nursing, message framing, defaults, incentives, social norms, commitment devices, health care

  20. Decision Making in Action

    Science.gov (United States)

    Orasanu, Judith; Statler, Irving C. (Technical Monitor)

    1994-01-01

    The importance of decision-making to safety in complex, dynamic environments like mission control centers and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. A similar observation has been made in nuclear power plants. Yet laboratory research on decision making has not proven especially helpful in improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multidimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication

  1. Decision time for clinical decision support systems

    OpenAIRE

    O'Sullivan, D.; Fraccaro, P.; Carson, E; Weller, P

    2014-01-01

    Clinical decision support systems are interactive software systems designed to assist clinicians with decision making tasks, such as determining a diagnosis or recommending a treatment for a patient. Clinical decision support systems are a widely researched topic in the Computer Science community but their inner workings are less well understood by and known to clinicians. In this article we provide a brief explanation of clinical decision support systems and provide some examples of real wor...

  2. Proceedings of Joint International Symposium on the role of noninvasive imaging modalities in clinical decision making of coronary artery disease

    International Nuclear Information System (INIS)

    This report contains ten papers on the use of noninvasive imaging in clinical diagnosis and decision making. Topics include a cost analysis of magnetic resonance imaging in medical technology, diagnostic uses of MRI in chronic coronary artery disease, clinical applications of cine computed tomography, the use of PET as a clinical tool, and the use of echocardiography in coronary artery disease. Individual papers are processed separately for the data base

  3. Handbook on Decision Making

    CERN Document Server

    Jain, Lakhmi C

    2010-01-01

    The present "Volume 1: Techniques and Applications" of the "Handbook on Decision Making" presents a useful collection of AI techniques, as well as other complementary methodologies, that are useful for the design and development of intelligent decision support systems. Application examples of how these intelligent decision support systems can be utilized to help tackle a variety of real-world problems in different domains, such as business, management, manufacturing, transportation and food industries, and biomedicine, are presented. The handbook includes twenty condensed c

  4. Ethical decision making

    OpenAIRE

    Zsolnai, László

    1997-01-01

    The self-centeredness of modern organizations leads to environmental destruction and human deprivation. The principle of responsibility developed by Hans Jonas requires caring for the beings affected by our decisions and actions. Ethical decision-making creates a synthesis of reverence for ethical norms, rationality in goal achievement, and respect for the stakeholders. The maximin rule selects the "least worst alternative" in the multidimensional decision space of deontologica...

  5. Molecular profiling of liver tumors: classification and clinical translation for decision making.

    Science.gov (United States)

    Pinyol, Roser; Nault, Jean Charles; Quetglas, Iris M; Zucman-Rossi, Jessica; Llovet, Josep M

    2014-11-01

    Hepatocellular carcinoma (HCC) is a complex disease with a dismal prognosis. Consequently, a translational approach is required to personalized clinical decision making to improve survival of HCC patients. Molecular signatures from cirrhotic livers and single nucleotide polymorphism have been linked with HCC occurrence. Identification of high-risk populations will be useful to design chemopreventive trials. In addition, molecular signatures derived from tumor and nontumor samples are associated with early tumor recurrence due to metastasis and late tumor recurrence due to de novo carcinogenesis after curative treatment, respectively. Identification of patients with a high risk of relapse will guide adjuvant randomized trials. The genetic landscape drawn by next-generation sequencing has highlighted the genomic diversity of HCC. Genetic drivers recurrently mutated belong to different signaling pathways including telomere maintenance, cell-cycle regulators, chromatin remodeling, Wnt/b-catenin, RAS/RAF/MAPK kinase, and AKT/mTOR pathway. These cancer genes will be ideally targeted by biotherapies as a paradigm of stratified medicine adapted to tumor biology. PMID:25369299

  6. Decision Making: Superiority Degree

    OpenAIRE

    Zhukovin, Vladimer; Alimbarashvili, Zurab

    2010-01-01

    It is introduced the concept of Superiority Degree one competitive decision over another. On the basis of this concept the mathematics theoretic structure is developed, which is part of pairs comparisons branch in modern decision making theory. It will be useful for practice and interesting for scientific research.

  7. Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

    Directory of Open Access Journals (Sweden)

    Légaré France

    2008-11-01

    Full Text Available Abstract Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior. Methods Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval. Discussion The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views

  8. Consumer decision making

    OpenAIRE

    Hansen, Torben

    2003-01-01

    In the consumer behaviour literature several perspectives on consumer decision making have been considered, including the ‘value perspective’, the ‘information processing perspective’, the ‘emotional perspective’, and ‘cue utilization theory’. In this paper, a framework which integrates several perspectives on consumer decision making and which hypothesizes possible links between several basic constructs is developed. The framework is tested by the use of two experimental desig...

  9. Fertility Intent and Contraceptive Decision-making among HIV Positive and Negative Antenatal Clinic Attendees in Durban, South Africa

    OpenAIRE

    Marlow, Heather M.; Maman, Suzanne; Groves, Allison K.; Moodley, Daya

    2012-01-01

    We explored contraceptive decision-making among South African antenatal clinic attendees, fertility intent post-HIV diagnosis, and women’s experiences at government health facilities. Data are from in-depth interviews with HIV negative and HIV positive women. We interviewed women in Zulu; interviews were recorded, transcribed and translated. We conducted qualitative analyses of interviews. Women were the dominant decision-makers about contraceptive use, whether they involved their partners or...

  10. How brains make decisions

    CERN Document Server

    Yukalov, V I

    2014-01-01

    This chapter, dedicated to the memory of Mino Freund, summarizes the Quantum Decision Theory (QDT) that we have developed in a series of publications since 2008. We formulate a general mathematical scheme of how decisions are taken, using the point of view of psychological and cognitive sciences, without touching physiological aspects. The basic principles of how intelligence acts are discussed. The human brain processes involved in decisions are argued to be principally different from straightforward computer operations. The difference lies in the conscious-subconscious duality of the decision making process and the role of emotions that compete with utility optimization. The most general approach for characterizing the process of decision making, taking into account the conscious-subconscious duality, uses the framework of functional analysis in Hilbert spaces, similarly to that used in the quantum theory of measurements. This does not imply that the brain is a quantum system, but just allows for the simple...

  11. An Exploration of the Relationship between Clinical Decision-Making Ability and Educational Preparation among New Graduate Nurses

    Science.gov (United States)

    Blount, Kamilah V.

    2013-01-01

    This study examined the impact of accelerated nursing direct entry master's programs on the development of clinical decision-making skills of new graduate nurses that completed the Performance Based Development System (PBDS) assessment during the study period of 2008-2012 at a healthcare organization. Healthcare today is practiced in a…

  12. C-reactive protein and white blood cell count do not improve clinical decision-making in acute appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Lassen, Annmarie Touborg; Zimmermann-Nielsen, Erik;

    2015-01-01

    INTRODUCTION: Acute appendicitis (AA) remains a diagnostic challenge as indicated by the high rate of unnecessary surgery. Blood samples, primarily C-reactive protein (CRP) and leucocyte counts, are used as a diagnostic supplement despite their relatively low sensitivities and specificities...... leucocyte counts did not influence clinical decision-making....

  13. Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making.

    Science.gov (United States)

    Dalke, Katharine Baratz; Wenzel, Amy; Kim, Deborah R

    2016-06-01

    Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making. PMID:27091646

  14. Professional autonomy in 21st century healthcare: Nurses' accounts of clinical decision-making

    DEFF Research Database (Denmark)

    Traynor, Michael; Boland, Maggie; Buus, Niels

    2010-01-01

    Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible...... profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus group study of UK nurses participating in post-qualifying professional development in 2008. Three groups of nurses in different specialist areas comprised a total of 26 participants. The...... study uses accounts of decision-making to gain insight into contemporary professional nursing. The study also aims to explore the usefulness of a theory of professional work set out by Jamous and Peloille (1970). The analysis draws on notions of interpretive repertoires and elements of narrative...

  15. Editorial: The search for core symptoms - will this help clinical decision-making?

    Science.gov (United States)

    Frazier Norbury, Courtenay

    2016-08-01

    Diagnosis is an important component of our clinical roles, and should also lead to particular treatment pathways. The diagnostic process may be challenged by co-occurring deficits that are neither specific nor universal to the diagnosis under consideration and may well be evident across a range of other clinical conditions. How important is it to refine our instruments so that they measure unique symptoms? Will this alter or improve intervention choices? This Editorial focuses on the extent to which fine tuning diagnostic instruments improves our decisions about treatment, in the context of articles published in this issue of JCPP. PMID:27445109

  16. Decision making and imperfection

    CERN Document Server

    Karny, Miroslav; Wolpert, David

    2013-01-01

    Decision making (DM) is ubiquitous in both natural and artificial systems. The decisions made often differ from those recommended by the axiomatically well-grounded normative Bayesian decision theory, in a large part due to limited cognitive and computational resources of decision makers (either artificial units or humans). This state of a airs is often described by saying that decision makers are imperfect and exhibit bounded rationality. The neglected influence of emotional state and personality traits is an additional reason why normative theory fails to model human DM process.   The book is a joint effort of the top researchers from different disciplines to identify sources of imperfection and ways how to decrease discrepancies between the prescriptive theory and real-life DM. The contributions consider:   ·          how a crowd of imperfect decision makers outperforms experts' decisions;   ·          how to decrease decision makers' imperfection by reducing knowledge available;   ...

  17. Ethical Decision Making

    DEFF Research Database (Denmark)

    Lauesen, Linne Marie

    2012-01-01

    interaction between a corporation and its stakeholders. Methodology/approach: This paper offers a theoretical 'Organic Stakeholder Model' based on decision making theory, risk assessment and adaption to a rapidly changing world combined with appropriate stakeholder theory for ethical purposes in decision...... by the inclusion of multiple stakeholders. The conceptualization of the model enhances business ethics in decision making by managing and balancing stakeholder concerns with the same concerns as the traditional risk management models does – for the sake of the wider social responsibilities of the......Purpose: For the last three decades, Stakeholder management has been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models that can explain the complexities of the...

  18. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Tessitore, Enrico, E-mail: enrico.tessitore@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Molliqaj, Granit, E-mail: granitmolliqaj@gmail.com [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland); Schatlo, Bawarjan, E-mail: schatlo@gmail.com [Department of Neurosurgery, Georg-August University, University of Medicine Gottingen, 37075 Gottingen (Germany); Schaller, Karl, E-mail: karl.schaller@hcuge.ch [Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University of Geneva (Switzerland)

    2015-05-15

    In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making.

  19. Clinical evaluation and surgical decision making for patients with lumbar discogenic pain and facet syndrome

    International Nuclear Information System (INIS)

    In industrialized countries, more than two thirds of the population suffers from low back pain (LBP) in their lifetime. LBP associated with lumbar disc herniation, stenosis, and instability is a well-known and documented entity. On the other hand, the lumbar discogenic pain and facet syndrome are difficult to be clearly identified, and they are not always detectable by imaging. This article describes the causes of these painful syndromes, which are typically without radicular component, explains the modern diagnostic procedures, and provides guidelines for surgical decision making

  20. Clinical decision making in response to performance validity test failure in a psychiatric setting.

    Science.gov (United States)

    Marcopulos, Bernice A; Caillouet, Beth A; Bailey, Christopher M; Tussey, Chriscelyn; Kent, Julie-Ann; Frederick, Richard

    2014-01-01

    This study examined the clinical utility of a performance validity test (PVT) for screening consecutive referrals (N = 436) to a neuropsychology service at a state psychiatric hospital treating both civilly committed and forensic patients. We created a contingency table with Test of Memory Malingering (TOMM) pass/fail (355/81) and secondary gain present/absent (181/255) to examine pass rates associated with patient demographic, clinical and forensic status characteristics. Of the 81 failed PVTs, 48 had secondary gain defined as active criminal legal charges; 33 failed PVTs with no secondary gain. These individuals tended to be older, female, Caucasian, and civilly committed compared with the group with secondary gain who failed. From estimations of TOMM False Positive Rate and True Positive Rate we estimated base rates of neurocognitive malingering for our clinical population using the Test Validation Summary (TVS; Frederick & Bowden, 2009 ). Although PVT failure is clearly more common in a group with secondary gain (31%), there were a number of false positives (11%). Clinical ratings of patients without gain who failed suggested cognitive deficits, behavioral issues, and inattention. Low scores on PVTs in the absence of secondary gain provide useful information on test engagement and can inform clinical decisions about testing. PMID:24678658

  1. Oil industry decision making

    International Nuclear Information System (INIS)

    This paper reports that the oil and gas business is undergoing a significant restructuring. In order to maintain control of our own destiny and succeed in an increasingly competitive business environment, the industry must set goals which are consistent with its continued success and focus on those goals in every aspect of its strategic management. By applying an approach to decision making which focuses on the achievement of the key goals required for success at every decision point and systematic follow-up, a firm can greatly increase its ability to succeed in the business environment of the future

  2. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

    Directory of Open Access Journals (Sweden)

    Andrew Barber

    2016-05-01

    Full Text Available The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate. Trainees perceived their own values to be less important than the patient’s values (p < 0.001 in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1. In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001. Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making. There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.

  3. Interrelation between orthodontics and phonoaudiology in the clinical decision-making of individuals with mouth breathing

    Directory of Open Access Journals (Sweden)

    Rúbia Vezaro Vanz

    2012-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to investigate the decision making of orthodontists of Passo Fundo district - Rio Grande do Sul (RS, Brazil, in the Orthodontics/Speech Therapy interdisciplinary treatment of mouth breathing individuals. METHODS: The present study is a quantitative approach and the design is descriptive, using as instrument data collection of a questionnaire sent to 22 orthodontists practicing in the above-mentioned district. The project was approved the the Ethics in Research Committee and all individuals signed a free informed consent. RESULTS: All professionals considered the inter-relation between Orthodontics and Speech Therapy necessary, but divergences were found in situations where a associated therapy may exist, considering that 54.5% trust the inter-relation to develop aspects associated to language, orofacial motricity and habits. In cases of associated treatment, the results obtained were considered satisfactory by 73.7% of professionals, even though they consider that only 6 to 20% of their patients collaborate with treatment. CONCLUSION: In relation to decision-making in treatment of mouth breathing individuals, the orthodontists in Passo Fundo/RS agree that there is need for speech therapy. The full vision of the individual in a multidisciplinary team is of fundamental importance in the treatment of patients with mouth breathing syndrome.

  4. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making

    Directory of Open Access Journals (Sweden)

    Bradley D. Gordon

    2015-12-01

    Full Text Available Introduction: The objective of the study was to understand the immediate utility of health information exchange (HIE on emergency department (ED providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. Methods: Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. Results: We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. Conclusion: ED providers are driven to use HIE when they’re missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

  5. Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

    OpenAIRE

    Andrew Barber; James Puryer; Sam Leary; Lisa McNally; Dominic O’Sullivan

    2016-01-01

    The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of dis...

  6. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

    OpenAIRE

    Sivasangari Subramaniam; Sotheenathan Krishinan; Revathy U. Thandapani; Hans Van Rostenberghe; Azriani Berahim

    2015-01-01

    In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4) Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM), Hospital Pulau Pinang (HPP), Hospital Sultan Abdul Halim (HSAH) and Hospital Seberang Jaya (HSJ). A cross-sectional study was conducted from January until Dec...

  7. Ethical Decision Making

    OpenAIRE

    Lauesen, Linne Marie

    2013-01-01

    Purpose: For the last three decades, Stakeholder management has been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models that can explain the complexities of the interaction between a corporation and its stakeholders. Methodology/approach: This paper offers a theoretical ‘Organic Stakeholder Model’ based on decision making theory, risk assessment and adaption to a ...

  8. Participation in decision making

    Directory of Open Access Journals (Sweden)

    EG Valoyi

    2000-06-01

    Full Text Available The aim of the present study was to determine the extent to which employees would like to participate in decision making concerning various organisational issues, especially those concerning: the work itself, working conditions, human resources issues, and corporate policy and planning. The sample consisted of 146 participants, including managers, middle managers, and junior officials from a South African development corporation. A questionnaire to measure employees' desire to participate in decision making was specially constructed for this investigation. It has found that employees with higher academic qualifications were more desirous to participate in decision-making at all levels than employees with lower academic qualifications. This was also true for employees in higher job grades than in lower job grades. Men were more desirous to participate in decision making than women. The implications of the findings are discussed. Opsomming Die doel van die huidige studie was om vas te stel in watter mate werknemers sal wil deelneem aan die besluit- nameproses van organisasies, veral rakende die volgende sake: die werk self, werksomstandighede, menslike hulpbronaangeleenthede en korporatiewe beleid en beplanning. Die steekproef het uit 146 deelnemers, insluitende bestuurders, middelvlakbestuurders en junior amptenare van'n Suid Afrikaanse ontwikkelingskorporasie, bestaan. nVraelys wat die begeerte van werknemers meet om aan die besluitnameproses deel te neem, is spesiaal vir die doel van hierdie ondersoek, ontwerp. Dit is bevind dat werknemers met hoer akademiese kwalifikasies meer begerig is om aan die besluitnameproses op alle vlakke deel te neem as werknemers met laer akademiese kwalifikasies. Dit was ook waar vir werknemers in hoervlakposte vergeleke met werknemers in laervlakposte. Mans was ook meer begerig om aan die besluitnameproses deel te neem as vroue. Die implikasies van die studie word bespreek.

  9. Clinical Trial Decision Making in Pediatric Sickle Cell Disease: A Qualitative Study of Perceived Benefits and Barriers to Participation.

    Science.gov (United States)

    Patterson, Chavis A; Chavez, Veronica; Mondestin, Valerie; Deatrick, Janet; Li, Yimei; Barakat, Lamia P

    2015-08-01

    Clinical trial research forms the foundation for advancing treatments; yet, children with sickle cell disease (SCD) are currently underrepresented. This qualitative study examines decision-making processes of youth with SCD and their caregivers regarding enrollment in clinical trial research. A subsample of participants from a study of clinical trial decision making among youth with health disparity conditions, 23 caregivers and 29 children/teens/young adults with SCD (age, 10 to 29 y), indicated whether or not they would participate in hypothetical medical and psychosocial clinical trials and prioritized barriers and benefits to participation via card sort and semistructured interviews. Audio recordings were transcribed and coded for themes. Participants reported that concerns of potential harm most affected their decision. Secondary factors were potential benefit, manageable study demands, and trust in the medical staff. Caregivers weighed potential harm more heavily than their children. Young children were more likely to endorse potential benefit. Overall, participants stated they would be willing to participate in research if the potential benefit outweighs potential harm and unmanageable study demands. To optimize recruitment, results suggest addressing potential harm first while highlighting potential benefits, creating manageable study demands, and endorsing the future benefits of research to the sickle cell community. PMID:25072368

  10. [An expert system of aiding decision making in breast pathology connected to a clinical data base].

    Science.gov (United States)

    Brunet, M; Durrleman, S; Ferber, J; Ganascia, J G; Hacene, K; Hirt, F; Jouniaux, F; Meeus, L

    1987-01-01

    The René Huguenin Cancer Center holds a medical file for each patient which is intended to store and process medical data. Since 1970, we introduced computerization: a development plan was elaborated and simultaneously a statistical software (Clotilde--GSI/CFRO) was selected. Thus, we now have access to a large database, structured according to medical rationale, and utilizable with methods of artificial intelligence towards three objectives: improved data acquisition, decision making and exploitation. The first application was to breast pathology, which represents one of the Center's primary activities. The structure of the data concerning patients is by all criteria part of the medical knowledge. This information needs to be presented as well as processed with a suitable language. To this end, we chose a language-oriented object, Mering II, usable with Apple and IBM 4 micro-computers. This project has already allowed to work out an operational model. PMID:3620732

  11. Understanding marketing decision-making

    OpenAIRE

    Wierenga, Berend

    2012-01-01

    textabstractWhile a whole range of factors influences the outcomes of a marketing policy, it is managerial decision-making that can really make a difference. A clearer understanding of how marketers make decisions should therefore improve their quality.

  12. Making training decisions proactively

    International Nuclear Information System (INIS)

    The challenge of making training decisions with a high degree of confidence as to the results of those decisions face every DOD, Federal, State, and City agency. Training has historically been a very labor and paper intensive system with limited automation support. This paper outlines how one DOD component, the Air Force, is approaching that challenge. The Training Decision System (TDS) will provide the Air Force with an automated decision aid to help plan and estimate the consequences of various mixes of resident training, On-The-Job Training (OJT), and field training within a specialty such as security. The system described provides training from enlistment to separation and responds to hundreds of related security task needs. This system identifies what the tasks are, who should provide the training, what training setting should be used, what proficiency should be achieved, and through computer modeling provides an assessment of training effectiveness options and estimate the impact of implementing those options. With current budgetary constraints and with the possibility of further reductions in the future, the most cost effective training mix must be found to sustain required capabilities

  13. Decision Making with Imperfect Decision Makers

    CERN Document Server

    Guy, Tatiana Valentine; Wolpert, David H

    2012-01-01

    Prescriptive Bayesian decision making has reached a high level of maturity and is well-supported algorithmically. However, experimental data shows that real decision makers choose such Bayes-optimal decisions surprisingly infrequently, often making decisions that are badly sub-optimal. So prevalent is such imperfect decision-making that it should be accepted as an inherent feature of real decision makers living within interacting societies. To date such societies have been investigated from an economic and gametheoretic perspective, and even to a degree from a physics perspective. However, lit

  14. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making

    Directory of Open Access Journals (Sweden)

    Manns PJ

    2012-11-01

    Full Text Available Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1 identify prevalent condition and brainstorm interventions; (2 literature search; (3 develop scenario framework; and (4 write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum

  15. Confidence and Information Access in Clinical Decision-Making: An Examination of the Cognitive Processes that affect the Information-seeking Behavior of Physicians

    OpenAIRE

    Uy, Raymonde Charles; Sarmiento, Raymond Francis; Gavino, Alex; Fontelo, Paul

    2014-01-01

    Clinical decision-making involves the interplay between cognitive processes and physicians’ perceptions of confidence in the context of their information-seeking behavior. The objectives of the study are: to examine how these concepts interact, to determine whether physician confidence, defined in relation to information need, affects clinical decision-making, and if information access improves decision accuracy. We analyzed previously collected data about resident physicians’ perceptions of ...

  16. Chronic hepatitis C: Treat or wait? Medical decision making in clinical practice

    Institute of Scientific and Technical Information of China (English)

    Claus Niederau; Dietrich Hüppe; Elmar Zehnter; Bernd M(o)ller; Renate Heyne; Stefan Christensen; Rainer Pfaff

    2012-01-01

    AIM:To analyzes the decision whether patients with chronic hepatitis C virus (HCV) infection are treated or not.METHODS:This prospective cohort study included 7658 untreated patients and 6341 patients receiving pegylated interferon α2a/ribavirin,involving 434 physicians/institutions throughout Germany (377 in private practice and 57 in hospital settings).A structured questionnaire had to be answered prior to the treatment decision,which included demographic data,information about the personal life situation of the patients,anamnesis and symptomatology of hepatitis C,virological data,laboratory data and data on concomitant diseases.A second part of the study analyzes patients treated with pegylated interferon α2a.All questionnaires included reasons against treatment mentioned by the physician.RESULTS:Overall treatment uptake was 45%.By multivariate analysis,genotype 1/4/5/6,HCV-RNA ≤ 520 000 IU/mL,normal alanine aminotransferase (ALT),platelets ≤ 142 500/μL,age > 56 years,female gender,infection length > 12.5 years,concomitant diseases,human immunodeficiency virus co-infection,liver biopsy not performed,care in private practice,asymptomatic disease,and unemployment were factors associated with reduced treatment rate.Treatment and sustained viral response rates in migrants (1/3 of cohort) were higher than in German natives although 1/3 of migrants had language problems.Treatment rate and liver biopsy were higher in clinical settings when compared to private practice and were low when ALT and HCV-RNA were low.CONCLUSION:Some reasons against treatment were medically based whereas others were related to fears,socio-economical problems,and information deficits both on the side of physicians and patients.

  17. Decision making and programming

    CERN Document Server

    Kolbin, V V

    2003-01-01

    The problem of selection of alternatives or the problem of decision making in the modern world has become the most important class of problems constantly faced by business people, researchers, doctors and engineers. The fields that are almost entirely focused on conflicts, where applied mathematics is successfully used, are law, military science, many branches of economics, sociology, political science, and psychology. There are good grounds to believe that medicine and some branches of biology and ethics can also be included in this list. Modern applied mathematics can produce solutions to ma

  18. Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study.

    Science.gov (United States)

    Ackman, Jeanne B; Gaissert, Henning A; Lanuti, Michael; Digumarthy, Subba R; Shepard, Jo-Anne O; Halpern, Elkan F; Wright, Cameron D

    2016-08-01

    Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016

  19. Knowledge, decision making, and uncertainty

    International Nuclear Information System (INIS)

    Artificial intelligence (AI) systems depend heavily upon the ability to make decisions. Decisions require knowledge, yet there is no knowledge-based theory of decision making. To the extent that AI uses a theory of decision-making it adopts components of the traditional statistical view in which choices are made by maximizing some function of the probabilities of decision options. A knowledge-based scheme for reasoning about uncertainty is proposed, which extends the traditional framework but is compatible with it

  20. Attitudes of Oncologists, Oncology Nurses, and Patients from a Women's Clinic Regarding Medical Decision Making for Older and Younger Breast Cancer Patients.

    Science.gov (United States)

    Beisecker, Analee E.; And Others

    1994-01-01

    Administered Beisecker Locus of Authority in Decision Making: Breast Cancer survey to 67 oncologists, 94 oncology nurses, and 288 patients from women's clinic. All groups believed that physicians should have dominant role in decision making. Nurses felt that patients should have more input than patients or physicians felt they should. Physicians…

  1. CLINICAL DECISION MAKING IN NURSING CARE: EVIDENCE BASED PRACTICE AND SENIORITY

    Directory of Open Access Journals (Sweden)

    Sivasangari Subramaniam

    2015-03-01

    Full Text Available In the nursing profession, EBP makes a positive contribution to healthcare outcomes, care delivery, clinical teaching and research. The research objective was to determine the nurses' knowledge, attitude, practice towards EBP and barriers to use EBP in four (4 Government Hospitals in Malaysia, Hospital Universiti Sains Malaysia (HUSM, Hospital Pulau Pinang (HPP, Hospital Sultan Abdul Halim (HSAH and Hospital Seberang Jaya (HSJ. A cross-sectional study was conducted from January until December 2012 among (n=600 nurses working in all disciplines, on shift or day time duties in four selected hospitals. The questionnaire was adapted from a Singapore study (Majid, 2011. Results showed that among the nurses working in 4 different Malaysian hospitals, close to fifty percent (53 % knew what the evidence based practice meant. The items assessing the attitude showed a large number nurses responding that they did neither agree nor disagree with statements provided. The majority of the remaining nurses tended to show a rather positive attitude except when asked about how the workload interfered with their EBP practice. The practice level of EBP scored a mean of more than 3 out of maximal five for most items. Most nurses recognized there were many barriers to EBP in their working place. In conclusion, this study may have helped to increase our understanding of knowledge, attitudes, practice and barriers towards to use of EBP to the utilization of research by nurses through an exploration of perceived barriers and facilitators on the part of nurses.

  2. [Decision Making and Electrodermal Activity].

    Science.gov (United States)

    Kobayakawa, Mutsutaka

    2016-08-01

    Decision making is aided by emotions. Bodily responses, such as sweating, heartbeat, and visceral sensation, are used to monitor the emotional state during decision making. Because decision making in dairy life is complicated and cognitively demanding, these bodily signals are thought to facilitate the decision making process by assigning positive or negative values for each of the behavioral options. The sweat response in a decision making task is measured by skin conductance response (SCR). SCR in decision making is divided into two categories: anticipatory SCR is observed before making decisions, and reward/punishment SCR is observed after the outcome of the decision is perceived. Brain lesion studies in human revealed that the amygdala and ventromedial prefrontal cortex are important in decision making. Patients with lesinon in the amygdala exhibit neither the anticipatory nor reward/punishment SCRs, while patients with the ventromedial prefrontal lesions have deficits only in the anticipatory SCRs. Decision making tasks and SCR analysis have contributed to reveal the implicit aspects of decision making. Further research is necessary for clarifying the role of explicit process of decision making and its relationship with the implicit process. PMID:27503819

  3. Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

    OpenAIRE

    Légaré France; Tapp Sylvie; Gagnon Marie-Pierre; Desroches Sophie

    2008-01-01

    Abstract Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The...

  4. Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score

    OpenAIRE

    Ramnarayan, Padmanabhan; Kapoor, Ritika R; Coren, Michael; Nanduri, Vasantha; Tomlinson, Amanda L.; Taylor, Paul M.; Wyatt, Jeremy C; Britto, Joseph F.

    2003-01-01

    Objective: Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful.

  5. The Decision Making Strategies of Modern Matrons

    OpenAIRE

    McNichol, Elaine

    2011-01-01

    Modern Matrons are at the vanguard of both care delivery and the NHS reforms and have an important role in the modernisation of, and future delivery of healthcare. An important contextual feature of their role and a concept that has been widely embraced by the National Health Service, is that of decentralized decision making. Unlike clinical decision making which has been extensively studied, there is little in the healthcare literature regarding leadership and management decision making or t...

  6. Development and validation of a tool to measure self-confidence and anxiety in nursing students during clinical decision making.

    Science.gov (United States)

    White, Krista A

    2014-01-01

    Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety affect the learning and adeptness of CDM. This study aimed to develop and test a quantitative tool to assess undergraduate nursing students' self-confidence and anxiety during CDM. The 27-item Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale is a 6-point, Likert-type tool with two subscales. Two samples of prelicensure associate and baccalaureate nursing students participated in the pilot (n = 303) and main testing (n = 242) phases of the study. Construct validity assessment, using exploratory factor analysis, produced a stable three-dimensional scale. Convergent validity assessment produced positive, moderate, and statistically significant correlations of the tool sub-scales with two existing instruments. Internal consistency reliability was assessed for each subscale (self-confidence, α = .97; anxiety, α = .96). The NASC-CDM scale may be a useful assessment tool for nurse educators to help novice clinicians improve CDM skills. PMID:24256004

  7. Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness (CEDAR: Study protocol

    Directory of Open Access Journals (Sweden)

    Nemes Zoltan

    2010-11-01

    Full Text Available Abstract Background A considerable amount of research has been conducted on clinical decision making (CDM in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness. Methods/Design The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK. First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560. This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs by taking into account significant variables moderating the relationship between CDM and outcome. Discussion The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe. Trial register ISRCTN75841675.

  8. Perspective: The Challenge of Clinical Decision-Making for Drug Treatment in Older People. The Role of Multidimensional Assessment and Prognosis

    OpenAIRE

    Pilotto, Alberto; Sancarlo, Daniele; Daragjati, Julia; Panza, Francesco

    2015-01-01

    A complex decision path with a careful evaluation of the risk–benefit ratio is mandatory for drug treatment in advanced age. Enrollment biases in randomized clinical trials (RCTs) cause an under-representation of older individuals. In high-risk frail older subjects, the lack of RCTs makes clinical decision-making particularly difficult. Frail individuals are markedly susceptible to adverse drug reactions, and frailty may result in reduced treatment efficacy. Life expectancy should be included...

  9. Composite collective decision-making.

    Science.gov (United States)

    Czaczkes, Tomer J; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

    2015-06-22

    Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. PMID:26019155

  10. Influence of framing on medical decision making

    OpenAIRE

    Feng, Jun; Gong, Jingjing; Huang, Yonghua; Wei, Yazhou; Zhang, Weiwei; Zhang, Yan

    2013-01-01

    Numerous studies have demonstrated the robustness of the framing effect in a variety of contexts, especially in medical decision making. Unfortunately, research is still inconsistent as to how so many variables impact framing effects in medical decision making. Additionally, much attention should be paid to the framing effect not only in hypothetical scenarios but also in clinical experience.

  11. Making Evidence-based Decisions in the Clinical Practice of Integrative Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hao; CHEN Ke-ji

    2010-01-01

    @@ In 1948.the first clinical paper adopting the protocol of randomized and controlled design was published in British Medical Journal by Bradford Hill, a noted British biostatistician, who introduced rigorous theory of mathematical statistics into clinical design the first time and successfully evaluated the therapeutic effect of streptomycin on tuberculosis(1).

  12. Inertia and Decision Making.

    Science.gov (United States)

    Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Li, Jiahui

    2016-01-01

    Decision inertia is the tendency to repeat previous choices independently of the outcome, which can give rise to perseveration in suboptimal choices. We investigate this tendency in probability-updating tasks. Study 1 shows that, whenever decision inertia conflicts with normatively optimal behavior (Bayesian updating), error rates are larger and decisions are slower. This is consistent with a dual-process view of decision inertia as an automatic process conflicting with a more rational, controlled one. We find evidence of decision inertia in both required and autonomous decisions, but the effect of inertia is more clear in the latter. Study 2 considers more complex decision situations where further conflict arises due to reinforcement processes. We find the same effects of decision inertia when reinforcement is aligned with Bayesian updating, but if the two latter processes conflict, the effects are limited to autonomous choices. Additionally, both studies show that the tendency to rely on decision inertia is positively associated with preference for consistency. PMID:26909061

  13. Emotions, Mood and Decision Making

    OpenAIRE

    Agnes Virlics

    2014-01-01

    Decisions are made according to a complex cognitive and emotional evaluation of the situation. The aim of the paper is to examine the effect of mood on risky investment decision making by using a mood induction procedure. The paper investigates how happy and sad mood affects risky investment decision making and whether there is a difference between the perception of fix investments and monetary investments. The analysis has been conducted focusing on individual investment decisions. Data for ...

  14. Clinical, pathological and molecular prognostic factors in prostate cancer decision-making process.

    Science.gov (United States)

    Pugliese, Dario; Palermo, Giuseppe; Totaro, Angelo; Bassi, Pier Francesco; Pinto, Francesco

    2016-03-01

    Prostate cancer is the most common urologic neoplasm and the second leading cause of cancer-related death among men in many developed countries. Given the highly heterogeneous behaviour of the disease, there is a great need for prognostic factors, in order to stratify the clinical risk and give the best treatment options to the patient. Clinical factors, such as prostate-specific antigen value and derivatives, and pathological factors, such as stage and Gleason grading, are well kown prognostic factors. Nomograms can provide useful prediction in each clinical sceario. The field of molecular biomarkers is briskly evolving towards personalized medicine. TMPRSS2-ERG fusion, deletion of PTEN ed and gene panels are some of the more extensively explored molecular features in prostate cancer outcome prediction. In the near future, circulating tumour cells, exosomes and microRNAs could give us further, not invasive important tools. PMID:26917215

  15. Decision-Making: Qualitative Information

    OpenAIRE

    Zhukovin, V.; Chkhikvadze, N.; Alimbarashvili, Z.

    2010-01-01

    From this set of procedures for given clause we shall choose only interrogation of experts on pairs decisions. It is widely widespread method. It makes the whole chapter in the theory of the decision-making, well investigated with the formal point of view. In the modern theory of decision-making at gathering the initial information for mathematical model it practically does not have alternative.

  16. The amygdala and decision making

    OpenAIRE

    Gupta, Rupa; Koscik, Timothy R.; Bechara, Antoine; Tranel, Daniel

    2010-01-01

    Decision-making is a complex process that requires the orchestration of multiple neural systems. For example, decision-making is believed to involve areas of the brain involved in emotion (e.g., amygdala, ventromedial prefrontal cortex) and memory (e.g., hippocampus, dorsolateral prefrontal cortex). In this article, we will present findings related to the amygdala’s role in decision-making, and differentiate the contributions of the amygdala from those of other structurally and functionally c...

  17. Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia

    Science.gov (United States)

    Klein, Evelyn; Schlembach, Dietmar; Ramoni, Angela; Langer, Elena; Bahlmann, Franz; Grill, Sabine; Schaffenrath, Helene; van der Does, Reinhard; Messinger, Diethelm; Verhagen-Kamerbeek, Wilma D. J.; Reim, Manfred; Hund, Martin; Stepan, Holger

    2016-01-01

    Objective To evaluate the influence of the soluble fms-like tyrosine kinase 1/placental growth factor ratio in physicians’ decision making in pregnant women with signs and symptoms of preeclampsia in routine clinical practice. Methods A multicenter, prospective, open, non-interventional study enrolled pregnant women presenting with preeclampsia signs and symptoms in several European perinatal care centers. Before the soluble fms-like tyrosine kinase 1/placental growth factor ratio result was known, physicians documented intended clinical procedures using an iPad® application (data locked/time stamped). After the result was available, clinical decisions were confirmed or revised and documented. An independent adjudication committee evaluated the appropriateness of decisions based on maternal/fetal outcomes. Clinician decision making with regard to hospitalization was the primary outcome. Results In 16.9% of mothers (20/118) the hospitalization decision was changed after knowledge of the ratio. In 13 women (11.0%), the initial decision to hospitalize was changed to no hospitalization. In seven women (5.9%) the revised decision was hospitalization. All revised decisions were considered appropriate by the panel of adjudicators (McNemar test; p preeclampsia. This is the first study to demonstrate the impact of angiogenic biomarkers on decision making in a routine clinical practice. PMID:27243815

  18. Making Decisions about Treatment

    Science.gov (United States)

    ... decision later. What has been the experience of friends and people you trust? Learning about other people’s ... paid by the company. Consider how that might influence their ability to provide unbiased information. There are ...

  19. Primary care clinic location decision-making and spatial accessibility for the region of Thessaly

    OpenAIRE

    Yorgos N. Photis; Manetos, Panos

    2008-01-01

    The prospect for establishing a General Clinic at the Thessaly Region was examined. The new facility aimes to provide full medical care by qualified scientists (permanent personnel, shareholders or associates), by experienced, trained and skilled nursing personnel, fully organised with sophisticated technological equipment, in a hospitable and pleasant environment, with easy and fast access. The main aim of this study is the determination of the optimum location for the construction of...

  20. Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations

    OpenAIRE

    Latter, Sue; Smith, Alesha; Blenkinsopp, Alison; Nicholls, Peter G.; Little, Paul; Chapman, Stephen

    2012-01-01

    OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was pr...

  1. Constraint programming and decision making

    CERN Document Server

    Kreinovich, Vladik

    2014-01-01

    In many application areas, it is necessary to make effective decisions under constraints. Several area-specific techniques are known for such decision problems; however, because these techniques are area-specific, it is not easy to apply each technique to other applications areas. Cross-fertilization between different application areas is one of the main objectives of the annual International Workshops on Constraint Programming and Decision Making. Those workshops, held in the US (El Paso, Texas), in Europe (Lyon, France), and in Asia (Novosibirsk, Russia), from 2008 to 2012, have attracted researchers and practitioners from all over the world. This volume presents extended versions of selected papers from those workshops. These papers deal with all stages of decision making under constraints: (1) formulating the problem of multi-criteria decision making in precise terms, (2) determining when the corresponding decision problem is algorithmically solvable; (3) finding the corresponding algorithms, and making...

  2. Clinical decision-making tools for exam selection, reporting and dose tracking

    International Nuclear Information System (INIS)

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  3. Clinical decision-making tools for exam selection, reporting and dose tracking

    Energy Technology Data Exchange (ETDEWEB)

    Brink, James A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2014-10-15

    Although many efforts have been made to reduce the radiation dose associated with individual medical imaging examinations to ''as low as reasonably achievable,'' efforts to ensure such examinations are performed only when medically indicated and appropriate are equally if not more important. Variations in the use of ionizing radiation for medical imaging are concerning, regardless of whether they occur on a local, regional or national basis. Such variations among practices can be reduced with the use of decision support tools at the time of order entry. These tools help reduce radiation exposure among practices through the appropriate use of medical imaging. Similarly, adoption of best practices among imaging facilities can be promoted through tracking the radiation exposure among imaging patients. Practices can benchmark their aggregate radiation exposures for medical imaging through the use of dose index registries. However several variables must be considered when contemplating individual patient dose tracking. The specific dose measures and the variation among them introduced by variations in body habitus must be understood. Moreover the uncertainties in risk estimation from dose metrics related to age, gender and life expectancy must also be taken into account. (orig.)

  4. Making the Decision to Breastfeed

    Medline Plus

    Full Text Available ... size | Print | Skip left navigation It's Only Natural Planning ahead Breastfeeding and baby basics Making breastfeeding work ... Enter email address Submit Home > It's Only Natural > Planning ahead Making the decision to breastfeed Moms explain ...

  5. Making the Decision to Breastfeed

    Medline Plus

    Full Text Available A project of the U.S. Department of Health and Human Services Office on Women's Health Skip Navigation ... Breastfeeding and baby basics Making breastfeeding work for you Making the decision to breastfeed Secrets to ...

  6. Developing a Physiotherapy-Specific Preliminary Clinical Decision-Making Tool for Oxygen Titration: A Modified Delphi Study

    Science.gov (United States)

    Duong, Michelle; Bertin, Kendra; Henry, Renee; Singh, Deepti; Timmins, Nolla; Brooks, Dina; Mathur, Sunita

    2014-01-01

    ABSTRACT Purpose: To develop and evaluate a preliminary clinical decision-making tool (CDMT) to assist physiotherapists in titrating oxygen for acutely ill adults in Ontario. Methods: A panel of 14 experienced cardiorespiratory physiotherapists was recruited. Factors relating to oxygen titration were identified using a modified Delphi technique. Four rounds of questionnaires were conducted, during which the goals were to (1) generate factors, (2) reduce factors and debate contentious factors, (3) finalize factors and develop the preliminary CDMT, and (4) evaluate the usability of the tool in a clinical context. Results: The panel reached consensus on a total of 89 factors, which were compiled to create the preliminary CDMT. The global tool reached consensus for sensibility, receiving a mean score of 6/7 on a 7-point Likert-type scale (1=unacceptable; 7=excellent). Five of the nine individual components of evaluation of the tool achieved scores ≥6.0; the remaining four had mean scores between 5.4 and 5.9. Conclusion: This study produced a preliminary CDMT for oxygen titration, which the panel agreed was highly comprehensible and globally sensible. Further research is necessary to evaluate the sensibility and applicability of the tool in a clinical setting. PMID:25125782

  7. "Metabolic staging" after major trauma - a guide for clinical decision making?

    Directory of Open Access Journals (Sweden)

    Moore Ernest E

    2010-06-01

    Full Text Available Abstract Metabolic changes after major trauma have a complex underlying pathophysiology. The early posttraumatic stress response is associated with a state of hyperinflammation, with increased oxygen consumption and energy expenditure. This hypercatabolic state must be recognized early and mandates an early nutritional management strategy. A proactive concept of early enteral "immunonutrition" in severely injured patients, is aimed at counterbalancing the negative aspects of hyperinflammation and hypercatabolism in order to reduce the risk of late complications, including infections and posttraumatic organ failure. Recently, the concept of "metabolic staging" has been advocated, which takes into account the distinct inflammatory phases and metabolic phenotypes after major trauma, including the "ischemia/reperfusion phenotype", the "leukocytic phenotype", and the "angiogenic phenotype". The potential clinical impact of metabolic staging, and of an appropriately adapted "metabolic control" and nutritional support, remains to be determined.

  8. Pharmacogenetics Informed Decision Making in Adolescent Psychiatric Treatment: A Clinical Case Report

    Directory of Open Access Journals (Sweden)

    Teri Smith

    2015-02-01

    Full Text Available Advances made in genetic testing and tools applied to pharmacogenetics are increasingly being used to inform clinicians in fields such as oncology, hematology, diabetes (endocrinology, cardiology and expanding into psychiatry by examining the influences of genetics on drug efficacy and metabolism. We present a clinical case example of an adolescent male with anxiety, attention deficit hyperactivity disorder (ADHD and autism spectrum disorder who did not tolerate numerous medications and dosages over several years in attempts to manage his symptoms. Pharmacogenetics testing was performed and DNA results on this individual elucidated the potential pitfalls in medication use because of specific pharmacodynamic and pharmacokinetic differences specifically involving polymorphisms of genes in the cytochrome p450 enzyme system. Future studies and reports are needed to further illustrate and determine the type of individualized medicine approach required to treat individuals based on their specific gene patterns. Growing evidence supports this biological approach for standard of care in psychiatry.

  9. Tc99m - Dextran Sentinel Node detection: Improvement of clinical decision making in malignant skin lesions

    International Nuclear Information System (INIS)

    Introduction: Preoperative lymphoscintigraphy and sentinel node detection are necessary to perform selective lymphadenectomies for staging purposes in malignant skin lesions. Aim: Our goal was to assess the usefulness of Tc99m-Dextran lymphoscintigraphy and sentinel node detection in the nodal staging of malignant skin lesions. Materials and Methods: Retrospectively an experienced oncologic surgeon defined the nodal staging approach he would have had based on the clinical information excluding only the scintigraphic sentinel node detection result in 44 consecutive patients, 21 men, ages 5 - 79, with melanoma (41), Merkel cell tumor (2) and squamous cell tumor (1). We analyze the changes introduced by the use of sentinel node detection in view of anatomopathological findings and clinical outcome. Results: In 35/44 patients no adenectomy would have been performed. Thus, leaving 3 (+) sentinel nodes and 32 (-) sentinel nodes undetected. One of this 32 patients would have had unnecessary radiotherapy because of unknown nodal status. Two of these 32 patients, with malignant melanoma, had metastasis after 15 and 22 month to 1/16 regional lymph nodes and to the skin close to the original lesion respectively. In two other patients the sentinel node could not be identified by scintigraphy : one had negative pathology of regional lymphadenectomy and the other is healthy 20 month after surgery. In 9/44 patients regional adenectomy would have excised 4 (+) sentinel nodes, 4 (-) sentinel nodes and left 1 (+) sentinel node located in an unexpected lymphatic bed. Conclusion: Preoperative sentinel node location guides the surgeon to a rational, limited lymph node excision avoiding staging errors. Selective adenectomy has less complications thus permitting anatomopathological evaluation even for lower risk patients

  10. Ethical Decision Making: Basic Issues

    Science.gov (United States)

    Bradley, Loretta J.; Hendricks, C. Bret

    2008-01-01

    Among counselors, ethical dilemmas occur often. Although ethical dilemmas are challenging, they can be solved by implementing a code of ethics and/or an ethical decision-making model. Using case studies, the authors illustrate how counselors can make informed, accurate decisions that are made to protect the welfare of the client. It also helps…

  11. Financial Decision Making Support System

    OpenAIRE

    Lobanova, E. N.; Zmitrovich, A. I.; Voshevoz, A. A.; Krivko-Krasko, A. V.

    2010-01-01

    In this article we consider concepts and components of the Financial Decision Making System that is being developed in the Institute of Business and Management Technology, BSU. Such system can be successfully used either for training experts in financial analytics and financial management or for financial managers and financial directors in an enterprise for the effective financial decision making.

  12. Improved clinical utility in clavicle fracture decision-making with true orthogonal radiographs

    Directory of Open Access Journals (Sweden)

    Joshua D Harris

    2012-01-01

    Full Text Available Operative treatment of displaced clavicle fractures has demonstrated lower rates of nonunion and symptomatic malunion, improved functional outcomes, and earlier return to activities versus nonoperative treatment. Surgical treatment may offer a reduction in the relative risk of nonunion and symptomatic malunion and an earlier return to work or sport. To present an easy and safe method of acquiring orthogonal views of the clavicle without any manipulation of the patient′s upper extremity. Academic medical center and private clinic in the Midwestern United States; retrospective patient cohort. We reviewed records of patients with acute clavicle fractures between January 2010 and August 2011. Thirty-four patients were treated with sling immobilization and 52 patients were treated surgically with superior plate and screw internal fixation. Prior to the introduction of orthogonal views, 19 patients were treated nonoperatively and 22 treated with internal fixation. Addition of orthogonal views increased the number of patients treated surgically: In the same period, 15 patients were treated nonoperatively and 30 with internal fixation. Following surgery, patients were evaluated in the outpatient office at 2 and 6 weeks and 3 and 6 months. Nonoperatively treated patients were evaluated at 1, 2, and 4 weeks and 3 and 6 months postinjury. Standard use of orthogonal views has led to greater utilization of surgical treatment of clavicle fractures at our institution and improved both the understanding and treatment of these injuries.

  13. Managerial Decision-Making Methods

    OpenAIRE

    ŘÍHOVÁ, Veronika

    2013-01-01

    Managerial Decision Making Methods ---------------------------------------------------------------------- Summary The bachelor thesis is focused on „Managerial Decision Making Methods". In the theoretical part of the literature review described the decision itself , which governs not only the manager, but basically everyone in everyday life. Deciding not be linked only with large contracts, whether public or private sector, but may relate to common things like buying a new car. The ...

  14. How clinical decisions are made

    OpenAIRE

    Bate, Louise; Hutchinson, Andrew; Underhill, Jonathan; Maskrey, Neal

    2012-01-01

    There is much variation in the implementation of the best available evidence into clinical practice. These gaps between evidence and practice are often a result of multiple individual decisions. When making a decision, there is so much potentially relevant information available, it is impossible to know or process it all (so called ‘bounded rationality’). Usually, a limited amount of information is selected to reach a sufficiently satisfactory decision, a process known as satisficing. There a...

  15. Decision Making in the Airplane

    Science.gov (United States)

    Orasanu, Judith; Shafto, Michael G. (Technical Monitor)

    1995-01-01

    The Importance of decision-making to safety in complex, dynamic environments like mission control centers, aviation, and offshore installations has been well established. NASA-ARC has a program of research dedicated to fostering safe and effective decision-making in the manned spaceflight environment. Because access to spaceflight is limited, environments with similar characteristics, including aviation and nuclear power plants, serve as analogs from which space-relevant data can be gathered and theories developed. Analyses of aviation accidents cite crew judgement and decision making as causes or contributing factors in over half of all accidents. Yet laboratory research on decision making has not proven especially helpful In improving the quality of decisions in these kinds of environments. One reason is that the traditional, analytic decision models are inappropriate to multi-dimensional, high-risk environments, and do not accurately describe what expert human decision makers do when they make decisions that have consequences. A new model of dynamic, naturalistic decision making is offered that may prove useful for improving decision making in complex, isolated, confined and high-risk environments. Based on analyses of crew performance in full-mission simulators and accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that

  16. Making Healthy Sexual Decisions

    Science.gov (United States)

    ... right reasons? (It shouldn’t be based on peer pressure, a need to fit in or make your ... ready! Tags: birth control , condoms , contraception , healthy sex , peer pressure Related Content Talking With Your Partner about Condoms ...

  17. The Role of Proteomics in Biomarker Development for Improved Patient Diagnosis and Clinical Decision Making in Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Claire L. Tonry

    2016-07-01

    Full Text Available Prostate Cancer (PCa is the second most commonly diagnosed cancer in men worldwide. Although increased expression of prostate-specific antigen (PSA is an effective indicator for the recurrence of PCa, its intended use as a screening marker for PCa is of considerable controversy. Recent research efforts in the field of PCa biomarkers have focused on the identification of tissue and fluid-based biomarkers that would be better able to stratify those individuals diagnosed with PCa who (i might best receive no treatment (active surveillance of the disease; (ii would benefit from existing treatments; or (iii those who are likely to succumb to disease recurrence and/or have aggressive disease. The growing demand for better prostate cancer biomarkers has coincided with the development of improved discovery and evaluation technologies for multiplexed measurement of proteins in bio-fluids and tissues. This review aims to (i provide an overview of these technologies as well as describe some of the candidate PCa protein biomarkers that have been discovered using them; (ii address some of the general limitations in the clinical evaluation and validation of protein biomarkers; and (iii make recommendations for strategies that could be adopted to improve the successful development of protein biomarkers to deliver improvements in personalized PCa patient decision making.

  18. Personalised Medicine Possible With Real-Time Integration of Genomic and Clinical Data To Inform Clinical Decision-Making.

    Science.gov (United States)

    Martin-Sanchez, Fernando; Turner, Maureen; Johnstone, Alice; Heffer, Leon; Rafael, Naomi; Bakker, Tim; Thorne, Natalie; Macciocca, Ivan; Gaff, Clara

    2015-01-01

    Despite widespread use of genomic sequencing in research, there are gaps in our understanding of the performance and provision of genomic sequencing in clinical practice. The Melbourne Genomics Health Alliance (the Alliance), has been established to determine the feasibility, performance and impact of using genomic sequencing as a diagnostic tool. The Alliance has partnered with BioGrid Australia to enable the linkage of genomic sequencing, clinical treatment and outcome data for this project. This integrated dataset of genetic, clinical and patient sourced information will be used by the Alliance to evaluate the potential diagnostic value of genomic sequencing in routine clinical practice. This project will allow the Alliance to provide recommendations to facilitate the integration of genomic sequencing into clinical practice to enable personalised disease treatment. PMID:26262351

  19. Making Decisions by Analytical Chemistry

    DEFF Research Database (Denmark)

    Andersen, Jens Enevold Thaulov

    discrepancies are very unfortunate because erroneous conclusions may arise from an otherwise meticulous and dedicated effort of research staff. This may eventually lead to unreliable conclusions thus jeopardizing investigations of environmental monitoring, climate changes, food safety, clinical chemistry......It has been long recognized that results of analytical chemistry are not flawless, owing to the fact that professional laboratories and research laboratories analysing the same type of samples by the same type of instruments are likely to obtain significantly different results. The European......, forensics and other fields of science where analytical chemistry is the key instrument of decision making. In order to elucidate the potential origin of the statistical variations found among laboratories, a major program was undertaken including several analytical technologies where the purpose was to...

  20. Decision-making in autism spectrum conditions

    OpenAIRE

    Luke, Lydia R.

    2011-01-01

    Background: The difficulties experienced by intellectually able adults with autism spectrum conditions (ASCs) have been hinted at in autobiographical accounts as well as in the clinical and neuropsychological research literature. Little is known, however, about the nature of these putative difficulties, nor how people with ASCs might best be supported to make decisions for themselves. The aim of this project is to improve understanding of the effects of ASCs on decision-making in a way that m...

  1. Decision making: the neuroethological turn

    OpenAIRE

    Pearson, John M; Watson, Karli K.; Platt, Michael L.

    2014-01-01

    Neuroeconomics applies models from economics and psychology to inform neurobiological studies of choice. This approach has revealed neural signatures of concepts like value, risk, and ambiguity, which are known to influence decision-making. Such observations have led theorists to hypothesize a single, unified decision process that mediates choice behavior via a common neural currency for outcomes like food, money, or social praise. In parallel, recent neuroethological studies of decision-maki...

  2. Aging and consumer decision making

    OpenAIRE

    Carpenter, Stephanie M.; Yoon, Carolyn

    2011-01-01

    Research on consumer decision making and aging is especially important for fostering a better understanding of ways to maintain consumer satisfaction and high decision quality across the life span. We provide a review of extant research on the effects of normal aging on cognition and decision processes and how these age-related processes are influenced by task environment, meaningfulness of the task, and consumer expertise. We consider how research centered on these topics generates insights ...

  3. TOOLS USED IN DECISION MAKING

    Directory of Open Access Journals (Sweden)

    Perez Bernabeu Elena

    2011-07-01

    Full Text Available Decision making is one of the important tasks of every manager. The process of taking decisions has to be based on knowledge. For optimizing this process some software solutions has been created. In this article we tried to summarize some of the features which exists in some software applications.

  4. Weather to Make a Decision

    Science.gov (United States)

    Hoyle, Julie E.; Mjelde, James W.; Litzenberg, Kerry K.

    2006-01-01

    DECIDE is a teacher-friendly, integrated approach designed to stimulate learning by allowing students to make decisions about situations they face in their lives while using scientific weather principles. This learning unit integrates weather science, decision theory, mathematics, statistics, geography, and reading in a context of decision…

  5. Making the Decision to Breastfeed

    Medline Plus

    Full Text Available ... on Women's Health Skip Navigation Skip top navigation Home A-Z Health Topics ePublications News About Us ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Planning ahead Making the decision ...

  6. Decision Making and Cooperation Restrictions.

    OpenAIRE

    2000-01-01

    Decision making by various individuals can result in conflicts or cooperation between these individuals. Game theory deals with both the mathematical modeling of these situations of conflict and cooperation and with the analysis of these models using math atical techniques. This thesis focuses on decision making and cooperation restrictions and can roughly be divided into two parts. The first part provides an analysis of cooperative games with exogenously given cooperation structures. Three t...

  7. Decision making and cooperation restrictions

    OpenAIRE

    Slikker, M.

    2000-01-01

    Decision making by various individuals can result in conflicts or cooperation between these individuals. Game theory deals with both the mathematical modeling of these situations of conflict and cooperation and with the analysis of these models using math atical techniques. This thesis focuses on decision making and cooperation restrictions and can roughly be divided into two parts. The first part provides an analysis of cooperative games with exogenously given cooperation structures. Three t...

  8. GOAL: an inverse toxicity-related algorithm for daily clinical practice decision making in advanced kidney cancer.

    Science.gov (United States)

    Bracarda, Sergio; Sisani, Michele; Marrocolo, Francesca; Hamzaj, Alketa; del Buono, Sabrina; De Simone, Valeria

    2014-03-01

    Metastatic renal cell carcinoma (mRCC), considered almost an orphan disease only six years ago, appears today a very dynamic pathology. The recently switch to the actual overcrowded scenario defined by seven active drugs has driven physicians to an incertitude status, due to difficulties in defining the best possible treatment strategy. This situation is mainly related to the absence of predictive biomarkers for any available or new therapy. Such issue, associated with the nearly absence of published face-to-face studies, draws a complex picture frame. In order to solve this dilemma, decisional algorithms tailored on drug efficacy data and patient profile are recognized as very useful tools. These approaches try to select the best therapy suitable for every patient profile. On the contrary, the present review has the "goal" to suggest a reverse approach: basing on the pivotal studies, post-marketing surveillance reports and our experience, we defined the polarizing toxicity (the most frequent toxicity in the light of clinical experience) for every single therapy, creating a new algorithm able to identify the patient profile, mainly comorbidities, unquestionably unsuitable for each single agent presently available for either the first- or the second-line therapy. The GOAL inverse decision-making algorithm, proposed at the end of this review, allows to select the best therapy for mRCC by reducing the risk of limiting toxicities. PMID:24309065

  9. Frontal Decision-Making System

    Directory of Open Access Journals (Sweden)

    Dragan M. Pavlovic

    2011-12-01

    Full Text Available Frontal decision making system is both deliberative and authomatic. Cognitive part of this system is mediated by prefrontal areas and emotive by limbyc system and amygdala. Dopaminergic system is important in this function. Th e decision making process is constantly adjusted. Orbitofrontal cortex constantly evaluates the desirability of each action and adjusts decision-making strategy according to the current situation. If the environment is rapidly changing or is uncertain, the anterior cingulate cortex includes in decision-making. Interaction between prefrontal cortex and basal ganglia is necessary for decision-making. Autoactivation is mediated by medial prefrontal cortex and internal palidum. Apathy is a result of disruption of prefrontal decision-making system that consists of prefrontal cortex and prefrontal-subcortical neuronal circuits. Th eory of mind (ToM describes our ability to understand the mental state of others and to appreciate how it diff ers from our mental state and to predict their behavior. It is believed that the cellular level of ToM are mirror neurons. Impairment of the ToM leads to problems in social relations, providing adequate information, commenting on the conversation, thought disturbance and results in poor communication skills.

  10. Does accountability for reasonableness work? A protocol for a mixed methods study using an audit tool to evaluate the decision-making of clinical commissioning groups in England

    OpenAIRE

    Kieslich, Katharina; Littlejohns, Peter

    2015-01-01

    Introduction Clinical commissioning groups (CCGs) in England are tasked with making difficult decisions on which healthcare services to provide against the background of limited budgets. The question is how to ensure that these decisions are fair and legitimate. Accounts of what constitutes fair and legitimate priority setting in healthcare include Daniels’ and Sabin's accountability for reasonableness (A4R) and Clark's and Weale's framework for the identification of social values. This study...

  11. Regulatory decision making by decision analyses

    International Nuclear Information System (INIS)

    The Technical Research Centre of Finland (VTT) has studied with the Finnish Centre for Radiation and Nuclear Safety (STUK) the applicability of decision analytic approach to the treatment of nuclear safety related problems at the regulatory body. The role of probabilistic safety assessment (PSA) in decision making has also been discussed. In the study, inspectors from STUK exercised with a decision analytic approach by reoperationalizing two occurred and solved problems. The research scientist from VTT acted as systems analysts guiding the analysis process. The first case was related to a common cause failure phenomenon in solenoid valves controlling pneumatic valves important to safety of the plant. The problem of the regulatory body was to judge whether to allow continued operation or to require more detailed inspections and in which time chedule the inspections should be done. The latter problem was to evaluate design changes of external electrical grid connections after a fire incident had revealed weakness in the separation of electrical system. In both cases, the decision analysis was carried out several sessions in which decision makers, technical experts as well as experts of decision analysis participated. A multi-attribute value function was applied as a decision model so that attributes had to be defined to quantify the levels of achievements of the objectives. The attributes included both indicators related to the level of operational safety of the plant such as core damage frequency given by PSA, and indicators related to the safety culture, i.e., how well the chosen option fits on the regulatory policy. (24 refs., 6 figs., 9 tabs.)

  12. Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians with and without Training in Evidence-Based Treatment

    Science.gov (United States)

    Baker-Ericzén, Mary J.; Jenkins, Melissa M.; Park, Soojin; Garland, Ann F.

    2015-01-01

    Background: Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities. Objective: The present study explored the role of prior training in evidence-based treatments (EBTs) on clinicians' assessment and treatment formulations using…

  13. The Development and Validation of a Tool to Measure Self-Confidence and Anxiety in Nursing Students While Making Clinical Decisions

    Science.gov (United States)

    White, Krista Alaine

    2011-01-01

    Clinical decision making (CDM) is a cornerstone skill for nurses. Self-confidence and anxiety are two affective influences that impact the learning and adeptness of CDM. Currently, no instruments exist that measure perceived self-confidence and anxiety level of undergraduate nursing students related to CDM. The purpose of this research was to…

  14. Writing as decision-making

    Science.gov (United States)

    Souther, J. W.

    1981-01-01

    The need to teach informational writing as a decision-making process is discussed. Situational analysis, its relationship to decisions in writing, and the need for relevant assignments are considered. Teaching students to ask the right questions is covered. The need to teach writing responsiveness is described. Three steps to get started and four teaching techniques are described. The information needs of the 'expert' and the 'manager' are contrasted.

  15. Unrealistic optimism and decision making

    Directory of Open Access Journals (Sweden)

    Božović Bojana

    2009-01-01

    Full Text Available One of the leading descriptive theories of decision-making under risk, Tversky & Kahneman's Prospect theory, reveals that normative explanation of decisionmaking, based only on principle of maximizing outcomes expected utility, is unsustainable. It also underlines the effect of alternative factors on decision-making. Framing effect relates to an influence that verbal formulation of outcomes has on choosing between certain and risky outcomes; in negative frame people tend to be risk seeking, whereas in positive frame people express risk averse tendencies. Individual decisions are not based on objective probabilities of outcomes, but on subjective probabilities that depend on outcome desirability. Unrealistically pessimistic subjects assign lower probabilities (than the group average to the desired outcomes, while unrealistically optimistic subjects assign higher probabilities (than the group average to the desired outcomes. Experiment was conducted in order to test the presumption that there's a relation between unrealistic optimism and decision-making under risk. We expected optimists to be risk seeking, and pessimist to be risk averse. We also expected such cognitive tendencies, if they should become manifest, to be framing effect resistant. Unrealistic optimism scale was applied, followed by the questionnaire composed of tasks of decision-making under risk. Results within the whole sample, and results of afterwards extracted groups of pessimists and optimists both revealed dominant risk seeking tendency that is resistant to the influence of subjective probabilities as well as to the influence of frame in which the outcome is presented.

  16. Decision Making Under Uncertain Categorization

    Directory of Open Access Journals (Sweden)

    Stephanie Ying-Fen Chen

    2014-09-01

    Full Text Available Two experiments investigated how category information is used in decision making under uncertainty and whether the framing of category information influences how it is used. Subjects were presented with vignettes in which the categorization of a critical item was ambiguous and were asked to choose among a set of actions with the goal of attaining the desired outcome for the main character in the story. The normative decision making strategy was to base the decision on all possible categories; however, research on a related topic, category-based induction, has found that people often only consider a single category when making predictions when categorization is uncertain. These experiments found that subjects tend to consider multiple categories when making decisions, but do so both when it is and is not appropriate, suggesting that use of multiple categories is not driven by an understanding of what categories are and are not relevant to the decision. Similarly, although a framing manipulation increased the rate of multiple-category use, it did so in situations in which multiple-category use was and was not appropriate.

  17. Decision-making: Theory and practice

    OpenAIRE

    SM Turpin; MA Marais

    2004-01-01

    This paper compares a number of theoretical models of decision-making with the way in which senior managers make decisions in practice. Six prominent decision-makers were interviewed about their own decision-making style, as well as their use of decision support technology. Significant variation was found in personal decision-making styles. However, some central themes emerged, such as the importance of sensitivity to the decision-making context, attention to the presentation of information, ...

  18. Decision making by Berry's flux

    OpenAIRE

    Sung, Benjamin O.; Lawler, Michael J

    2015-01-01

    Order by disorder is a decision making process for frustrated systems but often leads to simple answers. We study order by disorder in the kagome Kondo model known for its complexity seeking rich decision making capabilities. At half filling and large Kondo coupling to hopping ratio $J_K/t$, the full manifold of 120$^o$ kagome ground states are degenerate at second order in $t/J_K$. We show this degeneracy lifts at sixth order when a fermion can hop around a hexagon and feel the Berry flux in...

  19. Clinical decision modeling system

    Directory of Open Access Journals (Sweden)

    Lyons-Weiler James

    2007-08-01

    Full Text Available Abstract Background Decision analysis techniques can be applied in complex situations involving uncertainty and the consideration of multiple objectives. Classical decision modeling techniques require elicitation of too many parameter estimates and their conditional (joint probabilities, and have not therefore been applied to the problem of identifying high-performance, cost-effective combinations of clinical options for diagnosis or treatments where many of the objectives are unknown or even unspecified. Methods We designed a Java-based software resource, the Clinical Decision Modeling System (CDMS, to implement Naïve Decision Modeling, and provide a use case based on published performance evaluation measures of various strategies for breast and lung cancer detection. Because cost estimates for many of the newer methods are not yet available, we assume equal cost. Our use case reveals numerous potentially high-performance combinations of clinical options for the detection of breast and lung cancer. Results Naïve Decision Modeling is a highly practical applied strategy which guides investigators through the process of establishing evidence-based integrative translational clinical research priorities. CDMS is not designed for clinical decision support. Inputs include performance evaluation measures and costs of various clinical options. The software finds trees with expected emergent performance characteristics and average cost per patient that meet stated filtering criteria. Key to the utility of the software is sophisticated graphical elements, including a tree browser, a receiver-operator characteristic surface plot, and a histogram of expected average cost per patient. The analysis pinpoints the potentially most relevant pairs of clinical options ('critical pairs' for which empirical estimates of conditional dependence may be critical. The assumption of independence can be tested with retrospective studies prior to the initiation of

  20. Impaired decision making among morbidly obese adults.

    LENUS (Irish Health Repository)

    Brogan, Amy

    2011-02-01

    The Iowa Gambling Task (IGT) measures affective decision making and has revealed decision making impairments across a wide range of eating disorders. This study aimed to investigate affective decision making in severely obese individuals.

  1. Knowledge of Fecal Calprotectin and Infliximab Trough Levels Alters Clinical Decision-making for IBD Outpatients on Maintenance Infliximab Therapy

    OpenAIRE

    Huang, Vivian W; Prosser, Connie; Kroeker, Karen I.; Wang, Haili; Shalapay, Carol; Dhami, Neil; Fedorak, Darryl K; Halloran, Brendan; Dieleman, Levinus A.; Goodman, Karen J; Richard N Fedorak

    2015-01-01

    Background: Infliximab is an effective therapy for inflammatory bowel disease (IBD). However, more than 50% of patients lose response. Empiric dose intensification is not effective for all patients because not all patients have objective disease activity or subtherapeutic drug level. The aim was to determine how an objective marker of disease activity or therapeutic drug monitoring affects clinical decisions regarding maintenance infliximab therapy in outpatients with IBD. Methods: Consecutiv...

  2. Factors influencing dental decision making.

    Science.gov (United States)

    Grembowski, D; Milgrom, P; Fiset, L

    1988-01-01

    In clinical decision making, dentists routinely choose between alternative treatments such as crown vs amalgam/composite buildup, root canal vs extraction, fixed bridge vs removable partial denture, and prophylaxis vs subgingival curettage or periodontal scaling. A number of technical and patient factors can influence dentists' choice of treatment in these situations; however, little is known about their relative importance. To address this issue, a list of technical (e.g., periodontal status and caries rate) and patient (e.g., cost and patient preference) factors possibly influencing choice of treatment was developed for each pair of services. Responding to a mail questionnaire, 156 general dentists in Washington State listed the top three factors influencing their choice of service in each pair. Results revealed that dentists took different factors into account in choosing among alternative treatments. Technical factors dominated over patient concerns; only about 33 percent of the dentists considered patient factors important in choosing alternative therapies. The latter group was less preventively oriented, were solo practitioners, worked longer hours, and had lower prices. Results suggest patients may have little influence on prescriptions of therapy among experienced general dentists. PMID:3045303

  3. External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

    International Nuclear Information System (INIS)

    Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/quality assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs

  4. Pharmacoeconomics and formulary decision making.

    Science.gov (United States)

    Sanchez, L A

    1996-01-01

    Pharmacoeconomic assessment of formulary actions has become increasingly common in local, national, and international formulary decision making. Tactics for managing medication use include formulary management and drug policies. Pharmacoeconomic data can provide support for these formulary decisions. For example, pharmacoeconomic data can support the inclusion or exclusion of a drug on or from the formulary and support practice guidelines that promote the most cost-effective or appropriate utilisation of pharmaceutical products. Various strategies can be used to incorporate pharmacoeconomics into formulary decision making. These include using published pharmacoeconomic studies and economic modelling techniques, and conducting local pharmacoeconomic research. Criteria for evaluating the pharmacoeconomic literature, suggestions for employing economic models, and suggested guidelines for conducting pharmacoeconomic projects are discussed. Although most formularies are viewed as cost-containment tools, formularies should not be a list of the 'cheapest' alternatives. Today's formulary should contain agents that optimise therapeutic outcomes while controlling cost. Pharmacoeconomic assessments of formulary decisions help to ensure that the agents promoted by our formularies yield the highest outcome per dollar spent. A discussion of the process for formulary action in a US hospital, the influence of pharmacoeconomics on US formularies, and strategies for incorporating pharmacoeconomics into formulary decision making are presented in this paper. PMID:10160112

  5. Making Healthy Decisions About Sex

    Science.gov (United States)

    ... Sleep Safety & Prevention Safety & Prevention Safety and Prevention Immunizations At Home At Play On The Go All ... Healthy Decisions About Sex Ages & Stages ... read on. Your doctor wants to make sure you know the facts. Important Reminders: No one should ever be forced to have ...

  6. Teaching Rational Decision-Making.

    Science.gov (United States)

    Woolever, Roberts

    1978-01-01

    Presented is an outline of a college course, "Education in American Society," that focused on teaching students rational decision-making skills while examining current issues in American Education. The outline is followed by student comments, reactions, and evaluations of the course. (JMD)

  7. Enhanced decision making through neuroscience

    Science.gov (United States)

    Szu, Harold; Jung, TP; Makeig, Scott

    2012-06-01

    We propose to enhance the decision making of pilot, co-pilot teams, over a range of vehicle platforms, with the aid of neuroscience. The goal is to optimize this collaborative decision making interplay in time-critical, stressful situations. We will research and measure human facial expressions, personality typing, and brainwave measurements to help answer questions related to optimum decision-making in group situations. Further, we propose to examine the nature of intuition in this decision making process. The brainwave measurements will be facilitated by a University of California, San Diego (UCSD) developed wireless Electroencephalography (EEG) sensing cap. We propose to measure brainwaves covering the whole head area with an electrode density of N=256, and yet keep within the limiting wireless bandwidth capability of m=32 readouts. This is possible because solving Independent Component Analysis (ICA) and finding the hidden brainwave sources allow us to concentrate selective measurements with an organized sparse source -->s sensing matrix [Φs], rather than the traditional purely random compressive sensing (CS) matrix[Φ].

  8. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population.

    Science.gov (United States)

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-11-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES-in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective-Threshold-Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr(-1)). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  9. Comparison of an effect-model-law-based method versus traditional clinical practice guidelines for optimal treatment decision-making: application to statin treatment in the French population

    Science.gov (United States)

    Kahoul, Riad; Gueyffier, François; Amsallem, Emmanuel; Haugh, Margaret; Marchant, Ivanny; Boissel, François-Henri; Boissel, Jean-Pierre

    2014-01-01

    Healthcare authorities make difficult decisions about how to spend limited budgets for interventions that guarantee the best cost-efficacy ratio. We propose a novel approach for treatment decision-making, OMES—in French: Objectif thérapeutique Modèle Effet Seuil (in English: Therapeutic Objective–Threshold–Effect Model; TOTEM). This approach takes into consideration results from clinical trials, adjusted for the patients' characteristics in treatment decision-making. We compared OMES with the French clinical practice guidelines (CPGs) for the management of dyslipidemia with statin in a computer-generated realistic virtual population, representing the adult French population, in terms of the number of all-cause deaths avoided (number of avoided events: NAEs) under treatment and the individual absolute benefit. The total budget was fixed at the annual amount reimbursed by the French social security for statins. With the CPGs, the NAEs was 292 for an annual cost of 122.54 M€ compared with 443 with OMES. For a fixed NAEs, OMES reduced costs by 50% (60.53 M€ yr−1). The results demonstrate that OMES is at least as good as, and even better than, the standard CPGs when applied to the same population. Hence the OMES approach is a practical, useful alternative which will help to overcome the limitations of treatment decision-making based uniquely on CPGs. PMID:25209407

  10. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making

    DEFF Research Database (Denmark)

    Schmoll, H J; Van Cutsem, E; Stein, A;

    2012-01-01

    Colorectal cancer (CRC) is the most common tumour type in both sexes combined in Western countries. Although screening programmes including the implementation of faecal occult blood test and colonoscopy might be able to reduce mortality by removing precursor lesions and by making diagnosis...... patients by a combination of chemotherapy and surgery. Treatment decisions must be based on the available evidence, which has been the basis for this consensus conference-based guideline delivering a clear proposal for diagnostic and treatment measures in each stage of rectal and colon cancer...

  11. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as...... changes as indicative of less serious fetal stress than did their junior colleagues, explaining why junior residents 30% more frequently than their older colleagues found an indication for Cesarean section. Relatively low regional inter-observer agreement scores were primarily due to low agreement between...

  12. Implications of Decision Making Research for Decision Support and Displays

    OpenAIRE

    Morrison, Jeffrey G.; Kelly, Richard T.; Moore, Ronald A.; Hutchins, Susan G.

    1998-01-01

    To appear in J. A. Cannon-Bowers & E. Salas (Eds.), Decision Making Under Stress: Implications for Training and Simulation. A prototype decision support system (DSS) was developed to enhance Navy tactical decision making based on naturalistic decision processes. Displays were developed to support critical decision making tasks through recognition-primed and explanation-based reasoning processes, and cognitive analysis was conducted of the decision making problems faced by Navy ...

  13. Acceptability, acceptance and decision making

    International Nuclear Information System (INIS)

    There is a fundamental difference between the acceptability of a civilizatory or societal risk and the acceptability of the decision-making process that leads to a civilizatory or societal risk. The analysis of individual risk decisions - regarding who, executes when which indisputably hazardous, unhealthy or dangerous behaviour under which circumstances - is not helpful in finding solutions for the political decisions at hand in Germany concerning nuclear energy in particular or energy in general. The debt for implementation of any technology, in the sense of making the technology a success in terms of broad acceptance and general utilisation, lies with the particular industry involved. Regardless of the technology, innovation research identifies the implementation phase as most critical to the success of any innovation. In this sense, nuclear technology is at best still an innovation, because the implementation has not yet been completed. Fear and opposition to innovation are ubiquitous. Even the economy - which is often described as 'rational' - is full of this resistance. Innovation has an impact on the pivotal point between stability, the presupposition for the successful execution of decisions already taken and instability, which includes insecurity, but is also necessary for the success of further development. By definition, innovations are beyond our sphere of experience; not at the level of reliability and trust yet to come. Yet they are evaluated via the simplifying heuristics for making decisions proven not only to be necessary and useful, but also accurate in the familiar. The 'settlement of the debt of implementation', the accompanying communication, the decision-making procedures concerning the regulation of averse effects of the technology, but also the tailoring of the new technology or service itself must be directed to appropriate target groups. But the group often aimed at in the nuclear debate, the group, which largely determines political

  14. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna

    International Nuclear Information System (INIS)

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E, Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993;29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects

  15. Description, evaluation and clinical decision making according to various fetal heart rate patterns. Inter-observer and regional variability

    DEFF Research Database (Denmark)

    Lidegaard, O; Bøttcher, L M; Weber, Tom

    1992-01-01

    departments, especially between departments far apart. It is concluded that we still need a scientific clarification of which specific heart rate changes are the best predictors of fetal stress. Artificial intelligence programs for interpreting fetal cardiotocograms and ECG signals constitute one promising......At 10 Danish obstetrical departments, 116 residents (42 senior and 74 junior) participated in a study to assess inter-observer and regional variability in the description and evaluation of and clinical decision regarding 11 fetal heart rate patterns. The 11 traces included normal as well as...... pathological patterns, and normal as well as clinically asphyxiated babies. Five antepartum and six intrapartum patterns were included. A total of 1,276 descriptions and evaluations were obtained. The degree of agreement in description of fetal heart rate changes was high regarding the baseline and the...

  16. Decision making in xia2.

    Science.gov (United States)

    Winter, Graeme; Lobley, Carina M C; Prince, Stephen M

    2013-07-01

    xia2 is an expert system for the automated reduction of macromolecular crystallography (MX) data employing well trusted existing software. The system can process a full MX data set consisting of one or more sequences of images at one or more wavelengths from images to structure-factor amplitudes with no user input. To achieve this many decisions are made, the rationale for which is described here. In addition, it is critical to support the testing of hypotheses and to allow feedback of results from later stages in the analysis to earlier points where decisions were made: the flexible framework employed by xia2 to support this feedback is summarized here. While the decision-making protocols described here were developed for xia2, they are equally applicable to interactive data reduction. PMID:23793152

  17. Argumentation and Multi-Agent Decision Making

    OpenAIRE

    Parsons, S.; Jennings, N.R.

    1998-01-01

    This paper summarises our on-going work on mixed- initiative decision making which extends both classical decision theory and a symbolic theory of decision making based on argumentation to a multi-agent domain.

  18. Serious gaming for complex decision making

    NARCIS (Netherlands)

    Hulst, A.H. van der; Ruijsendaal, M.

    2012-01-01

    Tactical-and strategic decision making in the safety domain is a form of 'complex decision making with Naturalistic Decision Making as the predomi-nant line of research. At the heart of the Decision Making expertise are 'situa-tion assessment capabilities, the most 'intuitive aspect of complex decis

  19. Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

    Directory of Open Access Journals (Sweden)

    Walker A

    2006-03-01

    Full Text Available Abstract Objective To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons Design Six cases of coronary heart disease were presented at an open meeting in a standard format including clinical details which might influence the decision to revascularise. Clinicians (n = 53 were then asked to vote using an anonymous electronic system for one of 5 treatment options: medical, surgical (CABG, percutaneous coronary intervention (PCI or initially medical proceeding to revascularisation if symptoms dictated. Each case was then discussed in an open forum following which clinicians were asked to revote. Differences in treatment preference were compared by chi squared test and agreement between groups and between voting rounds compared using Kappa. Results Surgeons were more likely to choose surgery as a form of treatment (p = 0.034 while interventional cardiologists were more likely to choose PCI (p = 0.056. There were no significant differences between non-interventional and interventional cardiologists (p = 0.13 in their choice of treatment. There was poor agreement between all clinicians in the first round of voting (Kappa 0.26 but this improved to a moderate level of agreement after open discussion for the second vote (Kappa 0.44. The level of agreement among surgeons (0.15 was less than that for cardiologists (0.34 in Round 1, but was similar in Round 2 (0.45 and 0.45 respectively Conclusion In this case series, there was poor agreement between cardiac clinical specialists in the choice of treatment offered to patients. Open discussion appeared to improve agreement. These results would support the need for decisions to revascularise to be made by a multidisciplinary panel.

  20. An ABC for decision making

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Luiz Henrique Costa, E-mail: luiz_mogi@yahoo.com.br [Associacao de Medicina Intensiva Brasileira (AMIB), Sao Paulo, SP (Brazil); Irmandade da Santa Casa de Misericordia de Sao Paulo, SP (Brazil); Ferreira, Bruna Cortez [Hospital de Base de Sao Jose do Rio Preto, SP (Brazil)

    2015-03-15

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw-Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. (author)

  1. Decision Making and Revealed Preference

    DEFF Research Database (Denmark)

    de la Rosa, Leonidas Enrique

    If our decision-making processes are to some extent shaped by evolutionary pressures and our environment is different from that to which we adapted, some of our choices will not be in our best interest. But revealed preference is the only tool that we have so far to conduct a normative analysis. ....... Given advances in evolutionary psychology and neuroscience, I propose one way to model those evolutionary pressures that will hopefully prove useful in expanding normative economics.......If our decision-making processes are to some extent shaped by evolutionary pressures and our environment is different from that to which we adapted, some of our choices will not be in our best interest. But revealed preference is the only tool that we have so far to conduct a normative analysis...

  2. An ABC for decision making.

    Science.gov (United States)

    Garcia, Luiz Henrique Costa; Ferreira, Bruna Cortez

    2015-01-01

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. PMID:25987751

  3. An ABC for decision making

    International Nuclear Information System (INIS)

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw-Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters); Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations. (author)

  4. An ABC for decision making

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Costa Garcia

    2015-04-01

    Full Text Available The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education; British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQuest; Micromedex (Thomson Reuters; Embase. Once the literature review was completed, the authors identified the main diseases with tomographic repercussions and proposed the present system to evaluate cranial computed tomography images. An easy-to-memorize ABC system will facilitate the decision making in emergency settings, as it covers the main diseases encountered by intensivists and emergency physicians, and provides a sequential guidance about anatomical structures to be investigated as well as their respective alterations.

  5. Bounded interpersonal inferences and decision making

    OpenAIRE

    Nobu-Yuki Suzuki; Mamoru Kaneko

    2001-01-01

    Individual decision making is based on predictions about other players' choices as well as on valuations of reactions to predictions. In this sense, a player has a prediction-decision criterion for decision making. We develop a theory of prediction-decision criteria, which enables us to capture new phenomena on individual decision making in games. The decision making situation is described in the epistemic logic GL$_{EF}$ of shallow depths. There, each player considers his and other players' ...

  6. Provenance for Online Decision Making

    OpenAIRE

    Sezavar Keshavarz, Amir; Huynh, Trung Dong; Moreau, Luc

    2015-01-01

    It is commonly believed that provenance can be utilised to form assessments about the quality, reliability or trustworthiness of data. Once presented with contradictory or questionable information, users can seek further validation by referring to its provenance. While there has been some effort to design principled methods to analyse provenance, the focus has mostly been on offline use of provenance. How to use provenance at runtime, i.e., as the application runs, to help users make decision...

  7. An ABC for decision making*

    OpenAIRE

    Luiz Henrique Costa Garcia; Bruna Cortez Ferreira

    2015-01-01

    The present study was aimed at proposing a systematic evaluation of cranial computed tomography, identifying the main aspects to be analyzed in order to facilitate the decision making process regarding diagnosis and management in emergency settings. The present descriptive study comprised a literature review at the following databases: Access Medicine and Access Emergency Medicine (McGraw- Hill Education); British Medical Journal Evidence Center; UptoDate; Bireme; PubMed; Lilacs; SciELO; ProQ...

  8. Ethical decision-making, passivity and pharmacy

    OpenAIRE

    Cooper, R. J.; Bissell, P; Wingfield, J

    2008-01-01

    Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals' ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making. Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-...

  9. Decision Support for Tactical Decision Making Under Stress

    OpenAIRE

    Hutchins, Susan G.; Kelly, Richard T.; Morrison, Jeffrey G.

    1996-01-01

    A decision support system was designed for naval shipboard command-level decision makers to enhance decision making in a littoral environment or in any short-fused, ambiguous, decision making situation. Design of the prototype DSS was based on (1) an understanding of the cognitive strategies people bring to bear when dealing with the types of decisions required in tactical decision making, (2) applying human-system interface design principles which are expected t...

  10. Group decision making: integrating different interests into a joint decision:

    OpenAIRE

    RajkoviÄ Vladislav

    2011-01-01

    The paper discusses group decision making as a way of managing decision knowledge. Described are pros and cons of group decision making. Special emphasis is given to the leveraging of different interests and possibilities of formulating a joint decision. Available methods and techniques together with a properly organized group work can make a substantial contribution.

  11. Couples' fertility decision-making

    Directory of Open Access Journals (Sweden)

    Petra Stein

    2014-06-01

    Full Text Available Background: The decision about whether to start a family within a partnership can be viewed as a result of an interaction process. The influence of each of the partners in a couple differs depending on their individual preferences and intentions towards having children. Both of the partners additionally influence each other's fertility intentions and preferences. Objective: We specify, estimate, and test a model that examines the decision about whether to have a child as a choice that is made jointly by the two partners. The transition to the birth of a (further child is investigated with the explicit consideration of both the female partner and the male partner in the partnership context. Methods: An approach for modelling the interactive influences of the two actors in the decision-making process was proposed. A trivariate distribution consisting of both the female and the male partners' fertility intentions, as well as the joint generative decision, was modelled. A multivariate non-linear probit model was chosen and the problem of identification in estimating the relative effects of the actors was resolved. These parameters were used to assess the relative importance of each of the partners' intentions in the decision. We carried out the analysis with MPLUS. Data from the panel of intimate relationships and family dynamics (pairfam was used to estimate the model. Results: The biographical context of each of the partners in relation to their own as well as to their partner's fertility intentions was found to be of considerable importance. Of the significant individual and partner effects, the male partner was shown to have the greater influence. But the female partner was found to have stronger parameters overall and she ultimately has a veto power in the couple's final decision.

  12. Organizational Aspects of Multicriteria Decision Making

    OpenAIRE

    F Seo

    1980-01-01

    Decision making processes include organizational or institutional aspects in which human judgement and reflection of the decision maker are formed. Thus, analysis of organizational behaviors in the decision making processes has been attracting increasing attention since the 1950s. Now studies on institutional structure of the decision making processes are on a new line of research projects in the System and Decision Sciences Area of IIASA. Especially in Task 1 : Decision and Planning The...

  13. Decision Making in Adults with ADHD

    Science.gov (United States)

    Montyla, Timo; Still, Johanna; Gullberg, Stina; Del Missier, Fabio

    2012-01-01

    Objectives: This study examined decision-making competence in ADHD by using multiple decision tasks with varying demands on analytic versus affective processes. Methods: Adults with ADHD and healthy controls completed two tasks of analytic decision making, as measured by the Adult Decision-Making Competence (A-DMC) battery, and two affective…

  14. Distributed Decision Making and Control

    CERN Document Server

    Rantzer, Anders

    2012-01-01

    Distributed Decision Making and Control is a mathematical treatment of relevant problems in distributed control, decision and multiagent systems, The research reported was prompted by the recent rapid development in large-scale networked and embedded systems and communications. One of the main reasons for the growing complexity in such systems is the dynamics introduced by computation and communication delays. Reliability, predictability, and efficient utilization of processing power and network resources are central issues and the new theory and design methods presented here are needed to analyze and optimize the complex interactions that arise between controllers, plants and networks. The text also helps to meet requirements arising from industrial practice for a more systematic approach to the design of distributed control structures and corresponding information interfaces Theory for coordination of many different control units is closely related to economics and game theory network uses being dictated by...

  15. Ensuring Resident Competence: A Narrative Review of the Literature on Group Decision Making to Inform the Work of Clinical Competency Committees.

    Science.gov (United States)

    Hauer, Karen E; Cate, Olle Ten; Boscardin, Christy K; Iobst, William; Holmboe, Eric S; Chesluk, Benjamin; Baron, Robert B; O'Sullivan, Patricia S

    2016-05-01

    Background The expectation for graduate medical education programs to ensure that trainees are progressing toward competence for unsupervised practice prompted requirements for a committee to make decisions regarding residents' progress, termed a clinical competency committee (CCC). The literature on the composition of these committees and how they share information and render decisions can inform the work of CCCs by highlighting vulnerabilities and best practices. Objective We conducted a narrative review of the literature on group decision making that can help characterize the work of CCCs, including how they are populated and how they use information. Methods English language studies of group decision making in medical education, psychology, and organizational behavior were used. Results The results highlighted 2 major themes. Group member composition showcased the value placed on the complementarity of members' experience and lessons they had learned about performance review through their teaching and committee work. Group processes revealed strengths and limitations in groups' understanding of their work, leader role, and information-sharing procedures. Time pressure was a threat to the quality of group work. Conclusions Implications of the findings include the risks for committees that arise with homogeneous membership, limitations to available resident performance information, and processes that arise through experience rather than deriving from a well-articulated purpose of their work. Recommendations are presented to maximize the effectiveness of CCC processes, including their membership and access to, and interpretation of, information to yield evidence-based, well-reasoned judgments. PMID:27168881

  16. Clinical decision-making: midwifery students' recognition of, and response to, post partum haemorrhage in the simulation environment

    Directory of Open Access Journals (Sweden)

    Scholes Julie

    2012-03-01

    Full Text Available Abstract Background This paper reports the findings of a study of how midwifery students responded to a simulated post partum haemorrhage (PPH. Internationally, 25% of maternal deaths are attributed to severe haemorrhage. Although this figure is far higher in developing countries, the risk to maternal wellbeing and child health problem means that all midwives need to remain vigilant and respond appropriately to early signs of maternal deterioration. Methods Simulation using a patient actress enabled the research team to investigate the way in which 35 midwifery students made decisions in a dynamic high fidelity PPH scenario. The actress wore a birthing suit that simulated blood loss and a flaccid uterus on palpation. The scenario provided low levels of uncertainty and high levels of relevant information. The student's response to the scenario was videoed. Immediately after, they were invited to review the video, reflect on their performance and give a commentary as to what affected their decisions. The data were analysed using Dimensional Analysis. Results The students' clinical management of the situation varied considerably. Students struggled to prioritise their actions where more than one response was required to a clinical cue and did not necessarily use mnemonics as heuristic devices to guide their actions. Driven by a response to single cues they also showed a reluctance to formulate a diagnosis based on inductive and deductive reasoning cycles. This meant they did not necessarily introduce new hypothetical ideas against which they might refute or confirm a diagnosis and thereby eliminate fixation error. Conclusions The students response demonstrated that a number of clinical skills require updating on a regular basis including: fundal massage technique, the use of emergency standing order drugs, communication and delegation of tasks to others in an emergency and working independently until help arrives. Heuristic devices helped the

  17. Cooperative decision making without facilitator

    Czech Academy of Sciences Publication Activity Database

    Kárný, Miroslav; Kracík, Jan; Guy, Tatiana Valentine

    Saint Petersburg: IFAC, 2007 - ( And rievsky, B.; Fradkov, A.), s. 1-6 [IFAC Workshop "Adaptation and Learning in Control and Signal Processing" /9./. Saint Petersburg (RU), 29.08.2007-31.08.2007] R&D Projects: GA AV ČR 1ET100750401; GA MŠk 2C06001; GA AV ČR 1ET100750404 Institutional research plan: CEZ:AV0Z10750506 Keywords : Bayesian distributed decision making * cooperation * learning Subject RIV: BD - Theory of Information http://as.utia.cz/publications/2007/KarKraGuy_07.pdf

  18. Simulation of human decision making

    Science.gov (United States)

    Forsythe, J. Chris; Speed, Ann E.; Jordan, Sabina E.; Xavier, Patrick G.

    2008-05-06

    A method for computer emulation of human decision making defines a plurality of concepts related to a domain and a plurality of situations related to the domain, where each situation is a combination of at least two of the concepts. Each concept and situation is represented in the computer as an oscillator output, and each situation and concept oscillator output is distinguishable from all other oscillator outputs. Information is input to the computer representative of detected concepts, and the computer compares the detected concepts with the stored situations to determine if a situation has occurred.

  19. Future perspectives toward the early definition of a multivariate decision-support scheme employed in clinical decision making for senior citizens.

    Science.gov (United States)

    Frantzidis, Christos A; Gilou, Sotiria; Billis, Antonis; Karagianni, Maria; Bratsas, Charalampos D; Bamidis, Panagiotis

    2016-03-01

    Recent neuroscientific studies focused on the identification of pathological neurophysiological patterns (emotions, geriatric depression, memory impairment and sleep disturbances) through computerised clinical decision-support systems. Almost all these research attempts employed either resting-state condition (e.g. eyes-closed) or event-related potentials extracted during a cognitive task known to be affected by the disease under consideration. This Letter reviews existing data mining techniques and aims to enhance their robustness by proposing a holistic decision framework dealing with comorbidities and early symptoms' identification, while it could be applied in realistic occasions. Multivariate features are elicited and fused in order to be compared with average activities characteristic of each neuropathology group. A proposed model of the specific cognitive function which may be based on previous findings (a priori information) and/or validated by current experimental data should be then formed. So, the proposed scheme facilitates the early identification and prevention of neurodegenerative phenomena. Neurophysiological semantic annotation is hypothesised to enhance the importance of the proposed framework in facilitating the personalised healthcare of the information society and medical informatics research community. PMID:27222732

  20. Has Lean improved organizational decision making?

    Science.gov (United States)

    Simons, Pascale; Benders, Jos; Bergs, Jochen; Marneffe, Wim; Vandijck, Dominique

    2016-06-13

    Purpose - Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization's decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization's decision-making context, making it more amenable for QI initiatives. Design/methodology/approach - In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings - Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications - Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value - Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI's sustainability. PMID:27256776

  1. ClinicalAccess: a clinical decision support tool.

    Science.gov (United States)

    Crowell, Karen; Vardell, Emily

    2015-01-01

    ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines. PMID:25927513

  2. Viewpoint: Decision-making in committees

    OpenAIRE

    Li Hao; Wing Suen

    2009-01-01

    This article reviews recent developments in the theory of committee decision-making. A committee consists of self-interested members who make a public decision by aggregating imperfect information dispersed among them according to a pre-specified decision rule. We focus on costly information acquisition, strategic information aggregation, and rules and processes that enhance the quality of the committee decision. Seeming inefficiencies of the committee decision-making process such as over-cau...

  3. Patients’ decision making in total knee arthroplasty

    OpenAIRE

    Barlow, T.; Griffin, D.; Barlow, D; Realpe, A.

    2015-01-01

    Objectives A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review’s objective is to systematically examine the qualitative literature surrounding patients’ decision making in knee arthroplasty. Methods A systematic literature review using Medline and Embase was conducted to ...

  4. Rule-based decision making model

    International Nuclear Information System (INIS)

    A rule-based decision making model is designed in G2 environment. A theoretical and methodological frame for the model is composed and motivated. The rule-based decision making model is based on object-oriented modelling, knowledge engineering and decision theory. The idea of safety objective tree is utilized. Advanced rule-based methodologies are applied. A general decision making model 'decision element' is constructed. The strategy planning of the decision element is based on e.g. value theory and utility theory. A hypothetical process model is built to give input data for the decision element. The basic principle of the object model in decision making is division in tasks. Probability models are used in characterizing component availabilities. Bayes' theorem is used to recalculate the probability figures when new information is got. The model includes simple learning features to save the solution path. A decision analytic interpretation is given to the decision making process. (author)

  5. Collective Decision Making as the Actualization of Decision Potential

    Directory of Open Access Journals (Sweden)

    Andrej Ule

    2009-12-01

    Full Text Available This paper presents some characteristics and dilemmas of collective decision making. Collective decision making could be presented as the process of successive crystallization of dominant alternatives under the influence of different decision contexts from primary given decision potentials. This process is presented as the many-phased process of the acting of contextually dependent “energizing factors” of the collective decision making on the “attractiveness matrix” of outcomes of collective decisions. The attractiveness matrix determines the attractiveness for each alternative of decision, and the most attractive alternative in the given situation presents the rational decision in the given situation. In the final phase of decision making holds a context which gets a simplified attractiveness matrix. It corresponds to the common decision for one of the alternatives.

  6. Adolescent women's contraceptive decision making.

    Science.gov (United States)

    Weisman, C S; Plichta, S; Nathanson, C A; Chase, G A; Ensminger, M E; Robinson, J C

    1991-06-01

    A modified rational decision model incorporating salient events and social influences (particularly from sexual partners) is used to analyze adolescent women's consistent use of oral contraceptives (OCs) over a six-month period. Data are taken from a panel study of 308 clients of an inner-city family planning clinic. Expected OC use was computed for each subject on the basis of subjective expected utility (SEU) theory, and is found in multivariate analyses to be a significant predictor of actual OC use. In addition, variables representing baseline and follow-up partner influences, the salience of pregnancy for the subject, and positive side effects of OCs during the first months of use are found to predict OC use. Partner's support of OC use during follow-up and positive side effects of OCs are found to predict OC use among subjects for whom OC use was not the expected decision according to baseline SEU. Implications of the findings for models of adolescents' contraceptive behavior and for clinicians are discussed. PMID:1861049

  7. Values in Decision Making: The INVOLVE Model.

    Science.gov (United States)

    Elfrink, Victoria L.; Coldwell, LuAnn Linson

    1993-01-01

    Describes the function of values and participatory decision making within the student affairs profession. Introduces a process model as a means of operationalizing values in the decision-making process and uses case studies to illustrate how the model can be used to improve student affairs professionals' decision making. (RJM)

  8. DEVELOPMENT OF THE DECISION-MAKING CULTURE

    OpenAIRE

    Galina GLOBA

    2013-01-01

    The article shows the stages of development of the theory and practice of decision-making. Emphasis is placed on the contemporary culture of decision-making. At the base of the current trends is the transition from intuition and experience in decision-making to analytics. Modern business intelligence means the development of the culture of work with big data.

  9. Incorporating patients' preferences into medical decision making.

    Science.gov (United States)

    Fraenkel, Liana

    2013-02-01

    Current models of care emphasize the importance of including patients' values in the decision-making process. This is particularly important for decisions for which there are few data supporting a clear strategy or treatment choice. Constructing preferences for complex decisions requires that patients be able to consider multiple trade-offs between specific risks and benefits. Several marketing research techniques have been recently applied to heath care settings to facilitate this process. Most can be programmed to generate patients' preferences or priorities, which can then be used to improve patient-physician communication. In this article, we will describe some of the currently available approaches that have been successfully used in the health care setting. We provide case examples to illustrate the potential value of adopting each of these approaches in clinical practice. PMID:23132890

  10. Cardio Online Reader/COR: A Web 2.0-Based Tool Aimed at Clinical Decision-Making Support in Cardiology

    Czech Academy of Sciences Publication Activity Database

    Papíková, Vendula; Zvolský, Miroslav

    Heidelberg: Springer Science-Business Media, 2012 - (Kostkova, P.; Szomszor, M.; Fowler, D.), s. 122-127. (Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering . 91). ISBN 978-3-642-29261-3. ISSN 1867-8211. [eHealth 2011. International Conference /4./. Málaga (ES), 21.11.2011-23.11.2011] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : EBM * Web 2.0 * medical information sources * clinical decision-making support Subject RIV: IN - Informatics, Computer Science

  11. Ethical case deliberation and decision making.

    Science.gov (United States)

    Gracia, Diego

    2003-01-01

    During the last thirty years different methods have been proposed in order to manage and resolve ethical quandaries, specially in the clinical setting. Some of these methodologies are based on the principles of Decision-making theory. Others looked to other philosophical traditions, like Principlism, Hermeneutics, Narrativism, Casuistry, Pragmatism, etc. This paper defends the view that deliberation is the cornerstone of any adequate methodology. This is due to the fact that moral decisions must take into account not only principles and ideas, but also emotions, values and beliefs. Deliberation is the process in which everyone concerned by the decision is considered a valid moral agent, obliged to give reasons for their own points of view, and to listen to the reasons of others. The goal of this process is not the reaching of a consensus but the enrichment of one's own point of view with that of the others, increasing in this way the maturity of one's own decision, in order to make it more wise or prudent. In many cases the members of a group of deliberation will differ in the final solution of the case, but the confrontation of their reasons will modify the perception of the problem of everyone. This is the profit of the process. Our moral decisions cannot be completely rational, due to the fact that they are influenced by feelings, values, beliefs, etc., but they must be reasonable, that is, wise and prudent. Deliberation is the main procedure to reach this goal. It obliges us to take others into account, respecting their different beliefs and values and prompting them to give reasons for their own points of view. This method has been traditional in Western clinical medicine all over its history, and it should be also the main procedure for clinical ethics. PMID:14620459

  12. Shared decision making after MacIntyre.

    Science.gov (United States)

    Tilburt, Jon

    2011-04-01

    This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision-making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques. PMID:21378085

  13. Organizational Decision Making: The Luhmannian Decision Communication Perspective

    OpenAIRE

    Mykkänen, Markus; Tampere, Kaja

    2014-01-01

    Studies of organizational communication around decision-making and decision communication have largely concerned how decisions should be made and promoted. Less efforts have focused on how decisions should be communicated inside organizations and how they influence organizational effectiveness and performance. This study examined decision communication in an engineer-based organization 2008–2009. Key findings demonstrate that effective decision communication can be considered as the backbone ...

  14. The involvement of the striatum in decision making.

    Science.gov (United States)

    Goulet-Kennedy, Julie; Labbe, Sara; Fecteau, Shirley

    2016-03-01

    Decision making has been extensively studied in the context of economics and from a group perspective, but still little is known on individual decision making. Here we discuss the different cognitive processes involved in decision making and its associated neural substrates. The putative conductors in decision making appear to be the prefrontal cortex and the striatum. Impaired decision-making skills in various clinical populations have been associated with activity in the prefrontal cortex and in the striatum. We highlight the importance of strengthening the degree of integration of both cognitive and neural substrates in order to further our understanding of decision-making skills. In terms of cognitive paradigms, there is a need to improve the ecological value of experimental tasks that assess decision making in various contexts and with rewards; this would help translate laboratory learnings into real-life benefits. In terms of neural substrates, the use of neuroimaging techniques helps characterize the neural networks associated with decision making; more recently, ways to modulate brain activity, such as in the prefrontal cortex and connected regions (eg, striatum), with noninvasive brain stimulation have also shed light on the neural and cognitive substrates of decision making. Together, these cognitive and neural approaches might be useful for patients with impaired decision-making skills. The drive behind this line of work is that decision-making abilities underlie important aspects of wellness, health, security, and financial and social choices in our daily lives. PMID:27069380

  15. Risk and uncertainty in strategic decision making

    OpenAIRE

    Jiří Fotr; Lenka Švecová

    2006-01-01

    Importance of risk and uncertainty in present period of dynamic changes grows. The article deals with risk and uncertainty in strategic decision making. First the concepts of risk and uncertainty and possibilities of their measurement are discussed. Further shortcomings of strategic decision making from the point of view risk integration are described. The emphasis is on discussion of decision making methods under risk and uncertainty (including decision tables, scenarios, Monte Carlo simulat...

  16. Eventological Theory of Decision-Making

    OpenAIRE

    Vorobyev, Oleg Yu.; Goldblatt, Joe Jeff; Finkel, Rebecca

    2008-01-01

    The eventological theory of decision-making, the theory of event-based decision-making is a theory of decision-making based on eventological principles and using results of mathematical eventology [1]; a theoretical basis of the practical eventology [2, 3, 4]. The beginnings of this theory which have arisen from event-based representation of the reasonable subject and his decisions in the form of eventological distributions (E-distributions) of sets of events [5] and which are bas...

  17. Entrepreneurs` Cognitive and Decision Making Styles

    Directory of Open Access Journals (Sweden)

    Mahmoud Motvaseli

    2015-12-01

    Full Text Available The main purpose of this study is to explore the relation between decision-making styles which are measured by the General decision-making style (GDMS test and information processing styles which are often termed cognitive styles and are, in this study, measured by Cognitive Style Inventory. The authors directed a survey research on 162 Iranian students. Structural equation modeling techniques were used to measure the impact of cognitive styles on decision-making styles. The authors found that cognitive styles have a positive impact on decision-making styles. In spite of the abundant research on factors that affect decision-making styles, few researches have tested the relationship between cognitive styles and decision-making styles. This study examines the impact of cognitive styles on decision-making styles in Iran. This study, like most research paper studies, cannot easily be generalized. Furthermore, the results of this study could be affected by economic conditions.

  18. Changing Times, Complex Decisions: Presidential Values and Decision Making

    Science.gov (United States)

    Hornak, Anne M.; Garza Mitchell, Regina L.

    2016-01-01

    Objective: The objective of this article is to delve more deeply into the thought processes of the key decision makers at community colleges and understand how they make decisions. Specifically, this article focuses on the role of the community college president's personal values in decision making. Method: We conducted interviews with 13…

  19. How Firms Make Boundary Decisions

    DEFF Research Database (Denmark)

    Dobrajska, Magdalena; Billinger, Stephan; Becker, Markus

    2014-01-01

    We report findings from an analysis of 234 firm boundary decisions that a manufacturing firm has made during a 10 year period. Extensive interviews with all major decision makers located both at the headquarters and subsidiaries allow us to examine (a) who was involved in each boundary decision...

  20. The emerging role of histology in the choice of first-line treatment of advanced non-small cell lung cancer: implication in the clinical decision-making.

    Science.gov (United States)

    Rossi, Antonio; Maione, Paolo; Bareschino, Maria Anna; Schettino, Clorinda; Sacco, Paola Claudia; Ferrara, Marianna Luciana; Castaldo, Vincenzo; Gridelli, Cesare

    2010-01-01

    Lung cancer is the leading cause of cancer mortality worldwide. Non-small cell lung cancer (NSCLC), accounting for about 85% of all lung cancers, includes squamous carcinoma, adenocarcinoma and undifferentiated large cell carcinoma. The majority of patients have advanced disease at diagnosis, and medical treatment is the cornerstone of management. Several randomized trials comparing third-generation platinum-based doublets concluded that all such combinations are comparable in their clinical efficacy, failing to document a difference based on histology. However, recent evidences, arising from the availability of pemetrexed, have shown that histology represents an important variable in the decision making. The major progresses in the understanding cancer biology and mechanism of oncogenesis have allowed the development of several potential molecular targets for cancer treatment such as vascular growth factor and its receptors and epidermal growth factor receptor. Targeted drugs seem to be safer or more effective in a specific histology subtype. All of these data have led to choose the optimal first-line treatment of advanced NSCLC based on histologic diagnosis. However, this scenario raises a diagnostic issue: a specific diagnosis of NSCLC histologic subtype is mandatory. This review will discuss these new evidences in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making. PMID:20156162

  1. Decision making in global product development

    DEFF Research Database (Denmark)

    Søndergaard, Erik Stefan; Ahmed-Kristensen, Saeema

    2014-01-01

    Many engineering companies experience new challenges when globalising product development. Global product development (GPD) is a relatively nascent research area, and previous research reveals the need for decision support frameworks. This research investigates how decisions are made when companies...... outsource or offshore product development tasks, and how these decisions can be improved. A brief literature review on existing research on GPD and decision making is given, followed by two case studies, where implications of decisions are investigated. The findings point towards further studies required...... for creating a decision support framework for managers to make better decisions in the future....

  2. Decision-Making Theories and Career Assessment: A Psychometric Evaluation of the Decision Making Inventory

    Science.gov (United States)

    Hardin, Erin E.; Leong, Frederick T. L.

    2004-01-01

    To address criticisms that the empirical literature on assessment of career decision making has tended to lack a theoretical base, the present study explored the relevance of a general theory of decision making to career decision making by assessing the psychometric properties of the Decision Making Inventory (DMI), designed to measure Johnson's…

  3. Testing Decision Rules for Multiattribute Decision Making

    OpenAIRE

    Seidl, C.; Traub, S.

    1996-01-01

    This paper investigates the existence of an editing phase and studies the com- pliance of subjects' behaviour with the most popular multiattribute decision rules. We observed that our data comply well with the existence of an editing phase, at least if we allow for a natural error rate of some 25%. We also found a satis- factory performance of certain groups of subjects for the conjunctive rule, for the elimination{by{aspects rule, for the majority rule, and for the maximin rule. Our data sug...

  4. A mapping of design decision-making

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp; Andreasen, Mogens Myrup

    2004-01-01

    In this paper we present the decision score, which is a model of decision-making seen in the engineering designer's perspective of the design process dynamics, where a decision has multiple objects and where it is based on earlier decisions, prediction of consequences and design process progressi...

  5. Training family physicians and residents in family medicine in shared decision making to improve clinical decisions regarding the use of antibiotics for acute respiratory infections: protocol for a clustered randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Frémont Pierre

    2011-01-01

    and physicians, intention to engage in SDM in future clinical encounters will be assessed. Intention-to-treat analyses will be applied and account for the nested design of the trial will be taken into consideration. Discussion DECISION+2 has the potential to reduce antibiotics use for ARIs by priming physicians and patients to share decisional process and empowering patients to make informed, value-based decisions. Trial Registration ClinicalTrials.gov: NCT01116076

  6. Medical decision making tools: Bayesian analysis and ROC analysis

    International Nuclear Information System (INIS)

    During the diagnostic process of the various oral and maxillofacial lesions, we should consider the following: 'When should we order diagnostic tests? What tests should be ordered? How should we interpret the results clinically? And how should we use this frequently imperfect information to make optimal medical decision?' For the clinicians to make proper judgement, several decision making tools are suggested. This article discusses the concept of the diagnostic accuracy (sensitivity and specificity values) with several decision making tools such as decision matrix, ROC analysis and Bayesian analysis. The article also explain the introductory concept of ORAD program

  7. The art of decision-making.

    Science.gov (United States)

    Clancy, Thomas R

    2003-06-01

    As important as sound decision-making is, many executives neglect to utilize any formal decisionmaking process. As many executives know, making the wrong decision can be disastrous, if not career ending. In today's high-pressure, complex, and challenging healthcare environment, it makes sense to follow a tried and true process for making decisions. The author examines the traditional method of problem identification, setting objectives, listing alternatives and consequences, and selecting the best solution in the decision-making process as well as new research in this field. PMID:12796632

  8. Do humans make good decisions?

    OpenAIRE

    Summerfield, Christopher; Tsetsos, Konstantinos

    2014-01-01

    Human performance on perceptual classification tasks approaches that of an ideal observer, but economic decisions are often inconsistent and intransitive, with preferences reversing according to the local context. We discuss the view that suboptimal choices may result from the efficient coding of decision-relevant information, a strategy that allows expected inputs to be processed with higher gain than unexpected inputs. Efficient coding leads to ‘robust’ decisions that depart from optimality...

  9. Intelligent Data Mining and Decision System for Commercial Decision Making

    OpenAIRE

    Shanhui Wang; Qiu Ying; Zuowei Yin; Qishen Zhou

    2013-01-01

    Information system and data mining are important resources for the investors to make decisions. Information theory pointed that the information is increasing all the time, when the corporations build their millions of databases in order to improve the efficiency. Database technology caters to the needs of fully developing the information resources. This essay discusses the problem of decision making support system and the application of business data mining in commercial decision making. It i...

  10. Principles For Aiding Complex Military Decision Making

    OpenAIRE

    Hutchins, Susan G.; Morrison, Jeffrey G.; Kelly, Richard T.

    1996-01-01

    Paper presented to the Second International Command and Control Research and Technology Symposium, Monterey, Ca. The Tactical Decision Making Under Stress (TADMUS) program is being conducted to apply recent developments in decision theory and human-system interaction technology to the design of a decision support system for enhancing tactical decision making under the highly complex conditions involved in anti-air warfare scenarios in littoral environments. Our goal...

  11. Shared Problem Models and Crew Decision Making

    Science.gov (United States)

    Orasanu, Judith; Statler, Irving C. (Technical Monitor)

    1994-01-01

    The importance of crew decision making to aviation safety has been well established through NTSB accident analyses: Crew judgment and decision making have been cited as causes or contributing factors in over half of all accidents in commercial air transport, general aviation, and military aviation. Yet the bulk of research on decision making has not proven helpful in improving the quality of decisions in the cockpit. One reason is that traditional analytic decision models are inappropriate to the dynamic complex nature of cockpit decision making and do not accurately describe what expert human decision makers do when they make decisions. A new model of dynamic naturalistic decision making is offered that may prove more useful for training or aiding cockpit decision making. Based on analyses of crew performance in full-mission simulation and National Transportation Safety Board accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation and reflect the crew's metacognitive skill. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relation between communication that serves to build performance. Implications of these findings for crew training will be discussed.

  12. Decision story strategy: a practical approach for teaching decision making.

    Science.gov (United States)

    Smith, D L; Hamrick, M H; Anspaugh, D J

    1981-12-01

    Teachers are usually very enthusiastic in their evaluations of decision stories. Decision Story Strategies offer a change of pace, promote student involvement and stimulate creative thinking, problem solving and everpresent creative teaching-learning opportunities. The real-life problems presented within the structure of a decision story provide meaningful learning opportunities for students. Students begin to think in a broader perspective when considering other points of view and information sources. The Decision Story Strategy used with the Decision-Making Model provides a powerful tool for health educators to develop skills for making and evaluating decisions in an interesting and meaningful context. It may not be a panacea for all health educators, but is an effective strategy for the teacher concerned with developing independent decision makers. Most importantly, students are provided opportunities to solve their present problems as well as develop decision-making skills for the future. PMID:6916032

  13. Factors that influence the clinical decision-making of rehabilitation professionals in long-term care settings.

    Science.gov (United States)

    Wainwright, Susan Flannery; McGinnis, Patricia Quinn

    2009-01-01

    The purpose of this qualitative research was to evaluate the reasoning of clinicians practicing in long-term care facilities and to explore factors influencing their professional development. Eighteen participants were recruited from eight clinical sites and included seven occupational therapists, eight physical therapists, and three speech therapists distributed across three groups relative to experience. Nonparticipant observation and videotape of therapist-patient interactions were used in semi-structured interviews with each participant. Qualitative data analysis software was used during a process of open and axial coding, followed by thematic analysis. The facilitory and inhibitory factors that affect clinical reasoning and professional development were identified. Rehabilitation professionals in long-term care demonstrated clinical reasoning within the context of patient-centered goals. Well-developed and explicit programs for mentorship, professional development, and continuing education fostered their clinical reasoning abilities. Participants perceived that these factors were vital to achieving optimal patient outcomes. PMID:19753425

  14. DECISION-MAKING AS A MANAGEMENT FUNCTION

    OpenAIRE

    Mato Puseljic; Ana Skledar; Ivan Pokupec

    2015-01-01

    Organizations survive or disappear primarily thanks to the quality of management that leads them. Decision-making is not the only, but the basic function of management that contributes most to the success or failure of the organization. The manager is the one who makes decisions and decision-making is the essence of planning. Planning is the first and most important function of management as a process that determines all other functions: organizing, managing human resources, managing and cont...

  15. Ordering based decision making: a survey

    OpenAIRE

    Chen, Shuwei; Liu, Jun; Wang, Hui; Augusto, Juan Carlos

    2013-01-01

    Decision making is the crucial step in many real applications such as organization management, financial planning, products evaluation and recommendation. Rational decision making is to select an alternative from a set of different ones which has the best utility (i.e., maximally satisfies given criteria, objectives, or preferences). In many cases, decision making is to order alternatives and select one or a few among the top of the ranking. Orderings provide a natural and effective way for r...

  16. Application of Decision-Making Methods

    OpenAIRE

    Obdržálek, Petr

    2014-01-01

    This thesis deals with an issue of the application of decision-making methods aiming strengthening the effectiveness of the decision-making processes, which leads to improvement, but ensures subsequent cost savings as well. The theoretical part can be divided into two areas. First part with theroretical base focuses on managerial decision-making proceses nature as such; it’s structure, phases and the classification. The second part undertakes logistics, distribution models, transport task,...

  17. The decision-making entrepreneur; Literature review

    OpenAIRE

    Petra Gibcus; Elissaveta Ivanova

    2003-01-01

    This study provides a literature overview of the entrepreneurial decision-making process. The literature review is used as background information for a qualitative study, which investigates, by means of case studies, the decision-making process of small business enterpreneurs in The Netherlands (Gibcus and Van Hoesel, 2003). The literature overview is the starting point of a confrontation between the literature on decision-making and the empirical findings of the latter qualitive study. First...

  18. Decision Making: Social and Creative Dimensions

    OpenAIRE

    2010-01-01

    This volume presents research that integrates decision making and creativity within the social contexts in which these processes occur. The volume is an essential addition to and expansion of recent approaches to decision making. Such approaches attempt to incorporate more of the psychological and socio-cultural context in which human decision making takes place. The authors come from different disciplines and also belong to a broad spectrum of research traditions. They present innovative cha...

  19. Cognitive characteristics affecting rational decision making style

    OpenAIRE

    2011-01-01

    Abstract Decision making is one of the most important and frequent tasks among managers and employees in an organization. Knowledge about more stable cognitive characteristics underlying decision making styles has been requested. This study aimed to examine the relationship between rational decision making style, cognitive style, self efficacy and locus of control. Possible interaction effects in relation to gender were also analyzed. 186 employees at the Ministry of Defence were surveyed...

  20. INVESTOR BASED PSYCHOLOGICAL DECISION MAKING MODEL

    OpenAIRE

    Mohd Alnajjar

    2013-01-01

    Significance of behavioral finance has been realized. Intrinsic value of behavioral finance is to investigate the irrational attitude of investor while making investment decision. This study explores the investor based psychological decision making model for enhancing the understanding about the psychological decision making process of investors in Islamabad Stock Exchange. A self-administered structured questionnaire is used for gathering data from 168 respondents (investors of ISE). Correla...

  1. Decision-making in abnormal radiological situations

    International Nuclear Information System (INIS)

    General problems associated with social impacts of radiology and decision making is discussed, as the main topics of the meeting. The problem of population is discussed living in areas contaminates with radioactive substances resulting from a major accident or from pest practices. This situation needs decision making process for initiating actions like relocation, resettlement or large-scale decontamination. The roles of various participants in this decision making process and in the communication with the public are considered. (R.P.)

  2. Chinese Adolescents' Influence on Family Decision Making

    OpenAIRE

    He, Shushi

    2008-01-01

    The purpose of this study is to investigate Chinese adolescents' influence on family decision making regarding on the effect of children's characteristics including academic performance, product knowledge and financial saving. The concept of value alignment is initially introduced to the family decision making since it greatly concerns on the Chinese culture. It is assumed that China's only children would have more influence on the decision making of high-end electronic goods when they align ...

  3. Modeling of Mixed Decision Making Process

    CERN Document Server

    Yahia, Nesrine Ben; Ghezala, Henda Ben

    2012-01-01

    Decision making whenever and wherever it is happened is key to organizations success. In order to make correct decision, individuals, teams and organizations need both knowledge management (to manage content) and collaboration (to manage group processes) to make that more effective and efficient. In this paper, we explain the knowledge management and collaboration convergence. Then, we propose a formal description of mixed and multimodal decision making (MDM) process where decision may be made by three possible modes: individual, collective or hybrid. Finally, we explicit the MDM process based on UML-G profile.

  4. Complex Decision Making Theory and Practice

    CERN Document Server

    Qudrat-Ullah, Hassan; Spector, J Michael

    2007-01-01

    The increasingly complex environment of today's world, characterized by technological innovation and global communication, generates myriads of possible and actual interactions while limited physical and intellectual resources severely impinge on decision makers, be it in the public or private domains. At the core of the decision-making process is the need for quality information that allows the decision maker to better assess the impact of decisions in terms of outcomes, nonlinear feedback processes and time delays on the performance of the complex system invoked. This volume is a timely review on the principles underlying complex decision making, the handling of uncertainties in dynamic envrionments and of the various modeling approaches used. The book consists of five parts, each composed of several chapters: I: Complex Decision Making: Concepts, Theories and Empirical Evidence II: Tools and Techniques for Decision Making in Complex Environments and Systems III: System Dynamics and Agent-Based Modeling IV:...

  5. Decision making uncertainty, imperfection, deliberation and scalability

    CERN Document Server

    Kárný, Miroslav; Wolpert, David

    2015-01-01

    This volume focuses on uncovering the fundamental forces underlying dynamic decision making among multiple interacting, imperfect and selfish decision makers. The chapters are written by leading experts from different disciplines, all considering the many sources of imperfection in decision making, and always with an eye to decreasing the myriad discrepancies between theory and real world human decision making. Topics addressed include uncertainty, deliberation cost and the complexity arising from the inherent large computational scale of decision making in these systems. In particular, analyses and experiments are presented which concern: • task allocation to maximize “the wisdom of the crowd”; • design of a society of “edutainment” robots who account for one anothers’ emotional states; • recognizing and counteracting seemingly non-rational human decision making; • coping with extreme scale when learning causality in networks; • efficiently incorporating expert knowledge in personalized...

  6. Decision Making Practices In Universities Of Pakistan

    Directory of Open Access Journals (Sweden)

    M. Nadeem Anwar

    2011-07-01

    Full Text Available Decision making can be regarded as an outcome of mental processes (cognitive process leading to the selection of a course of action among several alternatives. Every decision making process produces a final choice. The output can be an action or an opinion. The purpose of this descriptive survey was to explore the Decision making practices in administrative and academic matters in the universities of Pakistan. A sample of nineteen universities was selected by applying stratified random sampling technique.  The respondents, i-e members of university bodies; teachers and administrative officers were selected randomly. Three questionnaires constructed on Likert’s five-point scale were used for data collection. Data was tabulated and analyzed by using the F-ratio and Chi-square. The survey results revealed that overall decision-making practices in the universities were found unsatisfactory and, most of the decisions were made without application of management decision-making techniques.

  7. Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Eiring, Øystein; Nielsen, Jesper Bo;

    in which an individual's preferences over the multiple criteria that matter to them are synthesised with the Best Estimate Available Now (at the point of decision) for how well each of the available options will perform on each criterion. Conventional evidence-based approaches can meet the latter...... (‘living’) production of BEANs, within a Bayesian framework and by a process that is ARAPAN - As Rigorous As Practical And Necessary. This will involve the systematic elicitation and analysis of the potential ‘big data’ that expert beliefs collectively represent, as well as the exploitation...... events, given the known existence of, and differential concern with, effects on sexual, and other functions. Working to the standards appropriate to practice as opposed to science, and simultaneously increasing the range of source inputs to include expert beliefs, is essential to give such modelling...

  8. Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities.

    Science.gov (United States)

    Dovidio, John F; Fiske, Susan T

    2012-05-01

    Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities. Biases are complex but systematic, differing by racial/ethnic group and not limited to love-hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions. Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health. PMID:22420809

  9. A pilot study for development of a novel tool for clinical decision making to identify fallers among ophthalmic patients

    OpenAIRE

    Melillo, P; Orrico, A; Attanasio, M.; Rossi, S.; Pecchia, L; Chirico, F.; F. Testa; Simonelli, F.

    2015-01-01

    Background Falls in the elderly is a major problem. Although falls have a multifactorial etiology, a commonly cited cause of falls in older people is poor vision. This study proposes a method to discriminate fallers and non-fallers among ophthalmic patients, based on data-mining algorithms applied to health and socio-demographic information. Methods A group of 150 subjects aged 55 years and older, recruited at the Eye Clinic of the Second University of Naples, underwent a baseline ophthalmic ...

  10. Decision-making under great uncertainty

    International Nuclear Information System (INIS)

    Five types of decision-uncertainty are distinguished: uncertainty of consequences, of values, of demarcation, of reliance, and of co-ordination. Strategies are proposed for each type of uncertainty. The general conclusion is that it is meaningful for decision theory to treat cases with greater uncertainty than the textbook case of 'decision-making under uncertainty'. (au)

  11. RATIONALIST MODEL IN PUBLIC DECISION MAKING

    OpenAIRE

    LEOVEANU Andy Constantin

    2013-01-01

    The paper addresses the issue of public decision-making rationalist model. In its preamble are presented the stages of the process of public decision rationalist model but also barriers and criticisms of this model. The core of the paper is represented by the public decision through the theory of rational choice, here being presented in addition to theoretical concepts, also some practical examples.

  12. Intelligent Information System to support decision making.

    OpenAIRE

    Kathrin Rodríguez Llanes

    2010-01-01

    Making decisions is complicated in a generalized way, the materials and humans resources of the entity we belong to depends on it, such as the fulfillment of its goals. But when the situations are complex, making decisions turns into a very difficult work, due to the great amount of aspects to consider when making the right choice. To make this efficiently the administration must to consult an important volume of information, which generally, is scattered and in any different formats. That’...

  13. Computer support of group decision making

    OpenAIRE

    E.A. Trachtenherz

    2001-01-01

    In this paper we consider techniques of computer group decision making support. The interrelation of support methods, negotiation process type, and character of problems to be managed is shown. The structure of a computer-aided system supporting group decision making is offered, and some methods to support the course of negotiations using such systems are discussed.

  14. Decision-making under risk and uncertainty

    International Nuclear Information System (INIS)

    Fuzzy sets and interval analysis tools to make computations and solve optimisation problems are presented. Fuzzy and interval extensions of Decision Theory criteria for decision-making under parametric uncertainty of prior information (probabilities, payoffs) are developed. An interval probability approach to the mean-value criterion is proposed. (author)

  15. Decision-Making at the Top

    OpenAIRE

    Jack R. Borsting

    1982-01-01

    The author's current decision-making environment is summarized. A short history of the Planning, Programming and Budgeting System is given and then the recent changes made by the Reagan Administration are discussed. Some remarks on analysis and decision-making at the top government levels are given.

  16. Reading and Consumer Decision Making Skills.

    Science.gov (United States)

    Peck, Michaeleen P.; Laughlin, Margaret A.

    Teachers at all grade levels need to recognize the importance of instruction in consumer reading and decision making skills. The definitions and prerequisites of a literate consumer underscore the importance of reading and reasoning skills development for making effective decisions. Consumer educators must also recognize that economic…

  17. Decision Making: New Paradigm for Education.

    Science.gov (United States)

    Wales, Charles E.; And Others

    1986-01-01

    Defines education's new paradigm as schooling based on decision making, the critical thinking skills serving it, and the knowledge base supporting it. Outlines a model decision-making process using a hypothetical breakfast problem; a late riser chooses goals, generates ideas, develops an action plan, and implements and evaluates it. (4 references)…

  18. Intuitionistic preference modeling and interactive decision making

    CERN Document Server

    Xu, Zeshui

    2014-01-01

    This book offers an in-depth and comprehensive introduction to the priority methods of intuitionistic preference relations, the consistency and consensus improving procedures for intuitionistic preference relations, the approaches to group decision making based on intuitionistic preference relations, the approaches and models for interactive decision making with intuitionistic fuzzy information, and the extended results in interval-valued intuitionistic fuzzy environments.

  19. Affective Decision Making in Insurance Markets

    OpenAIRE

    Anat Bracha

    2004-01-01

    This paper suggests incorporating affective considerations into decision making theory and insurance decision in particular. I describe a decision maker with two internal accounts - the rational account and the mental account. The rational account decides on insurance to maximize expected (perceived) utility, while the mental account chooses risk perceptions which then affect the perceived expected utility. The two accounts interact to reach a decision which is composed of both risk perceptio...

  20. Decision-Making Autonomy and Subsidiary Innovation

    DEFF Research Database (Denmark)

    Van Vo, Dut; Beugelsdijk, Sjoerd; de Jong, Gjalt; Jindra, Björn

    2013-01-01

    of how much decision-making autonomy subsidiaries should have is a core issue in the management of headquarters-subsidiary relationships. Using two complementary theoretical perspectives, we hypothesize a non-linear relationship between subsidiary’s decision-making autonomy and innovation. We test......This paper investigates how decision-making autonomy affects the possibility and intensity of innovation in subsidiaries of multinational enterprises (MNEs). Subsidiaries are increasingly identified as sources of innovation and as vehicles for cross-border transfer of new competences. The question......-making autonomy and innovation intensity....

  1. Clinical Holistic Medicine: Factors Influencing The Therapeutic Decision-Making. From Academic Knowledge to Emotional Intelligence and Spiritual “Crazy” Wisdom

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available Scientific holistic medicine is built on holistic medical theory, on therapeutic and ethical principles. The rationale is that the therapist can take the patient into a state of salutogenesis, or existential healing, using his skills and knowledge. But how ever much we want to make therapy a science it remains partly an art, and the more developed the therapist becomes, the more of his/her decisions will be based on intuition, feeling and even inspiration that is more based on love and human concern and other spiritual motivations than on mental reason and rationality in a simple sense of the word. The provocative and paradoxal medieval western concept of the “truth telling clown”, or the eastern concepts of “crazy wisdom” and “holy madness” seems highly relevant here. The problem is how we can ethically justify this kind of highly “irrational” therapeutic behavior in the rational setting of a medical institution. We argue here that holistic therapy has a very high success rate and is doing no harm to the patient, and encourage therapists, psychiatrists, psychologist and other academically trained “helpers” to constantly measure their own success-rate. This paper discusses many of the important factors that influence clinical holistic decision-making. Sexuality could, as many psychoanalysts from Freud to Reich and Searles have believed, be the most healing power that exists and also the most difficult for the mind to comprehend, and thus the most “crazy-wise” tool of therapy.

  2. Decision making in xia2

    OpenAIRE

    Winter, Graeme; Lobley, Carina M. C.; Prince, Stephen M.

    2013-01-01

    xia2 is an expert system for the automated reduction of macromolecular crystallography (MX) data employing well trusted existing software. The system can process a full MX data set consisting of one or more sequences of images at one or more wavelengths from images to structure-factor amplitudes with no user input. To achieve this many decisions are made, the rationale for which is described here. In addition, it is critical to support the testing of hypotheses and to allow feedback of result...

  3. Clinical Decision Support (CDS) Inventory

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Decision Support (CDS) Inventory contains descriptions of past and present CDS projects across the Federal Government. It includes Federal projects,...

  4. Gender and internet consumers' decision-making.

    Science.gov (United States)

    Yang, Chyan; Wu, Chia-Chun

    2007-02-01

    The purpose of this research is to provide managers of shopping websites information regarding consumer purchasing decisions based on the Consumer Styles Inventory (CSI). According to the CSI, one can capture what decision-making styles online shoppers use. Furthermore, this research also discusses the gender differences among online shoppers. Exploratory factor analysis (EFA) was used to understand the decision-making styles and discriminant analysis was used to distinguish the differences between female and male shoppers. The result shows that there are differences in purchasing decisions between online female and male Internet users. PMID:17305453

  5. Doctor's dilemma: Medical decision making

    International Nuclear Information System (INIS)

    How a doctor arrives at a decision is of interest to both the developed and the developing countries. The developed and the developing want to walk on the same road but from different directions: one wants to develop a little more and the other wants to develop a little less for cost containment. To justify nuclear medicine in a developing country we have to see nuclear medicine in a new role. It is not for putting the diagnostic labels, not for differential diagnosis as we have been conditioned to think so far. In a developing country it should be for differential management, How does it alter the management decision in respect to a particular patient? If management outcomes are restricted, there is no need for an investigation which does not help in any way the management of the patient. If there is no bypass surgery, what use is the thallium perfusion? Although primarily a diagnostic discipline for its justification and survival in the developing country it should lead to a sensible differential management

  6. Probabilistic Analysis in Management Decision Making

    DEFF Research Database (Denmark)

    Delmar, M. V.; Sørensen, John Dalsgaard

    1992-01-01

    The target group in this paper is people concerned with mathematical economic decision theory. It is shown how the numerically effective First Order Reliability Methods (FORM) can be used in rational management decision making, where some parameters in the applied decision basis are uncertainty...... quantities. The uncertainties are taken into account consistently and the decision analysis is based on the general decision theory in combination with reliability and optimization theory. Examples are shown where the described technique is used and some general conclusion are stated....

  7. Customer Decision Support Systems: Resources for Student Decision Making

    OpenAIRE

    Cara Okleshen Peters; David A. Bradbard; Mary C. Martin

    2005-01-01

    This paper highlights the potential of customer decision support systems (CDSS) to assist students in education-related decision making. Faculty can use these resources to more effectively advise students on various elements of college life, while students can employ them to more actively participate in their own learning and improve their academic experience. This conceptual paper summarizes consumer decision support systems (CDSS) concepts and presents exemplar websites students could utili...

  8. Probabilistic Decision Making for Collision Avoidance Systems: Postponing Decisions

    OpenAIRE

    Lefèvre, Stéphanie; Bajcsy, Ruzena; Laugier, Christian

    2013-01-01

    For collision avoidance systems to be accepted by human drivers, it is important to keep the rate of unnecessary interventions very low. This is challenging since the decision to intervene or not is based on incomplete and uncertain information. The contribution of this paper is a decision making strategy for collision avoidance systems which allows the system to occasionally postpone a decision in order to collect more information. The problem is formulated in the framework of statistical de...

  9. A voice in decision making

    DEFF Research Database (Denmark)

    Broström, Stig

    2010-01-01

    part in and influence his/her daily life, the child is not seen as a becoming but as a being. Theoretical foundation and practical examples will be given, and the chapter will explore not only how to bring up children as active democrats but also how to encourage them from early age to make use of...

  10. Ethics and environmental decision making

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, R.J.

    The subject of environmental ethics trends to be dominated by the idea that the right environmental actions require a change in the value systems of many people. The author argues that the rebirth approach is perverse in that moral attitudes are not easily changed by moral suasion. A properly ethical approach must begin where we are, as moderately moral people desiring the best for all. The real ethical problem is to develop procedures for collectively defining environmental ends that will be fair to the parties participating in the decision process. This idea is essentially utilitarian, and depends on the maximization of expected social utility. This type of environmental ethics is contrasted with current theories of social choice in welfare economics and with Rawls' theory of justice as fairness. 26 references.

  11. Handbook on Decision Making Vol 2 Risk Management in Decision Making

    CERN Document Server

    Lu, Jie; Zhang, Guangquan

    2012-01-01

    This book presents innovative theories, methodologies, and techniques in the field of risk management and decision making. It introduces new research developments and provides a comprehensive image of their potential applications to readers interested in the area. The collection includes: computational intelligence applications in decision making, multi-criteria decision making under risk, risk modelling,forecasting and evaluation, public security and community safety, risk management in supply chain and other business decision making, political risk management and disaster response systems. The book is directed to academic and applied researchers working on risk management, decision making, and management information systems.

  12. Making the Connection between Environmental Science and Decision Making

    Science.gov (United States)

    Woodhouse, C. A.; Crimmins, M.; Ferguson, D. B.; Garfin, G. M.; Scott, C. A.

    2011-12-01

    As society is confronted with population growth, limited resources, and the impacts of climate variability and change, it is vital that institutions of higher education promote the development of professionals who can work with decision-makers to incorporate scientific information into environmental planning and management. Skills for the communication of science are essential, but equally important is the ability to understand decision-making contexts and engage with resource managers and policy makers. It is increasingly being recognized that people who understand the linkages between science and decision making are crucial if science is to better support planning and policy. A new graduate-level seminar, "Making the Connection between Environmental Science and Decision Making," is a core course for a new post-baccalaureate certificate program, Connecting Environmental Science and Decision Making at the University of Arizona. The goal of the course is to provide students with a basic understanding of the dynamics between scientists and decision makers that result in scientific information being incorporated into environmental planning, policy, and management decisions. Through readings from the environmental and social sciences, policy, and planning literature, the course explores concepts including scientific information supply and demand, boundary organizations, co-production of knowledge, platforms for engagement, and knowledge networks. Visiting speakers help students understand some of the challenges of incorporating scientific information into planning and decision making within institutional and political contexts. The course also includes practical aspects of two-way communication via written, oral, and graphical presentations as well as through the interview process to facilitate the transfer of scientific information to decision makers as well as to broader audiences. We aspire to help students develop techniques that improve communication and

  13. Decision Theatre in decision making and urban planning : case: Decision Theatre for Niemi Campus

    OpenAIRE

    Vesikko, Ari

    2013-01-01

    The aim of this thesis was to study the impact of visualization on the decision making process and establish an immersive information laboratory, named Decision Theatre, to help decision making. The laboratory was built for a project called Sustainable urban environment laboratory. In the first part, the consistent decision making process, effective tools and methods are investigated and presented. Investigation shows that it is possible to develop individual and group decision making ski...

  14. Biologically inspired intelligent decision making

    OpenAIRE

    Manning, Timmy; Sleator, Roy D.; Walsh, Paul

    2013-01-01

    Artificial neural networks (ANNs) are a class of powerful machine learning models for classification and function approximation which have analogs in nature. An ANN learns to map stimuli to responses through repeated evaluation of exemplars of the mapping. This learning approach results in networks which are recognized for their noise tolerance and ability to generalize meaningful responses for novel stimuli. It is these properties of ANNs which make them appealing for applications to bioinfo...

  15. TRAVEL DECISION MAKING - THE ROLE OF HABIT

    Directory of Open Access Journals (Sweden)

    Therese Jansson

    2008-10-01

    Full Text Available The complexity of travel decision making is widely recognized and has previous been studied by the means of grand models and process studies. This study has used the Self-Reported Habit Index of Verplanken and Orbell (2003 to measure habit strength in 23 statements concerning travel decision making. The four sub-decisions of particular interest in this study were; where and when to go on vacation, what to do, as well as how to travel to the chosen destination. The developed instrument unfolds a well recognized structure of travel behavior, results which validate the statements of SRHI and its applicability to the field of tourism. This research adds to the field of travel decision making by emphasizing the possibility to identify sub-decisions that are made out of habit and to use habit as a platform for tourist segmentation.

  16. Making Sustainable Decisions Using the KONVERGENCE Framework

    Energy Technology Data Exchange (ETDEWEB)

    Piet, Steven James; Gibson, Patrick Lavern; Joe, Jeffrey Clark; Kerr, Thomas A; Nitschke, Robert Leon; Dakins, Maxine Ellen

    2003-02-01

    Hundreds of contaminated facilities and sites must be cleaned up. “Cleanup” includes decommissioning, environmental restoration, and waste management. Cleanup can be complex, expensive, risky, and time-consuming. Decisions are often controversial, can stall or be blocked, and are sometimes re-done - some before implementation, some decades later. Making and keeping decisions with long time horizons involves special difficulties and requires new approaches, including: • New ways (mental model) to analyze and visualize the problem, • Awareness of the option to shift strategy or reframe from a single decision to an adaptable network of decisions, and • Improved tactical processes that account for several challenges. These include the following: • Stakeholder values are a more fundamental basis for decision making and keeping than “meeting regulations.” • Late-entry players and future generations will question decisions. • People may resist making “irreversible” decisions. • People need “compelling reasons” to take action in the face of uncertainties. Our project goal is to make cleanup decisions easier to make, implement, keep, and sustain. By sustainability, we mean decisions that work better over the entire time-period—from when a decision is made, through implementation, to its end point. That is, alternatives that can be kept “as is” or adapted as circumstances change. Increased attention to sustainability and adaptability may decrease resistance to making and implementing decisions. Our KONVERGENCE framework addresses these challenges. The framework is based on a mental model that states: where Knowledge, Values, and Resources converge (the K, V, R in KONVERGENCE), you will find a sustainable decision. We define these areas or universes as follows: • Knowledge: what is known about the problem and possible solutions? • Values: what is important to those affected by the decision? • Resources: what is available to implement

  17. Neuronal adaptation effects in decision making

    OpenAIRE

    Theodoni, Panagiota; Kovacs, Gyula; Mark W Greenlee; Deco, Gustavo

    2011-01-01

    Recently, there has been an increased interest on the neural mechanisms underlying perceptual decision making. However, the effect of neuronal adaptation in this context has not yet been studied. We begin our study by investigating how adaptation can bias perceptual decisions. We considered behavioral data from an experiment on high-level adaptation-related aftereffects in a perceptual decision task with ambiguous stimuli on humans. To understand the driving force behind the perceptual decisi...

  18. Moral agency as enacted justice: a clinical and ethical decision-making framework for responding to health inequities and social injustice.

    Science.gov (United States)

    Edwards, Ian; Delany, Clare M; Townsend, Anne F; Swisher, Laura Lee

    2011-11-01

    This is the second of 2 companion articles in this issue. The first article explored the clinical and ethical implications of new emphases in physical therapy codes of conduct reflecting the growing evidence regarding the importance of social determinants of health, epidemiological trends for health service delivery, and the enhanced participation of physical therapists in shaping health care reform in a number of international contexts. The first article was theoretically oriented and proposed that a re-thinking of ethical frameworks expressed in codes of ethics could both inform and underpin practical strategies for working in primary health care. A review of the ethical principle of "justice," which, arguably, remains the least consensually understood and developed principle in the ethics literature of physical therapy, was provided, and a more recent perspective-the capability approach to justice-was discussed. The current article proposes a clinical and ethical decision-making framework, the ethical reasoning bridge (ER bridge), which can be used to assist physical therapy practitioners to: (1) understand and implement the capability approach to justice at a clinical level; (2) reflect on and evaluate both the fairness and influence of beliefs, perspectives, and context affecting health and disability through a process of "wide reflective equilibrium" and assist patients to do this as well; and (3) nurture the development of moral agency, in partnership with patients, through a transformative learning process manifest in a mutual "crossing" and "re-crossing" of the ER bridge. It is proposed that the development and exercise of moral agency represent an enacted justice that is the result of a shared reasoning and learning experience on the part of both therapists and patients. PMID:21885448

  19. The Basic Teaching Skill: Decision Making.

    Science.gov (United States)

    Shavelson, Richard J.

    Any teaching act is the result of a decision, either conscious or unconscious. Previous research on basic teaching skills examined alternative teaching acts, such as explaining, questioning, reinforcing, without examining how teachers choose between one or another act. This paper argues that the basic teaching skill is decision making. This…

  20. The Neuroscience of Social Decision-Making

    NARCIS (Netherlands)

    Rilling, J.K.; Sanfey, A.G.

    2011-01-01

    Given that we live in highly complex social environments, many of our most important decisions are made in the context of social interactions. Simple but sophisticated tasks from a branch of experimental economics known as game theory have been used to study social decision-making in the laboratory

  1. Decision Making System for Operative Tasks

    OpenAIRE

    Shakah, G.; Krasnoproshin, V. V.; Valvachev, A. N.

    2009-01-01

    Actual problems of construction of computer systems for operative tasks of decision making are considered. possibilities of solving the problems on the basis of the theory of active systems (tas) are investigated.

  2. Strategies for promoting ethical decision-making.

    Science.gov (United States)

    Mysak, S

    1997-01-01

    The structured controversy as a strategy for helping the non-licensed caregiver make ethical decisions as well as develop critical thinking skills was an innovative teaching technique. Students in the Homecare/Special care aide program are essential providers of care to residents or clients in a special care facility or in a homecare setting. Theory and practice of ethical decision-making is not usually dealt with in the curriculum of the non-licensed caregiver. Implementation of this approach helped students learn theory and skills necessary when dealing with controversial issues in making ethical decisions. Thompson and Thompson's (1985) ten steps of bioethical decision-making were implemented to assist in the process. Structured controversy was defined and the process of implementing structured controversy outlined. A variety of ethical issues were presented based on the ethical principles of beneficence, justice, autonomy, truthfulness, confidentiality, and integrity (Yeo, 1991). Several definitions of critical thinking are presented. PMID:9136367

  3. Overcoming Barriers to Shared Decision Making

    Science.gov (United States)

    ... team to break it down. Barriers to shared decision making and solutions to overcome them include: Barrier: Fear, anger, stress or other emotions Solution: Strong emotions can interfere with your ability ...

  4. Dynamic decision making without expected utility

    DEFF Research Database (Denmark)

    Nielsen, Thomas Dyhre; Jaffray, Jean-Yves

    2006-01-01

    Non-expected utility theories, such as rank dependent utility (RDU) theory, have been proposed as alternative models to EU theory in decision making under risk. These models do not share the separability property of expected utility theory. This implies that, in a decision tree, if the reduction of...... between the decision maker’s discordant goals at the different decision nodes. Relative to the computations involved in the standard expected utility evaluation of a decision problem, the main computational increase is due to the identification of non-dominated strategies by linear programming. A...... compound lotteries assumption is made (so that preferences at each decision node reduce to RDU preferences among lotteries) and that preferences at different decision nodes are identical (same utility function and same weighting function), then the preferences are not dynamically consistent; in particular...

  5. Cognitive Reflection Versus Calculation in Decision Making

    Directory of Open Access Journals (Sweden)

    Aleksandr eSinayev

    2015-05-01

    Full Text Available Scores on the three-item Cognitive Reflection Test (CRT have been linked with dual-system theory and normative decision making (Frederick, 2005. In particular, the CRT is thought to measure monitoring of System 1 intuitions such that, if cognitive reflection is high enough, intuitive errors will be detected and the problem will be solved. However, CRT items also require numeric ability to be answered correctly and it is unclear how much numeric ability vs. cognitive reflection contributes to better decision making. In two studies, CRT responses were used to calculate Cognitive Reflection and numeric ability; a numeracy scale was also administered. Numeric ability, measured on the CRT or the numeracy scale, accounted for the CRT’s ability to predict more normative decisions (a subscale of decision-making competence, incentivized measures of impatient and risk-averse choice, and self-reported financial outcomes; Cognitive Reflection contributed no independent predictive power. Results were similar whether the two abilities were modeled (Study 1 or calculated using proportions (Studies 1 and 2. These findings demonstrate numeric ability as a robust predictor of superior decision making across multiple tasks and outcomes. They also indicate that correlations of decision performance with the CRT are insufficient evidence to implicate overriding intuitions in the decision-making biases and outcomes we examined. Numeric ability appears to be the key mechanism instead.

  6. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand......Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand...

  7. Decision making: Tourism and hospitality game

    OpenAIRE

    Zapalska, Alina M.; Brozik, Dallas; Niewiadomska-Bugaj, Magdalena

    2006-01-01

    This paper introduces the reader to an experiment that proposes an expanded format of cooperative learning techniques with sets of pedagogical innovations to better meet the teaching outcomes. In this context the paper presents a decision-making game where Tourism and Hospitality students are fully involved in the educational process via active participation in the Tourism and Travel Game. The game demonstrates decision-making processes that must be taken within competitive environment ...

  8. Collective decision-making in microbes

    OpenAIRE

    Ross-Gillespie, Adin; Kümmerli, Rolf

    2014-01-01

    Microbes are intensely social organisms that routinely cooperate and coordinate their activities to express elaborate population level phenotypes. Such coordination requires a process of collective decision-making, in which individuals detect and collate information not only from their physical environment, but also from their social environment, in order to arrive at an appropriately calibrated response. Here, we present a conceptual overview of collective decision-making as it applies to al...

  9. Collective decision-making in microbes

    OpenAIRE

    RolfKümmerli

    2014-01-01

    Microbes are intensely social organisms that routinely cooperate and coordinate their activities to express elaborate population-level phenotypes. Such coordination requires a process of collective decision-making, in which individuals detect and collate information not only from their physical environment, but also from their social environment, in order to arrive at an appropriately calibrated response. Here, we present a conceptual overview of collective decision-making as it applies to al...

  10. A neural model of decision making

    OpenAIRE

    Larsen, Torben

    2008-01-01

    Background: A descriptive neuroeconomic model is aimed for relativity of the concept of economic man to empirical science.Method: A 4-level client-server-integrator model integrating the brain models of McLean and Luria is the general framework for the model of empirical findings.Results: Decision making relies on integration across brain levels of emotional intelligence (LU) and logico-matematico intelligence (RIA), respectively. The integrated decision making formula approaching zero by bot...

  11. INTERNAL CALCULATION IN TERM BUSINESS DECISION MAKING

    OpenAIRE

    Jugoslav Aničić, Miloje Jelić, Jasmina M. Đurović, Srećko Radoičić, Živojin B. Prokopović

    2014-01-01

    Business-financial decision making represent prime activity of top management. Growing complexity in the business ,market and rapid technological change require fast and appropriate answer of top management. Confident and efficient system of internal calculation gives confident base, for making financial decision and strategic as well. Companies of industrial sector in Serbia can significantly improve their business performance by improving internal calculation systems. The preservation and s...

  12. Consumer decision-making on festival attendance

    OpenAIRE

    Noman, Md. Abu

    2012-01-01

    It has been challenging for the festival organizers to sell their festival tickets due to overcrowded festival market. To increase the ticket sale it is becoming more important to know the consumers and their decision making on festival attendance. There are many factors that influence people to make decision over festival attendance and the main purpose of this study was to identify those factors. The research was conducted for GigsWiz.com Ltd. to help the company gather information about fe...

  13. The Neuroscience of Consumer Decision-Making

    OpenAIRE

    Pirouz, Dante

    2004-01-01

    While there is an extensive history of neuroscience, only recently has the theory and the methods of this discipline been applied to answer questions about decision making, choice, preference, risk and happiness. This new area of research, coined neuroeconomics, seeks to reveal more about the neural functioning and associated implications for economic and consumer behavior. In this paper are some of the key developments in neuroeconomics research as they relate to consumer decision-making, cu...

  14. DECISION MAKING AND FIRMS’ PERFORMANCE INDICATORS

    OpenAIRE

    Georgeta BÃRBULESCU;

    2011-01-01

    In the paper, a conceptual model of recurrent decision-making in a competitive environment is developed and used as a framework for analyzing some examples of decision– making strategies. The conceptual model is then used to predict firm performance based on factors such as: decision rules developed by the management groups, the business climate features, the complexity of the implementation process. The relevance of the chosen topic is explained by the meaning of the firm efficiency concept ...

  15. Making Decisions with Unknown Sensory Reliability

    OpenAIRE

    SophieDeneve

    2012-01-01

    To make fast and accurate behavioural choices, we need to integrate the noisy sensory input, take into account prior knowledge, and adjust our decision criteria. It was shown previously that in a two alternative forced choice tasks, optimal decision making can be formalized in the framework of a sequential probability ratio test and is then equivalent to a diffusion model. However, this analogy hides a “chicken and egg” problem: To know how quickly we should integrate the sensory input and to...

  16. Neutrosophic Logic Applied to Decision Making

    DEFF Research Database (Denmark)

    Madsen, Henrik; Albeanu, Grigore; Burtschy, Bernard;

    2014-01-01

    Decision making addresses the usage of various methods to select "the best", in some way, alternative strategy (from many available) when a problem is given for solving. The authors propose the usage of neutrosophic way of thinking, called also Smarandache's logic, to select a model by experts when...... degrees of trustability, ultrastability (falsehood), and indeterminacy are used to decide. The procedures deal with multi-attribute neutrosophic decision making and a case study on e-learning software objects is presented....

  17. Hierarchical Decision Making In Electricity Grid Management

    OpenAIRE

    Dalal, Gal; Gilboa, Elad; Mannor, Shie

    2016-01-01

    The power grid is a complex and vital system that necessitates careful reliability management. Managing the grid is a difficult problem with multiple time scales of decision making and stochastic behavior due to renewable energy generations, variable demand and unplanned outages. Solving this problem in the face of uncertainty requires a new methodology with tractable algorithms. In this work, we introduce a new model for hierarchical decision making in complex systems. We apply reinforcement...

  18. Primary School Principals Decision Making Styles

    OpenAIRE

    Kaya YILDIZ

    2013-01-01

    The purpose of the present study was to determine styles of decision making of school principals’ who work in primary schools. The study group of the research is consist of 100 primary school principles who are trained within the scope of Ministry of National Education's project called MEBGEB (Capacity Bulding Support fort he Ministry National Education). The data were collected through "General Decision Making-Style" Scale developed by Scott and Bruce (1995). For the analysis ...

  19. On emotion specificity in decision making

    OpenAIRE

    Marcel Zeelenberg; Rob M. A. Nelissen; Seger M. Breugelmans; Rik Pieters

    2008-01-01

    We present a motivational account of the impact of emotion on decision making, termed the feeling-is-for-doing approach. We first describe the psychology of emotion and argue for a need to be specific when studying emotion's impact on decision making. Next we describe what our approach entails and how it relates emotion, via motivation to behavior. Then we offer two illustrations of our own research that provide support for two important elements in our reasoning. We end with specifying four ...

  20. Geospatial decision support systems for societal decision making

    Science.gov (United States)

    Bernknopf, R.L.

    2005-01-01

    While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the

  1. From Career Decision-Making Styles to Career Decision-Making Profiles: A Multidimensional Approach

    Science.gov (United States)

    Gati, Itamar; Landman, Shiri; Davidovitch, Shlomit; Asulin-Peretz, Lisa; Gadassi, Reuma

    2010-01-01

    Previous research on individual differences in career decision-making processes has often focused on classifying individuals into a few types of decision-making "styles" based on the most dominant trait or characteristic of their approach to the decision process (e.g., rational, intuitive, dependent; Harren, 1979). In this research, an alternative…

  2. Making Sustainable Decisions Using The KONVERGENCE Framework

    Energy Technology Data Exchange (ETDEWEB)

    Piet, S. J.; Gibson, P. L.; Joe, J. C.; Kerr, T. A.; Nitschke, R. L.; Dakins, M. E.

    2003-02-25

    Hundreds of contaminated facilities and sites must be cleaned up. ''Cleanup'' includes decommissioning, environmental restoration, and waste management. Cleanup can be complex, expensive, risky, and time-consuming. Decisions are often controversial, can stall or be blocked, and are sometimes re-done--some before implementation, some decades later. Making and keeping decisions with long time horizons involves special difficulties and requires new approaches. Our project goal is to make cleanup decisions easier to make, implement, keep, and sustain. By sustainability, we mean decisions that work better over the entire time-period-from when a decision is made, through implementation, to its end point. That is, alternatives that can be kept ''as is'' or adapted as circumstances change. Increased attention to sustainability and adaptability may decrease resistance to making and implementing decisions. Our KONVERGENCE framework addresses these challenges. The framework is based on a mental model that states: where Knowledge, Values, and Resources converge (the K, V, R in KONVERGENCE), you will find a sustainable decision. We define these areas or universes as follows: (1) Knowledge: what is known about the problem and possible solutions? (2) Values: what is important to those affected by the decision? (3) Resources: what is available to implement possible solutions or improve knowledge? This mental model helps analyze and visualize what is happening as decisions are made and kept. Why is there disagreement? Is there movement toward konvergence? Is a past decision drifting out of konvergence? The framework includes strategic improvements, i.e., expand the spectrum of alternatives to include adaptable alternatives and decision networks. It includes tactical process improvements derived from experience, values, and relevant literature. This paper includes diagnosis and medication (suggested path forward) for intractable cases.

  3. Decision-making based on emotional images.

    Science.gov (United States)

    Katahira, Kentaro; Fujimura, Tomomi; Okanoya, Kazuo; Okada, Masato

    2011-01-01

    The emotional outcome of a choice affects subsequent decision making. While the relationship between decision making and emotion has attracted attention, studies on emotion and decision making have been independently developed. In this study, we investigated how the emotional valence of pictures, which was stochastically contingent on participants' choices, influenced subsequent decision making. In contrast to traditional value-based decision-making studies that used money or food as a reward, the "reward value" of the decision outcome, which guided the update of value for each choice, is unknown beforehand. To estimate the reward value of emotional pictures from participants' choice data, we used reinforcement learning models that have successfully been used in previous studies for modeling value-based decision making. Consequently, we found that the estimated reward value was asymmetric between positive and negative pictures. The negative reward value of negative pictures (relative to neutral pictures) was larger in magnitude than the positive reward value of positive pictures. This asymmetry was not observed in valence for an individual picture, which was rated by the participants regarding the emotion experienced upon viewing it. These results suggest that there may be a difference between experienced emotion and the effect of the experienced emotion on subsequent behavior. Our experimental and computational paradigm provides a novel way for quantifying how and what aspects of emotional events affect human behavior. The present study is a first step toward relating a large amount of knowledge in emotion science and in taking computational approaches to value-based decision making. PMID:22059086

  4. Decision making based on emotional images

    Directory of Open Access Journals (Sweden)

    Kentaro eKatahira

    2011-10-01

    Full Text Available The emotional outcome of a choice affects subsequent decision making. While the relationship between decision making and emotion has attracted attention, studies on emotion and decision making have been independently developed. In this study, we investigated how the emotional valence of pictures, which was stochastically contingent on participants’ choices, influenced subsequent decision making. In contrast to traditional value-based decision-making studies that used money or food as a reward, the reward value of the decision outcome, which guided the update of value for each choice, is unknown beforehand. To estimate the reward value of emotional pictures from participants’ choice data, we used reinforcement learning models that have success- fully been used in previous studies for modeling value-based decision making. Consequently, we found that the estimated reward value was asymmetric between positive and negative pictures. The negative reward value of negative pictures (relative to neutral pictures was larger in magnitude than the positive reward value of positive pictures. This asymmetry was not observed in valence for an individual picture, which was rated by the participants regarding the emotion experienced upon viewing it. These results suggest that there may be a difference between experienced emotion and the effect of the experienced emotion on subsequent behavior. Our experimental and computational paradigm provides a novel way for quantifying how and what aspects of emotional events affect human behavior. The present study is a first step toward relating a large amount of knowledge in emotion science and in taking computational approaches to value-based decision making.

  5. Quantum probability and quantum decision making

    CERN Document Server

    Yukalov, V I

    2016-01-01

    A rigorous general definition of quantum probability is given, which is valid for elementary events and for composite events, for operationally testable measurements as well as for inconclusive measurements, and also for non-commuting observables in addition to commutative observables. Our proposed definition of quantum probability makes it possible to describe quantum measurements and quantum decision making on the same common mathematical footing. Conditions are formulated for the case when quantum decision theory reduces to its classical counterpart and for the situation where the use of quantum decision theory is necessary.

  6. Rationality and Emotions in Decision Making

    Directory of Open Access Journals (Sweden)

    Olga Markič

    2009-12-01

    Full Text Available Decision making is traditionally viewed as a rational process where reason calculates the best way to achieve the goal. Investigations from different areas of cognitive science have shown that human decisions and actions are much more influenced by intuition and emotional responses then it was previously thought. In this paper I examine the role of emotion in decision making, particularly Damasio’s hypothesis of somatic markers and Green’s dual process theory of moral judgment. I conclude the paper with the discussion of the threat that deliberation and conscious rationality is an illusion.

  7. Task Release Control for Decision Making Queues

    CERN Document Server

    Srivastava, Vaibhav; Bullo, Francesco; Langbort, Cédric

    2010-01-01

    We consider the optimal duration allocation in a decision making queue. Decision making tasks arrive at a given rate to a human operator. The correctness of the decision made by human evolves as a sigmoidal function of the duration allocated to the task. Each task in the queue loses its value continuously. We elucidate on this trade-off and determine optimal policies for the human operator. We show the optimal policy requires the human to drop some tasks. We present a receding horizon optimization strategy, and compare it with the greedy policy.

  8. Examining Decision-Making Regarding Environmental Information

    Energy Technology Data Exchange (ETDEWEB)

    Marble, Julie Lynne; Medema, Heather Dawne; Hill, Susan Gardiner

    2001-10-01

    Eight participants were asked to view a computer-based multimedia presentation on an environmental phenomenon. Participants were asked to play a role as a senior aide to a national legislator. In this role, they were told that the legislator had asked them to review a multimedia presentation regarding the hypoxic zone phenomenon in the Gulf of Mexico. Their task in assuming the role of a senior aide was to decide how important a problem this issue was to the United States as a whole, and the proportion of the legislator’s research budget that should be devoted to study of the problem. The presentation was divided into 7 segments, each containing some new information not contained in the previous segments. After viewing each segment, participants were asked to indicate how close they were to making a decision and how certain they were that their current opinion would be their final decision. After indicating their current state of decision-making, participants were interviewed regarding the factors affecting their decision-making. Of interest was the process by which participants moved toward a decision. This experiment revealed a number of possible directions for future research. There appeared to be two approaches to decision-making: Some decision-makers moved steadily toward a decision, and occasionally reversed decisions after viewing information, while others abruptly reached a decision after a certain time period spent reviewing the information. Although the difference in estimates of distance to decisions did not differ statistically for these two groups, that difference was reflected in the participants’ estimates of confidence that their current opinion would be their final decision. The interviews revealed that the primary difference between these two groups was in their trade-offs between willingness to spend time in information search and the acquisition of new information. Participants who were less confident about their final decision, tended to be

  9. Rethinking how retail buyers make buying decisions

    DEFF Research Database (Denmark)

    Esbjerg, Lars

    The nature of retailer buying is changing, but not so our conceptualisations. Existing literature on retailer buying is characterised by a rather narrow focus on what retail buyers decide and which decision criteria they use to make decisions, whereas comparatively little attention has been devoted...... to the processes of how and why certain decisions are made. This paper aims to move beyond a focus on single decisions as discrete events to viewing retailer buying as something that occurs in ongoing relationally-responsive interaction between retailers and suppliers....

  10. Goals and plans in decision making

    Directory of Open Access Journals (Sweden)

    David H. Krantz

    2007-06-01

    Full Text Available We propose a constructed-choice model for general decision making. The model departs from utility theory and prospect theory in its treatment of multiple goals and it suggests several different ways in which context can affect choice. It is particularly instructive to apply this model to protective decisions, which are often puzzling. Among other anomalies, people insure against non-catastrophic events, underinsure against catastrophic risks, and allow extraneous factors to influence insurance purchases and other protective decisions. Neither expected-utility theory nor prospect theory can explain these anomalies satisfactorily. To apply this model to the above anomalies, we consider many different insurance-related goals, organized in a taxonomy, and we consider the effects of context on goals, resources, plans and decision rules. The paper concludes by suggesting some prescriptions for improving individual decision making with respect to protective measures.

  11. Unstated factors in orthopaedic decision-making: a qualitative study

    Directory of Open Access Journals (Sweden)

    Learmonth Ian D

    2010-09-01

    Full Text Available Abstract Background Total joint replacement (TJR of the hip or knee for osteoarthritis is among the most common elective surgical procedures. There is some inequity in provision of TJR. How decisions are made about who will have surgery may contribute to disparities in provision. The model of shared decision-making between patients and clinicians is advocated as an ideal by national bodies and guidelines. However, we do not know what happens within orthopaedic practice and whether this reflects the shared model. Our study examined how decisions are made about TJR in orthopaedic consultations. Methods The study used a qualitative research design comprising semi-structured interviews and observations. Participants were recruited from three hospital sites and provided their time free of charge. Seven clinicians involved in decision-making about TJR were approached to take part in the study, and six agreed to do so. Seventy-seven patients due to see these clinicians about TJR were approached to take part and 26 agreed to do so. The patients' outpatient appointments ('consultations' were observed and audio-recorded. Subsequent interviews with patients and clinicians examined decisions that were made at the appointments. Data were analysed using thematic analysis. Results Clinical and lifestyle factors were central components of the decision-making process. In addition, the roles that patients assigned to clinicians were key, as were communication styles. Patients saw clinicians as occupying expert roles and they deferred to clinicians' expertise. There was evidence that patients modified their behaviour within consultations to complement that of clinicians. Clinicians acknowledged the complexity of decision-making and provided descriptions of their own decision-making and communication styles. Patients and clinicians were aware of the use of clinical and lifestyle factors in decision-making and agreed in their description of clinicians' styles

  12. FUZZY DECISION MAKING MODEL FOR BYZANTINE AGREEMENT

    Directory of Open Access Journals (Sweden)

    S. MURUGAN

    2014-04-01

    Full Text Available Byzantine fault tolerance is of high importance in the distributed computing environment where malicious attacks and software errors are common. A Byzantine process sends arbitrary messages to every other process. An effective fuzzy decision making approach is proposed to eliminate the Byzantine behaviour of the services in the distributed environment. It is proposed to derive a fuzzy decision set in which the alternatives are ranked with grade of membership and based on that an appropriate decision can be arrived on the messages sent by the different services. A balanced decision is to be taken from the messages received across the services. To accomplish this, Hurwicz criterion is used to balance the optimistic and pessimistic views of the decision makers on different services. Grades of membership for the services are assessed using the non-functional Quality of Service parameters and have been estimated using fuzzy entropy measure which logically ranks the participant services. This approach for decision making is tested by varying the number of processes, varying the number of faulty services, varying the message values sent to different services and considering the variation in the views of the decision makers about the services. The experimental result shows that the decision reached is an enhanced one and in case of conflict, the proposed approach provides a concrete result, whereas decision taken using the Lamport’s algorithm is an arbitrary one.

  13. How well-run boards make decisions.

    Science.gov (United States)

    Useem, Michael

    2006-11-01

    In the aftermath of seismic debacles like those that toppled Enron and WorldCom, corporate boards have been shaken up and made over. More directors are independent these days, for instance, and corporations now disclose directors' salaries and committee members' names. Research shows that most of the changes are having a positive effect on companies' performance. They are primarily structural, though, and don't go to the heart of a board's work: making the choices that shape a firm's future. Which decisions boards own and how those calls are made are largely hidden from the public. As a result, boards are often unable to learn from the best governance practices of their counterparts at other companies. This article pulls back the curtain and provides an inside look. Drawing on interviews with board members and executives at 31 companies, along with a close examination of three boardroom decisions, the author identifies several formal processes that can help companies improve their decision making: creating calendars that specify when the board and the standing committees will consider key items; drafting charters that define the decisions committees are responsible for; and developing decision protocols that divvy up responsibilities between directors and executives. The author also identifies a number of informal decision-making principles: Items that are strategically significant and touch on the firm's core values should go to the board. Large decisions should be divided into small pieces, so the board can devote sufficient attention to each one. Directors must remain vigilant to ensure that their decisions are effectively implemented. The CEO and either the nonexecutive chair or the lead director should engage in ongoing dialogue regarding which decisions to take to the full board and when. And directors should challenge assumptions before making yes-or-no decisions on management proposals. PMID:17131569

  14. Staged decision making based on probabilistic forecasting

    Science.gov (United States)

    Booister, Nikéh; Verkade, Jan; Werner, Micha; Cranston, Michael; Cumiskey, Lydia; Zevenbergen, Chris

    2016-04-01

    Flood forecasting systems reduce, but cannot eliminate uncertainty about the future. Probabilistic forecasts explicitly show that uncertainty remains. However, as - compared to deterministic forecasts - a dimension is added ('probability' or 'likelihood'), with this added dimension decision making is made slightly more complicated. A technique of decision support is the cost-loss approach, which defines whether or not to issue a warning or implement mitigation measures (risk-based method). With the cost-loss method a warning will be issued when the ratio of the response costs to the damage reduction is less than or equal to the probability of the possible flood event. This cost-loss method is not widely used, because it motivates based on only economic values and is a technique that is relatively static (no reasoning, yes/no decision). Nevertheless it has high potential to improve risk-based decision making based on probabilistic flood forecasting because there are no other methods known that deal with probabilities in decision making. The main aim of this research was to explore the ways of making decision making based on probabilities with the cost-loss method better applicable in practice. The exploration began by identifying other situations in which decisions were taken based on uncertain forecasts or predictions. These cases spanned a range of degrees of uncertainty: from known uncertainty to deep uncertainty. Based on the types of uncertainties, concepts of dealing with situations and responses were analysed and possible applicable concepts where chosen. Out of this analysis the concepts of flexibility and robustness appeared to be fitting to the existing method. Instead of taking big decisions with bigger consequences at once, the idea is that actions and decisions are cut-up into smaller pieces and finally the decision to implement is made based on economic costs of decisions and measures and the reduced effect of flooding. The more lead-time there is in

  15. Use of ultrasonography to make management decisions

    Science.gov (United States)

    Transrectal ultrasonography has been available for making management decisions since the mid 1980’s. This technology allows for the real-time visualization of internal structures (i.e. ovary and fetus) that are otherwise difficult to evaluate. The use of this technology in making reproductive manag...

  16. Nonrational Processes in Ethical Decision Making

    Science.gov (United States)

    Rogerson, Mark D.; Gottlieb, Michael C.; Handelsman, Mitchell M.; Knapp, Samuel; Younggren, Jeffrey

    2011-01-01

    Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasi-legal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior,…

  17. Making better decisions in uncertain times (Invited)

    Science.gov (United States)

    St John, C.

    2013-12-01

    Scientific information about climate change and other human impacts on the environment are increasingly available and sought after (often in the form of probabilistic forecasts or technical information related to engineering solutions). However, it is increasingly apparent that there are barriers to the use of this information by decision makers - either from its lack of application altogether, its usability for people without scientific backgrounds, or its ability to inform sound decisions and widespread behavior change. While the argument has been made that an information deficit is to blame, we argue that there is also a motivation deficit contributing to a lack of understanding of information about climate change impacts and solutions. Utilizing insight from over thirty years of research in social and cognitive psychology, in addition to other social sciences, the Center for Research on Environmental Decisions (CRED) seeks to understand how people make environmental decisions under conditions of uncertainty, and how these decisions can be improved. This presentation will focus specifically on recent research that has come forth since the 2009 publication of CRED's popular guide 'The Psychology of Climate Change Communication: A Guide for Scientists, Journalists, Educators, Political Aides, and the Interested Public.' Utilizing case studies from real world examples, this talk will explore how decision making can be improved through a better understanding of how people perceive and process uncertainty and risk. It will explore techniques such as choice architecture and 'nudging' behavior change, how social goals and group participation affect decision making, and how framing of environmental information influences mitigative behavior.

  18. Living kidney donation; considerations and decision-making

    DEFF Research Database (Denmark)

    Agerskov, Hanne; Bistrup, Claus; Ludvigsen, Mette Spliid;

    2014-01-01

    professionals to meet and involve donors' narratives in reflections about and modifications to clinical nursing practice. It is essential that health care professionals have an understanding and appreciation of the experiences and concerns among LKDs, and this can help in planning and providing individual...... nursing care and support to donors....... interpretation theory on the three levels of naïve reading, structural analysis and critical interpretation and discussion. RESULTS: Two themes emerged: the decision-making process and dilemmas in decision-making. The study identifies that the decision about donation was made in relation to one's own life...

  19. Generating Decision Structures and Causal Explanations for Decision Making

    OpenAIRE

    Star, Spencer

    2013-01-01

    This paper examines two related problems that are central to developing an autonomous decision-making agent, such as a robot. Both problems require generating structured representafions from a database of unstructured declarative knowledge that includes many facts and rules that are irrelevant in the problem context. The first problem is how to generate a well structured decision problem from such a database. The second problem is how to generate, from the same database, a well-structured exp...

  20. On the Complexity of Decision Making in Possibilistic Decision Trees

    CERN Document Server

    Fargier, Helene; Guezguez, Wided

    2012-01-01

    When the information about uncertainty cannot be quantified in a simple, probabilistic way, the topic of possibilistic decision theory is often a natural one to consider. The development of possibilistic decision theory has lead to a series of possibilistic criteria, e.g pessimistic possibilistic qualitative utility, possibilistic likely dominance, binary possibilistic utility and possibilistic Choquet integrals. This paper focuses on sequential decision making in possibilistic decision trees. It proposes a complexity study of the problem of finding an optimal strategy depending on the monotonicity property of the optimization criteria which allows the application of dynamic programming that offers a polytime reduction of the decision problem. It also shows that possibilistic Choquet integrals do not satisfy this property, and that in this case the optimization problem is NP - hard.

  1. Acceptable regret in medical decision making.

    Science.gov (United States)

    Djulbegovic, B; Hozo, I; Schwartz, A; McMasters, K M

    1999-09-01

    When faced with medical decisions involving uncertain outcomes, the principles of decision theory hold that we should select the option with the highest expected utility to maximize health over time. Whether a decision proves right or wrong can be learned only in retrospect, when it may become apparent that another course of action would have been preferable. This realization may bring a sense of loss, or regret. When anticipated regret is compelling, a decision maker may choose to violate expected utility theory to avoid regret. We formulate a concept of acceptable regret in medical decision making that explicitly introduces the patient's attitude toward loss of health due to a mistaken decision into decision making. In most cases, minimizing expected regret results in the same decision as maximizing expected utility. However, when acceptable regret is taken into consideration, the threshold probability below which we can comfortably withhold treatment is a function only of the net benefit of the treatment, and the threshold probability above which we can comfortably administer the treatment depends only on the magnitude of the risks associated with the therapy. By considering acceptable regret, we develop new conceptual relations that can help decide whether treatment should be withheld or administered, especially when the diagnosis is uncertain. This may be particularly beneficial in deciding what constitutes futile medical care. PMID:10580533

  2. Decision Making Models and Tools to Support Strategic Decision Making - Case: Tarvekaluste Oy

    OpenAIRE

    Vuorinen, Jarkko

    2015-01-01

    The purpose of the study was to examine theories in decision making and de-cision making process and cultivate information about valid practices and tools to supplement the company’s decision making. The study was commissioned by Tarvekaluste Oy, a carpentry and joinery factory located in Kouvola. The information was gathered from books and journals and by interviews. The interview format was a semi-structured interview, and information was gathered interviewing the company management, C...

  3. Decision-making styles and their associations with decision-making competencies and mental health

    OpenAIRE

    Jozef Bavoľár; Oľga Orosová

    2015-01-01

    This study investigates the psychometric characteristics of the General Decision-Making Scale (GDMS) on a sample of Slovak high-school and university students. Secondly, it addresses the relationship between decision-making styles and a) decision making competencies and b) mental health as validity criteria. Participants were 427 Slovak high school and university students (64.6% females). The GDMS showed a good internal consistency and its original factor structure was co...

  4. Logical and Decisive Combining Criterion for Binary Group Decision Making

    Directory of Open Access Journals (Sweden)

    Ivan Vrana

    2010-04-01

    Full Text Available A new combining criterion, the Multiplicative Proportional Deviative Influence (MPDI is presented for combining or aggregating multi-expert numerical judgments in Yes-or-No type ill-structured group decision making situations. This newly proposed criterion performs well in comparison with the widely used aggregation means: the Arithmetic Mean (AM, and Geometric Mean (GM, especially in better reflecting the degree of agreement between criteria levels or numerical experts’ judgments. The MPDI can be considered as another class of combining criteria that make effect of the degree of agreement among multiple numerical judgments. The MPDI is applicable in integrating several collaborative or synergistic decision making systems through combining final numerical decision outputs. A discussion and generalization of the proposed MPDI is discussed withnumerical example.

  5. NASA Risk-Informed Decision Making Handbook

    Science.gov (United States)

    Dezfuli, Homayoon; Stamatelatos, Michael; Maggio, Gaspare; Everett, Christopher; Youngblood, Robert; Rutledge, Peter; Benjamin, Allan; Williams, Rodney; Smith, Curtis; Guarro, Sergio

    2010-01-01

    This handbook provides guidance for conducting risk-informed decision making in the context of NASA risk management (RM), with a focus on the types of direction-setting key decisions that are characteristic of the NASA program and project life cycles, and which produce derived requirements in accordance with existing systems engineering practices that flow down through the NASA organizational hierarchy. The guidance in this handbook is not meant to be prescriptive. Instead, it is meant to be general enough, and contain a sufficient diversity of examples, to enable the reader to adapt the methods as needed to the particular decision problems that he or she faces. The handbook highlights major issues to consider when making decisions in the presence of potentially significant uncertainty, so that the user is better able to recognize and avoid pitfalls that might otherwise be experienced.

  6. The primacy of conscious decision making

    OpenAIRE

    Shanks, D. R.; B.R. Newell

    2014-01-01

    The target article sought to question the common belief that our decisions are often biased by unconscious influences. While many commentators offer additional support for this perspective, others question our theoretical assumptions, empirical evaluations, and methodological criteria. We rebut in particular the starting assumption that all decision making is unconscious, and that the onus should be on researchers to prove conscious influences. Further evidence is evaluated in relati...

  7. Group decision making in meerkats (Suricata suricatta)

    OpenAIRE

    Bousquet, C A H

    2011-01-01

    Groups of social animals are common in nature and often remain cohesive despite variation in each member’s needs and optimal activity. How and why individuals coordinate themselves within groups has long been a puzzle for behavioural ecologists. Recently, theories on group decision-making have greatly advanced but there is still a lack of empirical evidence about the applicability and the generality of such theories in animals. Within my PhD project, I addressed questions on group decision ma...

  8. Decision making in child protection practice

    OpenAIRE

    Kelly, Nancy

    2000-01-01

    This research explores the decision making processes of individuals and groups engaged in child protection practice within social services departments in the UK. The emphasis of the research was to consider how the application of psychological theories and concepts might allow a descriptive and interpretative evaluation of decision processes in child protection practice. The research sought to elaborate upon much of previous social work literature in that it focused upon the pr...

  9. Improving Adolescent Judgment and Decision Making

    OpenAIRE

    Dansereau, Donald F.; Knight, Danica K.; Flynn, Patrick M.

    2013-01-01

    Human judgment and decision making (JDM) has substantial room for improvement, especially among adolescents. Increased technological and social complexity “ups the ante” for developing impactful JDM interventions and aids. Current explanatory advances in this field emphasize dual processing models that incorporate both experiential and analytic processing systems. According to these models, judgment and decisions based on the experiential system are rapid and stem from automatic reference to ...

  10. Embodied decision making and its neural substrate

    OpenAIRE

    Marcos Sanmart??n, Encarni

    2014-01-01

    Decisions are the result of a deliberative process that evaluates the suitability of specific options. Studies about decision making have been mainly conducted by using restricted tasks in which humans or animals are requested to discriminate between options. However, the influence that factors related to embodiment, such as motor cost, might have on this process has frequently been ignored. In this thesis, we adopt a combined experimental and theoretical approach to examine the effect that s...

  11. Decision making under uncertainty using imprecise probabilities.

    OpenAIRE

    Troffaes, M. C. M.

    2007-01-01

    Various ways for decision making with imprecise probabilities—admissibility, maximal expected utility, maximality, E-admissibility, Gamma-maximax, Gamma-maximin, all of which are well known from the literature—are discussed and compared. We generalise a well-known sufficient condition for existence of optimal decisions. A simple numerical example shows how these criteria can work in practice, and demonstrates their differences. Finally, we suggest an efficient approach to calculate optimal de...

  12. Decision making of vending machine users.

    Science.gov (United States)

    Verhoef, L W

    1988-06-01

    This article discusses two possible solutions to decision making about controls by users of vending machines: the 'one button to press' system (requiring a compound decision - the pressing of one button only); the 'several buttons to press' system (requiring a compound decision - the pressing of several buttons). The basis for the discussion is a field evaluation of a train ticket vending machine (TVM) that can sell 800 different types of tickets and can accept all kinds of payment. For this evaluation several hundred TVM users and ticket window users were observed and interviewed. Special attention was paid to the errors which were made. PMID:15676652

  13. Interference effects of categorization on decision making.

    Science.gov (United States)

    Wang, Zheng; Busemeyer, Jerome R

    2016-05-01

    Many decision making tasks in life involve a categorization process, but the effects of categorization on subsequent decision making has rarely been studied. This issue was explored in three experiments (N=721), in which participants were shown a face stimulus on each trial and performed variations of categorization-decision tasks. On C-D trials, they categorized the stimulus and then made an action decision; on X-D trials, they were told the category and then made an action decision; on D-alone trials, they only made an action decision. An interference effect emerged in some of the conditions, such that the probability of an action on the D-alone trials (i.e., when there was no explicit categorization before the decision) differed from the total probability of the same action on the C-D or X-D trials (i.e., when there was explicit categorization before the decision). Interference effects are important because they indicate a violation of the classical law of total probability, which is assumed by many cognitive models. Across all three experiments, a complex pattern of interference effects systematically occurred for different types of stimuli and for different types of categorization-decision tasks. These interference effects present a challenge for traditional cognitive models, such as Markov and signal detection models, but a quantum cognition model, called the belief-action entanglement (BAE) model, predicted that these results could occur. The BAE model employs the quantum principles of superposition and entanglement to explain the psychological mechanisms underlying the puzzling interference effects. The model can be applied to many important and practical categorization-decision situations in life. PMID:26896726

  14. Dynamical decision making in a genetic perceptron

    Science.gov (United States)

    Filicheva, Svetlana; Zaikin, Alexey; Kanakov, Oleg

    2016-04-01

    Decision making is an essential element of cell functioning, which determines milestones of its evolution including differentiation, apoptosis and possible transition to cancerous state. Recently the concept of stochastic resonance in decision making (SRIDM) was introduced, demonstrated and explained using a synthetic genetic classifier circuit as an example. It manifests itself as a maximum in the dependence of classification accuracy upon noise intensity, and was caused by the concurrent action of two factors, both coarsening the classification accuracy by themselves, but found to extenuate the effect of each other: perturbation of classifier threshold and additive noise in classifier inputs. In the present work we extend the SRIDM concept to dynamical decision making, in which a classifier keeps track of the changeable input. We reproduce the stochastic resonance effect caused by noise and threshold perturbation, and demonstrate a new mechanism of SRIDM, which is associated with bistability and not connected with threshold perturbation.

  15. Neural Basis of Strategic Decision Making.

    Science.gov (United States)

    Lee, Daeyeol; Seo, Hyojung

    2016-01-01

    Human choice behaviors during social interactions often deviate from the predictions of game theory. This might arise partly from the limitations in the cognitive abilities necessary for recursive reasoning about the behaviors of others. In addition, during iterative social interactions, choices might change dynamically as knowledge about the intentions of others and estimates for choice outcomes are incrementally updated via reinforcement learning. Some of the brain circuits utilized during social decision making might be general-purpose and contribute to isomorphic individual and social decision making. By contrast, regions in the medial prefrontal cortex (mPFC) and temporal parietal junction (TPJ) might be recruited for cognitive processes unique to social decision making. PMID:26688301

  16. {sup 13}N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Siegrist, Patrick T.; Husmann, Lars; Knabenhans, Martina; Gaemperli, Oliver; Valenta, Ines; Hoefflinghaus, Tobias [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Scheffel, Hans; Stolzmann, Paul; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); University Zurich, Center for Integrative Human Physiology, Zurich (Switzerland)

    2008-05-15

    The purpose of the study is to determine the impact of {sup 13}N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) on clinical decision making and its cost-effectiveness. One hundred consecutive patients (28 women, 72 men; mean age 60.9 {+-} 12.0 years; range 24-85 years) underwent {sup 13}N-ammonia PET scanning (and computed tomography, used only for attenuation correction) to assess myocardial perfusion in patients with known (n = 79) or suspected (n = 8) coronary artery disease (CAD), or for suspected small-vessel disease (SVD; n = 13). Before PET, the referring physician was asked to determine patient treatment if PET would not be available. Four weeks later, PET patient management was reassessed for each patient individually. Before PET management strategies would have been: diagnostic angiography (62 of 100 patients), diagnostic angiography and percutaneous coronary intervention (PCI; 6 of 100), coronary artery bypass grafting (CABG; 3 of 100), transplantation (1 of 100), or conservative medical treatment (28 of 100). After PET scanning, treatment strategies were altered in 78 patients leading to: diagnostic angiography (0 of 100), PCI (20 of 100), CABG (3 of 100), transplantation (1 of 100), or conservative medical treatment (76 of 100). Patient management followed the recommendations of PET findings in 97% of the cases. Cost-effectiveness analysis revealed lower costs of EUR206/patient as a result of PET scanning. In a population with a high prevalence of known CAD, PET is cost-effective and has an important impact on patient management. (orig.)

  17. Tools for Decision Making under Uncertainty

    Czech Academy of Sciences Publication Activity Database

    Sečkárová, Vladimíra

    Prague : MATFYZPRESS, 2011, s. 19-24. ISBN 978-80-7378-184-2. [20th Annual Conference of Doctoral Students - WDS 2011. Prague (CZ), 31.05.2011-03.06.2011] R&D Projects: GA MŠk 1M0572; GA ČR GA102/08/0567 Grant ostatní: UK SVV(CZ) 261315/2011 Institutional research plan: CEZ:AV0Z10750506 Keywords : decision making under uncertainty * information fusion Subject RIV: BD - Theory of Information http://library.utia.cas.cz/separaty/2012/AS/seckarova-tools for decision making under uncertainty.pdf

  18. On emotion specificity in decision making

    Directory of Open Access Journals (Sweden)

    Marcel Zeelenberg

    2008-01-01

    Full Text Available We present a motivational account of the impact of emotion on decision making, termed the feeling-is-for-doing approach. We first describe the psychology of emotion and argue for a need to be specific when studying emotion's impact on decision making. Next we describe what our approach entails and how it relates emotion, via motivation to behavior. Then we offer two illustrations of our own research that provide support for two important elements in our reasoning. We end with specifying four criteria that we consider to be important when studying how feeling guides our everyday doing.

  19. Shared decision making in endocrinology: present and future directions.

    Science.gov (United States)

    Rodriguez-Gutierrez, Rene; Gionfriddo, Michael R; Ospina, Naykky Singh; Maraka, Spyridoula; Tamhane, Shrikant; Montori, Victor M; Brito, Juan P

    2016-08-01

    In medicine and endocrinology, there are few clinical circumstances in which clinicians can accurately predict what is best for their patients. As a result, patients and clinicians frequently have to make decisions about which there is uncertainty. Uncertainty results from limitations in the research evidence, unclear patient preferences, or an inability to predict how treatments will fit into patients' daily lives. The work that patients and clinicians do together to address the patient's situation and engage in a deliberative dialogue about reasonable treatment options is often called shared decision making. Decision aids are evidence-based tools that facilitate this process. Shared decision making is a patient-centred approach in which clinicians share information about the benefits, harms, and burden of different reasonable diagnostic and treatment options, and patients explain what matters to them in view of their particular values, preferences, and personal context. Beyond the ethical argument in support of this approach, decision aids have been shown to improve patients' knowledge about the available options, accuracy of risk estimates, and decisional comfort. Decision aids also promote patient participation in the decision-making process. Despite accumulating evidence from clinical trials, policy support, and expert recommendations in endocrinology practice guidelines, shared decision making is still not routinely implemented in endocrine practice. Additional work is needed to enrich the number of available tools and to implement them in practice workflows. Also, although the evidence from randomised controlled trials favours the use of this shared decision making in other settings, populations, and illnesses, the effect of this approach has been studied in a few endocrine disorders. Future pragmatic trials are needed to explore the effect and feasibility of shared decision making implementation into routine endocrinology and primary care practice. With the

  20. The ethical decision making model in obstetrics and gynaecology practice

    OpenAIRE

    Nazimah Idris; Sivalingam Nalliah

    2014-01-01

    This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physicianeducators should be competent to use ethical d...

  1. Making decisions with unknown sensory reliability

    Directory of Open Access Journals (Sweden)

    SophieDeneve

    2012-06-01

    Full Text Available To make fast and accurate behavioural choices, we need to integrate the noisy sensory input, take into account prior knowledge, and adjust our decision criteria. It was shown previously that in a two alternative forced choice tasks, optimal decision making can be formalized in the framework of a sequential probability ratio test and is then equivalent to a diffusion model. However, this analogy hides a “chicken and egg” problem: To know how quickly we should integrate the sensory input and to set the optimal decision threshold, the reliability of the sensory observations has to be known in advance. Most of the time, we cannot know this reliability without first observing the decision outcome. We consider here a Bayesian decision model simultaneously inferring the probability of two different choice alternatives and estimating at the same time the reliability of the sensory information on which this choice is based. We show that this can be done within a single trial, based on the noisy responses of sensory spiking neurons. The resulting model is a non-linear diffusion to bound where the weight of the sensory inputs and the decision threshold are both dynamically changing over time. In difficult decision trials, sensory inputs early in the trial have a stronger impact on the decision, and the threshold collapse such that choices are made faster but with low accuracy. The reverse is true in easy trial: the sensory weight and the threshold increase over time, leading to slower decisions but at much higher accuracy. In contrast to standard diffusion model, adaptive sensory weights construct an accurate representation for the probability of each choice. This information can thus be appropriately combined with other unreliable cues, such as priors. We show that this model can account for recent findings in a motion discrimination task, and can be implemented in a neural architecture by fast Hebbian learning.

  2. Influence of extroversion and introversion on decision making ability

    OpenAIRE

    Rehana Khalil

    2016-01-01

    Background: Decision is defined as a choice that you make about something after thinking about several possibilities. Human decision making and judgment is readily observable in reality. The Personality trait that Influence Decision Making is usually missing from research of decision making. The current study is focused on the characteristics which stimulate the decision making behavior but is not concerned about what makes a decision good or bad.This study aimed to compare the differences in...

  3. ENTREPRENEURSHIP AS DECISION MAKING: RATIONAL, INTUITIVE AND IMPROVISATIONAL APPROACHES

    OpenAIRE

    Miguel Pina e Cunha

    2007-01-01

    In this paper entrepreneurship is presented as decision making. Mintzberg and Westley's (2001) decision making typology is adapted to the case of entrepreneurial decision making. These authors complemented the rational, step-by-step mode of decision making, with the intuitive and improvisational modes, Complementing the rational view of decision making with the analysis of entrepreneurship as intuitive or improvisational decision making, a richer and more integrated understanding of entrepren...

  4. Motivations Underlying Career Decision-Making Activities: The Career Decision-Making Autonomy Scale (CDMAS)

    Science.gov (United States)

    Guay, Frederic

    2005-01-01

    The purpose of the present research was to develop and validate a measure of motivation toward career decision-making activities, the Career Decision-Making Autonomy Scale (CDMAS). The CDMAS is designed to assess the constructs of intrinsic motivation, identified regulation, introjected regulation, and external regulation. A longitudinal study was…

  5. Should patients participate in clinical decision making? An optimised balance block design controlled study of goal setting in a rehabilitation unit

    OpenAIRE

    Holliday, R. C.; Cano, S; Freeman, J. A.; Playford, E. D.

    2007-01-01

    Objectives: The recent National Service Framework for Long Term Conditions recommends that patients participate more in decision making about their care. However, few protocols exist to support this. One potentially useful method is goal setting, but little has been done to evaluate the added value of increasing patient participation in this way. Therefore, this study examined the impact of an increased participation goal setting protocol in a neurorehabilitation setting.Design: The study was...

  6. Enhancing Decision Making Using Intelligent System Solution

    Directory of Open Access Journals (Sweden)

    Sushanta Kumar Panigrahi

    2011-01-01

    Full Text Available The development and deployment of managerial decision support system represents an emerging trend in the business and organizational field in which the increased application of Decision Support Systems (DSS can be compiling by Intelligent Systems (IS. Decision Support Systems (DSS are a specific class of computerized information system that supports business and organizational decision-making activities. A properly designed DSS is an interactive software-based system intended to help decision makers compile useful information from raw data, documents, personal knowledge, and/or business models to identify and solve problems and make decisions. Competitive business pressures and a desire to leverage existing information technology investments have led many firms to explore the benefits of intelligent data management solutions such as Particle Swarm Optimization (PSO. This technology is designed to help businesses to finding multi objective functions, which can help to understand the purchasing behavior of their key customers, detect likely credit card or insurance claim fraud, predict probable changes in financial markets, etc.

  7. Age Effects and Heuristics in Decision Making

    OpenAIRE

    Besedes, Tibor; Deck, Carey; Sarangi, Sudipta; Shor, Mikhael

    2010-01-01

    Using controlled experiments, we examine how individuals make choices when faced with multiple options. Choice tasks are designed to mimic the selection of health insurance, prescription drug, or retirement savings plans. In our experiment, available options can be objectively ranked allowing us to examine optimal decision making. First, the probability of a person selecting the optimal option declines as the number of options increases, with the decline being more pronounced for older subjec...

  8. Intelligent Information System to support decision making.

    Directory of Open Access Journals (Sweden)

    Kathrin Rodríguez Llanes

    2010-06-01

    Full Text Available Making decisions is complicated in a generalized way, the materials and humans resources of the entity we belong to depends on it, such as the fulfillment of its goals. But when the situations are complex, making decisions turns into a very difficult work, due to the great amount of aspects to consider when making the right choice. To make this efficiently the administration must to consult an important volume of information, which generally, is scattered and in any different formats. That’s why appears the need of developing software that crowd together all that information and be capable of, by using powerful search engines and process algorithms improve the good decisions making process. Considering previous explanation, a complete freeware developed product is proposed, this constitutes a generic and multi-platform solution, that using artificial intelligence techniques, specifically the cases based reasoning, gives the possibility to leaders of any institution or organism of making the right choice in any situation.With client-server architecture, this system is consumed from web as a service and it can be perfectly integrated with a management system or the geographic information system to facilitate the business process.

  9. Morality, Imagination and Human decision making

    Directory of Open Access Journals (Sweden)

    L.H. Human

    2001-08-01

    Full Text Available The authors of this article explore the possibility of using imagination instead of so-called objective truths in human decision making. They argue that imagination plays a role even if one operates with the objectivist view of morality. What now is needed is to elaborate on the role that imagination plays when humans have to make moral decisions, especially when they experience that they are lost, that they are in a state of aporia. In the approach suggested, one is forced to come to grips with the full complexity of one's situation. No easy, ultimately correct decision is presupposed. Instead, one is forced to take full responsibility both for the construction of alternative stories (and therefore alternative moralities and also for choosing the preferred story and its desired and undesired moral consequences.

  10. How expert advice influences decision making.

    Science.gov (United States)

    Meshi, Dar; Biele, Guido; Korn, Christoph W; Heekeren, Hauke R

    2012-01-01

    People often use expert advice when making decisions in our society, but how we are influenced by this advice has yet to be understood. To address this, using functional magnetic resonance imaging, we provided expert and novice advice to participants during an estimation task. Participants reported that they valued expert advice more than novice advice, and activity in the ventral striatum correlated with this valuation, even before decisions with the advice were made. When using advice, participants compared their initial opinion to their advisor's opinion. This comparison, termed the "opinion difference", influenced advice utilization and was represented in reward-sensitive brain regions. Finally, the left lateral orbitofrontal cortex integrated both the size of the opinion difference and the advisor's level of expertise, and average activity in this area correlated with mean advice utilization across participants. Taken together, these findings provide neural evidence for how advice engenders behavioral change during the decision-making process. PMID:23185425

  11. Decision Making: Between Rationality and Reality

    Directory of Open Access Journals (Sweden)

    Marko Polič

    2009-12-01

    Full Text Available Almost by definition decision-making is typical human activity, and therefore important psychological subject. The starting point of its classical conception within psychology could be traced back to economy and mathematic, with ideas of human as rational economic being, and conceptualising decision making as choice between two or more alternatives, and as such being a separate event in space and time. Already in fifties Herbert Simon challenged such a view with his concept of bounded rationality, emerging from the joint effect of internal limitations of the human mind, and the structure of external environments in which the mind operates. During the last decades with the shift to the real word situations where decisions are embedded in larger tasks, becoming so part of the study of action, the lost rational human appeared again as efficient creature in the complex environment. Gigerenzer showed how heuristics help in this process.

  12. Decision making dynamics in corporate boards

    Science.gov (United States)

    Battiston, Stefano; Bonabeau, Eric; Weisbuch, Gérard

    2003-05-01

    Members of boards of directors of large corporations who also serve together on an outside board, form the so-called interlock graph of the board and are assumed to have a strong influence on each others’ opinion. We here study how the size and the topology of the interlock graph affect the probability that the board approves a strategy proposed by the Chief Executive Officer. We propose a measure of the impact of the interlock on the decision making, which is found to be a good predictor of the decision dynamics outcome. We present two models of decision making dynamics, and we apply them to the data of the boards of the largest US corporations in 1999.

  13. Biometric and intelligent decision making support

    CERN Document Server

    Kaklauskas, Arturas

    2015-01-01

    This book presents different methods for analyzing the body language (movement, position, use of personal space, silences, pauses and tone, the eyes, pupil dilation or constriction, smiles, body temperature and the like) for better understanding people’s needs and actions, including biometric data gathering and reading. Different studies described in this book indicate that sufficiently much data, information and knowledge can be gained by utilizing biometric technologies. This is the first, wide-ranging book that is devoted completely to the area of intelligent decision support systems, biometrics technologies and their integrations. This book is designated for scholars, practitioners and doctoral and master’s degree students in various areas and those who are interested in the latest biometric and intelligent decision making support problems and means for their resolutions, biometric and intelligent decision making support systems and the theory and practice of their integration and the opportunities fo...

  14. Consumer Decision Making in a Global Context.

    Science.gov (United States)

    Lusby, Linda A.

    This document examines the underlying rationale for the development of a global approach in consumer studies. The concept of consumer ethics is discussed and the consumer decision-making process is placed within an ecosystem perspective of the marketplace. The model developed introduces educators, marketers, and consumers to a more global…

  15. New Paradoxes of Risky Decision Making

    Science.gov (United States)

    Birnbaum, Michael H.

    2008-01-01

    During the last 25 years, prospect theory and its successor, cumulative prospect theory, replaced expected utility as the dominant descriptive theories of risky decision making. Although these models account for the original Allais paradoxes, 11 new paradoxes show where prospect theories lead to self-contradiction or systematic false predictions.…

  16. Teaching Decision Making in Business Dynamics Course.

    Science.gov (United States)

    Rosas, Marilyn V.

    1981-01-01

    Teaching decision making in the classroom provides an excellent opportunity for students to clarify their feelings regarding problems that employers experience with entry-level employees. Some of these may include excessive absences, inappropriate dress, the effect of personal problems on job performance, and ethics in the work situation. (CT)

  17. Nature of Science and Decision-Making

    Science.gov (United States)

    Khishfe, Rola

    2012-01-01

    The study investigated the relationship of nature of science (NOS) instruction and students' decision-making (DM) related to a controversial socioscientific issue about genetically modified food. Participants were ninth-grade students in four intact sections (two regulars and two honors) in a public high school in the Midwest. All four groups were…

  18. Recent developemts in multiple criteria decision making

    Directory of Open Access Journals (Sweden)

    Z. Zionts

    2003-12-01

    Full Text Available Problems involving more than one criterion abound. To help in the solution of such problems, a field of management science and operations research known as multiple criteria decision making (MCDM has emerged to help solve such problems. In this paper we discuss some recent developments in this important field.

  19. Knowledge, responsibility, decision making and ignorance

    DEFF Research Database (Denmark)

    Huniche, Lotte

    2001-01-01

    closer look at genetic knowledge, responsibility and decision making, because these seem to be important issues in my field of study. I have added ignorance to the list in order to discuss a further aspect of dealing with hereditary disease. Interestingly, ignorance (understood both as being ignorant of...

  20. Hyperchaotic phenomena in dynamic decision making

    DEFF Research Database (Denmark)

    Thomsen, Jesper Skovhus; Mosekilde, Erik; Sterman, John David

    1992-01-01

    article is to show how the decision making behavior of real people in simulated corporate environments can lead to chaotic, hyperchaotic and higher-order hyperchaotic phenomena. Characteristics features of these complicated forms of behavior are analyzed with particular emphasis on an interesting form of...

  1. Libre courseware for Bayesian decision making

    Czech Academy of Sciences Publication Activity Database

    Suzdaleva, Evgenia

    2005-01-01

    Roč. 1, č. 2 (2005), s. 1-3. ISSN 1860-7470 Grant ostatní: Commission EU(XE) 110330-CP-1-2003-1-ES-MINERVA-M Institutional research plan: CEZ:AV0Z10750506 Keywords : software tools * education * decision making Subject RIV: JC - Computer Hardware ; Software

  2. Student decision making in large group discussion

    Science.gov (United States)

    Kustusch, Mary Bridget; Ptak, Corey; Sayre, Eleanor C.; Franklin, Scott V.

    2015-04-01

    It is increasingly common in physics classes for students to work together to solve problems and perform laboratory experiments. When students work together, they need to negotiate the roles and decision making within the group. We examine how a large group of students negotiates authority as part of their two week summer College Readiness Program at Rochester Institute of Technology. The program is designed to develop metacognitive skills in first generation and Deaf and hard-of-hearing (DHH) STEM undergraduates through cooperative group work, laboratory experimentation, and explicit reflection exercises. On the first full day of the program, the students collaboratively developed a sign for the word ``metacognition'' for which there is not a sign in American Sign Language. This presentation will focus on three aspects of the ensuing discussion: (1) how the instructor communicated expectations about decision making; (2) how the instructor promoted student-driven decision making rather than instructor-driven policy; and (3) one student's shifts in decision making behavior. We conclude by discussing implications of this research for activity-based physics instruction.

  3. Respecting Teachers' Diverse Decision-Making Systems.

    Science.gov (United States)

    Starnes, Bobby Ann

    1999-01-01

    Reflects on teachers' diverse decision-making systems. Matching teachers' beliefs, or frameworks, to the programs they are asked to use is crucial to success and sustainability. Incompatible programs and curricula that are forced on teachers will not succeed. Examples of "teacher-proof" programs illustrate this viewpoint. (CDS)

  4. Uncertainty as a parameter for decision making

    International Nuclear Information System (INIS)

    The uncertainty is a very important measure which can contribute to proper decision making. Another very important role of the uncertainty is that uncertainty is the measurable value which can be used as quality describing factor. Thus the uncertainty is very important for quality assurance of research process

  5. Decision making performance in obsessive compulsive disorder

    NARCIS (Netherlands)

    Nielen, MMA; Veltman, DJ; de Jong, R; Mulder, G; den Boer, JA

    2002-01-01

    Background: Neuro-imaging studies in OCD report the orbitofrontal cortex to be functionally abnormal. As these areas are presumed to be involved in decision making, studying this behavior in OCD may provide further insight into the cognitive deficits accompanying the disorder. Methods: Performance o

  6. Economics: Scarcity and Citizen Decision-Making.

    Science.gov (United States)

    Gilliard, June V.; Morton, John S.

    1981-01-01

    Maintaining that economics can contribute significantly to the achievement of citizenship education goals within the social studies program, this article offers information on concepts for analyzing economic policies, dealing with policy issues in the classroom, and understanding the relationship of scarcity to decision making. (DB)

  7. Career Decision-Making and Corporate Responsibility

    Science.gov (United States)

    Sainty, Rosemary

    2008-01-01

    This paper seeks to investigate the extent of influence of corporate (or organisational) responsibility on university students' career decision-making. It reports on a pilot study conducted at the University of Sydney which aims to: explore students' ethical, professional and social understanding regarding corporate responsibility; determine the…

  8. Emotion, decision-making and the brain

    NARCIS (Netherlands)

    Chang, L.J.; Sanfey, A.G.

    2008-01-01

    PURPOSE: Initial explorations in the burgeoning field of neuroeconomics have highlighted evidence supporting a potential dissociation between a fast automatic system and a slow deliberative controlled system. Growing research in the role of emotion in decision-making has attempted to draw parallels

  9. Decision Making and Systems Thinking: Educational Issues

    Science.gov (United States)

    Yurtseven, M. Kudret; Buchanan, Walter W.

    2016-01-01

    Decision making in most universities is taught within the conventional OR/MS (Operations Research/Management Science) paradigm. This paradigm is known to be "hard" since it is consisted of mathematical tools, and normally suitable for solving structured problems. In complex situations the conventional OR/MS paradigm proves to be…

  10. Study on Knowledge and Decision Making

    Czech Academy of Sciences Publication Activity Database

    Klimešová, Dana

    New York : Springer, 2008 - (Machado, J.; Pátkai, B.; Rudas, I.), s. 76-89 ISBN 978-1-4020-8677-9 Institutional research plan: CEZ:AV0Z10750506 Keywords : knowledge * decision making * GIS Subject RIV: EB - Genetics ; Molecular Biology

  11. Supporting Medical Decision Making with Argumentation Tools

    Science.gov (United States)

    Lu, Jingyan; Lajoie, Susanne P.

    2008-01-01

    This study investigated the collaborative decision-making and communicative discourse of groups of learners engaged in a simulated medical emergency in two conditions. In one condition subgroups used a traditional whiteboard (TW group) to document medical arguments on how to solve a medical emergency. In the other condition subgroups used…

  12. On individual neutrality and collective decision making

    OpenAIRE

    Zhu, Mu; Wang, Shangsi; Xin, Lu

    2012-01-01

    We derive a simple mathematical "theory" to show that two decision-making entities can work better together only if at least one of them is occasionally willing to stay neutral. This provides a mathematical "justification" for an age-old cliche among marriage counselors.

  13. Emerging Educational Institutional Decision-Making Matrix

    Science.gov (United States)

    Ashford-Rowe, Kevin H.; Holt, Marnie

    2011-01-01

    The "emerging educational institutional decision-making matrix" is developed to allow educational institutions to adopt a rigorous and consistent methodology of determining which of the myriad of emerging educational technologies will be the most compelling for the institution, particularly ensuring that it is the educational or pedagogical but…

  14. The Dynamics of Strategic Decision-Making

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Bresser, Rudi K. F.; Hallin, Carina Antonia

    Effective strategy-making in turbulent industries needs current insights that can inform ongoing decisions around adaptive strategic moves. Frontline employees involved in the daily business transactions are the first to see the subtle changes not otherwise observed by top managers. Top managemen....... We present an experiment to investigate these effects and discuss the implications for strategic response capabilities among firms....

  15. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance

    Directory of Open Access Journals (Sweden)

    Knutson Gary A

    2005-07-01

    Full Text Available Abstract Background Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. Methods Online database – Medline, CINAHL and MANTIS – and library searches for the time frame of 1970–2005 were done using the term "leg-length inequality". Results and Discussion Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1. The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches ~ 20 mm (~3/4". Conclusion Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.

  16. Errors in Aviation Decision Making: Bad Decisions or Bad Luck?

    Science.gov (United States)

    Orasanu, Judith; Martin, Lynne; Davison, Jeannie; Null, Cynthia H. (Technical Monitor)

    1998-01-01

    Despite efforts to design systems and procedures to support 'correct' and safe operations in aviation, errors in human judgment still occur and contribute to accidents. In this paper we examine how an NDM (naturalistic decision making) approach might help us to understand the role of decision processes in negative outcomes. Our strategy was to examine a collection of identified decision errors through the lens of an aviation decision process model and to search for common patterns. The second, and more difficult, task was to determine what might account for those patterns. The corpus we analyzed consisted of tactical decision errors identified by the NTSB (National Transportation Safety Board) from a set of accidents in which crew behavior contributed to the accident. A common pattern emerged: about three quarters of the errors represented plan-continuation errors, that is, a decision to continue with the original plan despite cues that suggested changing the course of action. Features in the context that might contribute to these errors were identified: (a) ambiguous dynamic conditions and (b) organizational and socially-induced goal conflicts. We hypothesize that 'errors' are mediated by underestimation of risk and failure to analyze the potential consequences of continuing with the initial plan. Stressors may further contribute to these effects. Suggestions for improving performance in these error-inducing contexts are discussed.

  17. A comparative study on clinical decision-making ability of baccalaureate nursing students from different colleges and universities%不同学校本科护生护理临床决策能力的比较研究

    Institute of Scientific and Technical Information of China (English)

    胡可芹; 蒋晓莲

    2010-01-01

    Objective To compare the clinical decision-making ability of baccalaureate nursing students from different colleges and universities and provide a basis for these schools to strengthen the cultivation of clinical decision-making ability. Methods The Instrument for Measuring the Clinical Decision-making Ability of Nursing Students was adopted to investigate baccalaureate nursing students from four colleges and universities in Sichuan Province who had completed 10 ~ 12 month clinical practice. Results Differences in clinical decision-making ability of baccalaureate nursing students existed among the four schools of Sichuan Province.The highest score was ( 94. 06 ± 5.09 ) and the lowest score was ( 89. 01 ± 5.68 ). The score between universities showed statistical differences( P <0. 05 ). Conclusions The clinical nursing decision-making ability of baccalaureate nursing students of the key university in Sichuan Province, authorized directly by the Ministry of Health, is generally better than that of ordinary universities and colleges. Nursing education in the key university in Sichuan Province is more beneficial to the cultivation of clinical nursing decision-making ability than that in ordinary universities and colleges.%目的 比较不同学校本科护生的护理临床决策能力,为加强护理本科生护理临床决策能力培养提供依据.方法 利用护理专业大学生临床决策能力测量工具对四川省4所大学2008年护理专业毕业实习1本科生进行问卷调查.结果 4所学校护生临床决策能力不同,最高得分(94.06±5.09)分,最低得分(89.01±5.68)分,学校之间得分差异有统计学意义(P<0.05).结论 四川省部属重点大学护生的临床决策能力高于普通院校护生,教学方法更有利于学生护理临床决策能力的培养.

  18. Using Cluster Analysis to Examine Husband-Wife Decision Making

    Science.gov (United States)

    Bonds-Raacke, Jennifer M.

    2006-01-01

    Cluster analysis has a rich history in many disciplines and although cluster analysis has been used in clinical psychology to identify types of disorders, its use in other areas of psychology has been less popular. The purpose of the current experiments was to use cluster analysis to investigate husband-wife decision making. Cluster analysis was…

  19. Bioethics for clinicians: 5. Substitute decision-making.

    OpenAIRE

    Lazar, N M; Greiner, G G; Robertson, G; Singer, P A

    1996-01-01

    Substitute decision-making is a means of making health care decisions on behalf of people who are incapable of making these decisions for themselves. It is based on the ethical principle of respect for autonomy. Substitute decision-making poses two main questions: Who-should make the decision for the incapable person, and, How should the decision be made? Because the applicable statutory and common law varies across Canada, clinicians should become familiar with the legal requirements of thei...

  20. Elucidating poor decision-making in a rat gambling task.

    Directory of Open Access Journals (Sweden)

    Marion Rivalan

    Full Text Available Although poor decision-making is a hallmark of psychiatric conditions such as attention deficit/hyperactivity disorder, pathological gambling or substance abuse, a fraction of healthy individuals exhibit similar poor decision-making performances in everyday life and specific laboratory tasks such as the Iowa Gambling Task. These particular individuals may provide information on risk factors or common endophenotypes of these mental disorders. In a rodent version of the Iowa gambling task--the Rat Gambling Task (RGT, we identified a population of poor decision makers, and assessed how these rats scored for several behavioral traits relevant to executive disorders: risk taking, reward seeking, behavioral inflexibility, and several aspects of impulsivity. First, we found that poor decision-making could not be well predicted by single behavioral and cognitive characteristics when considered separately. By contrast, a combination of independent traits in the same individual, namely risk taking, reward seeking, behavioral inflexibility, as well as motor impulsivity, was highly predictive of poor decision-making. Second, using a reinforcement-learning model of the RGT, we confirmed that only the combination of extreme scores on these traits could induce maladaptive decision-making. Third, the model suggested that a combination of these behavioral traits results in an inaccurate representation of rewards and penalties and inefficient learning of the environment. Poor decision-making appears as a consequence of the over-valuation of high-reward-high-risk options in the task. Such a specific psychological profile could greatly impair clinically healthy individuals in decision-making tasks and may predispose to mental disorders with similar symptoms.

  1. Entanglement production in quantum decision making

    International Nuclear Information System (INIS)

    The quantum decision theory introduced recently is formulated as a quantum theory of measurement. It describes prospect states represented by complex vectors of a Hilbert space over a prospect lattice. The prospect operators, acting in this space, form an involutive bijective algebra. A measure is defined for quantifying the entanglement produced by the action of prospect operators. This measure characterizes the level of complexity of prospects involved in decision making. An explicit expression is found for the maximal entanglement produced by the operators of multimode prospects.

  2. PSA as a tool for decision making

    International Nuclear Information System (INIS)

    The question on ''How safe is safe enough'' is being responded presently by deterministic criteria. Probabilistic criteria in support to more rational and less emotional decisions in regulatory and licensing issues, rationalization of resource allocation and research prioritization, among others, have a potential which is only marginally being explored. This paper discussed PSA limitations and proposes three areas for the use of PSA in decision making, namely: preventing accidents, mitigating accidents, and defining regulatory requirements. Current activities of the International Atomic Energy Agency in these areas are mentioned. PSA studies depict clearly the uncertainties and this is viewed as a positive aspect, which is unique to the use of probabilistic methods. (orig.)

  3. 临床药师在静脉药物配置中心批次决策中的作用%Role of clinical pharmacists in batches decision making in pharmacy intravenous admixture services

    Institute of Scientific and Technical Information of China (English)

    秦娜; 魏立伟

    2015-01-01

    Reasonable batch decision-making of pharmacy intravenous admixture services (PIVAS) is a prerequisite for clinical rational drug use in the intravenous infusion. Clinical pharmacists in Luoyang Orthopedics Traumatological Hospital PIVAS draw up intravenous infusion batch rule according to the rational use of drug principle, and take manual intervention in special cases, which make the clinical PIVAS infusion delivery batches more scientific and reasonable, the clinical pharmacists play a decisive role in batches decision making.%静脉药物配置中心合理的批次决策能有效保障临床静脉输液合理用药。河南省洛阳正骨医院临床药师根据合理用药原则,制定静脉输液批次规则,在特殊情况下进行人工干预,使临床输液配送批次更加科学合理。临床药师在批次决策中起到举足轻重的作用。

  4. Clinical Informatics Consult Service Positively Affects Some Clinical Decisions in the ICU. A Review of: Mulvaney, Shelagh A., Leonard Bickman, Nunzia B. Giuse, Warren E. Lambert, Nila A. Sathe, and Rebecca N. Jerome." A Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge Implementation." Journal of the American Medical Informatics Association 15.2 (2008): 203-11.

    OpenAIRE

    Jennifer Kelson

    2009-01-01

    Objective – To determine whether the provision of synthesized research evidence provided by the Clinical Informatics Consult Service (CICS) affects the clinical decision-making of clinicians working in intensive care units (ICUs).Design – Non-blinded randomized control effectiveness trial.Setting – ICUs in United States-based 658 bed university hospital providing tertiary care for adults and children.Subjects – Clinical staff working within one of four ICUs who submitted a request for clinica...

  5. Evacuation decision-making: process and uncertainty

    International Nuclear Information System (INIS)

    The purpose was to describe the processes of evacuation decision-making, identify and document uncertainties in that process and discuss implications for federal assumption of liability for precautionary evacuations at nuclear facilities under the Price-Anderson Act. Four major categories of uncertainty are identified concerning the interpretation of hazard, communication problems, perceived impacts of evacuation decisions and exogenous influences. Over 40 historical accounts are reviewed and cases of these uncertainties are documented. The major findings are that all levels of government, including federal agencies experience uncertainties in some evacuation situations. Second, private sector organizations are subject to uncertainties at a variety of decision points. Third, uncertainties documented in the historical record have provided the grounds for liability although few legal actions have ensued. Finally it is concluded that if liability for evacuations is assumed by the federal government, the concept of a ''precautionary'' evacuation is not useful in establishing criteria for that assumption. 55 refs., 1 fig., 4 tabs

  6. The ethical decision making model in obstetrics and gynaecology practice

    Directory of Open Access Journals (Sweden)

    Nazimah Idris

    2014-01-01

    Full Text Available This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physicianeducators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.

  7. Decision Making in a Joint Doctoral Program in Educational Leadership

    Science.gov (United States)

    Vieth, Robert C.

    2007-01-01

    This article explores the decision making in developing and starting a partnership between three universities using the decision-making models developed by Graham Allison in 1971 and updated in 1999. University partnerships are complicated and require more than one decision-making model to explain all the significant decisions that are make in…

  8. Evolutionary Perspective on Collective Decision Making

    Science.gov (United States)

    Farrell, Dene; Sayama, Hiroki; Dionne, Shelley D.; Yammarino, Francis J.; Wilson, David Sloan

    Team decision making dynamics are investigated from a novel perspective by shifting agency from decision makers to representations of potential solutions. We provide a new way to navigate social dynamics of collective decision making by interpreting decision makers as constituents of an evolutionary environment of an ecology of evolving solutions. We demonstrate distinct patterns of evolution with respect to three forms of variation: (1) Results with random variations in utility functions of individuals indicate that groups demonstrating minimal internal variation produce higher true utility values of group solutions and display better convergence; (2) analysis of variations in behavioral patterns within a group shows that a proper balance between selective and creative evolutionary forces is crucial to producing adaptive solutions; and (3) biased variations of the utility functions diminish the range of variation for potential solution utility, leaving only the differential of convergence performance static. We generally find that group cohesion (low random variation within a group) and composition (appropriate variation of behavioral patterns within a group) are necessary for a successful navigation of the solution space, but performance in both cases is susceptible to group level biases.

  9. Sequential evidence accumulation in decision making

    Directory of Open Access Journals (Sweden)

    Daniel Hausmann

    2008-03-01

    Full Text Available Judgments and decisions under uncertainty are frequently linked to a prior sequential search for relevant information. In such cases, the subject has to decide when to stop the search for information. Evidence accumulation models from social and cognitive psychology assume an active and sequential information search until enough evidence has been accumulated to pass a decision threshold. In line with such theories, we conceptualize the evidence threshold as the ``desired level of confidence'' (DLC of a person. This model is tested against a fixed stopping rule (one-reason decision making and against the class of multi-attribute information integrating models. A series of experiments using an information board for horse race betting demonstrates an advantage of the proposed model by measuring the individual DLC of each subject and confirming its correctness in two separate stages. In addition to a better understanding of the stopping rule (within the narrow framework of simple heuristics, the results indicate that individual aspiration levels might be a relevant factor when modelling decision making by task analysis of statistical environments.

  10. Multistable binary decision making on networks

    CERN Document Server

    Lucas, Andrew

    2012-01-01

    We propose a simple model for a binary decision making process on a graph, motivated by modeling social decision making with cooperative individuals. The model is similar to a random field Ising model or fiber bundle model, but with key differences on heterogeneous networks. For many types of disorder and interactions between the nodes, we predict discontinuous phase transitions with mean field theory which are largely independent of network structure. We show how these phase transitions can also be understood by studying microscopic avalanches, and describe how network structure enhances fluctuations in the distribution of avalanches. We suggest theoretically the existence of a "glassy" spectrum of equilibria associated with a typical phase, even on infinite graphs, so long as the first moment of the degree distribution is finite. This behavior implies that the model is robust against noise below a certain scale, and also that phase transitions can switch from discontinuous to continuous on networks with too...

  11. Distributed Bayesian Decision Making: Early Experiments

    Czech Academy of Sciences Publication Activity Database

    Šmídl, Václav; Andrýsek, Josef

    Praha : ÚTIA AV ČR, 2006 - (Šmídl, V.; Přikryl, J.; And rýsek, J.), s. 245-255 ISBN 80-903834-1-6. [International PhD Workshop on Interplay of Societal and Technical Decision-Making, Young Generation Viewpoint /7./. Hrubá Skála (CZ), 25.09.2006-30.09.2006] R&D Projects: GA MŠk 1M0572; GA AV ČR 1ET100750401 Institutional research plan: CEZ:AV0Z10750506 Keywords : distributed decision making * Bayesian approach Subject RIV: BC - Control Systems Theory http://as.utia.cz/publications/2006/SmiAnd_06.pdf

  12. Ethical decision-making in forensic psychology

    Directory of Open Access Journals (Sweden)

    M. Swanepoel

    2010-07-01

    Full Text Available The purpose of this article is to develop a comprehensive process for identifying and addressing primarily ethical issues related to the psychology profession in South Africa. In fulfilling this purpose, research was conducted of relevant ethical and to a lesser extent, legal aspects pertaining to the psychology profession. In an attempt to prevent unprofessional conduct claims against psychologists from succeeding and to alert psychologists to the concurrent ethical problems that may lead to malpractice suits, this article offers material on some important issues – in the context of forensic psychology – such as ethical decision-making and principles, professional ethics, the regulation of psychology as a profession, the Ethical Code of Professional Conduct to which a psychologist should adhere, ethical aspects and issues pertaining to forensic psychology in general, some ethical issues pertaining to child forensic psychology, summary guidelines for ethical decision-making and some steps to follow to ensure sound ethical decisionmaking.

  13. Decision making in the manufacturing environment using graph theory and fuzzy multiple attribute decision making methods

    CERN Document Server

    Rao, Ravipudi Venkata

    2007-01-01

    Manufacturing is the backbone of any industrialized nation. Recent worldwide advances in manufacturing technologies have brought about a metamorphism in the industry. Fast-changing technologies on the product front have created a need for an equally fast response from manufacturing industries. To meet these challenges, manufacturing industries have to select appropriate manufacturing strategies, product designs, manufacturing processes, work piece and tool materials, and machinery and equipment. The selection decisions are complex as decision making is more challenging today. Decision makers i

  14. The Cumulative Prospect Theory and Managerial Decision Making

    OpenAIRE

    2004-01-01

    Can managerial decision making be predicted? Why would we want to predict managerial decision making? Managerial job is largely that of making decisions. In order to be successful, those decisions have to be right. In this article authors investigate if the cumulative prospect theory is applicable to managerial decision making and describe some divergent views about the theory. They also explore risk perception under the influence of decision framing. Risk propensity too is explored as it is ...

  15. Leadership of risk decision making in a complex, technology organization: The deliberative decision making model

    Science.gov (United States)

    Flaming, Susan C.

    2007-12-01

    The continuing saga of satellite technology development is as much a story of successful risk management as of innovative engineering. How do program leaders on complex, technology projects manage high stakes risks that threaten business success and satellite performance? This grounded theory study of risk decision making portrays decision leadership practices at one communication satellite company. Integrated product team (IPT) leaders of multi-million dollar programs were interviewed and observed to develop an extensive description of the leadership skills required to navigate organizational influences and drive challenging risk decisions to closure. Based on the study's findings the researcher proposes a new decision making model, Deliberative Decision Making, to describe the program leaders' cognitive and organizational leadership practices. This Deliberative Model extends the insights of prominent decision making models including the rational (or classical) and the naturalistic and qualifies claims made by bounded rationality theory. The Deliberative Model describes how leaders proactively engage resources to play a variety of decision leadership roles. The Model incorporates six distinct types of leadership decision activities, undertaken in varying sequence based on the challenges posed by specific risks. Novel features of the Deliberative Decision Model include: an inventory of leadership methods for managing task challenges, potential stakeholder bias and debates; four types of leadership meta-decisions that guide decision processes, and aligned organizational culture. Both supporting and constraining organizational influences were observed as leaders managed major risks, requiring active leadership on the most difficult decisions. Although the company's engineering culture emphasized the importance of data-based decisions, the uncertainties intrinsic to satellite risks required expert engineering judgment to be exercised throughout. An investigation into

  16. Rational group decision making in risk situations

    International Nuclear Information System (INIS)

    Risk management has received increasing attention recently as methods of quantifying risk have been evolving. This is considered a legitimate tendency in the context of the entirety of risk evaluation which connotes both risk quantification and decisions making thereon. A risk-free society does not appear possible; neither could one have zero competing risks or cost versus benefit resulting out of a risk-abatement effort. What further complicates the risk-decision problem is that there exists more than a single decision maker, who claim their own interests associated with risk decision. Furthermore, their risk perceptions are not at all same that the threshold risk levels for a particular actions are varying. In this dissertation, a brief survey on existing action levels for various sort of risk situations including carcinogens, toxic chemicals, etc., is reported on, with emphasis on nuclear risk situation. A decision theoretic approach is then adopted in both individual and group-level risk management. For the purpose of exemplification, multiplicative utility theory is applied for nuclear power risk; attributes derived for this specific purpose are discussed

  17. Implementing Participatory Decision Making in Forest Planning

    Science.gov (United States)

    Ananda, Jayanath

    2007-04-01

    Forest policy decisions are often a source of debate, conflict, and tension in many countries. The debate over forest land-use decisions often hinges on disagreements about societal values related to forest resource use. Disagreements on social value positions are fought out repeatedly at local, regional, national, and international levels at an enormous social cost. Forest policy problems have some inherent characteristics that make them more difficult to deal with. On the one hand, forest policy decisions involve uncertainty, long time scales, and complex natural systems and processes. On the other hand, such decisions encompass social, political, and cultural systems that are evolving in response to forces such as globalization. Until recently, forest policy was heavily influenced by the scientific community and various economic models of optimal resource use. However, growing environmental awareness and acceptance of participatory democracy models in policy formulation have forced the public authorities to introduce new participatory mechanisms to manage forest resources. Most often, the efforts to include the public in policy formulation can be described using the lower rungs of Arnstein’s public participation typology. This paper presents an approach that incorporates stakeholder preferences into forest land-use policy using the Analytic Hierarchy Process (AHP). An illustrative case of regional forest-policy formulation in Australia is used to demonstrate the approach. It is contended that applying the AHP in the policy process could considerably enhance the transparency of participatory process and public acceptance of policy decisions.

  18. Women's Hysterectomy Experiences and Decision-Making

    OpenAIRE

    Uskul, Ayse K.; Ahmad, Farah; Leyland, Nicholas A.; Stewart, Donna E.

    2003-01-01

    The goal of the study was to examine women's experiences with gynaecologic symptoms and how they decided to undergo hysterectomy. For this purpose, twenty-nine women were interviewed in hospital within three days of undergoing hysterectomy. The interviews elicited information about the nature of the problem that caused the women to seek medical help, actions taken to solve their problem, their relationship with their gynaecologist, information seeking patterns and decision-making about hyster...

  19. Role of conflict in decision making

    International Nuclear Information System (INIS)

    In the siting process for a low-level waste disposal facility, there is a place for conflict, negotiation, arbitration, and public involvement. Contrary to popular belief, conflict is good. It signals pluralism and demonstrates a distribution of power. Conflict should not be eliminated because it is a dynamic method of decision-making. Conflict causes negotiation, which leads to compromise. Conflict is the product of the legitimacy of dissent

  20. International students' decision-making process

    OpenAIRE

    Sánchez, Joaquín; Cerviño, Julio

    2006-01-01

    Purpose – The purpose of this paper is to propose a theoretical model that integrates the different groups of factors which influence the decision-making process of international students, analysing different dimensions of this process and explaining those factors which determine students’ choice. Design/methodology/approach – A hypothetical model is presented which shows the purchase intention as an independent variable dependent on five factors: personal reasons; the effect of c...

  1. Rock Slopes from Mechanics to Decision Making

    OpenAIRE

    Einstein, H.H.; Sousa, R.L.; Karam, K.; Manzella, Irène; Kveldsvik, V.

    2010-01-01

    Rock slope instabilities are discussed in the context of decision making for risk assessment and management. Hence, the state of the slope and possible failure mechanism need to be defined first. This is done with geometrical and mechanical models for which recent developments are presented. This leads with appropriate consideration of uncertainties to risk determination and to the description of tools for risk management through active and passive countermeasures, including warning systems. ...

  2. Collaborative Platforms Aid Emergency Decision Making

    Science.gov (United States)

    2013-01-01

    Terra. Aqua. Cloudsat. Landsat. NASA runs and partners in many missions dedicated to monitoring the Earth, and the tools used in these missions continuously return data on everything from shifts in temperature to cloud formation to pollution levels over highways. The data are of great scientific value, but they also provide information that can play a critical role in decision making during times of crisis. Real-time developments in weather, wind, ocean currents, and numerous other conditions can have a significant impact on the way disasters, both natural and human-caused, unfold. "NASA has long recognized the need to make its data from real-time sources compatible and accessible for the purposes of decision making," says Michael Goodman, who was Disasters Program manager at NASA Headquarters from 2009-2012. "There are practical applications of NASA Earth science data, and we d like to accelerate the use of those applications." One of the main obstacles standing in the way of eminently practical data is the fact that the data from different missions are collected, formatted, and stored in different ways. Combining data sets in a way that makes them useful for decision makers has proven to be a difficult task. And while the need for a collaborative platform is widely recognized, very few have successfully made it work. Dave Jones, founder and CEO of StormCenter Communications Inc., which consults with decision makers to prepare for emergencies, says that "when I talk to public authorities, they say, If I had a nickel for every time someone told me they had a common operating platform, I d be rich. But one thing we ve seen over the years is that no one has been able to give end users the ability to ingest NASA data sets and merge them with their own."

  3. PSA, subjective probability and decision making

    International Nuclear Information System (INIS)

    PSA is the natural way to making decisions in face of uncertainty relative to potentially dangerous plants; subjective probability, subjective utility and Bayes statistics are the ideal tools for carrying out a PSA. This paper reports that in order to support this statement the various stages of the PSA procedure are examined in detail and step by step the superiority of Bayes techniques with respect to sampling theory machinery is proven

  4. Economic Evaluation Enhances Public Health Decision Making

    OpenAIRE

    Rabarison, Kristina M.; Connie L. Bish; Massoudi, Mehran S.; Giles, Wayne H.

    2015-01-01

    Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking “how do investments in public health strategies influence or offset the need for downstream spending on medical ...

  5. Stakeholder Risk Management in Ethical Decision Making

    OpenAIRE

    Lauesen, Linne Marie

    2013-01-01

    Stakeholder management has for the last three decades been concerned either with strategic business management or business ethics, values and quality. Many models have been developed, but recently the literature asks for more dynamic models instead of the staticism that characterizes some models. This paper offers an ‘Organic Stakeholder Model’ based on decision making theory, risk assessment and adaption to a rapidly changing world combined with appropriate stakeholder theory for ethical pur...

  6. The physics of bacterial decision making

    OpenAIRE

    Ben-Jacob, Eshel; Lu, Mingyang; Schultz, Daniel; Onuchic, Jose N.

    2014-01-01

    The choice that bacteria make between sporulation and competence when subjected to stress provides a prototypical example of collective cell fate determination that is stochastic on the individual cell level, yet predictable (deterministic) on the population level. This collective decision is performed by an elaborated gene network. Considerable effort has been devoted to simplify its complexity by taking physics approaches to untangle the basic functional modules that are integrated to form ...

  7. Factors Influencing Korean Consumers' Ethical Decision Making

    OpenAIRE

    Jungbok Ha

    2013-01-01

    Ethics studies in business are more popular and their importance is also recognized more than ever. This conceptual study tries to shade light on consumer ethics study especially in cross-cultural context. Based on previous consumer ethics study, factors such as Hofstede's four dimensional cultural typology, Moral Philosophies and Machiavellianism, influencing consumer ethics decision making were identified and several propositions were formulated regarding to these factors.

  8. Understanding the Female Consumers’ Decision Making Styles

    OpenAIRE

    Yeşilada, Figen; Kavas, Alican

    2008-01-01

    Understanding consumer decision making styles is vital for companies in developing the appropriate marketing strategies to best satisfy their target groups. Many studies have been conducted on the issue using the Consumer Styles Inventory (CSI) in different cultural settings conducted mostly on student samples. This study aims to test the transferability of the CSI to the Cypriot context through working with a sample drawn from adult female consumers living in the northern part of the island....

  9. Decision making about nuclear energy, ch. 2

    International Nuclear Information System (INIS)

    A survey is given of the various influences on the process of making decisions at the governmental level in the Netherlands on nuclear power, covering the last 20 years. The conflicting statements in memoranda, the role of the industry, the lack of public information and the coloured information generated by different ministries as an answer to extra-parliamentary opposition to nuclear power, are in turn put into focus

  10. Simplifying decision making: a practical framework

    OpenAIRE

    Chaudhry, Muhammad Shirjeel Riaz; Sidek, Mohmad Safhree

    2014-01-01

    Approved for public release; distribution is unlimited This thesis proposes a decision-making model based on PESTEL (Political, Economic, Social, Technological, Environmental, and Legal) analysis, AHP (Analytical Hierarchical Process), and game theory. The case study used to demonstrate the concept is a 2013 Malaysian crisis wherein foreign intruders occupied a village in Sabah state. The Malaysian government, ultimately, launched a military operation to clear the area. The focus of our st...

  11. Effects of mood on risky decision making

    OpenAIRE

    Kwok, Fong-pui; 郭舫貝

    2014-01-01

    There is increasing evidence supporting the Affect Infusion Model (AIM), which accounts for the role of affect processing in social judgments. Based on the AIM, the study examined the role of mood states in making risky decisions. Forty female Chinese adults from Hong Kong were recruited for this study. A mood induction procedure was applied before they engaged in the experimental task. On random assignment, each subject was induced either a positive (Happy group), or negative mood (Sad group...

  12. Participation in Decision Making In School Management

    OpenAIRE

    Göksoy, Süleyman

    2014-01-01

    The purpose of this research is to reveal the extent of teacher incorporation in decision-making process in schools decided by school managers. The research was carried out with phenomenologik method of qualitative research methods and the data were collected through interview form. Purposive sampling and maximum variation sampling of purposive sampling methods were applied in the determination of the sample group. The data of the research was collected through semistructured interview form d...

  13. Decision Making in Patients with Pulmonary Nodules

    OpenAIRE

    Ost, David E.; Gould, Michael K.

    2012-01-01

    Integrating current evidence with fundamental concepts from decision analysis suggests that management of patients with pulmonary nodules should begin with estimating the pretest probability of cancer from the patient's clinical risk factors and computed tomography characteristics. Then, the consequences of treatment should be considered, by comparing the benefits of surgery if the patient has lung cancer with the potential harm if the patient does not have cancer. This analysis determines th...

  14. Policy issues in radiological protection decision making

    International Nuclear Information System (INIS)

    The societal aspects of risk governance are increasingly becoming a part of public decision-making processes. This tendency is particularly evident in matters dealing with the protection of human health and the environment. The NEA Committee on Radiation Protection and Public Health (CRPPH) organised a workshop to probe stakeholder involvement processes and their limitations in the field of radiation protection. An example of an area in which stakeholder involvement is particularly important is the clean-up of sites contaminated by accidents or by past industrial or research activities. Based on discussions during the workshop and previous CRPPH work in this area, this summary addresses the policy development and implementation issues that are key to identifying broadly accepted solutions for radiological protection situations in which stakeholders are an important part of the decision-making process. Applicable in a wide variety of national contexts, enhanced understanding of these policy issues will assist governments and regulatory authorities in better integrating stakeholder concerns in decision making. (author)

  15. Dopamine and Effort-Based Decision Making

    Directory of Open Access Journals (Sweden)

    IrmaTriasihKurniawan

    2011-06-01

    Full Text Available Motivational theories of choice focus on the influence of goal values and strength of reinforcement to explain behavior. By contrast relatively little is known concerning how the cost of an action, such as effort expended, contributes to a decision to act. Effort-based decision making addresses how we make an action choice based on an integration of action and goal values. Here we review behavioral and neurobiological data regarding the representation of effort as action cost, and how this impacts on decision making. Although organisms expend effort to obtain a desired reward there is a striking sensitivity to the amount of effort required, such that the net preference for an action decreases as effort cost increases. We discuss the contribution of the neurotransmitter dopamine (DA towards overcoming response costs and in enhancing an animal’s motivation towards effortful actions. We also consider the contribution of brain structures, including the basal ganglia (BG and anterior cingulate cortex (ACC, in the internal generation of action involving a translation of reward expectation into effortful action.

  16. Decision making on decision making : deciding governance in higher education in Serbia 2002-2005

    OpenAIRE

    2010-01-01

    Abstract This study analyses the decision making process which lies behind the drafting of the current legal framework regulating higher education system-level and institutional-level governance in Serbia. The research places particular focus on the relationship between the main actors in the process, namely the state, the academic community and the students, and looks into the logic of their actions, while also exploring the external factors which affected the decision making. The fundame...

  17. Climate Information Needs for Financial Decision Making

    Energy Technology Data Exchange (ETDEWEB)

    Higgins, Paul [American Meteorological Society, Washington, DC (United States)

    2013-11-19

    Climate Information Needs for Financial Decision Making (Final Report) This Department of Energy workshop award (grant #DE-SC0008480) provided primary support for the American Meteorological Society’s study on climate information needs for financial decision making. The goal of this study was to help advance societal decision making by examining the implications of climate variability and change on near-term financial investments. We explored four key topics: 1) the conditions and criteria that influence returns on investment of major financial decisions, 2) the climate sensitivity of financial decisions, 3) climate information needs of financial decision makers, and 4) potential new mechanisms to promote collaboration between scientists and financial decision makers. Better understanding of these four topics will help scientists provide the most useful information and enable financial decision makers to use scientific information most effectively. As a result, this study will enable leaders in business and government to make well-informed choices that help maximize long-term economic success and social wellbeing in the United States The outcomes of the study include a workshop, which brought together leaders from the scientific and financial decision making communities, a publication of the study report, and a public briefing of the results to the policy community. In addition, we will present the results to the scientific community at the AMS Annual Meeting in February, 2014. The study results were covered well by the media including Bloomberg News and E&E News. Upon request, we also briefed the Office of Science Technology Policy (OSTP) and the Council on Environmental Quality (CEQ) on the outcomes. We presented the results to the policy community through a public briefing in December on Capitol Hill. The full report is publicly available at www.ametsoc.org/cin. Summary of Key Findings The United States invests roughly $1.5 trillion U.S. dollars (USD) in

  18. Incorporating environmental justice into environmental decision making

    Energy Technology Data Exchange (ETDEWEB)

    Wolfe, A.K.; Vogt, D.P.; Hwang, Ho-Ling [Oak Ridge National Lab., TN (United States)] [and others

    1995-07-01

    Executive Order 12898, signed on February 11, 1994, broadly states that federal activities, programs, and policies should not produce disproportionately high and adverse impacts on minority and low-income populations. Moreover, the Order indicates that these populations should not be denied the benefits of, or excluded from participation in, these activities, programs, and policies. Because a presidential memorandum accompanying the order said that National Environmental Policy Act (NEPA) documents should begin to address environmental justice immediately, much attention has been paid to assessment-related issues. Also important, a topic that appears to have received relatively little attention, is how decision makers should be expected to use information about environmental justice in their decision making. This paper discusses issues surrounding the use of environmental justice information in the decision-making process by focusing on the following five main topics: (1) the importance, or weight, attached to environmental justice within larger decision-making contexts; (2) the potential tension between localized environmental justice issues and regional or national issues and needs; (3) the use of environmental justice information to develop (perhaps in concert with affected minority and low-income communities) appropriate mitigation strategies, or to establish conditions under which activities, programs, and policies may be accepted locally; (4) the general implications of shifting the distribution of broadly defined risks, costs, and benefits among different population groups; and (5) the implications of implementing environmental justice on an individual, ad hoc basis rather than within a larger environmental justice framework. This paper raises the issues and discusses the implications of alternative approaches to them.

  19. Neural network decision support system for effective decision making in the decision to bid process

    OpenAIRE

    Parvar, Jamshid; Lowe, David; Emsley, Margaret

    2002-01-01

    Important factors in the decision to bid process are identified. A rational and optimal model of decision making for the decision to bid process, which depicts the relationships between these factors and the decision to bid options, is developed. Regression models and neural networks approach are employed to automate the rational and optimal model. Prototyping system development methodology is used as the neural networks system development. The neural networks approach in addition to the abil...

  20. [HEALTH ECONOMIC ANALYSIS AND FAIR DECISION MAKING].

    Science.gov (United States)

    Jeantet, Marine; Lopez, Alain

    2015-09-01

    Health technology assessment consists in evaluating the incremental cost-benefit ratio of a medicine, a medical device, a vaccine, a health strategy, in comparison to alternative health technologies. This form of socio-eoonomic evaluation aims at optimizing resource allocation within the health system. By setting the terms of valid alternatives, it is useful to highlight public choices, but it cannot in itself make the decision as regards the public funding of patient's access to the considered technology. The decision to include such technology in the basket of health goods and sercices covered, the levels and conditions of the coverage, also result from budget constraints, from economic situation and from a political vision about health policy, social protection and public expenditure. Accordingly, health economic analysis must be implemented on specific and targeted topics. The decision making process, with its health, economic and ethical stakes, calls for a public procedure and debate, based on shared information and argument. Otherwise, health system regulation, confronted with radical and costly innovations in the coming years, will become harder to handle. This requires the development of health economic research teams able to contribute to this assessment exercise. PMID:26619723

  1. Improving Adolescent Judgment and Decision Making.

    Science.gov (United States)

    Dansereau, Donald F; Knight, Danica K; Flynn, Patrick M

    2013-01-01

    Human judgment and decision making (JDM) has substantial room for improvement, especially among adolescents. Increased technological and social complexity "ups the ante" for developing impactful JDM interventions and aids. Current explanatory advances in this field emphasize dual processing models that incorporate both experiential and analytic processing systems. According to these models, judgment and decisions based on the experiential system are rapid and stem from automatic reference to previously stored episodes. Those based on the analytic system are viewed as slower and consciously developed. These models also hypothesize that metacognitive (self-monitoring) activities embedded in the analytic system influence how and when the two systems are used. What is not included in these models is the development of an intersection between the two systems. Because such an intersection is strongly suggested by memory and educational research as the basis of wisdom/expertise, the present paper describes an Integrated Judgment and Decision-Making Model (IJDM) that incorporates this component. Wisdom/expertise is hypothesized to contain a collection of schematic structures that can emerge from the accumulation of similar episodes or repeated analytic practice. As will be argued, in comparisons to dual system models, the addition of this component provides a broader basis for selecting and designing interventions to improve adolescent JDM. Its development also has implications for generally enhancing cognitive interventions by adopting principles from athletic training to create automated, expert behaviors. PMID:24391350

  2. Money Related Decommissioning and Funding Decision Making

    International Nuclear Information System (INIS)

    'Money makes the world go round', as the song says. It definitely influences decommissioning decision-making and financial assurance for future decommissioning. This paper will address two money-related decommissioning topics. The first is the evaluation of whether to continue or to halt decommissioning activities at Fermi 1. The second is maintaining adequacy of financial assurance for future decommissioning of operating plants. Decommissioning costs considerable money and costs are often higher than originally estimated. If costs increase significantly and decommissioning is not well funded, decommissioning activities may be deferred. Several decommissioning projects have been deferred when decision-makers determined future spending is preferable than current spending, or when costs have risen significantly. Decommissioning activity timing is being reevaluated for the Fermi 1 project. Assumptions for waste cost-escalation significantly impact the decision being made this year on the Fermi 1 decommissioning project. They also have a major impact on the estimated costs for decommissioning currently operating plants. Adequately funding full decommissioning during plant operation will ensure that the users who receive the benefit pay the full price of the nuclear-generated electricity. Funding throughout operation also will better ensure that money is available following shutdown to allow decommissioning to be conducted without need for additional funds

  3. Human-centric decision-making models for social sciences

    CERN Document Server

    Pedrycz, Witold

    2014-01-01

    The volume delivers a wealth of effective methods to deal with various types of uncertainty inherently existing in human-centric decision problems. It elaborates on  comprehensive decision frameworks to handle different decision scenarios, which help use effectively the explicit and tacit knowledge and intuition, model perceptions and preferences in a more human-oriented style. The book presents original approaches and delivers new results on fundamentals and applications related to human-centered decision making approaches to business, economics and social systems. Individual chapters cover multi-criteria (multiattribute) decision making, decision making with prospect theory, decision making with incomplete probabilistic information, granular models of decision making and decision making realized with the use of non-additive measures. New emerging decision theories being presented as along with a wide spectrum of ongoing research make the book valuable to all interested in the field of advanced decision-mak...

  4. Exploring patient values in medical decision making: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Yew Kong Lee

    Full Text Available BACKGROUND: Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. METHODS AND FINDINGS: We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background and personal backgrounds (e.g. family situations. CONCLUSIONS: This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

  5. Shared decision-making: nurses must respect autonomy over paternalism.

    Science.gov (United States)

    Grffith, Richard; Tengnah, Cassam

    2013-06-01

    Shared decision-making lies at the heart of the Government's reforms of the NHS in England. The slogan, 'No decision about me without me', underpins shared decision-making that sees patients as active participants in their treatment decisions. In this article, Richard Griffith and Cassam Tengnah argue that for 'no decision about me, without me' to be a reality, district nurses must guard against paternalistic decision-making that excludes the views and wishes of their patients. PMID:24046930

  6. Clinical Decision Support Systems: A Useful Tool in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Kolostoumpis G.

    2012-01-01

    Full Text Available The possibility of supporting in decisionmaking shows an increase in recent years. Based on mathematic simulation tools, knowledge databases, processing methods, medical data and methods, artificial intelligence for coding of the available knowledge and for resolving complex problems arising into clinical practice. Aim: the aim of this review is to present the development of new methods and modern services, in clinical practice and the emergence in their implementation. Data and methods: the methodology that was followed included research of articles that referred to health sector and modern technologies, at the electronic data bases “pubmed” and “medline”. Results: Is a useful tool for medical experts using characteristics and medical data used by the doctors. Constitute innovation for the medical community, and ensure the support of clinical decisions with an overall way by providing a comprehensive solution in the light of the integration of computational decision support systems into clinical practice. Conclusions: Decision Support Systems contribute to improving the quality of health services with simultaneous impoundment of costs (i.e. avoid medical errors

  7. Goal Setting and Decision Making by At-Risk Youth

    Science.gov (United States)

    Galotti, Kathleen M.; Kozberg, Steven F.; Gustafon, Mary

    2009-01-01

    Typically, adolescence is a time when individuals begin to make consequential, life-framing decisions. However, much of the decision-making literature focuses on high-risk decisions, such as the use of drugs and alcohol, while much less is known about how adolescents make positive decisions, for example, regarding their educational or career…

  8. Clinical Decision-Making by Doctors in Township Hospitals in Gaolan:A Questionnaire Survey%皋兰县乡镇卫生院医务人员临床决策依据调查

    Institute of Scientific and Technical Information of China (English)

    汪泽皓; 冯琳琳; 赵阳阳; 肖晓娟; 姚亮; 王琪; 杨克虎; 郭一民; 陈耀龙

    2012-01-01

    Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts asfollows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents' decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients' willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients' value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.%目的 调查甘肃省皋兰县乡镇卫生院医务人员的临床决策依据,探讨其临床决策的科学性及合理性.方法 自行设计乡镇卫生院医务人员临床决策依据调查问卷,对该县7所卫生院108位医务人员进行现场调查,问卷内容包括被调查者基本情况、临床决策依据的一般情况和被调查者的临床决策与当前最佳临床证据的对比情况三部分.结果 共发放调查问卷108份,收回有效问卷89份.调查结果显示:79%的乡镇卫生院医务人员对患者作出诊断和治

  9. Training for decision making during emergencies

    Directory of Open Access Journals (Sweden)

    Margaret Crichton

    2001-12-01

    Full Text Available As crises or emergencies occur unexpectedly and without warning, the non-technical skills of the emergency response personnel are as crucial as their technical skills. This is particularly true in complex, large-scale organisations. This paper outlines a novel, low-fidelity, training method, Tactical Decision Games (TDGs, that is designed to enhance the non-technical skills required for effective emergency management. These skills include decision making, communication, situation awareness, teamwork and stress management. It is anticipated that emergency response personnel will be better prepared, more equipped, and more able to deal with the demands endemic in any incident response situation as a result of repeated exposure to TDGs, which encourage learning through experience and directed practice.

  10. Risk attributes theory: Decision making under risk

    DEFF Research Database (Denmark)

    He, Ying; Huang, Ruihua

    2008-01-01

    In this paper, some limitations in the conventional theories and models of the decision making under risk are presented from a new angle. To eliminate those limitations, a theoretical framework is proposed, in which the risk preference relation is constructed on a set of risk attributes instead of...... risky prospects. The axioms are presented to ensure the existence of the representation function for this risk preference relation through employing the Multi-attribute Utility Theory (MAUT). In our framework, we construct a risk decision model with four risk attributes. One of these attributes measured...... by a newly defined attribute measurement, the Relative Maximum Absolute Value (RMAV), can be employed in our model to explain the experimental result more intuitively compared with the overweighting of small probability proposed by Kahneman and Tversky in their Prospect Theory. In addition, the...

  11. Perspectives on decision-making among the Romanian managers

    OpenAIRE

    Razvan STEFANESCU

    2004-01-01

    This paper examines, in the tradition of descriptive approaches of decision-making, how Romanian executives actually make decisions. It is based on an investigation in which managers from Romania were interrogated about some aspects of the decision-making. The conclusion of this study is that the Romanian managers don’t follow all the recommendations of classical decision theory when they make decisions. That situation is caused not only by the high instability of business environment, but al...

  12. Automated Preference Elicitation for Decision Making

    Czech Academy of Sciences Publication Activity Database

    Kárný, Miroslav

    Vol. 3. Berlin: Springer, 2013, s. 65-99. (Studies in Computational Intelligence. 474). ISBN 978-3-642-36405-1 R&D Projects: GA ČR GA13-13502S; GA ČR GA102/08/0567 Institutional research plan: CEZ:AV0Z1075907 Institutional support: RVO:67985556 Keywords : Bayesian decision making * fully probabilistic design * DM preference elicitation * support of imperfect participants Subject RIV: BC - Control Systems Theory http://library.utia.cas.cz/separaty/2013/AS/karny-0389631.pdf

  13. A General Theory of Decision Making

    OpenAIRE

    Hansen, Frank

    2003-01-01

    We formulate a general theory of decision making based on a lattice of observable events, and we exhibit a large class of representations called the general model. Some of the representations are equivalent to the so called standard model in which observable events are modelled by an algebra of measurable subsets of a state space, while others are not compatible with such a description. We show that the general model collapses to the standard model, if and only if an additional axiom is satis...

  14. Risk - Informed decision making at Loviisa NPP

    International Nuclear Information System (INIS)

    PSA has been used in many ways for risk-informed decision making at Loviisa power station. The most fruitful areas so far include: 1) Identification of dominating risk contributors and possible means for reducing risk by plant modification and improved procedures. 2) Providing risk perspective and economic criteria for assessing backfitting proposals. 3) Assessing the significance of ageing and needs for renewals. 4) Limiting, prioritising and optimising plant modifications. 5) Reducing testing requirements. 6) Justification of temporary as well as permanent configurations and extended outage times. 7) Planning and prioritisation of training programs. (au)

  15. Ethics in economic decision-making

    OpenAIRE

    Leliveld, Marijke Christina

    2009-01-01

    This dissertation sheds more light on ethics in economic decision-making. Over the course of nine experiments, I studied (a) when people adhere to ethical standards like the do-no-harm principle, and (b) how people respond to situations in which ethical standards are violated by studying not only punishing behavior but also compensation behavior. I show that when people know that by furthering their self-interest they harm another person (either by taking from or by allocating a loss to the o...

  16. Impact of 11C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

    International Nuclear Information System (INIS)

    The aim of this retrospective two-centre study was to investigate the clinical impact of 11C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy. Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wuerzburg) with rPCa and biochemical relapse (PSA mean ± SD 4.3 ± 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of 11C-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse. Changes in therapy after 11C-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). 11C-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative imaging and/or clinical follow-up (follow-up mean 20.5 months, median 18.3 months, range 6.2-60 months). 11C-Choline PET/CT had a significant impact on therapeutic management in rPCa patients. It led to an overall change in 46.7 % of patients, with a major clinical change

  17. Decision Making in R&D Outsourcing

    DEFF Research Database (Denmark)

    Bals, Lydia; Kneis, Kyra; Lemke, Christine

    2011-01-01

    In an increasingly competitive environment, the pharmaceutical industry faces increasing R&D costs and longer development times, which increase a product’s time to market. Therefore, the issue of costs and outsourcing of R&D is increasing in importance, but systematic approaches for understanding...... the decision making process on R&D outsourcing are lacking. To address this gap, we present a framework developed in the context of a multinational pharmaceutical company. The framework builds on general make-or-buy frameworks and incorporates specificities of the service and knowledge-driven areas of...... pharmaceutical research. Tactical and strategic outsourcing considerations are reflected in the framework, which also reflects the increased fine slicing of activities beyond the common dichotomy of core and non-core activities. The framework may be applicable insimilar R&D-intensive settings and it therefore...

  18. Binary decision making with very heterogeneous influence

    International Nuclear Information System (INIS)

    We consider an extension of a binary decision model in which nodes make decisions based on influence-biased averages of their neighbors’ states, similar to Ising spin glasses with on-site random fields. In the limit where these influences become very heavy-tailed, the behavior of the model dramatically changes. On complete graphs, or graphs where nodes with large influence have large degree, this model is characterized by a new ‘phase’ with an unpredictable number of macroscopic shocks, with no associated critical phenomena. On random graphs where the degree of the most influential nodes is small compared to population size, a predictable ‘glassy’ phase without phase transitions emerges. Analytic results about both of these new phases are obtainable in limiting cases. We use numerical simulations to explore the model for more general scenarios. The phases associated with very influential decision makers are easily distinguishable experimentally from a homogeneous influence phase in many circumstances, in the context of our simple model. (paper)

  19. Dual processing model of medical decision-making

    Directory of Open Access Journals (Sweden)

    Djulbegovic Benjamin

    2012-09-01

    Full Text Available Abstract Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I and/or an analytical, deliberative (system II processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to

  20. Experience-based decision-making, non-technical skills and general decision-making styles among aviation pilots

    OpenAIRE

    Rotbring, Lina

    2010-01-01

    Aviation pilots are trained to base cockpit decisions on strategic and analytic reasoning, while naturalistic decision-making theory suggests that experts in naturalistic settings, like pilots, make decisions based on experience. In the present study, a scenario-based questionnaire was used, to explore the effects of aviation pilots´ non-technical skills and experience-based decision-making in a cockpit decision-making situation. Also, a negative relation between non-technical skills and deci...

  1. Planning and decision making for aerial robots

    CERN Document Server

    Bestaoui Sebbane, Yasmina

    2014-01-01

    This book provides an introduction to the emerging field of planning and decision making for aerial robots. An aerial robot is the ultimate form of Unmanned Aerial Vehicle, an aircraft endowed with built-in intelligence, requiring no direct human control and able to perform a specific task. It must be able to fly within a partially structured environment, to react and adapt to changing environmental conditions and to accommodate for the uncertainty that exists in the physical world. An aerial robot can be termed as a physical agent that exists and flies in the real 3D world, can sense its environment and act on it to achieve specific goals. So throughout this book, an aerial robot will also be termed as an agent.   Fundamental problems in aerial robotics include the tasks of spatial motion, spatial sensing and spatial reasoning. Reasoning in complex environments represents a difficult problem. The issues specific to spatial reasoning are planning and decision making. Planning deals with the trajectory algori...

  2. Collaborative decision making for sustainable development

    Energy Technology Data Exchange (ETDEWEB)

    Kinsley, M.J.

    1995-12-31

    For many years, economic development has mean industrial recruitment where business-at-any-cost was preached by a small elite, where civic discord replaced civic discussion, where families made more money but had less to spend, where residents learned to lock their doors, where communities changed from the unique to commonplace and a thousand towns looked alike. But now, scores of communities are saying no to old, worn-out approaches to development and embracing a new kind of development that respects the community and the environment. Created collaboratively by people from all walks of community life, this new approach is called sustainable community economic development. Though new, sustainable development is based on traditional values of stewardship and working together. Its principles are powerful in their simplicity. Its lessons enrich community decision making. This paper describes these principles and lessons. It introduces a community decision-making process that applies them and suggests the kinds of results you can expect from such a process in your town.

  3. Flood Impact Modelling to support decision making

    Science.gov (United States)

    Owen, Gareth; Quinn, Paul; O'Donnell, Greg

    2015-04-01

    Much of what is known about the impacts of landuse change and Natural Flood Management (NFM) is at the local/plot scale. Evidence of the downstream impacts at the larger catchment scale is limited. However, the strategic and financial decisions of land managers, stakeholders and policy makers are made at the larger scale. There are a number of techniques that have the potential to scale local impacts to the catchment scale. This poster will show findings for the 30km2 Leven catchment, North Yorkshire, England. A NFM approach has been adopted by the Environment Agency to reduce flood risk within the catchment. A dense network of stream level gauges were installed in the catchment at the commencement of this project to gain a detailed understanding of the catchment behaviour during storm events. A novel Flood Impact Modelling (FIM) approach has been adopted which uses the network of gauges to disaggregate the outlet hydrograph in terms of source locations. Using a combination of expert opinion and local evidence, the model can be used to assess the impacts of distributed changes in land use management and NFM on flood events. A number of potential future landuse and NFM scenarios have been modelled to investigate their impact on flood peaks. These modelled outcomes are mapped to a simple Decision Support Matrix (DSM). The DSM encourages end users (e.g. land managers and policy makers) to develop an NFM scheme by studying the degree to which local runoff can be attenuated and how that flow will propagate through the network to the point of impact. The DSM relates the impact on flood peaks in terms of alterations to soil management practices and landscape flow connectivity (e.g. soil underdrainage), which can be easily understood by farmers and land managers. The DSM and the FIM together provide a simple to use and transparent modelling tool, making best use of expert knowledge, to support decision making.

  4. Analysis of Political Decision-Making and Its Influencing Factors

    Directory of Open Access Journals (Sweden)

    Xing YAN

    2015-03-01

    Full Text Available Political decision-making means a country’s political parties, leaders or leadership compare and select implementing principles and approaches and means to achieve the target in political practical activities for the purpose, principles and direction of activities. The process of political decision-making is a dynamic political process that is related to the formation and implementation of major and general decisions of the national, political and social interest groups. This process is to integrate major and general decisions regarding national and social interests. The subjects are state organs, political parties and individual decision makers or decision-making participants, and the finally formed decision is backed by the country’s coercive power with mandatory features. Meanwhile, political decision-making is influenced by system pressure. In the decision-making process, there will be a certain degree of bias between the final decision and the targeted decision.

  5. Fertility and contraceptive decision-making and support for HIV infected individuals: client and provider experiences and perceptions at two HIV clinics in Uganda

    Directory of Open Access Journals (Sweden)

    Wanyenze Rhoda K

    2013-02-01

    Full Text Available Abstract Background Some people living with HIV/AIDS (PLHIV want to have children while others want to prevent pregnancies; this calls for comprehensive services to address both needs. This study explored decisions to have or not to have children and contraceptive preferences among PLHIV at two clinics in Uganda. Methods This was a qualitative cross-sectional study. We conducted seventeen focus group discussions and 14 in-depth interviews with sexually active adult men and women and adolescent girls and boys, and eight key informant interviews with providers. Overall, 106 individuals participated in the interviews; including 84 clients through focus group discussions. Qualitative latent content analysis technique was used, guided by key study questions and objectives. A coding system was developed before the transcripts were examined. Codes were grouped into categories and then themes and subthemes further identified. Results In terms of contraceptive preferences, clients had a wide range of preferences; whereas some did not like condoms, pills and injectables, others preferred these methods. Fears of complications were raised mainly about pills and injectables while cost of the methods was a major issue for the injectables, implants and intrauterine devices. Other than HIV sero-discordance and ill health (which was cited as transient, the decision to have children or not was largely influenced by socio-cultural factors. All adult men, women and adolescents noted the need to have children, preferably more than one. The major reasons for wanting more children for those who already had some were; the sex of the children (wanting to have both girls and boys and especially boys, desire for large families, pressure from family, and getting new partners. Providers were supportive of the decision to have children, especially for those who did not have any child at all, but some clients cited negative experiences with providers and information gaps for

  6. An Emerging Field of Research: Challenges in Pediatric Decision Making

    OpenAIRE

    Lipstein, Ellen A.; Brinkman, William B.; Fiks, Alexander G.; Hendrix, Kristin S.; Kryworuchko, Jennifer; Miller, Victoria A.; Prosser, Lisa A.; Ungar, Wendy J.; Fox, David

    2014-01-01

    There is growing interest in pediatric decision science, spurred by policies advocating for children’s involvement in medical decision making. Challenges specific to pediatric decision research include: the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this manuscript are t...

  7. A Survey of Web-based Collective Decision Making Systems

    OpenAIRE

    Watkins, Jennifer H; Rodriguez, Marko A.

    2008-01-01

    A collective decision making system uses an aggregation mechanism to combine the input of individuals to generate a decision. The decisions generated serve a variety of purposes from governance rulings to forecasts for planning. The Internet hosts a suite of collective decision making systems, some that were inconceivable before the web. In this paper, we present a taxonomy of collective decision making systems into which we place seven principal web-based tools. This taxonomy serves to eluci...

  8. Optimising Transport Decision Making using Customised Decision Models and Decision Conferences

    DEFF Research Database (Denmark)

    Barfod, Michael Bruhn

    impacts and non-monetary criteria. 2. Direct rating using pair wise comparisons is found to be an appropriate MCDA approach for computing scores for alternatives while rank based approaches are appropriate for eliciting criteria weights from the decision-makers’ preferences. 3. Decision analysis and......The subject of this Ph.D. thesis entitled “Optimising Transport Decision Making using Customised Decision Models and Decision Conferences” is multi-criteria decision analysis (MCDA) and decision support in the context of transport infrastructure assessments. Despite the fact that large amounts of...... money are spent on examinations of transport infrastructure projects, such as traffic model calculations, environmental impact assessments (EIA), and public hearings, the results mainly express the outcome of the examinations in monetary terms in form of e.g. a benefit-cost rate (B/C-rate). This thesis...

  9. Decision-making in multinational enterprises: concepts and research approaches.

    OpenAIRE

    Ghertman M

    1984-01-01

    ILO pub. Working paper on decision making processes in multinational enterprises - gives definition, type and classification of decision making in large enterprises; outlines the centralization decentralization theory and the iterative process; notes research needs. Bibliography.

  10. Hepatic steatosis assessment with {sup 1}H-spectroscopy and chemical shift imaging at 3.0 T before hepatic surgery: Reliable enough for making clinical decisions?

    Energy Technology Data Exchange (ETDEWEB)

    Koelblinger, Claus, E-mail: claus.koelblinger@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Krssak, Martin, E-mail: martin.krssak@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Maresch, Judith, E-mail: judith.maresch@meduniwien.ac.at [Department of Pathology, Medical University of Vienna (Austria); Wrba, Fritz, E-mail: fritz.wrba@meduniwien.ac.at [Department of Pathology, Medical University of Vienna (Austria); Kaczirek, Klaus, E-mail: klaus.kaczirek@meduniwien.ac.at [Department of Surgery, Medical University of Vienna (Austria); Gruenberger, Thomas, E-mail: thomas.gruenberger@meduniwien.ac.at [Department of Surgery, Medical University of Vienna (Austria); Tamandl, Dietmar, E-mail: dietmar.tamandl@meduniwien.ac.at [Department of Surgery, Medical University of Vienna (Austria); Ba-Ssalamah, Ahmed, E-mail: ahmed.ba-ssalamah@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Berger-Kulemann, Vanessa, E-mail: vanessa.berger-kulemann@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Weber, Michael, E-mail: michael.weber@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Schima, Wolfgang, E-mail: wolfgang.schima@khgh.at [Department of Radiology, KH Goettlicher Heiland and Herz-Jesu Krankenhaus, Dornbacher Strasse 20-28, 1170 Vienna (Austria)

    2012-11-15

    Purpose: To compare the accuracy of liver fat quantification using chemical shift imaging (CSI) and H1 MR-spectroscopy (MRS) at 3.0 T in patients undergoing liver resection. Methods: Totally 35 patients were included in this prospective IRB approved study. The histopathologically assessed liver fat was compared to the hepatic fat fractions calculated with CSI (with and without spleen correction) and MRS. Spearman's rank correlation and Fisher z-test were used for correlation analysis. Sensitivity and specificity regarding the detection of marked steatosis were calculated for the different modalities and compared using the McNemar test. Results: MRS (r = .85) and CSI with spleen correction (r = .85) showed a significantly better correlation (p = .03) with histology compared to CSI without spleen correction (r = .67). Sensitivity and specificity for the detection of marked steatosis was 100% (12/12) and 87% (20/23) for MRS and 92% (11/12) and 83% (19/23) for CSI with spleen correction (p > .12). Conclusion: For the assessment of hepatic steatosis both CSI with spleen correction and MRS at 3.0 T, show a good correlation with histology. CSI without spleen correction should not be used. Sensitivity and specificity for the detection of marked steatosis are high with both modalities. However, results that are scattered around the cut-off values are not reliable enough for clinical decisions.

  11. Impact of {sup 11}C-choline PET/CT on clinical decision making in recurrent prostate cancer: results from a retrospective two-centre trial

    Energy Technology Data Exchange (ETDEWEB)

    Ceci, Francesco [University of Bologna, Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna (Italy); Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna (Italy); Herrmann, Ken; Bluemel, Christina; Droll, Sabine; Buck, Andreas K. [Universitaetsklinikum Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Castellucci, Paolo; Graziani, Tiziano; Fanti, Stefano [University of Bologna, Service of Nuclear Medicine, Policlinico S. Orsola-Malpighi, Bologna (Italy); Schiavina, Riccardo; Brunocilla, Eugenio [University of Bologna, Department of Urology, Policlinico S. Orsola-Malpighi, Bologna (Italy); Vollmer, Christian [Universitaetsklinikum Wuerzburg, Department of Urology, Wuerzburg (Germany); Mazzarotto, Renzo [University of Bologna, Service of Radiotherapy, Policlinico S. Orsola-Malpighi, Bologna (Italy)

    2014-12-15

    The aim of this retrospective two-centre study was to investigate the clinical impact of {sup 11}C-choline PET/CT on treatment management decisions in patients with recurrent prostate cancer (rPCa) after radical therapy. Enrolled in this retrospective study were 150 patients (95 from Bologna, 55 from Wuerzburg) with rPCa and biochemical relapse (PSA mean ± SD 4.3 ± 5.5 ng/mL, range 0.2-39.4 ng/mL) after radical therapy. The intended treatment before PET/CT was salvage radiotherapy of the prostatic bed in 95 patients and palliative androgen deprivation therapy (ADT) in 55 patients. The effective clinical impact of {sup 11}C-choline PET/CT was rated as major (change in therapeutic approach), minor (same treatment, but modified therapeutic strategy) or none. Multivariate binary logistic regression analysis included PSA level, PSA kinetics, ongoing ADT, Gleason score, TNM, age and time to relapse. Changes in therapy after {sup 11}C-choline PET/CT were implemented in 70 of the 150 patients (46.7 %). A major clinical impact was observed in 27 patients (18 %) and a minor clinical impact in 43 (28.7 %). {sup 11}C-choline PET/CT was positive in 109 patients (72.7 %) detecting local relapse (prostate bed and/or iliac lymph nodes and/or pararectal lymph nodes) in 64 patients (42.7 %). Distant relapse (paraaortic and/or retroperitoneal lymph nodes and/or bone lesions) was seen in 31 patients (20.7 %), and both local and distant relapse in 14 (9.3 %). A significant difference was observed in PSA level and PSA kinetics between PET-positive and PET-negative patients (p < 0.05). In multivariate analysis, PSA level, PSA doubling time and ongoing ADT were significant predictors of a positive scan (p < 0.05). In statistical analysis no significant differences were observed between the Bologna and Wuerzburg patients (p > 0.05). In both centres the same criteria to validate PET-positive findings were used: in 17.3 % of patients by histology and in 82.7 % of patients by correlative

  12. Understanding business decision making on the environment

    International Nuclear Information System (INIS)

    This paper considers the influence of a range of factors within and around the firm on business decision making relating to the environment. Within the firm, it emphasises the importance of governance structures, corporate cultures and organisational capacities. Around the firm, it stresses the importance of the incentives, imperatives and informational pressures that emerge from governments, markets and civil society. It is argued that change is most likely where the various external pressures resonate with each other, and where they impact upon firms with receptive corporate cultures and adequate organisational capacities. It is also argued that these preconditions for change are often absent, which makes change more difficult or more expensive. It is further argued that even when these preconditions are in place, they are likely to engender only to incremental change. As prolonged periods of incremental change must eventually encounter diminishing returns, the key challenge for those seeking to promote significant changes in business behaviour is to put in place the full range of conditions needed to allow companies to make them. This can mean focusing not only on the operational but also on the strategic activities of businesses, and not only on individual businesses but also on the broader systems and networks within which they operate. (author)

  13. Understanding business decision making on the environment

    International Nuclear Information System (INIS)

    This paper considers the influence of a range of factors within and around the firm on business decision making relating to the environment. Within the firm, it emphasises the importance of governance structures, corporate cultures and organisational capacities. Around the firm, it stresses the importance of the incentives, imperatives and informational pressures that emerge from governments, markets and civil society. It is argued that change is most likely where the various external pressures resonate with each other, and where they impact upon firms with receptive corporate cultures and adequate organisational capacities. It is also argued that these preconditions for change are often absent, which makes change more difficult or more expensive. It is further argued that even when these preconditions are in place, they are likely to engender only to incremental change. As prolonged periods of incremental change must eventually encounter diminishing returns, the key challenge for those seeking to promote significant changes in business behaviour is to put in place the full range of conditions needed to allow companies to make them. This can mean focusing not only on the operational but also on the strategic activities of businesses, and not only on individual businesses but also on the broader systems and networks within which they operate

  14. [The decision making: neuroanatomy, functional exploration and mental disorders].

    Science.gov (United States)

    Tomassini, Annarita; Struglia, Francesca; Stratta, Paolo; Pacifico, Roberta; Gianfelice, Daniela; Spaziani, Daniela; Rossi, Alessandro

    2009-01-01

    The term decision making indicates aspects of the executive functions related to the ability to modulate the reward and punishment perception, in order to operate advantageous choices. From the clinical point of view it appears a transnosographic trait that may influence the suicide risk and aggressive acts, increase interpersonal difficulties and modulate therapeutic response: an interesting link between clinical symptomatology and functional daily abilities. We conducted a literature review on its neurophysiology and neuropsychology and the implications in different psychiatric disorders such as schizophrenia, bipolar disorder, unipolar depression, suicide, obsessive-compulsive disorder, substances abuse, personality disorders, aggressiveness and pathological gambling. PMID:20066795

  15. A multi-criteria decision making approach for food engineering

    OpenAIRE

    Abakarov, Alik

    2011-01-01

    The objective of this study was to propose a decision making approach and tools (software packages) to solve the multi-criteria decision making problems arising in the food engineering. The proposed decision making approach is based on a simultaneous utilization for a given set of Pareto-optimal solutions the two following decision making methods: 1) well-known Analytic Hierarchy Process method and 2) Tabular Method. The using of Tabular Method allows utilizing the AHP method in a...

  16. Neural Basis of Learning and Preference during Social Decision Making

    OpenAIRE

    Seo, Hyojung; Lee, Daeyeol

    2012-01-01

    Social decision making is arguably the most complex cognitive function performed by the human brain. This is due to two unique features of social decision making. First, predicting the behaviors of others is extremely difficult. Second, humans often take into consideration the well-beings of others during decision making, but this is influenced by many contextual factors. Despite such complexity, studies on the neural basis of social decision making have made substantial progress in the last ...

  17. Integrating Decision Making and Mental Health Interventions Research: Research Directions

    OpenAIRE

    Wills, Celia E.; Holmes-Rovner, Margaret

    2006-01-01

    The importance of incorporating patient and provider decision-making processes is in the forefront of the National Institute of Mental Health (NIMH) agenda for improving mental health interventions and services. Key concepts in patient decision making are highlighted within a simplified model of patient decision making that links patient-level/“micro” variables to services-level/“macro” variables via the decision-making process that is a target for interventions. The prospective agenda for in...

  18. How social cognition can inform social decision making

    OpenAIRE

    Lee, Victoria K.; Harris, Lasana T.

    2013-01-01

    Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may inf...

  19. How Social Cognition Can Inform Social Decision Making

    OpenAIRE

    Victoria eLee; Lasana eHarris

    2013-01-01

    Social decision-making is often complex, requiring the decision-maker to make inferences of others’ mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision- making involving social and nonsocial stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may inf...

  20. The physics of bacterial decision making

    Science.gov (United States)

    Ben-Jacob, Eshel; Lu, Mingyang; Schultz, Daniel; Onuchic, Jose' N.

    2014-01-01

    The choice that bacteria make between sporulation and competence when subjected to stress provides a prototypical example of collective cell fate determination that is stochastic on the individual cell level, yet predictable (deterministic) on the population level. This collective decision is performed by an elaborated gene network. Considerable effort has been devoted to simplify its complexity by taking physics approaches to untangle the basic functional modules that are integrated to form the complete network: (1) A stochastic switch whose transition probability is controlled by two order parameters—population density and internal/external stress. (2) An adaptable timer whose clock rate is normalized by the same two previous order parameters. (3) Sensing units which measure population density and external stress. (4) A communication module that exchanges information about the cells' internal stress levels. (5) An oscillating gate of the stochastic switch which is regulated by the timer. The unique circuit architecture of the gate allows special dynamics and noise management features. The gate opens a window of opportunity in time for competence transitions, during which the circuit generates oscillations that are translated into a chain of short intervals with high transition probability. In addition, the unique architecture of the gate allows filtering of external noise and robustness against variations in circuit parameters and internal noise. We illustrate that a physics approach can be very valuable in investigating the decision process and in identifying its general principles. We also show that both cell-cell variability and noise have important functional roles in the collectively controlled individual decisions. PMID:25401094

  1. Enhanced public participation in NRC decision making

    International Nuclear Information System (INIS)

    The U.S. Nuclear Regulatory Commission (NRC) published its below-regulatory-concern (BRC) policy statement in 1990. The policy provided a framework within which the NRC would promulgate rules or make licensing decisions to exempt from some or all regulatory controls certain practices involving small quantities of radioactive materials. The NRC's adoption of the BRC policy resulted in widespread public concern over the implications of the new policy. In an effort to better understand the nature of those concerns and to ensure that NRC's decisions related to BRC were based on clear and comprehensive information, the commission initiated an evaluation of the potential use of consensus-building techniques to address BRC issues. Based on the recommendations contained in the feasibility evaluation, the NRC, on June 28, 1991, approved the initiation of a phased consensus process to address BRC issues. The purpose of the consensus process was to provide advice to the commission from the full range of affected interests on the broad spectrum of issues related to the subject of BRC

  2. Collective decision making in cohesive flocks

    Science.gov (United States)

    Bhattacharya, K.; Vicsek, Tamás

    2010-09-01

    Most of us must have been fascinated by the eye-catching displays of collectively moving animals. Schools of fish can move in a rather orderly fashion and then change direction amazingly abruptly. There are a large number of further examples both from the living and the non-living world for phenomena during which the many interacting, permanently moving units seem to arrive at a common behavioural pattern taking place in a short time. As a paradigm of this type of phenomena we consider the problem of how birds arrive at a decision resulting in their synchronized landing. We introduce a simple model to interpret this process. Collective motion prior to landing is modelled using a simple self-propelled particle (SPP) system with a new kind of boundary condition, while the tendency and the sudden propagation of the intention of landing are introduced through rules analogous to the random field Ising model in an external field. We show that our approach is capable of capturing the most relevant features of collective decision making in a system of units with variance of individual intentions and being under an increasing level of pressure to switch states. We find that as a function of the few parameters of our model the collective switching from the flying to the landing state is indeed much sharper than the distribution of individual landing intentions. The transition is accompanied by a number of interesting features discussed in this paper.

  3. Sensorimotor decision making in the zebrafish tectum.

    Science.gov (United States)

    Barker, Alison J; Baier, Herwig

    2015-11-01

    An animal's survival depends on its ability to correctly evaluate sensory stimuli and select appropriate behavioral responses. When confronted with ambiguous stimuli, the brain is faced with the task of selecting one action while suppressing others. Although conceptually simple, the site and substrate of this elementary form of decision making is still largely unknown. Zebrafish larvae respond to a moving dot stimulus in either of two ways: a small object (potential prey) evokes approach, whereas a large object (potential predator) is avoided. The classification of object size relies on processing in the optic tectum. We genetically identified a population of cells, largely comprised of glutamatergic tectal interneurons with non-stratified morphologies, that are specifically required for approach toward small objects. When these neurons are ablated, we found that the behavioral response is shifted; small objects now tend to elicit avoidance. Conversely, optogenetic facilitation of neuronal responses with channelrhodopsin (ChR2) enhances approaches to small objects. Calcium imaging in head-fixed larvae shows that a large proportion of these neurons are tuned to small sizes. Their receptive fields are shaped by input from retinal ganglion cells (RGCs) that are selective for prey identity. We propose a model in which valence-based decisions arise, at a fundamental level, from competition between dedicated sensorimotor pathways in the tectum. PMID:26592341

  4. Decision making in patients with pulmonary nodules.

    Science.gov (United States)

    Ost, David E; Gould, Michael K

    2012-02-15

    Integrating current evidence with fundamental concepts from decision analysis suggests that management of patients with pulmonary nodules should begin with estimating the pretest probability of cancer from the patient's clinical risk factors and computed tomography characteristics. Then, the consequences of treatment should be considered, by comparing the benefits of surgery if the patient has lung cancer with the potential harm if the patient does not have cancer. This analysis determines the "treatment threshold," which is the point around which the decision centers. This varies widely among patients depending on their cardiopulmonary reserve, comorbidities, and individual preferences. For patients with a very low probability of cancer, careful observation with serial computed tomography is warranted. For those with a high probability of cancer, surgical diagnosis is warranted. For patients in the intermediate range of probabilities, either computed tomography-guided fine-needle aspiration biopsy or positron emission tomography, possibly followed by computed tomography-guided fine-needle aspiration biopsy, is best. Patient preferences should be considered because the absolute difference in outcome between strategies may be small. The optimal approach to the management of patients with pulmonary nodules is evolving as technologies develop. Areas of uncertainty include quantifying the hazard of delayed diagnosis; determining the optimal duration of follow-up for ground-glass and semisolid opacities; establishing the roles of volumetric imaging, advanced bronchoscopic technologies, and limited surgical resections; and calculating the cost-effectiveness of different strategies. PMID:21980032

  5. Perceptions of LWR risk for decision making

    International Nuclear Information System (INIS)

    The Industry Degraded Core (IDCOR) Program was designed to develop a comprehensive, technically sound position on the issues related to potential accidents in light water reactors. One of the goals is to acquire knowledge and data so that a more realistic approach to the problem is possible. Some of the IDCOR tasks develop information in a Probabilistic Risk Assessment (PRA) framework. The PRA approach is structured upon reliability characteristics for individual components, such as pumps, valves and relays, which can be used to predict the frequency of system failures. System failure combinations can then be used to predict the probability of undesirable plant response to given initiating events. The IDCOR PRA tasks provide a significant amount of information related to the response of the plant to severe accidents. This information has been derived in a logical and consistent manner and so provides a coherent and rational basis for decision-making

  6. Combining disparate data for decision making

    Science.gov (United States)

    Gettings, M. E.

    2010-12-01

    Combining information of disparate types from multiple data or model sources is a fundamental task in decision making theory. Procedures for combining and utilizing quantitative data with uncertainties are well-developed in several approaches, but methods for including qualitative and semi-quantitative data are much less so. Possibility theory offers an approach to treating all three data types in an objective and repeatable way. In decision making, biases are frequently present in several forms, including those arising from data quality, data spatial and temporal distribution, and the analyst's knowledge and beliefs as to which data or models are most important. The latter bias is particularly evident in the case of qualitative data and there are numerous examples of analysts feeling that a qualitative dataset is more relevant than a quantified one. Possibility theory and fuzzy logic now provide fairly general rules for quantifying qualitative and semi-quantitative data in ways that are repeatable and minimally biased. Once a set of quantified data and/or model layers is obtained, there are several methods of combining them to obtain insight useful in decision making. These include: various combinations of layers using formal fuzzy logic (for example, layer A and (layer B or layer C) but not layer D); connecting the layers with varying influence links in a Fuzzy Cognitive Map; and using the set of layers for the universe of discourse for agent based model simulations. One example of logical combinations that have proven useful is the definition of possible habitat for valley fever fungus (Coccidioides sp.) using variables such as soil type, altitude, aspect, moisture and temperature. A second example is the delineation of the lithology and possible mineralization of several areas beneath basin fill in southern Arizona. A Fuzzy Cognitive Map example is the impacts of development and operation of a hypothetical mine in an area adjacent to a city. In this model

  7. Shared Decision Making: Through the Patient's Eyes.

    Science.gov (United States)

    Klassa, Patricia J; Dendrinos, Susan; Penn, Annette; Radke, Judith

    2016-01-01

    Birth is an intimate moment in a woman's life, and healthcare providers play a pivotal role in pregnant women having safe and memorable birth experiences. Utilizing the shared decision-making model during the prenatal period involves listening to the voices of identified high-risk patients and giving them options for care during labor and birth. "Through the Patient's Eyes" is an innovative program that evolved from the care planning process for these identified high-risk obstetric patients who are invited back postpartum to describe to the team birth through "their" eyes. Through this program, the team learned that compassionate care comes from truly listening to pregnant women and their families and that nurses play a pivotal role as educators and advocates. Sharing birth stories with the staff who cared for them not only had a positive effect on the staff but also many women described profound healing afterward. PMID:27465455

  8. An Instructional System for Consumer Decision-Making: Teacher's Manual.

    Science.gov (United States)

    Suchman, J. Richard; DiSario, Martha R.

    An instructional system is presented for building the competencies of adult basic education students in making consumer decisions, and offers a guide to teachers who wish to design their own decision-making problems for students. The first four chapters provide a brief introduction, discuss the rational consumer decision-making process and the…

  9. An Analysis of Design Decision-Making in Industrial Practice

    DEFF Research Database (Denmark)

    Ahmed, Saeema; Hansen, Claus Thorp

    examined. The analysis led to a deeper understanding of the decision-making activities undertaken by engineering designers in industrial practice. The decision-making episodes undertaken by individual designers were supported by design strategies, not by formal decision-making methods. This implies that...

  10. Dynamical system model of decision making and propagation

    OpenAIRE

    Demongeot, Jacques; Demongeot, J.; Volpert, Vitaly; Volpert, V.

    2015-01-01

    Individual decision making is described as a bistable dynamical system. It can be influenced by the environment represented by other individuals, public opinion, all kinds of visual, oral and other information. We will study how the interaction of the individual decision making with the environment results in various patterns of decision making in the society.

  11. Participative management in sport: Coaches views on decision making

    OpenAIRE

    E. Swanepoel; J. Surujlal

    2013-01-01

    Implementing participative decision making practices has become increasingly popular amongst organisations. Numerous benefits, including increased morale and job satisfaction, have been associated with the effective implementation of participative decision making. This qualitative study was designed to investigate sport coaches’ views on participative decision making at their respective organisations. Scheduled interviews of between 30 – 40 minutes were conducted and recorded with a sample of...

  12. Relation between Ego Identity Statuses and Decision-Making Styles.

    Science.gov (United States)

    Blustein, David L.; Phillips, Susan D.

    1990-01-01

    Examined proposition that variations in career decision making are related to identity formation process by identifying relations between ego identity statuses and decision making in college students (N=99). Findings support proposition and suggest stable identity persons use rational and systematic decision-making strategies, foreclosed identity…

  13. Age Differences in Adaptive Decision Making: The Role of Numeracy

    Science.gov (United States)

    Chen, Yiwei; Wang, Jiaxi; Kirk, Robert M.; Pethtel, Olivia L.; Kiefner, Allison E.

    2014-01-01

    The primary purposes of the present study were to examine age differences in adaptive decision making and to evaluate the role of numeracy in mediating the relationship between age and adaptive decision making. Adaptive decision making was assessed by the Cups task (Levin, Weller, Pederson, & Harshman, 2007). Forty-six younger (18 to 24 years…

  14. The Impact of PPBS on Educational Decision Making

    Science.gov (United States)

    Rajcic, John M.

    1976-01-01

    Attempts a brief analysis of the traditional decision-making process for budget preparation and the alternative, program planning, budgeting system (PPBS), in an effort to determine the effect of PPBS on the decision-making process for resource allocation and to answer the question of whether PPBS has improved decision-making processes. (Author/RK)

  15. Government: Political Decision-Making. Decision-Making in Contemporary America, Unit IV.

    Science.gov (United States)

    Vetter, Donald P.; And Others

    This unit on economic decision-making is the fourth of five units in a ninth grade social studies course (see SO 010 891). Major objectives are to help students (1) explain how dissent and protest may be used as effective means of change and to consider the consequences of such actions; (2) examine the judicial branch of government in order to…

  16. Systems Engineering Techniques for ALS Decision Making

    Science.gov (United States)

    Rodriquez, Luis F.; Drysdale, Alan E.; Jones, Harry; Levri, Julie A.

    2004-01-01

    The Advanced Life Support (ALS) Metric is the predominant tool for predicting the cost of ALS systems. Metric goals for the ALS Program are daunting, requiring a threefold increase in the ALS Metric by 2010. Confounding the problem, the rate new ALS technologies reach the maturity required for consideration in the ALS Metric and the rate at which new configurations are developed is slow, limiting the search space and potentially giving the perspective of a ALS technology, the ALS Metric may remain elusive. This paper is a sequel to a paper published in the proceedings of the 2003 ICES conference entitled, "Managing to the metric: an approach to optimizing life support costs." The conclusions of that paper state that the largest contributors to the ALS Metric should be targeted by ALS researchers and management for maximum metric reductions. Certainly, these areas potentially offer large potential benefits to future ALS missions; however, the ALS Metric is not the only decision-making tool available to the community. To facilitate decision-making within the ALS community a combination of metrics should be utilized, such as the Equivalent System Mass (ESM)-based ALS metric, but also those available through techniques such as life cycle costing and faithful consideration of the sensitivity of the assumed models and data. Often a lack of data is cited as the reason why these techniques are not considered for utilization. An existing database development effort within the ALS community, known as OPIS, may provide the opportunity to collect the necessary information to enable the proposed systems analyses. A review of these additional analysis techniques is provided, focusing on the data necessary to enable these. The discussion is concluded by proposing how the data may be utilized by analysts in the future.

  17. 论现代临床护理决策的“非语言性”道德语境%On “Non-verbal” Moral Context of Modern Clinical Nursing Decision-making

    Institute of Scientific and Technical Information of China (English)

    罗光强

    2013-01-01

    现代临床护理决策的“非语言性”道德语境包括道德多元化、患者中心化和责任独立化三个主要方面.对“非语言性”道德语境的忽视导致了护理决策缺乏公信力.临床护理决策伦理模式的建构能使护理决策主体充分考虑“非语言性”道德语境,有利于道德争议的有效解决.%The moral context of “non-verbal” includes three main areas of moral pluralism,patient-centered and responsibilities of independent.The negligence of the moral context of “non-verbal” led nursing decision-making to lack of credibility.The construction of ethical mode of clinical nursing decision-making is favor of decision-making body to fully take the “nonverbal” moral context into account.

  18. Social Networks and Decision Making: Women’s Participation in Household Decisions

    OpenAIRE

    Srinivasan KANNAN

    2009-01-01

    Decision making is always been an important in social setting. For understanding the process of decision making it is important to understand as to how people make decisions and the factors influence the decisions. Studies (Srinivasan and Sharan 2005, Pescosolido, 1992) show that decisions are not made in isolation but they are the products of influence and confluence of social correlates. These studies emphasize that the decisions are not made in isolation but in consultation with other ...

  19. Manipulating decision making of typical agents

    OpenAIRE

    V. I. Yukalov; Sornette, D.

    2014-01-01

    We investigate how the choice of decision makers can be varied under the presence of risk and uncertainty. Our analysis is based on the approach we have previously applied to individual decision makers, which we now generalize to the case of decision makers that are members of a society. The approach employs the mathematical techniques that are common in quantum theory, justifying our naming as Quantum Decision Theory. However, we do not assume that decision makers are quantum objects. The te...

  20. 心血管疾病患者参与临床决策倾向性的影响因素研究%The influence factors of clinical decision making in patients with cardiovascular disease

    Institute of Scientific and Technical Information of China (English)

    刘金涛; 杜昕; 马长生; 张萍; 吴雪松

    2014-01-01

    目的 分析影响心血管疾病患者参与临床决策倾向性的因素.方法 抽取符合入选标准的心血管疾病患者258例,采用问卷调查方法,对患者的就医过程及对其临床决策倾向性的影响进行探讨.问卷调查的具体内容包括:①一般人口学资料;②疾病状况;③患者心理健康状况评估;④患者参与临床决策的意愿.结果 患者平均年龄(64±13)岁;男性占55.8%(144/258),女性占44.2%(114/258);88.0%(227/258)的患者可以报销医疗费用;82.2%的患者家庭月收入≥3 000元;89例(34.5%)患者在做临床决策时倾向于"医生根据医学知识做出决策",61例(23.7%)患者在做临床决策时倾向于"医生在询问患者需求后做出决策",94例(36.4%)患者倾向于"和医生共同做出决策",14例(5.4%)患者倾向于"和医生讨论后自己做出决策".无患者依据自己的知识独立做出决策.患者对医生的信任评分:最低7分,最高10分,平均(9.7±0.5)分;文化程度(OR=4.052,95%CI:1.800~9.126)是患者和医生做出共同决策的危险因素,对医生的信任评分(OR=0.071,95%CI:0.016~0.309)是患者和医生做出共同决策的保护因素.结论 心血管疾病患者对医生的信任度很高,患者的临床决策倾向性主要取决于患者对医生的信任程度.%Objective To analyze the influence factors of clinical decision making in patients with cardiovascular disease. Methods Totally 258 patients with cardiovascular disease were selected; the treatment process of patients and its effect on clinical decision preference were discussed by questionnaire investigation. The specific content of questionnaire included: ①general demographic data; ②the disease status; ③assessment of mental health status for patients; ④the willingness of clinical decision making participating in patients. Results The average age of patients was (64±13) years; there were 55.8%(144/258)of males, 44.2%(114/258)of female; 88.0%(227/258) of the